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Luomala L, Mattila K, Vainio P, Nisén H, Pellinen T, Lohi J, Laajala TD, Järvinen P, Koskenniemi A, Jaakkola P, Mirtti T. Low nuclear expression of HIF-hydroxylases PHD2/EGLN1 and PHD3/EGLN3 are associated with poor recurrence-free survival in clear cell renal cell carcinoma. Cancer Med 2024; 13:e6998. [PMID: 38400673 PMCID: PMC10891444 DOI: 10.1002/cam4.6998] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Hypoxia inducible factors, HIF-1α and HIF-2α, and their main regulators, the prolyl hydroxylase domain proteins (PHDs), mediate cellular response to hypoxia and contribute to tumor progression in clear cell renal cell carcinoma (ccRCC). These biomarkers may improve the value of traditional histopathological features in predicting disease progression after nephrectomy for localized ccRCC and guide patient selection for adjuvant treatments. PATIENTS AND METHODS In this study, we analyzed the associations of PHD2 and PHD3 with histopathological tumor features and recurrence-free survival (RFS) in a retrospective cohort of 173 patients who had undergone surgery for localized ccRCC at Helsinki University Hospital (HUH), Finland. An external validation cohort of 191 patients was obtained from Turku University Hospital (TUH), Finland. Tissue-microarrays (TMA) were constructed using the primary tumor samples. Clinical parameters and follow-up information from 2006 to 2019 were obtained from electronic medical records. The cytoplasmic and nuclear expression of PHD2, and PHD3 were scored based on immunohistochemical staining and their associations with histopathological features and RFS were evaluated. RESULTS Nuclear PHD2 and PHD3 expression in cancer cells were associated with lower pT-stage and Fuhrman grade compared with negative nuclei. Patients with positive nuclear expression of PHD2 and PHD3 in cancer cells had favorable RFS compared with patients having negative tumors. The nuclear expression of PHD2 was independently associated with a decreased risk of disease recurrence or death from RCC in multivariable analysis. These results were observed in both cohorts. CONCLUSIONS The absence of nuclear PHD2 and PHD3 expression in ccRCC was associated with poor RFS and the nuclear expression of PHD2 predicted RFS regardless of other known histopathological prognostic factors. Nuclear PHD2 and PHD3 are potential prognostic biomarkers in patients with localized ccRCC and should be further investigated and validated in prospective studies.
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Affiliation(s)
- Lassi Luomala
- Dept. of UrologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Kalle Mattila
- Department of Oncology and Radiotherapy, FICAN West Cancer CentreUniversity of Turku, Turku University HospitalTurkuFinland
- InFlames Research FlagshipUniversity of TurkuTurkuFinland
| | - Paula Vainio
- Dept. of Pathology, Turku University HospitalUniversity of TurkuTurkuFinland
| | - Harry Nisén
- Dept. of UrologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Teijo Pellinen
- Institute for Molecular Medicine Finland, Helsinki Institute of Life ScienceUniversity of HelsinkiHelsinkiFinland
| | - Jouni Lohi
- Diagnostic Center, HUSLAB Laboratory ServicesHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Teemu D. Laajala
- Diagnostic Center, HUSLAB Laboratory ServicesHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Research Program in Systems Oncology (ONCOSYS) and iCAN – Digital Precision Cancer Medicine FlagshipUniversity of HelsinkiHelsinkiFinland
| | - Petrus Järvinen
- Dept. of UrologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | | | - Panu Jaakkola
- Department of Oncology and Radiotherapy, FICAN West Cancer CentreUniversity of Turku, Turku University HospitalTurkuFinland
| | - Tuomas Mirtti
- Diagnostic Center, HUSLAB Laboratory ServicesHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Research Program in Systems Oncology (ONCOSYS) and iCAN – Digital Precision Cancer Medicine FlagshipUniversity of HelsinkiHelsinkiFinland
- Foundation for the Finnish Cancer InstituteHelsinkiFinland
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Forss M, Bolsunovskyi K, Lee Y, Kilpeläinen TP, Aoki Y, Gudjonsson S, Hervé F, Järvinen P, Malde S, Miyazawa K, Sairanen J, Sander L, Violette PD, Witte LP, Guyatt GH, Tikkinen KA. Practice Variation in the Management of Adult Hydroceles: A Multinational Survey. EUR UROL SUPPL 2023; 58:1-7. [PMID: 38152484 PMCID: PMC10751538 DOI: 10.1016/j.euros.2023.09.005] [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: 09/14/2023] [Indexed: 12/29/2023] Open
Abstract
Background Although hydrocele is one of the most common urologic pathologies, it is seldom studied, and the major urologic associations have no guidelines for the management of adult hydroceles. Objective To characterize international practice variation in the treatment of adult hydroceles. Design setting and participants An international survey was conducted addressing the management of hydroceles among urologists in Belgium, Denmark, Finland, Iceland, Japan, and the Netherlands from September to December 2020. We invited a random sample of 170 urologists from each country (except Iceland). Outcome measurements and statistical analysis Urologists' treatment options, factors relevant for decision-making, expected patient satisfaction, and outcomes after aspiration versus surgery were assessed. Results and limitations Of the 864 urologists contacted, 437 (51%) participated. Of the respondents, 202 (53%) performed both hydrocelectomies and aspiration, 147 (39%) performed hydrocelectomies only, and 30 (8%) performed aspiration only. In Belgium (83%), the Netherlands (75%), and Denmark (55%), urologists primarily performed hydrocelectomies only, whereas in Finland (84%), Japan (61%), and Iceland (91%), urologists performed both hydrocelectomies and aspiration. Urologists favored hydrocelectomy for large hydroceles (78.8% vs 37.5% for small), younger patients (66.0% for patients <50 yr vs 41.2% for ≥70 yr), patients with few or no comorbidities (62.3% vs 23.1% with multiple comorbidities), and patients without antithrombotic agents (53.5% vs 36.5% with antithrombotic agents). Most urologists considered patient satisfaction to be highest after hydrocelectomy (53.8% vs 9.9% after aspiration) despite believing that hydrocelectomy is more likely to cause complications (hematoma 77.8% vs 8.8% after aspiration). Estimates varied between countries. Conclusions We found a large variation in the treatment of adult hydroceles within and between countries. Optimization of hydrocele management globally will require future studies. Patient summary Our international survey shows that treatment of adult hydrocele varies considerably within and between countries.
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Affiliation(s)
- Mikko Forss
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kostiantyn Bolsunovskyi
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tuomas P. Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yoshitaka Aoki
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Sigurdur Gudjonsson
- Department of Urology, Landspitali University Hospital; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - François Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sachin Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Jukka Sairanen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lotte Sander
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Philippe D. Violette
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Surgery, Woodstock Hospital, Woodstock, ON, Canada
| | | | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kari A.O. Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
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3
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Lee MH, Theodoropoulos J, Huuhtanen J, Bhattacharya D, Järvinen P, Tornberg S, Nísen H, Mirtti T, Uski I, Kumari A, Peltonen K, Draghi A, Donia M, Kreutzman A, Mustjoki S. Immunologic Characterization and T cell Receptor Repertoires of Expanded Tumor-infiltrating Lymphocytes in Patients with Renal Cell Carcinoma. Cancer Res Commun 2023; 3:1260-1276. [PMID: 37484198 PMCID: PMC10361538 DOI: 10.1158/2767-9764.crc-22-0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
The successful use of expanded tumor-infiltrating lymphocytes (TIL) in adoptive TIL therapies has been reported, but the effects of the TIL expansion, immunophenotype, function, and T cell receptor (TCR) repertoire of the infused products relative to the tumor microenvironment (TME) are not well understood. In this study, we analyzed the tumor samples (n = 58) from treatment-naïve patients with renal cell carcinoma (RCC), "pre-rapidly expanded" TILs (pre-REP TIL, n = 15) and "rapidly expanded" TILs (REP TIL, n = 25) according to a clinical-grade TIL production protocol, with single-cell RNA (scRNA)+TCRαβ-seq (TCRαβ sequencing), TCRβ-sequencing (TCRβ-seq), and flow cytometry. REP TILs encompassed a greater abundance of CD4+ than CD8+ T cells, with increased LAG-3 and low PD-1 expressions in both CD4+ and CD8+ T cell compartments compared with the pre-REP TIL and tumor T cells. The REP protocol preferentially expanded small clones of the CD4+ phenotype (CD4, IL7R, KLRB1) in the TME, indicating that the largest exhausted T cell clones in the tumor do not expand during the expansion protocol. In addition, by generating a catalog of RCC-associated TCR motifs from >1,000 scRNA+TCRαβ-seq and TCRβ-seq RCC, healthy and other cancer sample cohorts, we quantified the RCC-associated TCRs from the expansion protocol. Unlike the low-remaining amount of anti-viral TCRs throughout the expansion, the quantity of the RCC-associated TCRs was high in the tumors and pre-REP TILs but decreased in the REP TILs. Our results provide an in-depth understanding of the origin, phenotype, and TCR specificity of RCC TIL products, paving the way for a more rationalized production of TILs. Significance TILs are a heterogenous group of immune cells that recognize and attack the tumor, thus are utilized in various clinical trials. In our study, we explored the TILs in patients with kidney cancer by expanding the TILs using a clinical-grade protocol, as well as observed their characteristics and ability to recognize the tumor using in-depth experimental and computational tools.
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Affiliation(s)
- Moon Hee Lee
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Jason Theodoropoulos
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Jani Huuhtanen
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Dipabarna Bhattacharya
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Abdominal Center, Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Sara Tornberg
- Abdominal Center, Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Harry Nísen
- Abdominal Center, Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
- Department of Pathology, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Biomedical Engineering, School of Medicine, Emory University, Atlanta, Georgia
| | - Ilona Uski
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Anita Kumari
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Karita Peltonen
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Arianna Draghi
- National Center for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - Marco Donia
- National Center for Cancer Immune Therapy, Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - Anna Kreutzman
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
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Fallara G, Larcher A, Dabestani S, Fossati N, Järvinen P, Nisen H, Gudmundsson E, Lam TB, Marconi L, Fernandéz-Pello S, Meijer RP, Volpe A, Beisland C, Klatte T, Stewart GD, Bensalah K, Ljungberg B, Bertini R, Montorsi F, Bex A, Capitanio U. Recurrence pattern in localized RCC: results from a European multicenter database (RECUR). Urol Oncol 2022; 40:494.e11-494.e17. [DOI: 10.1016/j.urolonc.2022.08.007] [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] [Received: 03/20/2022] [Revised: 06/08/2022] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
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Mäki-Lohiluoma L, Kilpeläinen TP, Järvinen P, Söderström HK, Tikkinen KA, Sairanen J. Risk of Complications After Hydrocele Surgery: A Retrospective Multicenter Study in Helsinki Metropolitan Area. EUR UROL SUPPL 2022; 43:22-27. [PMID: 36353068 PMCID: PMC9638760 DOI: 10.1016/j.euros.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Despite being one of the most frequent urological procedures, the risk estimates for complications after hydrocele surgery (hydrocelectomy) are uncertain. Decision-making about hydrocelectomy involves balancing the risk of complications with efficacy of surgery—a tradeoff that critically depends on the complication risks of hydrocele surgery. Objective To examine the 90-d risks of complications of hydrocele surgery in a large, contemporary sample. Design, setting, and participants We retrospectively reviewed all surgeries performed for nonrecurrent hydroceles conducted in all five Helsinki metropolitan area public hospitals from the beginning of 2010 till the end of 2018, and evaluated the complication outcomes. Outcome measurements and statistical analysis The following outcomes were evaluated: (1) risk of moderate or severe (Clavien-Dindo II–V) hydrocele surgery complications, (2) risk of reoperation due to a surgical complication, and (3) risk of an unplanned postoperative visit to the emergency room or outpatient clinic, all within 90 d after surgery. Results and limitations We identified 866 hydrocele operations (38 [4.3%] bilateral operations). A total of 139 (16.1%) patients had moderate or severe hydrocele surgery complications within 90 d after surgery. Of the 139 complications, 94 were (10.9% of all or 67.6% of patients with moderate or severe complications) Clavien-Dindo grade II, 43 (5.0% and 30.9%, respectively) grade III, two (0.2% and 1.4%, respectively) grade IV, and none grade V. A total of 45 patients (5.2% of all and 32.4% of those who had moderate or severe complications) required immediate reoperation due to complications. All together 219 operated patients (25.3% of all operated patients) had an unplanned visit to the emergency room. The retrospective study design limits the reliability of the results. Conclusions Complications after hydrocele surgery are common and warrant further research. These estimates can be useful in shared decision-making between clinicians and patients. Patient summary We investigated the complication rates after hydrocele surgery and found that complications are common after a procedure often considered minor: every ninth patient had a moderate and every 20th a severe complication. Every fourth patient had an unplanned postoperative visit to the emergency room.
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Lee MH, Laajala E, Kreutzman A, Järvinen P, Nísen H, Mirtti T, Hollmén M, Mustjoki S. The tumor and plasma cytokine profiles of renal cell carcinoma patients. Sci Rep 2022; 12:13416. [PMID: 35927313 PMCID: PMC9352752 DOI: 10.1038/s41598-022-17592-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Renal cell carcinoma (RCC) accounts for 90% of all renal cancers and is considered highly immunogenic. Although many studies have reported the circulating peripheral cytokine profiles, the signatures between the tumor tissue and matching healthy adjacent renal tissue counterparts have not been explored. We aimed to comprehensively investigate the cytokine landscape of RCC tumors and its correlation between the amount and phenotype of the tumor infiltrating lymphocytes (TILs). We analyzed the secretion of 42 cytokines from the tumor (n = 46), adjacent healthy kidney tissues (n = 23) and matching plasma samples (n = 33) with a Luminex-based assay. We further explored the differences between the tissue types, as well as correlated the findings with clinical data and detailed immunophenotyping of the TILs. Using an unsupervised clustering approach, we observed distinct differences in the cytokine profiles between the tumor and adjacent renal tissue samples. The tumor samples clustered into three distinct profiles based on the cytokine expressions: high (52.2% of the tumors), intermediate (26.1%), and low (21.7%). Most of the tumor cytokines positively correlated with each other, except for IL-8 that showed no correlation with any of the measured cytokine expressions. Furthermore, the quantity of lymphocytes in the tumor samples analyzed with flow cytometry positively correlated with the chemokine-family of cytokines, CXCL10 (IP-10) and CXCL9 (MIG). No significant correlations were found between the tumor and matching plasma cytokines, suggesting that circulating cytokines poorly mirror the tumor cytokine environment. Our study highlights distinct cytokine profiles in the RCC tumor microenvironment and provides insights to potential biomarkers for the treatment of RCC.
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Affiliation(s)
- Moon Hee Lee
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Haartmaninkatu 8, N00290, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Essi Laajala
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Haartmaninkatu 8, N00290, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Anna Kreutzman
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Haartmaninkatu 8, N00290, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harry Nísen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Maija Hollmén
- Medicity Research Laboratory, University of Turku, Turku, Finland
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Haartmaninkatu 8, N00290, Helsinki, Finland. .,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland. .,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland.
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Luomala L, Rautiola J, Järvinen P, Mirtti T, Nisén H. Active surveillance versus initial surgery in the long-term management of Bosniak IIF-IV cystic renal masses. Sci Rep 2022; 12:10184. [PMID: 35715428 PMCID: PMC9205856 DOI: 10.1038/s41598-022-14056-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/31/2022] [Indexed: 11/09/2022] Open
Abstract
There may be surgical overtreatment of complex cystic renal masses (CRM). Growing evidence supports active surveillance (AS) for the management for Bosniak IIF-III CRMs. We aimed to evaluate and compare oncological and pathological outcomes of Bosniak IIF-IV CRMs treated by initial surgery (IS) or AS. We identified retrospectively 532 patients with CRM counseled during 2006-2017. IS and AS were delivered to, respectively, 1 and 286 patients in Bosniak IIF, to 54 and 85 patients in III and to 85 and 21 patients in Bosniak IV. Median follow-up was 66 months (IQR 50-96). Metastatic progression occurred for 1 (0.3%) AS patient in Bosniak IIF, 1 IS (1.8%) and 1 AS (1.2%) patient in Bosniak III and 5 IS (3.5%) patients in Bosniak IV, respectively. Overall 5-year metastasis-free survival was 98.9% and cancer-specific survival was 99.6% without statistically significant difference between IS and AS in Bosniak IIF-IV categories. AS did not increase the risk of metastatic spread or cancer-specific mortality in patients with Bosniak IIF-IV. Our data indicate AS in Bosniak IIF and III is safe. Surgery is the primary treatment for Bosniak IV due to its high malignancy rate.
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Affiliation(s)
- Lassi Luomala
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Juhana Rautiola
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Mirtti
- HUSLAB Laboratory Services and Research Program in Systemic Oncology, Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Program in Systemic Oncology, University of Helsinki, Helsinki, Finland
| | - Harry Nisén
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Lee MH, Järvinen P, Nísen H, Brück O, Ilander M, Uski I, Theodoropoulos J, Kankainen M, Mirtti T, Mustjoki S, Kreutzman A. T and NK cell abundance defines two distinct subgroups of renal cell carcinoma. Oncoimmunology 2022; 11:1993042. [PMID: 35003893 PMCID: PMC8741293 DOI: 10.1080/2162402x.2021.1993042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Renal cell carcinoma (RCC) is considered as an immunogenic cancer. Because not all patients respond to current immunotherapies, we aimed to investigate the immunological heterogeneity of RCC tumors. We analyzedthe immunophenotype of the circulating, tumor, and matching adjacent healthy kidney immune cells from 52 nephrectomy patients with multi-parameter flow cytometry. Additionally, we studied the transcriptomic and mutation profiles of 20 clear cell RCC (ccRCC) tumors with bulk RNA sequencing and a customized pan-cancer gene panel. The tumor samples clustered into two distinct subgroups defined by the abundance of intratumoral CD3+ T cells (CD3high, 25/52) and NK cells (NKhigh, 27/52). CD3high tumors had an overall higher frequency of tumor infiltrating lymphocytes and PD-1 expression on the CD8+ T cells compared to NKhigh tumors. The tumor infiltrating T and NK cells had significantly elevated expression levels of LAG-3, PD-1, and HLA-DR compared to the circulating immune cells. Transcriptomic analysis revealed increased immune signaling (IFN-γ, TNF-α via NF-κB, and T cell receptor signaling) and kidney metabolism pathways in the CD3high subgroup. Genomic analysis confirmed the typical ccRCC mutation profile including VHL, PBRM1, and SETD2 mutations, and revealed PBRM1 as a uniquely mutated gene in the CD3high subgroup. Approximately half of the RCC tumors have a high infiltration of NK cells associated with a lower number of tumor infiltrating lymphocytes, lower PD-1 expression, a distinct transcriptomic and mutation profile, providing insights to the immunological heterogeneity of RCC which may impact treatment responses to immunological therapies.
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Affiliation(s)
- Moon Hee Lee
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Abdominal Center, Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Harry Nísen
- Abdominal Center, Urology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Oscar Brück
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Mette Ilander
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Ilona Uski
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Jason Theodoropoulos
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Matti Kankainen
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,iCAN Digital Precision Cancer Medicine Flagship, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Mirtti
- Department of Pathology, Helsinki University Hospital and Research Program in Systems Oncology, University of Helsinki, Finland
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,iCAN Digital Precision Cancer Medicine Flagship, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna Kreutzman
- Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
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Fallara G, Larcher A, Dabestani S, Fossati N, Järvinen P, Nisen H, Gudmundsson E, Lam T, Marconi L, Fernandéz-Pello S, Meijer R, Volpe A, Beisland C, Klatte T, Stewart G, Ljungberg B, Montorsi F, Bex A, Capitanio U. Impact of surgical approach (open vs. minimally invasive) on oncological outcomes after nephrectomy for localised renal cell carcinoma: a recur database project. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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10
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Hamdan F, Ylösmäki E, Chiaro J, Giannoula Y, Long M, Fusciello M, Feola S, Martins B, Feodoroff M, Antignani G, Russo S, Kari O, Lee M, Järvinen P, Nisen H, Kreutzman A, Leusen J, Mustjoki S, McWilliams TG, Grönholm M, Cerullo V. Novel oncolytic adenovirus expressing enhanced cross-hybrid IgGA Fc PD-L1 inhibitor activates multiple immune effector populations leading to enhanced tumor killing in vitro, in vivo and with patient-derived tumor organoids. J Immunother Cancer 2021; 9:jitc-2021-003000. [PMID: 34362830 PMCID: PMC8351494 DOI: 10.1136/jitc-2021-003000] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Accepted: 07/21/2021] [Indexed: 01/18/2023] Open
Abstract
Background Despite the success of immune checkpoint inhibitors against PD-L1 in the clinic, only a fraction of patients benefit from such therapy. A theoretical strategy to increase efficacy would be to arm such antibodies with Fc-mediated effector mechanisms. However, these effector mechanisms are inhibited or reduced due to toxicity issues since PD-L1 is not confined to the tumor and also expressed on healthy cells. To increase efficacy while minimizing toxicity, we designed an oncolytic adenovirus that secretes a cross-hybrid Fc-fusion peptide against PD-L1 able to elicit effector mechanisms of an IgG1 and also IgA1 consequently activating neutrophils, a population neglected by IgG1, in order to combine multiple effector mechanisms. Methods The cross-hybrid Fc-fusion peptide comprises of an Fc with the constant domains of an IgA1 and IgG1 which is connected to a PD-1 ectodomain via a GGGS linker and was cloned into an oncolytic adenovirus. We demonstrated that the oncolytic adenovirus was able to secrete the cross-hybrid Fc-fusion peptide able to bind to PD-L1 and activate multiple immune components enhancing tumor cytotoxicity in various cancer cell lines, in vivo and ex vivo renal-cell carcinoma patient-derived organoids. Results Using various techniques to measure cytotoxicity, the cross-hybrid Fc-fusion peptide expressed by the oncolytic adenovirus was shown to activate Fc-effector mechanisms of an IgA1 (neutrophil activation) as well as of an IgG1 (natural killer and complement activation). The activation of multiple effector mechanism simultaneously led to significantly increased tumor killing compared with FDA-approved PD-L1 checkpoint inhibitor (Atezolizumab), IgG1-PDL1 and IgA-PDL1 in various in vitro cell lines, in vivo models and ex vivo renal cell carcinoma organoids. Moreover, in vivo data demonstrated that Ad-Cab did not require CD8+ T cells, unlike conventional checkpoint inhibitors, since it was able to activate other effector populations. Conclusion Arming PD-L1 checkpoint inhibitors with Fc-effector mechanisms of both an IgA1 and an IgG1 can increase efficacy while maintaining safety by limiting expression to the tumor using oncolytic adenovirus. The increase in tumor killing is mostly attributed to the activation of multiple effector populations rather than activating a single effector population leading to significantly higher tumor killing.
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Affiliation(s)
- Firas Hamdan
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Erkko Ylösmäki
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Jacopo Chiaro
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Yvonne Giannoula
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland
| | - Maeve Long
- Translational Stem Cell Biology & Metabolism Program, Research Programs Unit, Department of Anatomy, Faculty of Medicine, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Manlio Fusciello
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Sara Feola
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Beatriz Martins
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Michaela Feodoroff
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Gabriella Antignani
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Salvatore Russo
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Otto Kari
- Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Moon Lee
- TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Hematology Research Unit Helsinki, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Petrus Järvinen
- Abdominal Center, Urology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | - Harry Nisen
- Abdominal Center, Urology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | - Anna Kreutzman
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Jeanette Leusen
- Center for Translational Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Satu Mustjoki
- TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Hematology Research Unit Helsinki, University of Helsinki, Helsinki, Uusimaa, Finland.,iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland.,Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
| | - Thomas G McWilliams
- Translational Stem Cell Biology & Metabolism Program, Research Programs Unit, Department of Anatomy, Faculty of Medicine, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.,Department of Anatomy, University of Helsinki, Helsinki, Finland
| | - Mikaela Grönholm
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland.,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.,iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Vincenzo Cerullo
- Laboratory of Immunovirotherapy, Drug Research Program, University of Helsinki Faculty of Pharmacy, Helsinki, Uusimaa, Finland .,TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Uusimaa, Finland.,Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.,iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland.,Department of Molecular Medicine and Medical Biotechnology and CEINGE, Naples University 24 Federico II, 80131, Naples, Italy
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11
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Hamdan F, Ylösmäki E, Chiaro J, Giannoula Y, Long M, Fusciello M, Feola S, Martins B, Feodoroff M, Antignani G, Kari O, Lee MH, Järvinen P, Nisen H, Kreutzman A, Mustjoki S, McWilliams TG, Grönholm M, Cerullo V. Abstract 1867: Characterization in patient derived tumor organoids of novel oncolytic adenoviruses expressing enhanced cross-hybrid IgGA Fc PD-L1 inhibitors. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1867] [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
Despite the success of immune checkpoint inhibitors in the clinic, they only benefit a fraction of patients. A theoretical strategy to increase efficacy would be to enhance such antibodies with Fc-mediated effector mechanisms. Current IgG1 antibodies are excellent activators of natural killer cells yet neglect a crucial effector population, neutrophils. Hence, we designed a cross-hybrid Fc-fusion peptide against PD-L1 able to elicit simultaneously effector mechanisms of an IgG1 but also IgA1, consequently activating neutrophils, in order to combine multiple effector mechanisms. Moreover, to prevent toxicities, these Fc-fusion peptides were cloned in oncolytic adenoviruses whose replication is restricted to the tumor. Our oncolytic adenoviruses were able to selectively infect tumor cells, secrete the cross-hybrid Fc-fusion peptides able to bind to PD-L1 and activate multiple immune components enhancing tumor cytotoxicity compared to FDA-approved immune checkpoint inhibitors. We validated this in various human and murine cancer cell lines and also renal cell carcinoma patient derived organoids from four patients. In conclusion, our cross-hybrid Fc-fusion peptides demonstrate that activating multiple immune effector populations increases tumor cytotoxicity potentially leading to improved clinical outcomes.
Citation Format: Firas Hamdan, Erkko Ylösmäki, Jacopo Chiaro, Yvonne Giannoula, Maeve Long, Manlio Fusciello, Sara Feola, Beatriz Martins, Michaela Feodoroff, Gabriella Antignani, Otto Kari, Moon Hee Lee, Petrus Järvinen, Harry Nisen, Anna Kreutzman, Satu Mustjoki, Thomas G McWilliams, Mikaela Grönholm, Vincenzo Cerullo. Characterization in patient derived tumor organoids of novel oncolytic adenoviruses expressing enhanced cross-hybrid IgGA Fc PD-L1 inhibitors [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 1867.
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Affiliation(s)
| | | | | | | | - Maeve Long
- University of Helsinki, Helsinki, Finland
| | | | - Sara Feola
- University of Helsinki, Helsinki, Finland
| | | | | | | | - Otto Kari
- University of Helsinki, Helsinki, Finland
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12
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Fallara G, Larcher A, Dabestani S, Fossati N, Järvinen P, Nisen H, Gudmundsson E, Lam T, Marconi L, Fernandéz-Pello S, Meijer R, Volpe A, Beisland C, Klatte T, Stewart G, Ljungberg B, Montorsi F, Bex A, Capitanio U. Impact of surgical approach (open vs. minimally invasive) on oncological outcomes after nephrectomy for localized renal cell carcinoma: A RECUR database project. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00947-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Giles R, Nair R, Azawi N, Barber N, Bex A, Campi R, Capitanio U, Gatto F, Hakimi A, Järvinen P, Karam J, Ljungberg B, Lund L, Maddineni S, Marconi L, Master V, Minervini A, Nielsen T, Nisen H, Rochester M, Stewart G, Dabestani S. Patient perspective on serving on the steering committee of the AURORAX-0087A trial for non-metastatic clear cell renal cell carcinoma. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00589-3] [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: 11/26/2022]
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14
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Bolsunovskyi K, Forss M, Kilpeläinen T, Lee Y, Aoki Y, Gudjonsson S, Hervé F, Järvinen P, Malde S, Miyazawa K, Sairanen J, Sander L, Witte L, Guyatt G, Tikkinen K. Practice variation in the management of adult hydroceles: A multinational survey. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01512-8] [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: 11/16/2022]
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15
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Luomala L, Nisén H, Järvinen P, Rautiola J. Management and outcomes of complicated renal cysts, a single-institute observational study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Abu-Ghanem Y, Powles T, Capitanio U, Beisland C, Järvinen P, Stewart GD, Gudmundsson E, Lam TBL, Marconi L, Fernandéz-Pello S, Nisen H, Meijer RP, Volpe A, Ljungberg B, Klatte T, Bensalah K, Dabestani S, Bex A. Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy? BJU Int 2021; 128:386-394. [PMID: 33794055 DOI: 10.1111/bju.15415] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). SUBJECTS A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM). RESULTS From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73-3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03-2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3-4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3-8.5; P < 0.001). Kaplan-Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study. CONCLUSION Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
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Affiliation(s)
- Yasmin Abu-Ghanem
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petrus Järvinen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Harry Nisen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Saeed Dabestani
- Division of Urological Cancers, Department of Translational Medicine, Central Hospital Kristianstad, Lund University, Lund, Sweden
| | - Axel Bex
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Hammer HB, Hansen I, Järvinen P, Leirisalo-Repo M, Ziegelasch M, Agular B, Terslev L. Major reduction of ultrasound-detected synovitis during subcutaneous tocilizumab treatment: results from a multicentre 24 week study of patients with rheumatoid arthritis. Scand J Rheumatol 2021; 50:262-270. [PMID: 33464147 DOI: 10.1080/03009742.2020.1845394] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: Few studies have investigated the efficacy of subcutaneous tocilizumab (TCZ-SC) on ultrasound-detected inflammation. This study aimed to explore the clinical efficacy of TCZ-SC treatment in rheumatoid arthritis (RA) patients and to evaluate the response by ultrasound compared to Composite Disease Activity Scores (CDAS).Method: This open-label, single-arm study enrolled RA patients with inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs initiating TCZ-SC 162 mg once weekly for 24 weeks, with clinical assessments at baseline, 2, 4, 8, 12, 16, 20, and 24 weeks. Ultrasound examinations [semi-quantitative score (0-3) of 36 joints and four tendons] were performed at baseline, 4, 12, and 24 weeks. CDAS and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) response, and sum scores of ultrasound grey scale/Doppler were calculated. Changes during follow-up were explored by the Mann-Whitney test and correlations by Spearman's rho.Results: In total, 133 patients (mean ± sd age 55.9 ± 12.0 years) were assessed clinically and 110 patients were also examined with ultrasound. All clinical and ultrasound scores decreased significantly after 4 weeks (p < 0.001). At 24 weeks there was EULAR good response in 87.7% and ACR 70% response in 47.4%. Ultrasound scores had no or low correlations with patient-reported outcomes. At 24 weeks, CDAS remission was achieved in 27.4-83.5% and a sum score Doppler of 0 was found in 53.3%.Conclusions: Clinical and ultrasound scores decreased rapidly. Ultrasound scores were not associated with patient-reported variables. Half of the patients reached ultrasound remission, while there were large discrepancies in the percentage of patients reaching remission based on different CDAS.Trial registration: Study ML28691, registered 28 January 2014, ClinicalTrials.gov identifier: NCT02046616.
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Affiliation(s)
- H B Hammer
- Departmemt of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Medical Faculty, University of Oslo, Oslo, Norway
| | - Imj Hansen
- Department of Rheumatology, Svendborg Hospital, Svendborg, Denmark
| | - P Järvinen
- Department of Rheumatology, Kiljava Medical Research, Hyvinkää, Finland
| | - M Leirisalo-Repo
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Ziegelasch
- Department of Rheumatology, Linköping University Hospital, Linköping, Sweden
| | | | - L Terslev
- Department of Rheumatology, Rigshospitalet Glostrup, Copenhagen, Denmark
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18
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Brück O, Lee MH, Turkki R, Uski I, Penttilä P, Paavolainen L, Kovanen P, Järvinen P, Bono P, Pellinen T, Mustjoki S, Kreutzman A. Spatial immunoprofiling of the intratumoral and peritumoral tissue of renal cell carcinoma patients. Mod Pathol 2021; 34:2229-2241. [PMID: 34215851 PMCID: PMC8592837 DOI: 10.1038/s41379-021-00864-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/14/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 01/02/2023]
Abstract
While the abundance and phenotype of tumor-infiltrating lymphocytes are linked with clinical survival, their spatial coordination and its clinical significance remain unclear. Here, we investigated the immune profile of intratumoral and peritumoral tissue of clear cell renal cell carcinoma patients (n = 64). We trained a cell classifier to detect lymphocytes from hematoxylin and eosin stained tissue slides. Using unsupervised classification, patients were further classified into immune cold, hot and excluded topographies reflecting lymphocyte abundance and localization. The immune topography distribution was further validated with The Cancer Genome Atlas digital image dataset. We showed association between PBRM1 mutation and immune cold topography, STAG1 mutation and immune hot topography and BAP1 mutation and immune excluded topography. With quantitative multiplex immunohistochemistry we analyzed the expression of 23 lymphocyte markers in intratumoral and peritumoral tissue regions. To study spatial interactions, we developed an algorithm quantifying the proportion of adjacent immune cell pairs and their immunophenotypes. Immune excluded tumors were associated with superior overall survival (HR 0.19, p = 0.02) and less extensive metastasis. Intratumoral T cells were characterized with pronounced expression of immunological activation and exhaustion markers such as granzyme B, PD1, and LAG3. Immune cell interaction occurred most frequently in the intratumoral region and correlated with CD45RO expression. Moreover, high proportion of peritumoral CD45RO+ T cells predicted poor overall survival. In summary, intratumoral and peritumoral tissue regions represent distinct immunospatial profiles and are associated with clinicopathologic characteristics.
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Affiliation(s)
- Oscar Brück
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland. .,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland. .,Hematology Research Unit Helsinki, University of Helsinki and Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland. .,Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital, Helsinki, Finland.
| | - Moon Hee Lee
- grid.7737.40000 0004 0410 2071Translational Immunology Research Program, University of Helsinki, Helsinki, Finland ,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Hematology Research Unit Helsinki, University of Helsinki and Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Riku Turkki
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Ilona Uski
- grid.7737.40000 0004 0410 2071Translational Immunology Research Program, University of Helsinki, Helsinki, Finland ,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Hematology Research Unit Helsinki, University of Helsinki and Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Patrick Penttilä
- grid.15485.3d0000 0000 9950 5666Abdominal Center, Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lassi Paavolainen
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Panu Kovanen
- grid.7737.40000 0004 0410 2071Department of Pathology, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- grid.15485.3d0000 0000 9950 5666Abdominal Center, Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Petri Bono
- grid.15485.3d0000 0000 9950 5666Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Teijo Pellinen
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Satu Mustjoki
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland. .,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland. .,Hematology Research Unit Helsinki, University of Helsinki and Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland. .,Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland.
| | - Anna Kreutzman
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland. .,iCAN Digital Precision Cancer Medicine Flagship, Helsinki, Finland. .,Hematology Research Unit Helsinki, University of Helsinki and Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
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Dabestani S, Azawi N, Barber N, Bex A, Campi R, Capitanio U, Gatto F, Giles R, Hakimi A, Järvinen P, Karam J, Ljungberg B, Lund L, Maddineni S, Marconi L, Master V, Minervini A, Nielsen T, Nisen H, Rochester M, Stewart G, Nair R. Glycosaminoglycan (GAG) scores for surveillance of recurrence in Leibovich Points ≥5 non-metastatic clear cell renal cell carcinoma: AURORAX-0087A trial in progress report. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Abu-Ghanem Y, Powles T, Capitanio U, Beisland C, Järvinen P, Stewart GD, Gudmundsson EO, Lam TB, Marconi L, Fernandéz-Pello S, Nisen H, Meijer RP, Volpe A, Ljungberg B, Klatte T, Dabestani S, Bex A. The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery-Results from RECUR Consortium. Eur Urol Oncol 2020; 4:473-482. [PMID: 33109495 DOI: 10.1016/j.euo.2020.09.005] [Citation(s) in RCA: 28] [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: 06/30/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. OBJECTIVE To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. DESIGN, SETTING, AND PARTICIPANTS This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables (stage, grade, risk score, etc.) Patterns of recurrence for all histological subtypes were compared according to recurrence site and risk criteria. RESULTS AND LIMITATIONS Of the 3331 patients, 62.2% underwent radical nephrectomy and 37.8% partial nephrectomy. A total of 2565 patients (77.0%) had ccRCC, 535 (16.1%) had pRCC, and 231 (6.9%) had chRCC. The median postoperative follow-up period was 61.7 (interquartile range: 47-83) mo. Patients with ccRCC had significantly poorer 5-yr RFS than patients with pRCC and chRCC (78% vs 86% vs 91%, p = 0.001). The most common sites of recurrence for ccRCC were the lung and bone. Intermediate-/high-risk pRCC patients had an increased rate of lymphatic recurrence, both mediastinal and retroperitoneal, while recurrence in chRCC was rare (8.2%), associated with higher stage and positive margins, and predominantly in the liver and bone. Limitations include the retrospective nature of the study. CONCLUSIONS The main histological subtypes of RCC exhibit a distinct pattern and dynamics of recurrence. Results suggest that intermediate- to high-risk pRCC may benefit from cross-sectional abdominal imaging every 6 mo until 2 yr after surgery, while routine imaging might be abandoned for chRCC except for abdominal computed tomography in patients with advanced tumour stage or positive margins. PATIENT SUMMARY In this analysis of a large database from 15 countries around Europe, we found that the main histological subtypes of renal cell carcinoma have a distinct pattern and dynamics of recurrence. Patients should be followed differently according to subtype and risk score.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK.
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petrus Järvinen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Harry Nisen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK; Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Axel Bex
- Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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21
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Tornberg SV, Nisen H, Järvinen P, Järvinen R, Kilpeläinen TP, Taari K, Stenman UH, Visapää H. Serum tumour associated trypsin inhibitor, as a biomarker for survival in renal cell carcinoma. Scand J Urol 2020; 54:413-419. [PMID: 32748674 DOI: 10.1080/21681805.2020.1798501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Tumour associated trypsin inhibitor (TATI) is a peptide that is a marker for several tumours. TATI may also behave as an acute phase reactant in severe inflammatory disease. Overexpression of TATI predicts an unfavourable outcome for many cancers. This study aimed to evaluate the prognostic value of pre- and postoperative concentration of TATI in serum (S-TATI) of patients with renal cell carcinoma (RCC). MATERIALS AND METHODS S-TATI was determined by time resolved immunofluorometric assay in preoperative and postoperative samples that were collected from 132 RCC patients, who underwent partial or complete nephrectomy in Helsinki University Hospital from May 2005 to July 2010. RESULTS Preoperative S-TATI was significantly associated with tumour stage, lymph-node involvement, metastatic stage, Chronic Kidney Disease Stage (CKD grade), and preoperative C-reactive protein level (p < 0.05). Postoperative S-TATI was significantly associated only with CKD grade (p < 0.001). Multivariate Cox regression analysis of postoperative S-TATI, as a continuous variable, was an independent prognostic factor for overall survival (HR = 1.01, 95% CI = 1.00-1.01, p = 0.03) and cancer-specific survival (CSS) (HR = 1.01, 95% CI = 1.00-1.02, p = 0.004). CONCLUSIONS Our data suggest that elevated postoperative S-TATI may be associated with adverse prognosis in RCC patients.
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Affiliation(s)
- Sara V Tornberg
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harry Nisen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riikka Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Visapää
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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22
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Sandeman K, Eineluoto JT, Pohjonen J, Erickson A, Kilpeläinen TP, Järvinen P, Santti H, Petas A, Matikainen M, Marjasuo S, Kenttämies A, Mirtti T, Rannikko A. Prostate MRI added to CAPRA, MSKCC and Partin cancer nomograms significantly enhances the prediction of adverse findings and biochemical recurrence after radical prostatectomy. PLoS One 2020; 15:e0235779. [PMID: 32645056 PMCID: PMC7347171 DOI: 10.1371/journal.pone.0235779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/23/2020] [Indexed: 01/21/2023] Open
Abstract
Background To determine the added value of preoperative prostate multiparametric MRI (mpMRI) supplementary to clinical variables and their role in predicting post prostatectomy adverse findings and biochemically recurrent cancer (BCR). Methods All consecutive patients treated at HUS Helsinki University Hospital with robot assisted radical prostatectomy (RALP) between 2014 and 2015 were included in the analysis. The mpMRI data, clinical variables, histopathological characteristics, and follow-up information were collected. Study end-points were adverse RALP findings: extraprostatic extension, seminal vesicle invasion, lymph node involvement, and BCR. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, Cancer of the Prostate Risk Assessment (CAPRA) score and the Partin score were combined with any adverse findings at mpMRI. Predictive accuracy for adverse RALP findings by the regression models was estimated before and after the addition of MRI results. Logistic regression, area under curve (AUC), decision curve analyses, Kaplan-Meier survival curves and Cox proportional hazard models were used. Results Preoperative mpMRI data from 387 patients were available for analysis. Clinical variables alone, MSKCC nomogram or Partin tables were outperformed by models with mpMRI for the prediction of any adverse finding at RP. AUC for clinical parameters versus clinical parameters and mpMRI variables were 0.77 versus 0.82 for any adverse finding. For MSKCC nomogram versus MSKCC nomogram and mpMRI variables the AUCs were 0.71 and 0.78 for any adverse finding. For Partin tables versus Partin tables and mpMRI variables the AUCs were 0.62 and 0.73 for any adverse finding. In survival analysis, mpMRI-projected adverse RP findings stratify CAPRA and MSKCC high-risk patients into groups with distinct probability for BCR. Conclusions Preoperative mpMRI improves the predictive value of commonly used clinical variables for pathological stage at RP and time to BCR. mpMRI is available for risk stratification prebiopsy, and should be considered as additional source of information to the standard predictive nomograms.
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Affiliation(s)
- Kevin Sandeman
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Juho T. Eineluoto
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joona Pohjonen
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Andrew Erickson
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuomas P. Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrikki Santti
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anssi Petas
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Matikainen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi Marjasuo
- Department of Diagnostic Radiology, Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kenttämies
- Department of Diagnostic Radiology, Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Rannikko
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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23
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Eineluoto JT, Sandeman K, Pohjonen J, Sopyllo K, Nordling S, Stürenberg C, Malén A, Kilpeläinen TP, Santti H, Petas A, Matikainen M, Pellinen T, Järvinen P, Kenttämies A, Rannikko A, Mirtti T. Associations of PTEN and ERG with Magnetic Resonance Imaging Visibility and Assessment of Non-organ-confined Pathology and Biochemical Recurrence After Radical Prostatectomy. Eur Urol Focus 2020; 7:1316-1323. [PMID: 32620540 DOI: 10.1016/j.euf.2020.06.016] [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] [Received: 03/26/2020] [Revised: 05/18/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diagnosing clinically significant prostate cancer (PCa) is challenging, but may be facilitated by biomarkers and multiparametric magnetic resonance imaging (MRI). OBJECTIVE To determine the association between biomarkers phosphatase and tensin homolog (PTEN) and ETS-related gene (ERG) with visible and invisible PCa lesions in MRI, and to predict biochemical recurrence (BCR) and non-organ-confined (non-OC) PCa by integrating clinical, MRI, and biomarker-related data. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of a population-based cohort of men with PCa, who underwent preoperative MRI followed by radical prostatectomy (RP) during 2014-2015 in Helsinki University Hospital (n = 346), was conducted. A tissue microarray corresponding to the MRI-visible and MRI-invisible lesions in RP specimens was constructed and stained for PTEN and ERG. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations of PTEN and ERG with MRI-visible and MRI-invisible lesions were examined (Pearson's χ2 test), and predictions of non-OC disease together with clinical and MRI parameters were determined (area under the receiver operating characteristic curve and logistic regression analyses). BCR prediction was analyzed by Kaplan-Meier and Cox proportional hazard analyses. RESULTS AND LIMITATIONS Patients with MRI-invisible lesions (n = 35) had less PTEN loss and ERG-positive expression compared with patients (n = 90) with MRI-visible lesions (17.2% vs 43.3% [p = 0.006]; 8.6% vs 20.0% [p = 0.125]). Patients with invisible lesions had better, but not statistically significantly improved, BCR-free survival probability in Kaplan-Meier analyses (p = 0.055). Rates of BCR (5.7% vs 21.1%; p = 0.039), extraprostatic extension (11.4% vs 44.6%; p < 0.001), seminal vesicle invasion (0% vs 21.1%; p = 0.003), and lymph node metastasis (0% vs 12.2%; p = 0.033) differed between the groups in favor of patients with MRI-invisible lesions. Biomarkers had no independent role in predicting non-OC disease or BCR. The short follow-up period was a limitation. CONCLUSIONS PTEN loss, BCR, and non-OC RP findings were more often encountered with MRI-visible lesions. PATIENT SUMMARY Magnetic resonance imaging (MRI) of the prostate misses some cancer lesions. MRI-invisible lesions seem to be less aggressive than MRI-visible lesions.
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Affiliation(s)
- Juho T Eineluoto
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Kevin Sandeman
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joona Pohjonen
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Konrad Sopyllo
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Stig Nordling
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Carolin Stürenberg
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Adrian Malén
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrikki Santti
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anssi Petas
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Matikainen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teijo Pellinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kenttämies
- HUS Medical Imaging Center Department of Diagnostic Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland; Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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24
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Cervera-Carrascon V, Quixabeira DCA, Santos JM, Havunen R, Zafar S, Hemminki O, Heiniö C, Munaro E, Siurala M, Sorsa S, Mirtti T, Järvinen P, Mildh M, Nisen H, Rannikko A, Anttila M, Kanerva A, Hemminki A. Tumor microenvironment remodeling by an engineered oncolytic adenovirus results in improved outcome from PD-L1 inhibition. Oncoimmunology 2020; 9:1761229. [PMID: 32923123 PMCID: PMC7458667 DOI: 10.1080/2162402x.2020.1761229] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Checkpoint inhibitors have revolutionized cancer therapy and validated immunotherapy as an approach. Unfortunately, responses are seen in a minority of patients. Our objective is to use engineered adenoviruses designed to increase lymphocyte trafficking and cytokine production at the tumor, to assess if they increase the response rate to checkpoint inhibition, as these features have been regarded as predictive for the responses. When Ad5/3-E2F-d24-hTNFa-IRES-hIL2 (an oncolytic adenovirus coding for TNFa and IL-2, also known as TILT-123) and checkpoint inhibitors were used together in fresh urological tumor histocultures, a significant shift toward immune activity (not only tumor necrosis alpha and interleukin-2 but also interferon gamma and granzyme B) and increased T-cell trafficking signals (CXCL10) was observed. In vivo, our viruses enabled an anti-PD-L1 (a checkpoint inhibitor) delivering complete responses in all the treated animals (hazard ratios versus anti-PD-L1 alone 0.057 [0.007; 0.451] or virotherapy alone 0.067 [0.011; 0.415]). To conclude, when an engineered oncolytic adenovirus was utilized to modify the tumor microenvironment towards what meta-analyses have pointed as predictive markers for checkpoint inhibitory therapy, the response to them increased synergistically. Of note, key findings were confirmed in fresh patient-derived tumor explants.
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Affiliation(s)
- Victor Cervera-Carrascon
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,TILT Biotherapeutics Ltd, Helsinki, Finland
| | - Dafne C A Quixabeira
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland
| | - Joao Manuel Santos
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,TILT Biotherapeutics Ltd, Helsinki, Finland
| | - Riikka Havunen
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,TILT Biotherapeutics Ltd, Helsinki, Finland
| | - Sadia Zafar
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Camilla Heiniö
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland
| | - Eleonora Munaro
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland
| | - Mikko Siurala
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,TILT Biotherapeutics Ltd, Helsinki, Finland
| | - Suvi Sorsa
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,TILT Biotherapeutics Ltd, Helsinki, Finland
| | - Tuomas Mirtti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Pathology, Medicum, University of Helsinki, Helsinki, Finland.,Department of Pathology, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Markus Mildh
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Harry Nisen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Marjukka Anttila
- Pathology Unit, Finnish Food Safety Authority (EVIRA), Helsinki, Finland
| | - Anna Kanerva
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program and Department of Oncology, University of Helsinki, Helsinki, Finland.,TILT Biotherapeutics Ltd, Helsinki, Finland.,Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
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25
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Lee M, Järvinen P, Nísen H, Bruck O, Ilander M, Mustjoki S, Kreutzman A. Low NK cell abundance correlates with high expression of PD-1 in CD8+ T cells. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.034] [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: 11/14/2022] Open
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26
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Riikonen JM, Guyatt GH, Kilpeläinen TP, Craigie S, Agarwal A, Agoritsas T, Couban R, Dahm P, Järvinen P, Montori V, Power N, Richard PO, Rutanen J, Santti H, Tailly T, Violette PD, Zhou Q, Tikkinen KAO. Decision Aids for Prostate Cancer Screening Choice: A Systematic Review and Meta-analysis. JAMA Intern Med 2019; 179:1072-1082. [PMID: 31233091 PMCID: PMC6593633 DOI: 10.1001/jamainternmed.2019.0763] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. OBJECTIVE To estimate the association of decision aids with decisional outcomes in prostate cancer screening. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. STUDY SELECTION Randomized trials comparing decision aids for prostate cancer screening with usual care. DATA EXTRACTION AND SYNTHESIS Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. MAIN OUTCOMES AND MEASURES Knowledge, decisional conflict, screening discussion, and screening choice. RESULTS Of 19 eligible trials (12 781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I2 = 67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I2 = 75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I2 = 60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I2 = 36%; low quality). CONCLUSIONS AND RELEVANCE The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.
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Affiliation(s)
- Jarno M Riikonen
- Department of Urology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Science, University of Tampere, Tampere, Finland
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tuomas P Kilpeläinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samantha Craigie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of General Internal Medicine, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Philipp Dahm
- Urology Section, Minneapolis Veterans Administration Health Care System, Minneapolis, Minnesota.,Department of Urology, University of Minnesota, Minneapolis
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Patrick O Richard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jarno Rutanen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Henrikki Santti
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Thomas Tailly
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Philippe D Violette
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Surgery, Woodstock General Hospital, Woodstock, Ontario, Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kari A O Tikkinen
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
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27
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Lee MH, Järvinen P, Nisén H, Brück O, Ilander M, Mustjoki S, Anna K. Abstract A085: High infiltration of NK cells expressing elevated LAG-3 in a subgroup of renal cell carcinoma patients. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-a085] [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: Renal cell carcinoma (RCC) is considered one of the most immunogenic cancers with the highest number of indel mutations, frequent infiltration of T-cells, presence of many antigen-specific T-cell clones, and high immuno-oncologic (IO) sensitivity. Since less is known about natural killer (NK) cells in RCC, our primary aim was to investigate the intratumoral phenotype of NK cells as well as further assess the overall immune landscape of the tumors, peripheral blood (PB) and adjacent healthy kidney tissue, which may be critical for patient prognosis and predictions to targeted immunotherapies. Methods: We used multi-parameter flow cytometry together with a comprehensive immunostaining panel containing a total of 56 fundamental markers to cancer immunology to immunophenotype the tumor, adjacent healthy kidney tissue and presurgical peripheral blood (PB) samples from 31 RCC patients who underwent partial or radical nephrectomies. To study the intratumoral T-cell clonalities, T-cell receptor beta (TCRβ) deep sequencing was carried out with eight tumors. Results: Using hierarchical clustering (Spearman correlation distance and Ward linkage) and correlation analyses (Spearman correlation), we discovered that our patient cohort clustered into two distinct subgroups defined by a high (NKhigh, n=11; mean 29.7%) and low (NKlow, n=20; mean 9.4%) percentage of NK cells among the intratumoral lymphocyte population. Accordingly, the NKhigh subgroup had a lower percentage of T-cells (mean 36.9%) than the NKlow group (mean 65.7%), and overall, a significant negative correlation between T and NK cells was discovered. Our TCRβ sequencing results revealed a positive correlation between T-cell clonality and the intratumoral T-cell percentage, whereas the higher proportion of tumor NK cells associated with low T-cell clonality, possibly due to a polyclonal T-cell population. When we compared the expressions of the most clinically relevant IO markers (LAG-3 and PD-1) on the NK cells, LAG-3 was more expressed in the NKhigh group than in the NKlow group (21.3% vs 9.8%; p=0.08). In contrast, no differences were observed with PD-1. Clinical parameters such as tumor grade (Fuhrman), weight, size (diameter), the presence of necrosis, gender, or age of the patients did not differ between the two subgroups. To examine the overall immune landscape of RCC, we compared the cells from the tumor, PB, and healthy kidney tissue of seven patients. Our results showed that tumors have more NK cells compared to their corresponding T-cell-rich PB and healthy tissue counterparts, supporting our findings that some tumors accumulate NK cells. Compared to the adjacent healthy tissue, PD-1 and LAG-3 expressions were higher in the intratumoral CD8 cells. The expressions of PD-1 and LAG-3 on PB CD8+ T-cells or NK cells did not correlate with their intratumoral counterparts, whereas a positive correlation was found between the PB and tumor CD4+ T-cells for both LAG-3 and PD-1. Conclusions: Our study has led to the discovery of two distinct RCC tumor subgroups with differential expressions in the clinically leading molecules. These results suggest that immunophenotyping RCC patients may effectively aid in selecting those who will benefit the most from immune checkpoint inhibition therapies such as anti-PD1 and -LAG3. Prospective analyses on spatial immunoprofiling by multiplexed immunohistochemistry and mutational load by exome sequencing will be assessed next in order to find answers to why some tumors are NK-dominant, with expectations of understanding further the biologic differences between the two tumor types.
Citation Format: Moon Hee Lee, Petrus Järvinen, Harry Nisén, Oscar Brück, Mette Ilander, Satu Mustjoki, Kreutzman Anna. High infiltration of NK cells expressing elevated LAG-3 in a subgroup of renal cell carcinoma patients [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr A085.
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Affiliation(s)
- Moon Hee Lee
- Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Harry Nisén
- Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Oscar Brück
- Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Mette Ilander
- Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Satu Mustjoki
- Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Kreutzman Anna
- Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
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Tornberg SV, Visapää H, Kilpeläinen TP, Taari K, Järvinen R, Erkkilä K, Nisen H, Järvinen P. Surgery for metastases of renal cell carcinoma: outcome of treatments and preliminary assessment of Leuven-Udine prognostic groups in the targeted therapy era. Scand J Urol 2019; 52:419-426. [PMID: 30663485 DOI: 10.1080/21681805.2018.1553893] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/12/2022]
Abstract
AIM This study was conducted to evaluate the efficacy of surgical treatment for metastases accompanied by modern targeted therapies and to evaluate the performance of the Leuven-Udine (L.U.) prognostic groups model. METHODS This retrospective analysis included 97 consecutive patients with metastatic renal cell carcinoma (mR.C.C.) who underwent surgery for metastases at Helsinki University Hospital between 2006 and 2017. The endpoints were overall survival (O.S.), cancer-specific survival (C.S.S.), recurrence-free survival (R.F.S.) and interval from diagnosis to oncological treatment. RESULTS The median follow-up time was 46 months (interquartile range, I.Q.R. = 24-74). The estimated median O.S. was 67 months (I.Q.R. = 30-130). A radical surgical result at metastasectomy was achieved in 46 of 97 patients (47%). Of those 46 patients, 28 (61%) experienced recurrence after complete metastasectomy. Median R.F.S. after complete metastasectomy was 10 months (I.Q.R. = 3-37). Five-year O.S. was 59% for patients with complete metastasectomy and 44% for patients with non-complete metastasectomy (p = .035). The median interval from diagnosis to the initiation of targeted oncological treatment was 19 months for patients with non-complete metastasectomy and has hitherto not been reached for patients with complete metastasectomy (p = .006). A statistically significant validation of the prognostic value of the L.U. prognostic groups for predicting C.S.S. was not obtained (p = .420). CONCLUSIONS Metastasectomy is an option for selected patients with mR.C.C. Complete resection should be attempted when feasible. The data failed to support the prognostic significance of the L.U. model in patients with mR.C.C.
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Affiliation(s)
- Sara V Tornberg
- a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Harri Visapää
- b Department of Oncology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Tuomas P Kilpeläinen
- a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kimmo Taari
- a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Riikka Järvinen
- a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kaisa Erkkilä
- a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Harry Nisen
- a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Petrus Järvinen
- a Department of Urology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Erkkilä K, Tornberg SV, Järvinen P, Järvinen R, Kilpeläinen TP, Visapää H, Hervonen P, Taari K, Nisen H. Evolving Clinical Picture of Renal Cell Carcinoma: A Population-Based Study from Helsinki. Urol Int 2019; 102:390-398. [PMID: 30636255 DOI: 10.1159/000494363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a lack of detailed population-based data for renal cell carcinoma (RCC). OBJECTIVES The study aimed to examine the contemporary changes in the clinical picture and treatment of RCC. METHODS A total of 1,719 consecutive patients living in the Helsinki metropolitan area with a solid or cystic renal mass (Bosniak 3-4) ≥10 mm were identified. Data from medical records was evaluated for clinical characteristics and treatments in the periods I (2006-2008), II (2009-2011), III (2012-2014), and IV (2015-2016). RESULTS The proportions of patients with comorbidities (Charlson index ≥2) and frailty (Eastern Co-operative Oncology Group classification ≥2) increased significantly during the study period. The percentage of clinical stage I patients, cystic tumors and use of needle biopsies increased significantly. Use of observation increased from 9% (I) to 32% (IV; p < 0.001). First-line oncological treatments within 6 months were given to 47% of 262 patients with metastases and -cytoreductive nephrectomy (CN) was delivered to 54% of those patients. CONCLUSIONS The size of renal tumors continued to decrease, while the percentage of patients with significant comorbidity or frailty increased. Active surveillance emerged as the initial strategy. Tyrosine kinase inhibitors with CN remained the primary option in patients with metastatic RCC.
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Affiliation(s)
- Kaisa Erkkilä
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sara V Tornberg
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riikka Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Visapää
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Urology and Comprehensive Cancer Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Petteri Hervonen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Urology and Comprehensive Cancer Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harry Nisen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Lund L, Nisen H, Järvinen P, Fovaeus M, Gudmundsson E, Kromann-Andersen B, Ljungberg B, Nilsen F, Sundqvist P, Clark PE, Beisland C. Use of venous-thrombotic-embolic prophylaxis in patients undergoing surgery for renal tumors: a questionnaire survey in the Nordic countries (The NORENCA-2 study). Res Rep Urol 2018; 10:181-187. [PMID: 30464929 PMCID: PMC6209070 DOI: 10.2147/rru.s177774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the variation in venous thromboembolism prophylactic treatment (VTEP) among renal cancer patients undergoing surgery. Materials and methods An Internet-based questionnaire on renal tumor management before and after surgery was mailed to all Nordic departments of urology. The questions focused on the use of VTEP and were subdivided into different surgical modalities. Results Questionnaires were mailed to 91 institutions (response rate 53%). None of the centers used VTEP before surgery, unless the patient had a vena caval tumor thrombus. Overall, the VTEP utilized during hospitalization for patients undergoing renal surgery included early mobilization (45%), compression stockings (52%) and low-molecular-weight heparin (89%). In patients undergoing open radical Nx, 80% of institutions used VTEP during their hospitalization (23% compression stockings and 94% low-molecular-weight heparin). After leaving the hospital, the proportion and type of VTEP received varied considerably across institutions. The most common interval, used in 60% of the institutions, was for a period of 4 weeks. The restriction to the Nordic countries was a limitation and, therefore, may not reflect the practice patterns elsewhere. It is a survey study and, therefore, cannot measure the behaviors of those institutions that did not participate. Conclusion We found variation in the type and duration of VTEP use for each type of local intervention for renal cancer. These widely disparate variations in care strongly argue for the establishment of national and international guidelines regarding VTEP in renal surgery.
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Affiliation(s)
- Lars Lund
- Department of Urology, Odense University Hospital, .,Clinical Institute, Southern University of Denmark, Odense, Denmark,
| | - Harry Nisen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Magnus Fovaeus
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Frode Nilsen
- Department of Urology, Akershus University Hospital, Lörenskog, Norway
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Peter E Clark
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Saeed K, Ojamies P, Pellinen T, Eldfors S, Turkki R, Lundin J, Järvinen P, Nisen H, Taari K, Af Hällström TM, Rannikko A, Mirtti T, Kallioniemi O, Östling P. Clonal heterogeneity influences drug responsiveness in renal cancer assessed by ex vivo drug testing of multiple patient-derived cancer cells. Int J Cancer 2018; 144:1356-1366. [PMID: 30125350 DOI: 10.1002/ijc.31815] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 05/13/2018] [Revised: 07/13/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022]
Abstract
Renal cell cancer (RCC) has become a prototype example of the extensive intratumor heterogeneity and clonal evolution of human cancers. However, there is little direct evidence on how the genetic heterogeneity impacts on drug response profiles of the cancer cells. Our goal was to determine how genomic clonal evolution impacts drug responses. Finding from our study could help to define the challenge that clonal evolution poses on cancer therapy. We established multiple patient-derived cells (PDCs) from different tumor regions of four RCC patients, verified their clonal relationship to each other and to the uncultured tumor tissue by genome sequencing. Furthermore, comprehensive drug-sensitivity testing with 460 oncological drugs was performed on all PDC clones. The PDCs retained many cancer-specific copy number alterations and mutations in driver genes such as VHL, PBRM1, PIK3C2A, KMD5C and TSC2 genes. The drug testing highlighted vulnerability in the PDCs toward approved RCC drugs, such as the mTOR-inhibitor temsirolimus, but also novel sensitivities were uncovered. The individual PDC clones from different tumor regions in a patient showed distinct drug-response profiles, suggesting that genomic heterogeneity contributes to the variability in drug responses. Studies of multiple PDCs from a patient with cancer are informative for elucidating cancer heterogeneity and for the determination on how the genomic evolution is manifested in cancer drug responsiveness. This approach could facilitate tailoring of drugs and drug combinations to individual patients.
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Affiliation(s)
- Khalid Saeed
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Poojitha Ojamies
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Teijo Pellinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Samuli Eldfors
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Riku Turkki
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Johan Lundin
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Harry Nisen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Taija M Af Hällström
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,AstraZeneca, Espoo, Finland
| | - Antti Rannikko
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Pathology, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Olli Kallioniemi
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Päivi Östling
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
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Saeed K, Ojamies P, Pellinen T, Eldfors S, Turkki R, Lundin J, Nisen H, Järvinen P, Taari K, Hällström TA, Rannikko A, Mirtti T, Kallioniemi O, Östling P. Abstract 2199: Establishment and high-throughput drug testing of multiple patient-derived cells from each renal cancer; intratumor heterogeneity of drug response and implications for precision medicine. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2199] [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
Renal cell cancer (RCC) has become a prototype example of the extensive intra-tumor genetic heterogeneity and clonal evolution of human cancers. There is, however, little information on how the genetic heterogeneity will impact on drug responsiveness of the cancer cells. Establishment of multiple patient-derived cells (PDCs) from individual patients may help us to understand genomic clonal evolution pathways in cancer, explore intratumor heterogeneity of drug response across tumors, as well as help to define combinatorial treatments needed to target multiple subclones in a cancer patient. Here, we established several PDCs from different tumor regions of four RCC patients, verified clonal relationships of the PDCs with each others and with the uncultured tumor tissue by genome sequencing. PDCs retained cancer-specific copy number alterations and mutations in driver genes such as VHL, PBRM1, PIK3C2A, KMD5C and TSC2 genes, but also showed differences indicating genetic heterogeneity and clonal evolution, and thus generating a set of natural isogenic variants. Comprehensive drug-sensitivity testing of the PDC clones with 460 oncology drugs was performed. The drug testing analysis identified shared vulnerability of the PDCs towards several approved RCC drugs, such as mTOR-inhibitor (temsirolimus) and multi-kinase-inhibitor (pazopanib). The individual RCC PDC clones from different tumor regions in one patient showed distinct drug response profiles, confirming that genomic heterogeneity contributes to the variability in drug responses. We developed a capability to map drug response evolution on top of genomic evolution in cancer. In conclusion, our study suggested that comparison of drug response profiles among multiple (isogenic) PDC variants from a cancer patient may be informative for i) assessing intratumor heterogeneity in drug response ii) elucidating pharmacogenomic biomarkers among natural isogenic cell variants and iii) identifying drugs and drug combinations that may kill the multiple cancer subclones in a patient. Funding: EU-FP7-Systems Microscopy Network of Excellence, Sigrid Juselius Foundation, Cancer Society of Finland, Academy of Finland, the Magnus Ehrnrooth Foundation, TEKES FiDiPro Fellow Grant and Knut and Alice Wallenberg Foundation.
Citation Format: Khalid Saeed, Poojitha Ojamies, Teijo Pellinen, Samuli Eldfors, Riku Turkki, Johan Lundin, Harry Nisen, Petrus Järvinen, Kimmo Taari, Taija af Hällström, Antti Rannikko, Tuomas Mirtti, Olli Kallioniemi, Päivi Östling. Establishment and high-throughput drug testing of multiple patient-derived cells from each renal cancer; intratumor heterogeneity of drug response and implications for precision medicine [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 2199.
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Affiliation(s)
- Khalid Saeed
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Poojitha Ojamies
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Teijo Pellinen
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Samuli Eldfors
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Riku Turkki
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Johan Lundin
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Harry Nisen
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Petrus Järvinen
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Taija af Hällström
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Antti Rannikko
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Olli Kallioniemi
- 3Science for Life Laboratory, Dept of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Päivi Östling
- 3Science for Life Laboratory, Dept of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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Eineluoto JT, Järvinen P, Kilpeläinen T, Lahdensuo K, Kalalahti I, Sandeman K, Mirtti T, Rannikko A. Patient Experience of Systematic Versus Fusion Prostate Biopsies. Eur Urol Oncol 2018; 1:202-207. [PMID: 31102622 DOI: 10.1016/j.euo.2018.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The magnetic resonance imaging/ultrasound fusion-guided biopsy (FBx) technique has gained popularity in prostate cancer (PCa) diagnostics, but little is known about its effect on patient experience. OBJECTIVE To evaluate pain, discomfort and other non-infectious complications in PCa patients undergoing either systematic 12-core transrectal ultrasound-guided biopsy (SBx) or FBx and patient willingness to undergo rebiopsy. DESIGN, SETTING, AND PARTICIPANTS A prospective trial of 262 male patients, 203 of whom underwent transrectal SBx and 59 FBx at Helsinki University Hospital in 2015-2016. Patients completed two questionnaires immediately after and at 30 d after biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Patients reported pain and discomfort on a numeric rating scale (NRS; 0-10) immediately after biopsy. At 30 d, discomfort was measured on a scale ranging from 1 (no inconvenience) to 4 (maximal inconvenience). Other symptoms were reported dichotomously (yes/no) in both questionnaires. Mann-Whitney U, Pearson's χ2, and logistic regression tests were used. RESULTS AND LIMITATIONS For the SBx and FBx groups the median number of cores per patient was 12 and three, respectively. At 30 d, a higher proportion of patients in the SBx group had experienced pain than in the FBx group (70/203 [34%] vs 12/59 [20%]; p=0.043), whereas there was no difference in the median discomfort scores. Hematuria was less common in the FBx group (26/59 [44%] vs 140/203 [69%]; p<0.001). Patients willing to undergo rebiopsy immediately post-biopsy reported lower median NRS (3.0 [interquartile range 2.0-5.0] vs 5.0 [4.3-6.0]; p<0.001) and discomfort scores (4.0 [2.0-6.0] vs 7.0 [5.0-8.0]; p<0.001) than those unwilling. At 30 d, less discomfort (2.0 [interquartile range 1.0-2.0] vs 2.0 [2.0-3.0]; p=0.008) and fever (6/195 [3.1%] vs 6/28 [22%]; p=0.001) were experienced by patients willing to undergo rebiopsy. The nonrandomized design was a limitation. CONCLUSIONS FBx is associated with less pain and hematuria than SBx during the 30-d interval after biopsy. PATIENT SUMMARY Magnetic resonance imaging (MRI)-targeted prostate biopsy is associated with less pain, discomfort, and blood in the urine compared to the standard ultrasound-guided procedure. Performing MRI-targeted procedures may reduce biopsy-related complications and promote adherence to recommended repeat biopsy for patients on active surveillance for prostate cancer.
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Affiliation(s)
- Juho T Eineluoto
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kanerva Lahdensuo
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Inari Kalalahti
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kevin Sandeman
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Medicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Clinicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Riikonen J, Guyatt G, Kilpeläinen TP, Craigie S, Agarwal A, Agoritsas T, Couban R, Dahm P, Järvinen P, Montori V, Power N, Richard PO, Rutanen J, Santti H, Tailly T, Violette PD, Zhou Q, Tikkinen KAO. MP57-03 DECISION AIDS FOR PROSTATE CANCER SCREENING: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1815] [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]
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Eineluoto JT, Järvinen P, Kenttämies A, Kilpeläinen TP, Vasarainen H, Sandeman K, Erickson A, Mirtti T, Rannikko A. Repeat multiparametric MRI in prostate cancer patients on active surveillance. PLoS One 2017; 12:e0189272. [PMID: 29281647 PMCID: PMC5744936 DOI: 10.1371/journal.pone.0189272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction This study was conducted to describe the changes in repeat multiparametric MRI (mpMRI) occurring in prostate cancer (PCa) patients during active surveillance (AS), and to study possible associations between mpMRI-related parameters in predicting prostate biopsy (Bx) Gleason score (GS) upgrading >3+3 and protocol-based treatment change (TC). Materials and methods The study cohort consisted of 76 AS patients with GS 3+3 PCa and at least two consecutive mpMRIs of the prostate performed between 2006–2015. Patients were followed according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol and an additional mpMRI. The primary end points were GS upgrading (GU) (>3+3) in protocol-based Bxs and protocol-based TC. Results Out of 76 patients, 53 (69%) had progression (PIRADS upgrade, size increase or new lesion[s]), while 18 (24%) had radiologically stable disease, and 5 (7%) had regression (PIRADS or size decrease, disappearance of lesion[s]) in repeat mpMRIs during AS. PIRADS scores of 4–5 in the initial mpMRI were associated with GU (p = 0.008) and protocol-based TC (p = 0.009). Tumour progression on repeat mpMRIs was associated with TC (p = 0.045) but not with GU (p = 1.00). PIRADS scores of 4–5 predict GU (sensitivity 0.80 [95% confidence interval (CI); 0.51–0.95, specificity 0.62 [95% CI; 0.52–0.77]) with PPV and NPV values of 0.34 (95% CI; 0.21–0.55) and 0.93 (95% CI; 0.80–0.98), respectively. Conclusion mpMRI is a useful tool not only to select but also to monitor PCa patients on AS.
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Affiliation(s)
- Juho T. Eineluoto
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Petrus Järvinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kenttämies
- Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P. Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Vasarainen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kevin Sandeman
- Department of Pathology (HUSLAB), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andrew Erickson
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pathology (HUSLAB), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Department of Pathology (HUSLAB), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Institute for Molecular Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Medicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Rannikko
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Tornberg SV, Kilpeläinen TP, Järvinen P, Visapää H, Järvinen R, Taari K, Nisén H. Renal Tumor Invasion Depth and Diameter are the Two Most Accurate Anatomical Features Regarding the Choice of Radical Versus Partial Nephrectomy. Scand J Surg 2017; 107:54-61. [PMID: 28946808 DOI: 10.1177/1457496917731186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/20/2023]
Abstract
BACKGROUND AND AIMS To evaluate simple tumor characteristics (renal tumor diameter and parenchymal invasion depth) compared with more complex classifications, that is, Renal Tumor Invasion Index (RTII) and Preoperative Aspects and Dimensions Used for an Anatomical classification, in predicting the type of nephrectomy (radical vs partial) performed. MATERIAL AND METHODS A total of 915 patients who had undergone either partial nephrectomy ( n = 388, 42%) or radical nephrectomy ( n = 527, 58%) were identified from the Helsinki University Hospital kidney tumor database between 1 January 2006 and 31 December 2014. Tumor maximum diameter and depth of invasion into the parenchyma were estimated from computed tomography or magnetic resonance imaging images and compared with Preoperative Aspects and Dimensions Used for an Anatomical and Renal Tumor Invasion Index. Logistic regression and receiver operating curves were used to compare the parameters at predicting the type of nephrectomy. RESULTS AND CONCLUSION All the anatomical variables of receiver operating curve/area under the curve analyses were significant predictors for the type of nephrectomy. Parenchymal invasion (area under the curve 0.91; 95% confidence interval, 0.89-0.93), RTII (area under the curve 0.91; 95% confidence interval, 0.89-0.93), and diameter (area under the curve 0.91; 95% confidence interval, 0.89-0.93) performed significantly better than Preoperative Aspects and Dimensions Used for an Anatomical classification (area under the curve 0.88; 95% confidence interval, 0.85-0.89). In multivariable analysis, invasion depth was the best predictor of nephrectomy type (percentage correct, 85.6%). Addition of one anatomic parameter into the model of non-anatomical cofactors improved the accuracy of the model significantly, but the addition of more parameters did not. Parenchymal invasion depth and tumor diameter are the most accurate anatomical features for predicting the nephrectomy type. All potential anatomical classification systems should be tested against these two simple characteristics.
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Affiliation(s)
- S V Tornberg
- Department of Urology, Peijas Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - T P Kilpeläinen
- Department of Urology, Peijas Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - P Järvinen
- Department of Urology, Peijas Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - H Visapää
- Department of Urology, Peijas Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - R Järvinen
- Department of Urology, Peijas Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - K Taari
- Department of Urology, Peijas Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - H Nisén
- Department of Urology, Peijas Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Nisen H, Järvinen P, Fovaeus M, Guðmundsson E, Kromann-Andersen B, Ljungberg B, Lund L, Nilsen F, Sundqvist P, Beisland C. Contemporary treatment of renal tumors: a questionnaire survey in the Nordic countries (the NORENCA-I study). Scand J Urol 2017. [PMID: 28644697 DOI: 10.1080/21681805.2017.1326524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/19/2022]
Abstract
OBJECTIVE The five Nordic countries comprise 25 million people, and have similar treatment traditions and healthcare systems. To take advantage of these similarities, a collaborative group (Nordic Renal Cancer Group, NORENCA) was founded in 2015. MATERIALS AND METHODS A questionnaire of 17 questions on renal tumor management and surgical education was designed and sent to 91 institutions performing renal tumor surgery in 2015. The response rate was 68% (62 hospitals), including 28 academic, 25 central and nine district hospitals. Hospital volume was defined as low (LVH: < 20 operations), intermediate (IVH: 20-49 operations), high (HVH: 50-99) and very high (VHVH: ≥ 100). Descriptive statistics were performed. RESULTS Fifteen centers were LVH, 16 IVH, 21 HVH and 10 VHVH. Of all 3828 kidney tumor treatments, 55% were radical nephrectomies (RNs), 37% partial nephrectomies (PNs) and 8% thermoablations. For RN and PN, the percentages of open, laparoscopic and robotic approaches were 47%, 40%, 13% and 47%, 20%, 33%, respectively. The mean complication rate (Clavien-Dindo 3-5) was 4.9%, and 30 day mortality (TDM) was 0.5%. The median length of hospital stay was 4 days. Training with a simulator, black box or animal laboratory was possible in 48%, 74% and 21% of institutions, respectively. CONCLUSIONS Despite some differences between countries, the data suggest an overall general common Nordic treatment attitude for renal tumors. Furthermore, the data demonstrate high adherence to international standards, with a high proportion of PN and acceptable rates for major complications and TDM.
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Affiliation(s)
- Harry Nisen
- a Department of Urology , Helsinki University Hospital , Helsinki , Finland
| | - Petrus Järvinen
- a Department of Urology , Helsinki University Hospital , Helsinki , Finland
| | - Magnus Fovaeus
- b Department of Urology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Eirikur Guðmundsson
- c Department of Urology , Landspitali University Hospital , Reykjavik , Iceland
| | | | - Börje Ljungberg
- e Department of Surgical and Perioperative Sciences, Urology and Andrology , Umeå University , Umeå , Sweden
| | - Lars Lund
- f Department of Urology , Odense University Hospital , Odense , Denmark.,g Clinical Institute , Southern University of Denmark , Odense , Denmark
| | - Frode Nilsen
- h Department of Urology , Akershus University Hospital , Lörenskog , Norway
| | - Pernilla Sundqvist
- i Department of Urology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Christian Beisland
- j Department of Urology , Haukeland University Hospital , Bergen , Norway.,k Department of Clinical Medicine , University of Bergen , Bergen , Norway
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Saarinen L, Nummela P, Thiel A, Lehtonen R, Järvinen P, Järvinen H, Aaltonen LA, Lepistö A, Hautaniemi S, Ristimäki A. Multiple components of PKA and TGF-β pathways are mutated in pseudomyxoma peritonei. PLoS One 2017; 12:e0174898. [PMID: 28426742 PMCID: PMC5398530 DOI: 10.1371/journal.pone.0174898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/16/2017] [Indexed: 12/12/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) is a subtype of mucinous adenocarcinoma mainly restricted to the peritoneal cavity and most commonly originating from the appendix. The genetic background of PMP is poorly understood and no targeted treatments are currently available for this fatal disease. While RAS signaling pathway is affected in most if not all PMP cases and over half of them also have a mutation in the GNAS gene, other genetic alterations and affected pathways are, to a large degree, poorly known. In this study, we sequenced whole coding genome of nine PMP tumors and paired normal tissues in order to identify additional, commonly mutated genes and signaling pathways affected in PMP. These exome sequencing results were validated with an ultra-deep amplicon sequencing method, leading to 14 validated variants. The validated results contain seven genes that contribute to the protein kinase A (PKA) pathway. PKA pathway, which also contains GNAS, is a major player of overproduction of mucin, which is the characteristic feature of PMP. In addition to PKA pathway, we identified mutations in six genes that belong to the transforming growth factor beta (TGF-β) pathway, which is a key regulator of cell proliferation. Since either GNAS mutation or an alternative mutation in the PKA pathway was identified in 8/9 patients, inhibition of the PKA pathway might reduce mucin production in most of the PMP patients and potentially suppress disease progression.
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Affiliation(s)
- Lilli Saarinen
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Pirjo Nummela
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Alexandra Thiel
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Rainer Lehtonen
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Järvinen
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Lauri A. Aaltonen
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland
| | - Anna Lepistö
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sampsa Hautaniemi
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Ari Ristimäki
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Pathology, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- * E-mail:
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Järvinen P, Kivelä AJ, Nummela P, Lepistö A, Ristimäki A, Parkkila S. Carbonic anhydrase II: a novel biomarker for pseudomyxoma peritonei. APMIS 2017; 125:207-212. [PMID: 28233447 DOI: 10.1111/apm.12653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/06/2016] [Accepted: 11/21/2016] [Indexed: 01/12/2023]
Abstract
Altered expression of carbonic anhydrase (CA) II is associated with human carcinogenesis. We analysed CA II protein expression in 89 patients with pseudomyxoma peritonei (PMP) and correlated its association against survival. We determined the expression of CA II by immunohistochemistry and then scored the staining results. The correlations of CA II expression with Peritoneal Cancer Index (PCI) and tumour grade were examined. The effect of CA II and tumour grade on survival was investigated. Positive CA II expression was found in 58 patients (65%) and absent in 31 patients (35%). High-grade (HG) morphology was associated with a loss of CA II expression (p = 0.048). The mean CA II immunostaining intensity score was 1.00 ± 1.1 (median 1, range 0-3) for HG morphology and 1.54 ± 1.1 (median 2, range 0-3) for low-grade (LG) morphology. The 5-year overall survival (OS) for those patients with CA II expression was 80% and 59% for those without (p < 0.001). The 5-year OS rates for those patients with HG morphology and positive CA II expression was 72% and 31% for those with negative CA II expression (p = 0.044). This study suggests that the expression of CA II acts as independent prognostic biomarker for survival in PMP.
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Affiliation(s)
- Petrus Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti J Kivelä
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of GI Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Pirjo Nummela
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Department of Pathology, Helsinki University Hospital, Helsinki, Finland
| | - Anna Lepistö
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ari Ristimäki
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Department of Pathology, Helsinki University Hospital, Helsinki, Finland.,Department of Pathology at HUSLAB Laboratory Services, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Parkkila
- Fimlab Ltd, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Tornberg SV, Nisen H, Visapää H, Kilpeläinen TP, Järvinen R, Mirtti T, Kantonen I, Simpanen J, Bono P, Taari K, Järvinen P. Outcome of surgery for patients with renal cell carcinoma and tumour thrombus in the era of modern targeted therapy. Scand J Urol 2016; 50:380-6. [DOI: 10.1080/21681805.2016.1217558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Nummela P, Leinonen H, Järvinen P, Thiel A, Järvinen H, Lepistö A, Ristimäki A. Expression of CEA, CA19-9, CA125, and EpCAM in pseudomyxoma peritonei. Hum Pathol 2016; 54:47-54. [DOI: 10.1016/j.humpath.2016.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/17/2016] [Accepted: 02/25/2016] [Indexed: 02/06/2023]
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42
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Nummela P, Saarinen L, Thiel A, Lehtonen R, Järvinen P, Järvinen H, Aaltonen L, Lepistö A, Hautaniemi S, Ristimäki A. Characterization of the genomic profile of pseudomyxoma peritonei using amplicon sequencing combined with exome sequencing. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61061-4] [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: 11/30/2022]
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43
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Järvinen P, Taari K, Nisén H, Kilpel TP. From overdiagnosis to overtreatment of small renal mas- can the chain be broken? Duodecim 2016; 132:1420-1426. [PMID: 29188704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The incidence of small nephromas of less than four centimeters in size has increased over the past decades with the increasing number of imaging studies. The majority of these tumors are kidney cancers exhibiting large variation in their aggressiveness. Systematic surgical treatment of these tumors results in more harm than benefit especially for elderly patients having associated diseases. Biopsy procedures from tumors by current methods are safe. The challenge of active surveillance is to identify those nephromas that are no longer safely monitored before the cancer is beyond the reach of curative treatment.
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44
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Nisen H, Järvinen P, Kilpeläinen T, Järvinen R, Visapää H, Taari K. Hand-assisted laparoscopic versus open partial nephrectomy in patients with T1 renal tumor: Comparative perioperative, functional and oncological outcome. Scand J Urol 2015; 49:446-452. [PMID: 26317448 DOI: 10.3109/21681805.2015.1076030] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Studies comparing hand-assisted laparoscopic partial nephrectomy (HALPN) and open partial nephrectomy (OPN) for T1 kidney tumors are scarce. This study investigated the perioperative, functional and oncological outcomes of these methods. MATERIALS AND METHODS A prospective institutional kidney tumor register was used to identify patients between January 2006 and May 2014 undergoing HALPN (n = 139) or OPN (n = 165) for tumors 7 cm or smaller with non-absolute indication for nephron-sparing surgery. The outcomes were compared using univariate and multivariate statistical methods. RESULTS HALPN and OPN groups were similar with regard to tumor characteristics but HALPN patients were 2 years younger (p = 0.001) and had less comorbidity. Fewer intraoperative complications were encountered in HALPN than in OPN patients (7.2% vs 12.7%, p = 0.043). HALPN patients had less all-grade postoperative 30 day complications than OPN patients (27% vs 41%, p = 0.037), but there was no significant difference in Clavien 3-5 complications. Glomerular filtration rate 3 months after operation was lower in the HALPN than in the OPN group (7.1 ± 12.7% vs 10.0 ± 12.4%, p = 0.054). There was no difference in overall survival or recurrence-free survival during the median follow-up of 35 months. CONCLUSIONS HALPN is a feasible method to achieve equal perioperative, functional and oncological outcomes compared to OPN in patients with tumors 7 cm or smaller in diameter.
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Affiliation(s)
- Harry Nisen
- a 1 Department of Urology, Helsinki University Hospital , Helsinki, Finland
| | - Petrus Järvinen
- a 1 Department of Urology, Helsinki University Hospital , Helsinki, Finland
| | - Tuomas Kilpeläinen
- a 1 Department of Urology, Helsinki University Hospital , Helsinki, Finland
| | - Riikka Järvinen
- a 1 Department of Urology, Helsinki University Hospital , Helsinki, Finland
| | - Harri Visapää
- a 1 Department of Urology, Helsinki University Hospital , Helsinki, Finland.,b 2 Department of Oncology, Helsinki University Hospital Cancer Center , Helsinki, Finland
| | - Kimmo Taari
- a 1 Department of Urology, Helsinki University Hospital , Helsinki, Finland
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45
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Järvinen P, Ristimäki A, Kantonen J, Lepistö A. Feasibility of radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei of appendiceal origin. Scand J Surg 2015; 102:145-51. [PMID: 23963027 DOI: 10.1177/1457496913490463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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
BACKGROUND AND AIMS We analyzed the feasibility of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. MATERIAL AND METHODS A prospective database comprised 90 consecutive patients with demonstrable pseudomyxoma peritonei collected during 48 months. These patients, referred to our unit for consideration for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, received both cytoreductive surgery and hyperthermic intraperitoneal chemotherapy if possible. We evaluated the factors associated with a successful procedure. RESULTS Hyperthermic intraperitoneal chemotherapy was successfully delivered to 56 of 90 patients (62%) with demonstrable pseudomyxoma peritonei. Tumor morphology of low grade (p = 0.013), age under 65 years (p = 0.004), and serum carcinoembryonic antigen level under 5.0 µg/L (p = 0.003) were associated with successful administration of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Mean peritoneal cancer index was lower (18.9 vs 32.6, p < 0.001) and age was younger (54.3 vs 61.6, p = 0.003) in patients who underwent hyperthermic intraperitoneal chemotherapy than in patients who did not. Four patients had complete cytoreductive surgery alone, and 20 patients underwent palliative debulking, but 10 were ineligible for this operation. CONCLUSIONS Although the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is currently suggested the standard practice for pseudomyxoma peritonei, not all patients are eligible for this protocol. In this study, hyperthermic intraperitoneal chemotherapy was suitable for 62% of patients with pseudomyxoma peritonei of appendiceal origin.
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Affiliation(s)
- P Järvinen
- Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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46
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Nummela P, Saarinen L, Thiel A, Järvinen P, Lehtonen R, Lepistö A, Järvinen H, Aaltonen LA, Hautaniemi S, Ristimäki A. Genomic profile of pseudomyxoma peritonei analyzed using next-generation sequencing and immunohistochemistry. Int J Cancer 2014; 136:E282-9. [DOI: 10.1002/ijc.29245] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/29/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Pirjo Nummela
- Genome-Scale Biology Research Program, Research Programs Unit; University of Helsinki; Helsinki Finland
| | - Lilli Saarinen
- Genome-Scale Biology Research Program, Research Programs Unit; University of Helsinki; Helsinki Finland
| | - Alexandra Thiel
- Genome-Scale Biology Research Program, Research Programs Unit; University of Helsinki; Helsinki Finland
| | - Petrus Järvinen
- Department of Surgery; Helsinki University Central Hospital; Helsinki Finland
- Department of Urology; Helsinki University Central Hospital; Helsinki Finland
| | - Rainer Lehtonen
- Genome-Scale Biology Research Program, Research Programs Unit; University of Helsinki; Helsinki Finland
| | - Anna Lepistö
- Department of Surgery; Helsinki University Central Hospital; Helsinki Finland
| | - Heikki Järvinen
- Department of Surgery; Helsinki University Central Hospital; Helsinki Finland
| | - Lauri A Aaltonen
- Genome-Scale Biology Research Program, Research Programs Unit; University of Helsinki; Helsinki Finland
- Department of Medical Genetics; University of Helsinki; Helsinki Finland
| | - Sampsa Hautaniemi
- Genome-Scale Biology Research Program, Research Programs Unit; University of Helsinki; Helsinki Finland
| | - Ari Ristimäki
- Genome-Scale Biology Research Program, Research Programs Unit; University of Helsinki; Helsinki Finland
- Division of Pathology and Genetics; HUSLAB and Haartman Institute, Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
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47
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Abstract
BACKGROUND AND AIMS We analysed the clinical symptoms and signs of pseudomyxoma peritonei (PMP), a rare syndrome affecting one to two persons per million annually. Presumably, patients with PMP would benefit from early diagnosis. This study was conducted to further characterise the manifestations of PMP. MATERIAL AND METHODS We performed a retrospective chart review of a consecutive series of 82 PMP cases at the Helsinki University Central Hospital from June 1984 to September 2009. We then analysed the patients' characteristics, clinical manifestations, indications for surgery and preoperative radiological investigations. RESULTS The study involved 53 women (65%) and 29 men (35%). The preponderance of women was statistically significant (p = 0.008). Abdominal pain was the most common chief complaint in the initial evaluation with 23% of the cases. The subsequent more common chief complaints were acute abdomen with 21%, increased abdominal girth with 17%, coincidental diagnosis with 13%, other reasons with 13% and newly onset hernia with 12% of the cases. Suspected ovarian tumour was the most common cause for surgery overall, with 26 of 82 initial operations (32%). Of the 82 initial operations, 23 (28%) were performed with a suspicion or diagnosis of PMP. Computed tomography had a sensitivity of 51% in recognising PMP. CONCLUSIONS While only 28% of patients underwent initial surgery for presumed PMP, the accuracy of preoperative diagnostics was modest. Diagnostics of PMP is challenging due to the mimicking nature of the disease. In case of indistinct intra-abdominal tumour, we recommend, careful patient examination prior to the initial surgery, when possible.
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Affiliation(s)
- P Järvinen
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
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48
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Abstract
AIM We evaluated the outcome of patients with pseudomyxoma peritonei (PMP) after traditional debulking. PMP is a clinical condition characterized by disseminated intraperitoneal mucinous tumours often accompanied by mucinous ascites derived usually from an appendiceal neoplasm. Patients with PMP have traditionally been treated by serial debulking, but aggressive cytoreduction followed by hyperthermic intraperitoneal chemotherapy is now advocated as standard treatment in PMP. METHOD The analysis included 33 consecutive patients with PMP who underwent traditional debulking surgery between June 1984 and August 2008. The patient characteristics and details of the treatment were analysed retrospectively. The primary end-point was survival. RESULTS The overall 5- and 10-year survival rates were 67% and 31% respectively. The patients underwent an average of 3.2 +/- 0.4 operations (range 1-10). Of 33 patients, 23 (70%) underwent only 1-3 operations. The 30-day operative mortality rate was 2.7%. However, four patients (12%) seemed to have achieved long-term disease-free survival of more than 5 years. CONCLUSIONS The 5-year survival is comparable with results achieved in patients receiving a combination of cytoreductive surgery and intraperitoneal chemotherapy, but in the long term, the latter seems superior.
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Affiliation(s)
- P Järvinen
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
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49
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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Pohjolainen T, Korpela M, Vuori K, Ilva K, Yli-Kerttula U, Järvinen P, Leirisalo-Repo M. Cost of Finnish statutory inpatient rehabilitation and its impact on functional and work capacity of patients with early rheumatoid arthritis: experience from the FIN‐RACo trial. Scand J Rheumatol 2009; 36:270-7. [PMID: 17763204 DOI: 10.1080/03009740701286847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the cost of the statutory inpatient rehabilitation system in Finland and its impact on the functional and work capacity of patients with early rheumatoid arthritis (RA). METHODS In the Finnish Rheumatoid Arthritis Combination-Therapy trial (FIN-RACo), 195 patients with recent-onset RA, 162 of them available for the work force, were randomly assigned to two different drug treatment strategies for 2 years. Otherwise, the patients received routine multidisciplinary care and, if their functional or work capacity was endangered, were referred to inpatient rehabilitation. After a 5-year follow-up, data on rehabilitation, sick leave, and RA-related disability pensions were obtained from official registers. RESULTS Of the 162 patients, 49 (30%) underwent inpatient rehabilitation at an average cost of EURO5400. The rehabilitated patients more often worked in white-collar jobs and had more pain and a worse Health Assessment Questionnaire (HAQ) score (1.0 vs. 0.78; p = 0.01) at baseline. Their HAQ scores remained higher throughout follow-up (p<0.001); no change appeared over inpatient periods [mean 0.01; 95% confidence interval (CI) -0.13 to 0.16]. No independent impact of rehabilitation on the HAQ score emerged in an adjusted generalized estimating equations (GEE) model (p = 0.55). Nor did any improvement in work capacity appear: average lost productivity (human capital approach) per patient-year was EURO10 155 (95% CI 6994-14 196) before and EUR 12 839 (95% CI 8589-19 139) after the start of rehabilitation. CONCLUSION For patients with recent-onset RA, the Finnish statutory inpatient rehabilitation system had no positive impact on either functional or work capacity during the first few years, despite its considerable cost.
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Affiliation(s)
- K Puolakka
- Department of Medicine, Lappeenranta Central Hospital, Lappeenranta, Finland.
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50
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Hintsanen M, Puttonen S, Järvinen P, Pulkki-Råback L, Elovainio M, Merjonen P, Keltikangas-Järvinen L. Cardiac Stress Reactivity and Recovery of Novelty Seekers. Int J Behav Med 2009; 16:236-40. [DOI: 10.1007/s12529-009-9034-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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