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Reitsam NG, Grosser B, Enke JS, Mueller W, Westwood A, West NP, Quirke P, Märkl B, Grabsch HI. Stroma AReactive Invasion Front Areas (SARIFA): a novel histopathologic biomarker in colorectal cancer patients and its association with the luminal tumour proportion. Transl Oncol 2024; 44:101913. [PMID: 38593584 PMCID: PMC11024380 DOI: 10.1016/j.tranon.2024.101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Stroma AReactive Invasion Front Areas (SARIFA) is a novel prognostic histopathologic biomarker measured at the invasive front in haematoxylin & eosin (H&E) stained colon and gastric cancer resection specimens. The aim of the current study was to validate the prognostic relevance of SARIFA-status in colorectal cancer (CRC) patients and investigate its association with the luminal proportion of tumour (PoT). METHODS We established the SARIFA-status in 164 CRC resection specimens. The relationship between SARIFA-status, clinicopathological characteristics, recurrence-free survival (RFS), cancer-specific survival (CSS), and PoT was investigated. RESULTS SARIFA-status was positive in 22.6% of all CRCs. SARIFA-positivity was related to higher pT, pN, pTNM stage and high grade of differentiation. SARIFA-positivity was associated with shorter RFS independent of known prognostic factors analysing all CRCs (RFS: hazard ratio (HR) 2.6, p = 0.032, CSS: HR 2.4, p = 0.05) and shorter RFS and CSS analysing only rectal cancers. SARIFA-positivity, which was measured at the invasive front, was associated with PoT-low (p = 0.009), e.g., higher stroma content, and lower vessel density (p = 0.0059) measured at the luminal tumour surface. CONCLUSION Here, we validated the relationship between SARIFA-status and prognosis in CRC patients and provided first evidence for a potential prognostic relevance in the subgroup of rectal cancer patients. Interestingly, CRCs with different SARIFA-status also showed histological differences measurable at the luminal tumour surface. Further studies to better understand the relationship between high luminal intratumoural stroma content and absence of a stroma reaction at the invasive front (SARIFA-positivity) are warranted and may inform future treatment decisions in CRC patients.
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Affiliation(s)
- N G Reitsam
- Pathology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - B Grosser
- Pathology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - J S Enke
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - W Mueller
- Gemeinschaftspraxis Pathologie, Starnberg, Germany
| | - A Westwood
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK
| | - N P West
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK
| | - P Quirke
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK
| | - B Märkl
- Pathology, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
| | - H I Grabsch
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK; Department of Pathology, GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.
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Rosendahl Huber A, Pleguezuelos-Manzano C, Puschhof J, Ubels J, Boot C, Saftien A, Verheul M, Trabut LT, Groenen N, van Roosmalen M, Ouyang KS, Wood H, Quirke P, Meijer G, Cuppen E, Clevers H, van Boxtel R. Improved detection of colibactin-induced mutations by genotoxic E. coli in organoids and colorectal cancer. Cancer Cell 2024; 42:487-496.e6. [PMID: 38471458 DOI: 10.1016/j.ccell.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/26/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
Co-culture of intestinal organoids with a colibactin-producing pks+E. coli strain (EcC) revealed mutational signatures also found in colorectal cancer (CRC). E. coli Nissle 1917 (EcN) remains a commonly used probiotic, despite harboring the pks operon and inducing double strand DNA breaks. We determine the mutagenicity of EcN and three CRC-derived pks+E. coli strains with an analytical framework based on sequence characteristic of colibactin-induced mutations. All strains, including EcN, display varying levels of mutagenic activity. Furthermore, a machine learning approach attributing individual mutations to colibactin reveals that patients with colibactin-induced mutations are diagnosed at a younger age and that colibactin can induce a specific APC mutation. These approaches allow the sensitive detection of colibactin-induced mutations in ∼12% of CRC genomes and even in whole exome sequencing data, representing a crucial step toward pinpointing the mutagenic activity of distinct pks+E. coli strains.
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Affiliation(s)
- Axel Rosendahl Huber
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands; Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Carrer de Baldiri Reixac, 10, 08028 Barcelona, Spain
| | - Cayetano Pleguezuelos-Manzano
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Jens Puschhof
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands; Microbiome and Cancer Division, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Joske Ubels
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Charelle Boot
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Aurelia Saftien
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands; Microbiome and Cancer Division, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Mark Verheul
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Laurianne T Trabut
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Niels Groenen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Markus van Roosmalen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Kyanna S Ouyang
- Microbiome and Cancer Division, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Henry Wood
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Phil Quirke
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Gerrit Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Edwin Cuppen
- University Medical Center Utrecht, Utrecht, the Netherlands; Hartwig Medical Foundation, Amsterdam, the Netherlands
| | - Hans Clevers
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands; Roche Pharmaceutical Research and Early Development, 4058 Basel, Switzerland.
| | - Ruben van Boxtel
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Oncode Institute, Utrecht, the Netherlands.
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Caley LR, Wood HM, Bottomley D, Fuentes Balaguer A, Wilkinson L, Dyson J, Young C, White H, Benton S, Brearley M, Quirke P, Peckham DG. The gut microbiota in adults with cystic fibrosis compared to colorectal cancer. J Cyst Fibros 2023:S1569-1993(23)01728-9. [PMID: 38104000 DOI: 10.1016/j.jcf.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Gut dysbiosis is implicated in colorectal cancer (CRC) pathogenesis. Cystic fibrosis (CF) is associated with both gut dysbiosis and increased CRC risk. We therefore compared the faecal microbiota from individuals with CF to CRC and screening samples. We also assessed changes in CRC-associated taxa before and after triple CF transmembrane conductance regulator (CFTR) modulator therapy. METHODS Bacterial DNA amplification comprising V4 16S rRNA analysis was conducted on 84 baseline and 53 matched follow-up stool samples from adults with CF. These data were compared to an existing cohort of 430 CRC and 491 control gFOBT samples from the NHS Bowel Cancer Screening Programme. Data were also compared to 26 previously identified CRC-associated taxa from a published meta-analysis. RESULTS Faecal CF samples had a lower alpha diversity and clustered distinctly from both CRC and control samples, with no clear clinical variables explaining the variation. Compared to controls, CF samples had an increased relative abundance in 6 of the 20 enriched CRC-associated taxa and depletion of 2 of the 6 taxa which have been reported as reduced in CRC. Commencing triple modulator therapy had subtle influence on the relative abundance of CRC-associated microbiota (n = 23 paired CF samples). CONCLUSIONS CF stool samples were clearly dysbiotic, clustering distinctly from both CRC and control samples. Several bacterial shifts in CF samples resembled those observed in CRC. Studies assessing the impact of dietary or other interventions and the longer-term use of CFTR modulators on reducing this potentially pro-oncogenic milieu are needed.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research, Clinical Sciences Building, St James's University Hospital, University of Leeds, LS9 7TF, UK
| | - H M Wood
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - D Bottomley
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - A Fuentes Balaguer
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - L Wilkinson
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - J Dyson
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - C Young
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - H White
- Leeds Beckett University, Nutrition, Health & Environment, Leeds, LS1 3HE UK
| | - S Benton
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey NHS Foundation Trust, Guildford, GU2 7YS, UK
| | - M Brearley
- NHS Bowel Cancer Screening South of England Hub, Royal Surrey NHS Foundation Trust, Guildford, GU2 7YS, UK
| | - P Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - D G Peckham
- Leeds Institute of Medical Research, Clinical Sciences Building, St James's University Hospital, University of Leeds, LS9 7TF, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
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Hartwig MFS, Bulut M, Ravn-Eriksen J, Hansen LB, Bojesen RD, Klein MF, Jakobsen HL, Rasmussen M, Rud B, Eriksen JO, Eiholm S, Fiehn AMK, Quirke P, Gögenur I. Combined endoscopic and laparoscopic surgery (CELS) for early colon cancer in high-risk patients. Surg Endosc 2023; 37:8511-8521. [PMID: 37770605 PMCID: PMC10615913 DOI: 10.1007/s00464-023-10385-3] [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: 06/09/2023] [Accepted: 08/06/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Local excision of early colon cancers could be an option in selected patients with high risk of complications and no sign of lymph node metastasis (LNM). The primary aim was to assess feasibility in high-risk patients with early colon cancer treated with Combined Endoscopic and Laparoscopic Surgery (CELS). METHODS A non-randomized prospective feasibility study including 25 patients with Performance Status score ≥ 1 and/or American Society of Anesthesiologists score ≥ 3, and clinical Union of International Cancer Control stage-1 colon cancer suitable for CELS resection. The primary outcome was failure of CELS resection, defined as either: Incomplete resection (R1/R2), local recurrence within 3 months, complication related to CELS within 30 days (Clavien-Dindo grade ≥ 3), death within 30 days or death within 90 days due to complications to surgery. RESULTS Fifteen patients with clinical T1 (cT1) and ten with clinical T2 (cT2) colon cancer and without suspicion of metastases were included. Failure occurred in two patients due to incomplete resections. Histopathological examination classified seven patients as having pT1, nine as pT2, six as pT3 adenocarcinomas, and three as non-invasive tumors. In three patients, the surgical strategy was changed intraoperatively to conventional colectomy due to tumor location or size. Median length of stay was 1 day. Seven patients had completion colectomy performed due to histological high-risk factors. None had LNM. CONCLUSIONS In selected patients, CELS resection was feasible, and could spare some patients large bowel resection.
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Affiliation(s)
- Morten F S Hartwig
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark.
- Department of Surgery, Zealand University Hospital, Koege, Denmark.
| | - Mustafa Bulut
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ravn-Eriksen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lasse B Hansen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus D Bojesen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital - Herlev & Gentofte Hospital, Herlev, Denmark
| | - Henrik L Jakobsen
- Department of Surgery, Copenhagen University Hospital - Herlev & Gentofte Hospital, Herlev, Denmark
| | - Morten Rasmussen
- Department of Surgery, Copenhagen University Hospital - Bispebjerg Hospital, Copenhagen, Denmark
| | - Bo Rud
- Department of Surgery, Copenhagen University Hospital - Hvidovre Hospital, Hvidovre, Denmark
| | - Jens-Ole Eriksen
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Susanne Eiholm
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Anne-Marie K Fiehn
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Phil Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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5
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Hassanieh S, Domingo E, Blake A, Fisher D, Redmond K, Richman S, Walker S, Quirke P, Wilson R, Kennedy R, Tomlinson I, Kaplan R, L. brown, Dunne P, Seymour M, Morton D, Adams R, West N, Maughan T. 337P Prediction of poor response to oxaliplatin by an RNA signature derived and validated in colorectal cancer clinical trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.475] [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: 11/01/2022] Open
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6
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Echle A, Ghaffari Laleh N, Quirke P, Grabsch HI, Muti HS, Saldanha OL, Brockmoeller SF, van den Brandt PA, Hutchins GGA, Richman SD, Horisberger K, Galata C, Ebert MP, Eckardt M, Boutros M, Horst D, Reissfelder C, Alwers E, Brinker TJ, Langer R, Jenniskens JCA, Offermans K, Mueller W, Gray R, Gruber SB, Greenson JK, Rennert G, Bonner JD, Schmolze D, Chang-Claude J, Brenner H, Trautwein C, Boor P, Jaeger D, Gaisa NT, Hoffmeister M, West NP, Kather JN. Artificial intelligence for detection of microsatellite instability in colorectal cancer-a multicentric analysis of a pre-screening tool for clinical application. ESMO Open 2022; 7:100400. [PMID: 35247870 PMCID: PMC9058894 DOI: 10.1016/j.esmoop.2022.100400] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Microsatellite instability (MSI)/mismatch repair deficiency (dMMR) is a key genetic feature which should be tested in every patient with colorectal cancer (CRC) according to medical guidelines. Artificial intelligence (AI) methods can detect MSI/dMMR directly in routine pathology slides, but the test performance has not been systematically investigated with predefined test thresholds. METHOD We trained and validated AI-based MSI/dMMR detectors and evaluated predefined performance metrics using nine patient cohorts of 8343 patients across different countries and ethnicities. RESULTS Classifiers achieved clinical-grade performance, yielding an area under the receiver operating curve (AUROC) of up to 0.96 without using any manual annotations. Subsequently, we show that the AI system can be applied as a rule-out test: by using cohort-specific thresholds, on average 52.73% of tumors in each surgical cohort [total number of MSI/dMMR = 1020, microsatellite stable (MSS)/ proficient mismatch repair (pMMR) = 7323 patients] could be identified as MSS/pMMR with a fixed sensitivity at 95%. In an additional cohort of N = 1530 (MSI/dMMR = 211, MSS/pMMR = 1319) endoscopy biopsy samples, the system achieved an AUROC of 0.89, and the cohort-specific threshold ruled out 44.12% of tumors with a fixed sensitivity at 95%. As a more robust alternative to cohort-specific thresholds, we showed that with a fixed threshold of 0.25 for all the cohorts, we can rule-out 25.51% in surgical specimens and 6.10% in biopsies. INTERPRETATION When applied in a clinical setting, this means that the AI system can rule out MSI/dMMR in a quarter (with global thresholds) or half of all CRC patients (with local fine-tuning), thereby reducing cost and turnaround time for molecular profiling.
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Affiliation(s)
- A Echle
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - N Ghaffari Laleh
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - P Quirke
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - H I Grabsch
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - H S Muti
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - O L Saldanha
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - S F Brockmoeller
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - P A van den Brandt
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - G G A Hutchins
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - S D Richman
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - K Horisberger
- Department of Abdominal and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - C Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - M P Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Institute for Innate Immunoscience (MI3) and Clinical Cooperation Unit Healthy Metabolism, Center of Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Eckardt
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Boutros
- Division of Signaling and Functional Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Horst
- Institut für Pathologie Charité, Berlin, Germany
| | - C Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - E Alwers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - T J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Langer
- Institute of Pathology, Inselspital, University of Bern, Bern, Switzerland
| | - J C A Jenniskens
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - K Offermans
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - W Mueller
- Gemeinschaftspraxis Pathologie, Starnberg, Germany
| | - R Gray
- Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | - S B Gruber
- Center for Precision Medicine and Department of Medical Oncology, City of Hope National Medical Center, Duarte, USA
| | - J K Greenson
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - G Rennert
- Department of Community Medicine & Epidemiology, Lady Davis Carmel Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Steve and Cindy Rasmussen Institute for Genomic Medicine, Lady Davis Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa, Israel
| | - J D Bonner
- Center for Precision Medicine and Department of Medical Oncology, City of Hope National Medical Center, Duarte, USA
| | - D Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Trautwein
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - P Boor
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany; Department of Nephrology and Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - D Jaeger
- Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - N T Gaisa
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - M Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - N P West
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - J N Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany; Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
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7
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Ten Hoorn S, Sommeijer DW, Elliott F, Fisher D, de Back TR, Trinh A, Koens L, Maughan T, Seligmann J, Seymour MT, Quirke P, Adams R, Richman SD, Punt CJA, Vermeulen L. Molecular subtype-specific efficacy of anti-EGFR therapy in colorectal cancer is dependent on the chemotherapy backbone. Br J Cancer 2021; 125:1080-1088. [PMID: 34253874 PMCID: PMC8505637 DOI: 10.1038/s41416-021-01477-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 06/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patient selection for addition of anti-EGFR therapy to chemotherapy for patients with RAS and BRAF wildtype metastatic colorectal cancer can still be optimised. Here we investigate the effect of anti-EGFR therapy on survival in different consensus molecular subtypes (CMSs) and stratified by primary tumour location. METHODS Retrospective analyses, using the immunohistochemistry-based CMS classifier, were performed in the COIN (first-line oxaliplatin backbone with or without cetuximab) and PICCOLO trial (second-line irinotecan with or without panitumumab). Tumour tissue was available for 323 patients (20%) and 349 (41%), respectively. RESULTS When using an irinotecan backbone, anti-EGFR therapy is effective in both CMS2/3 and CMS4 in left-sided primary tumours (progression-free survival (PFS): HR 0.44, 95% CI 0.26-0.75, P = 0.003 and HR 0.12, 95% CI 0.04-0.36, P < 0.001, respectively) and in CMS4 right-sided tumours (PFS HR 0.17, 95% CI 0.04-0.71, P = 0.02). Efficacy using an oxaliplatin backbone was restricted to left-sided CMS2/3 tumours (HR 0.57, 95% CI 0.36-0.96, P = 0.034). CONCLUSIONS The subtype-specific efficacy of anti-EGFR therapy is dependent on the chemotherapy backbone. This may provide the possibility of subtype-specific treatment strategies for a more optimal use of anti-EGFR therapy.
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Affiliation(s)
- Sanne Ten Hoorn
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dirkje W Sommeijer
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Flevohospital, Department of Internal Medicine, Almere, The Netherlands
| | - Faye Elliott
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - David Fisher
- MRC Clinical Trials Unit, University College London, London, UK
| | - Tim R de Back
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anne Trinh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lianne Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim Maughan
- Department of Oncology, University of Oxford, Oxford, UK
| | - Jenny Seligmann
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Matthew T Seymour
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Phil Quirke
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Richard Adams
- Centre for Trials Research Cardiff University and Velindre Hospital, Cardiff, Wales, UK
| | - Susan D Richman
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Louis Vermeulen
- Amsterdam UMC, University of Amsterdam, LEXOR, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands.
- Oncode Institute, Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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8
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Seligmann J, Fisher D, Brown L, Adams R, Graham J, Quirke P, Richman S, Butler R, Domingo E, Blake A, Braun M, Collinson F, Jones R, Brown E, De Winton E, Humphies T, Kaplan R, Wilson R, Seymour M, Maughan T. 382O Inhibition of WEE1 is effective in TP53 and RAS mutant metastatic colorectal cancer (mCRC): A randomised phase II trial (FOCUS4-C) comparing adavosertib (AZD1775) with active monitoring. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.904] [Citation(s) in RCA: 1] [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: 11/26/2022] Open
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9
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Seppälä TT, Latchford A, Negoi I, Sampaio Soares A, Jimenez-Rodriguez R, Sánchez-Guillén L, Evans DG, Ryan N, Crosbie EJ, Dominguez-Valentin M, Burn J, Kloor M, Knebel Doeberitz MV, Duijnhoven FJBV, Quirke P, Sampson JR, Møller P, Möslein G. European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender. Br J Surg 2021; 108:484-498. [PMID: 34043773 PMCID: PMC10364896 DOI: 10.1002/bjs.11902] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/16/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lynch syndrome is the most common genetic predisposition for hereditary cancer but remains underdiagnosed. Large prospective observational studies have recently increased understanding of the effectiveness of colonoscopic surveillance and the heterogeneity of cancer risk between genotypes. The need for gene- and gender-specific guidelines has been acknowledged. METHODS The European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP) developed a multidisciplinary working group consisting of surgeons, clinical and molecular geneticists, pathologists, epidemiologists, gastroenterologists, and patient representation to conduct a graded evidence review. The previous Mallorca guideline format was used to revise the clinical guidance. Consensus for the guidance statements was acquired by three Delphi voting rounds. RESULTS Recommendations for clinical and molecular identification of Lynch syndrome, surgical and endoscopic management of Lynch syndrome-associated colorectal cancer, and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum. Manchester consensus guidelines for gynaecological management were endorsed. Executive and layperson summaries were provided. CONCLUSION The recommendations from the EHTG and ESCP for identification of patients with Lynch syndrome, colorectal surveillance, surgical management of colorectal cancer, lifestyle and chemoprevention in Lynch syndrome that reached a consensus (at least 80 per cent) are presented.
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Affiliation(s)
- T T Seppälä
- Department of Surgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.,Department of Surgical Oncology, Johns Hopkins Hospital, Baltimore Maryland, USA
| | - A Latchford
- Department of Cancer and Surgery, Imperial College London, UK.,St Mark's Hospital, London North West Healthcare NHS Trust, London, UK
| | - I Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - R Jimenez-Rodriguez
- Department of Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - L Sánchez-Guillén
- Colorectal Unit, Department of General Surgery, Elche University General Hospital Elche, Alicante, Spain
| | - D G Evans
- Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester University Hospitals NHS Foundation Trust, UK
| | - N Ryan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK.,Centre for Academic Women's Health, University of Bristol, Bristol, UK
| | - E J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - M Dominguez-Valentin
- Department of Tumour Biology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - J Burn
- Faculty of Medical Sciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Germany.,Cooperation Unit Applied Tumour Biology, German Cancer Research Centre, Heidelberg, Germany
| | - M von Knebel Doeberitz
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Germany.,Cooperation Unit Applied Tumour Biology, German Cancer Research Centre, Heidelberg, Germany
| | - F J B van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - P Quirke
- Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - J R Sampson
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - P Møller
- Department of Tumour Biology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,University of Witten/Herdecke, Witten, Germany
| | - G Möslein
- Centre for Hereditary Tumours, Bethesda Hospital, Duisburg, Germany.,University of Witten/Herdecke, Witten, Germany
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10
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Sirinukunwattana K, Domingo E, Richman SD, Redmond KL, Blake A, Verrill C, Leedham SJ, Chatzipli A, Hardy C, Whalley CM, Wu CH, Beggs AD, McDermott U, Dunne PD, Meade A, Walker SM, Murray GI, Samuel L, Seymour M, Tomlinson I, Quirke P, Maughan T, Rittscher J, Koelzer VH. Image-based consensus molecular subtype (imCMS) classification of colorectal cancer using deep learning. Gut 2021; 70:544-554. [PMID: 32690604 PMCID: PMC7873419 DOI: 10.1136/gutjnl-2019-319866] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Complex phenotypes captured on histological slides represent the biological processes at play in individual cancers, but the link to underlying molecular classification has not been clarified or systematised. In colorectal cancer (CRC), histological grading is a poor predictor of disease progression, and consensus molecular subtypes (CMSs) cannot be distinguished without gene expression profiling. We hypothesise that image analysis is a cost-effective tool to associate complex features of tissue organisation with molecular and outcome data and to resolve unclassifiable or heterogeneous cases. In this study, we present an image-based approach to predict CRC CMS from standard H&E sections using deep learning. DESIGN Training and evaluation of a neural network were performed using a total of n=1206 tissue sections with comprehensive multi-omic data from three independent datasets (training on FOCUS trial, n=278 patients; test on rectal cancer biopsies, GRAMPIAN cohort, n=144 patients; and The Cancer Genome Atlas (TCGA), n=430 patients). Ground truth CMS calls were ascertained by matching random forest and single sample predictions from CMS classifier. RESULTS Image-based CMS (imCMS) accurately classified slides in unseen datasets from TCGA (n=431 slides, AUC)=0.84) and rectal cancer biopsies (n=265 slides, AUC=0.85). imCMS spatially resolved intratumoural heterogeneity and provided secondary calls correlating with bioinformatic prediction from molecular data. imCMS classified samples previously unclassifiable by RNA expression profiling, reproduced the expected correlations with genomic and epigenetic alterations and showed similar prognostic associations as transcriptomic CMS. CONCLUSION This study shows that a prediction of RNA expression classifiers can be made from H&E images, opening the door to simple, cheap and reliable biological stratification within routine workflows.
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Affiliation(s)
- Korsuk Sirinukunwattana
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Enric Domingo
- Department of Oncology, University of Oxford, Oxford, UK
| | - Susan D Richman
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Keara L Redmond
- Centre for Cancer Research and Cell Biology, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | - Andrew Blake
- Department of Oncology, University of Oxford, Oxford, UK
| | - Clare Verrill
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Simon J Leedham
- Gastrointestinal Stem-cell Biology Laboratory, Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, Oxford, UK
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | | | - Celina M Whalley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Chieh-Hsi Wu
- Department of Statistics, University of Oxford, Oxford, UK
| | - Andrew D Beggs
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | | | - Philip D Dunne
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Angela Meade
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Graeme I Murray
- Department of Pathology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Leslie Samuel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Matthew Seymour
- Department of Oncology, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Ian Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Edinburgh Cancer Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Phil Quirke
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Timothy Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Jens Rittscher
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Viktor H Koelzer
- Department of Oncology, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
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11
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Craig SG, Humphries MP, Alderdice M, Bingham V, Richman SD, Loughrey MB, Coleman HG, Viratham-Pulsawatdi A, McCombe K, Murray GI, Blake A, Domingo E, Robineau J, Brown L, Fisher D, Seymour MT, Quirke P, Bankhead P, McQuaid S, Lawler M, McArt DG, Maughan TS, James JA, Salto-Tellez M. Immune status is prognostic for poor survival in colorectal cancer patients and is associated with tumour hypoxia. Br J Cancer 2020; 123:1280-1288. [PMID: 32684627 PMCID: PMC7555485 DOI: 10.1038/s41416-020-0985-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Immunohistochemical quantification of the immune response is prognostic for colorectal cancer (CRC). Here, we evaluate the suitability of alternative immune classifiers on prognosis and assess whether they relate to biological features amenable to targeted therapy. METHODS Overall survival by immune (CD3, CD4, CD8, CD20 and FOXP3) and immune-checkpoint (ICOS, IDO-1 and PD-L1) biomarkers in independent CRC cohorts was evaluated. Matched mutational and transcriptomic data were interrogated to identify associated biology. RESULTS Determination of immune-cold tumours by combined low-density cell counts of CD3, CD4 and CD8 immunohistochemistry constituted the best prognosticator across stage II-IV CRC, particularly in patients with stage IV disease (HR 1.98 [95% CI: 1.47-2.67]). These immune-cold CRCs were associated with tumour hypoxia, confirmed using CAIX immunohistochemistry (P = 0.0009), which may mediate disease progression through common biology (KRAS mutations, CRIS-B subtype and SPP1 mRNA overexpression). CONCLUSIONS Given the significantly poorer survival of immune-cold CRC patients, these data illustrate that assessment of CD4-expressing cells complements low CD3 and CD8 immunohistochemical quantification in the tumour bulk, potentially facilitating immunophenotyping of patient biopsies to predict prognosis. In addition, we found immune-cold CRCs to associate with a difficult-to-treat, poor prognosis hypoxia signature, indicating that these patients may benefit from hypoxia-targeting clinical trials.
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Affiliation(s)
- Stephanie G Craig
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Matthew P Humphries
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Matthew Alderdice
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Victoria Bingham
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Susan D Richman
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Maurice B Loughrey
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Helen G Coleman
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Amelie Viratham-Pulsawatdi
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Kris McCombe
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Graeme I Murray
- Pathology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Andrew Blake
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, England
| | - Enric Domingo
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, England
| | - James Robineau
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, England
| | - Louise Brown
- MRC Clinical Trials Unit, University College London, London, UK
| | - David Fisher
- MRC Clinical Trials Unit, University College London, London, UK
| | - Matthew T Seymour
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Phil Quirke
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Peter Bankhead
- Division of Pathology, University of Edinburgh, Edinburgh, Scotland
| | - Stephen McQuaid
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Mark Lawler
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Darragh G McArt
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
| | - Tim S Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, England
| | - Jacqueline A James
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Manuel Salto-Tellez
- Precision Medicine Centre of Excellence, Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland.
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
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12
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Argilés G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, Laurent-Puig P, Quirke P, Yoshino T, Taieb J, Martinelli E, Arnold D. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31:1291-1305. [PMID: 32702383 DOI: 10.1016/j.annonc.2020.06.022] [Citation(s) in RCA: 500] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- G Argilés
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Spain
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
| | - R Labianca
- Department Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - R Salazar
- Department of Medical Oncology, Catalan Institute of Oncology, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Barcelona, Spain
| | - T Iveson
- University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - P Laurent-Puig
- Assitance Publique-Hôpitaux de Paris AP-HP Paris Centre, Paris, France; Paris Cancer Institute CARPEM, Centre de Recherche des Cordeliers, Paris Sorbonne University, Paris University, Paris, France; INSERM, CNRS, Paris, France
| | - P Quirke
- Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - T Yoshino
- National Cancer Centre Hospital East, Kashiwa, Japan
| | - J Taieb
- Assitance Publique-Hôpitaux de Paris AP-HP Paris Centre, Paris, France; Paris Cancer Institute CARPEM, Centre de Recherche des Cordeliers, Paris Sorbonne University, Paris University, Paris, France; INSERM, CNRS, Paris, France; Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - E Martinelli
- Università degli Studi della Campania Luigi Vanvitelli, Department of Precision Medicine, Naples, Italy
| | - D Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
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13
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Viratham Pulsawatdi A, Craig SG, Bingham V, McCombe K, Humphries MP, Senevirathne S, Richman SD, Quirke P, Campo L, Domingo E, Maughan TS, James JA, Salto‐Tellez M. A robust multiplex immunofluorescence and digital pathology workflow for the characterisation of the tumour immune microenvironment. Mol Oncol 2020; 14:2384-2402. [PMID: 32671911 PMCID: PMC7530793 DOI: 10.1002/1878-0261.12764] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022] Open
Abstract
Multiplex immunofluorescence is a powerful tool for the simultaneous detection of tissue-based biomarkers, revolutionising traditional immunohistochemistry. The Opal methodology allows up to eight biomarkers to be measured concomitantly without cross-reactivity, permitting identification of different cell populations within the tumour microenvironment. In this study, we aimed to validate a multiplex immunofluorescence workflow in two complementary multiplex panels and evaluate the tumour immune microenvironment in colorectal cancer (CRC) formalin-fixed paraffin-embedded tissue. We stained CRC and tonsil samples using Opal multiplex immunofluorescence on a Leica BOND RX immunostainer. We then acquired images on an Akoya Vectra Polaris and performed multispectral unmixing using inform. Antibody panels were validated on tissue microarray sections containing cores from six normal tissue types, using qupath for image analysis. Comparisons between chromogenic immunohistochemistry and multiplex immunofluorescence on consecutive sections from the same tissue microarray showed significant correlation (rs > 0.9, P-value < 0.0001), validating both panels. We identified many factors that influenced the quality of the acquired fluorescent images, including biomarker co-expression, staining order, Opal-antibody pairing, sample thickness, multispectral unmixing and biomarker detection order during image analysis. Overall, we report the optimisation and validation of a multiplex immunofluorescence process, from staining to image analysis, ensuring assay robustness. Our multiplex immunofluorescence protocols permit the accurate detection of multiple immune markers in various tissue types, using a workflow that enables rapid processing of samples, above and beyond previous workflows.
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Affiliation(s)
| | - Stephanie G. Craig
- Patrick G Johnston Centre for Cancer ResearchQueen's University BelfastBelfastUK
| | - Victoria Bingham
- Patrick G Johnston Centre for Cancer ResearchQueen's University BelfastBelfastUK
| | - Kris McCombe
- Patrick G Johnston Centre for Cancer ResearchQueen's University BelfastBelfastUK
| | - Matthew P. Humphries
- Patrick G Johnston Centre for Cancer ResearchQueen's University BelfastBelfastUK
| | - Seedevi Senevirathne
- Patrick G Johnston Centre for Cancer ResearchQueen's University BelfastBelfastUK
| | - Susan D. Richman
- Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | - Phil Quirke
- Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | - Leticia Campo
- CRUK/MRC Oxford Institute for Radiation OncologyOxford UniversityOxfordUK
| | - Enric Domingo
- CRUK/MRC Oxford Institute for Radiation OncologyOxford UniversityOxfordUK
| | - Timothy S. Maughan
- CRUK/MRC Oxford Institute for Radiation OncologyOxford UniversityOxfordUK
| | - Jacqueline A. James
- Patrick G Johnston Centre for Cancer ResearchQueen's University BelfastBelfastUK
- Belfast Health and Social Care TrustBelfastUK
| | - Manuel Salto‐Tellez
- Patrick G Johnston Centre for Cancer ResearchQueen's University BelfastBelfastUK
- CRUK/MRC Oxford Institute for Radiation OncologyOxford UniversityOxfordUK
- Belfast Health and Social Care TrustBelfastUK
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14
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Seligmann JF, Elliott F, Richman S, Hemmings G, Brown S, Jacobs B, Williams C, Tejpar S, Barrett JH, Quirke P, Seymour M. Clinical and molecular characteristics and treatment outcomes of advanced right-colon, left-colon and rectal cancers: data from 1180 patients in a phase III trial of panitumumab with an extended biomarker panel. Ann Oncol 2020; 31:1021-1029. [PMID: 32387453 DOI: 10.1016/j.annonc.2020.04.476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Primary tumour location (PTL) is being adopted by clinicians to guide treatment decisions in metastatic colorectal cancer (mCRC). Here we test PTL as a predictive marker for panitumumab efficacy, and examine its relationship with an extended biomarker profile. We also examine rectal tumours as a separate location. PATIENTS AND METHODS mCRC patients from the second-line PICCOLO trial of irinotecan versus irinotecan/panitumumab (IrPan). PTL was classified as right-PTL, left-PTL or rectal-PTL. PTL was assessed as a predictive biomarker for IrPan effect in RAS-wild-type (RAS-wt) patients (compared with irinotecan alone), then tested for independence alongside an extended biomarker profile (BRAF, epiregulin/amphiregulin (EREG/AREG) and HER3 mRNA expression). RESULTS PTL data were available for 1180 patients (98.5%), of whom 558 were RAS-wt. High HER3 expression was independently predictive of panitumumab overall survival improvement, but PTL and EREG/AREG were not. IrPan progression-free survival (PFS) improvement compared with irinotecan was seen in left-PTL [hazard ratio (HR) = 0.61, P = 0.002) but not right-PTL (HR = 0.98, P = 0.90) (interaction P = 0.05; RAS/BRAF-wt interaction P = 0.10), or in rectal-PTL (HR = 0.82, P = 0.20) (interaction P = 0.14 compared with left-PTL; RAS/BRAF-wt interaction P = 0.04). Patients with right-PTL and high EREG/AREG or HER3 expression, had IrPan PFS improvement (high EREG/AREG HR = 0.20, P = 0.04; high HER3 HR = 0.33, P = 0.10) compared with irinotecan. Similar effect was seen for rectal-PTL patients (high EREG/AREG HR = 0.44, P = 0.03; high HER3 HR = 0.34, P = 0.05). CONCLUSIONS RAS-wt patients with left-PTL are more likely to have panitumumab PFS advantage than those with right-PTL or rectal-PTL. However, an extended biomarker panel demonstrated significant heterogeneity in panitumumab PFS effect within a tumour location. AREG/EREG and HER3 mRNA expression identifies patients with right-PTL or rectal-PTL who achieve similar PFS effect with panitumumab as left-colon patients. Testing could provide a more reliable basis for clinical decision making. Further validation and development of these biomarkers is required to optimise routine patient care. CLINICAL TRIAL REGISTRATION ISRCTN identifier: ISRCTN93248876.
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Affiliation(s)
- J F Seligmann
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
| | - F Elliott
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - S Richman
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - G Hemmings
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - S Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - B Jacobs
- Molecular Digestive Oncology Unit, KU Leuven, Leuven, Belgium
| | - C Williams
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - S Tejpar
- Molecular Digestive Oncology Unit, KU Leuven, Leuven, Belgium
| | - J H Barrett
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - P Quirke
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - M Seymour
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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15
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Fokas E, Glynne-Jones R, Appelt A, Beets-Tan R, Beets G, Haustermans K, Marijnen C, Minsky BD, Ludmir E, Quirke P, Sebag-Montefiore D, Garcia-Aguilar J, Gambacorta MA, Valentini V, Buyse M, Rödel C. Outcome measures in multimodal rectal cancer trials. Lancet Oncol 2020; 21:e252-e264. [PMID: 32359501 DOI: 10.1016/s1470-2045(20)30024-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
There is a large variability regarding the definition and choice of primary endpoints in phase 2 and phase 3 multimodal rectal cancer trials, resulting in inconsistency and difficulty of data interpretation. Also, surrogate properties of early and intermediate endpoints have not been systematically assessed. We provide a comprehensive review of clinical and surrogate endpoints used in trials for non-metastatic rectal cancer. The applicability, advantages, and disadvantages of these endpoints are summarised, with recommendations on clinical endpoints for the different phase trials, including limited surgery or non-operative management for organ preservation. We discuss how early and intermediate endpoints, including patient-reported outcomes and involvement of patients in decision making, can be used to guide trial design and facilitate consistency in reporting trial results in rectal cancer.
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Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Frankfurt Cancer Institute, Frankfurt Germany.
| | | | - Ane Appelt
- Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Geerard Beets
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Corrie Marijnen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phil Quirke
- Division of Pathology and Data Analytics, School of Medicine, Leeds University, Leeds, UK
| | | | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Antonietta Gambacorta
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marc Buyse
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium; International Drug Development Institute, San Francisco, CA, USA
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Frankfurt Cancer Institute, Frankfurt Germany
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16
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Ng KS, West NP, Scott N, Holzgang M, Quirke P, Jayne DG. What factors determine specimen quality in colon cancer surgery? A cohort study. Int J Colorectal Dis 2020; 35:869-880. [PMID: 32112199 DOI: 10.1007/s00384-020-03541-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Tenets of 'good quality' colon cancer surgery include mesocolic plane dissection to preserve an intact mesocolic fascia/peritoneum, and excision of sufficient mesocolon for adequate lymphadenectomy. However, it remains controversial what clinicopathological factors determine 'good quality' surgery, and whether quality of surgery influences morbidity/mortality. This study documents the quality of colon cancer surgery at a quaternary referral centre and identifies factors that influence quality of surgery and post-operative outcomes. METHODS Consecutive patients who underwent resection for colon adenocarcinoma at St. James's University Hospital, Leeds, UK (2015-2017), were included. Primary outcome measures included (i) plane of mesocolic dissection, prospectively assessed; and (ii) tissue morphometry (area of mesentery and vascular pedicle length). Other histopathological data were extracted from a prospective database. Clinical data were obtained from the National Bowel Cancer Audit and individual records. RESULTS Four hundred five patients were included (mean 69.6 years). The majority (67.4%) of specimens were mesocolic plane dissections. Median area of mesentery excised was 12,085.4 mm2. Median vascular pedicle length was 89.3 mm. Post-operative complication was recorded in one-third of patients. Mesocolic plane excision was associated with open surgery (OR 1.80, 95% CI 1.05-3.09), especially in emergency colectomy. Open resections also had a greater mesentery excised (P = 0.002), but incurred more post-operative complication (OR 2.11, 95% CI 1.12-3.99). Post-operative complication was not associated with plane of excision or tissue morphometry. CONCLUSION Majority of resections were 'optimal' mesocolic plane dissections. Open resections yielded better quality specimens, but incurred more morbidity. There is room for improvement in the quality of laparoscopic colon cancer surgery, particularly those performed as emergency.
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Affiliation(s)
- Kheng-Seong Ng
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK. .,RPA Institute of Academic Surgery, University of Sydney, 145-147 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Nicholas P West
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Nigel Scott
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Melanie Holzgang
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK
| | - Phil Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - David G Jayne
- John Goligher Colorectal Unit, St. James's University Hospital, Leeds, UK.,Academic Surgery, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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17
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Pleguezuelos-Manzano C, Puschhof J, Rosendahl Huber A, van Hoeck A, Wood HM, Nomburg J, Gurjao C, Manders F, Dalmasso G, Stege PB, Paganelli FL, Geurts MH, Beumer J, Mizutani T, Miao Y, van der Linden R, van der Elst S, Garcia KC, Top J, Willems RJL, Giannakis M, Bonnet R, Quirke P, Meyerson M, Cuppen E, van Boxtel R, Clevers H. Mutational signature in colorectal cancer caused by genotoxic pks + E. coli. Nature 2020; 580:269-273. [PMID: 32106218 PMCID: PMC8142898 DOI: 10.1038/s41586-020-2080-8] [Citation(s) in RCA: 515] [Impact Index Per Article: 128.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/17/2020] [Indexed: 02/06/2023]
Abstract
Various species of the intestinal microbiota have been associated with the development of colorectal cancer1,2, but it has not been demonstrated that bacteria have a direct role in the occurrence of oncogenic mutations. Escherichia coli can carry the pathogenicity island pks, which encodes a set of enzymes that synthesize colibactin3. This compound is believed to alkylate DNA on adenine residues4,5 and induces double-strand breaks in cultured cells3. Here we expose human intestinal organoids to genotoxic pks+ E. coli by repeated luminal injection over five months. Whole-genome sequencing of clonal organoids before and after this exposure revealed a distinct mutational signature that was absent from organoids injected with isogenic pks-mutant bacteria. The same mutational signature was detected in a subset of 5,876 human cancer genomes from two independent cohorts, predominantly in colorectal cancer. Our study describes a distinct mutational signature in colorectal cancer and implies that the underlying mutational process results directly from past exposure to bacteria carrying the colibactin-producing pks pathogenicity island.
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Affiliation(s)
- Cayetano Pleguezuelos-Manzano
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Jens Puschhof
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Axel Rosendahl Huber
- Oncode Institute, Utrecht, The Netherlands
- The Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Arne van Hoeck
- Oncode Institute, Utrecht, The Netherlands
- Center for Molecular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henry M Wood
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jason Nomburg
- Graduate Program in Virology, Division of Medical Sciences, Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carino Gurjao
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Freek Manders
- Oncode Institute, Utrecht, The Netherlands
- The Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Guillaume Dalmasso
- University Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France
| | - Paul B Stege
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fernanda L Paganelli
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten H Geurts
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Joep Beumer
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands
| | - Tomohiro Mizutani
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - Yi Miao
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Molecular and Cellular Physiology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Reinier van der Linden
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands
| | - Stefan van der Elst
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands
| | - K Christopher Garcia
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Molecular and Cellular Physiology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Janetta Top
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rob J L Willems
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Richard Bonnet
- University Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France
- Department of Bacteriology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Phil Quirke
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edwin Cuppen
- Oncode Institute, Utrecht, The Netherlands
- Center for Molecular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
- Hartwig Medical Foundation, Amsterdam, The Netherlands
- CPCT Consortium, Rotterdam, The Netherlands
| | - Ruben van Boxtel
- Oncode Institute, Utrecht, The Netherlands.
- The Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Hans Clevers
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and UMC Utrecht, Utrecht, The Netherlands.
- Oncode Institute, Utrecht, The Netherlands.
- The Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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18
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D'Souza N, Lord AC, Shaw A, Patel A, Balyasnikova S, Tudyka V, Abulafi M, Moran B, Rasheed S, Tekkis P, Coffey JC, Terlizzo M, West NP, Quirke P, Brown G. Ex vivo specimen MRI and pathology confirm a rectosigmoid mesenteric waist at the junction of the mesorectum and mesocolon. Colorectal Dis 2020; 22:212-218. [PMID: 31535423 DOI: 10.1111/codi.14856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/10/2019] [Indexed: 02/08/2023]
Abstract
AIM Continuity of the mesentery has recently been established and may provide an anatomical basis for optimal colorectal resectional surgery. Preliminary data from operative specimen measurements suggest there is a tapering in the mesentery of the distal sigmoid. A mesenteric waist in this area may be a risk factor for local recurrence of colorectal cancer. This study aimed to investigate the anatomical characteristics of the mesentery at the colorectal junction. METHOD In this cross-sectional study, 20 patients were recruited. After planned colorectal resection, the surgical specimens were scanned in a MRI system and subsequently dissected and photographed as per national pathology guidelines. Mesenteric surface area and linear measurements were compared between MRI and pathology to establish the presence and location of a mesenteric waist. RESULTS Specimen analysis confirmed that a narrowing in the mesenteric surface area was consistently apparent at the rectosigmoid junction. Above the anterior peritoneal reflection, the surface area and posterior distance of the mesentery of the upper rectum initially decreased before increasing as the mesentery of the sigmoid colon. These anatomical properties created the appearance of a mesenteric 'waist' at the rectosigmoid junction. Using the anterior reflection as a reference landmark, the rectosigmoid waist occurred at a mean height of 23.6 and 21.7 mm on MRI and pathology, respectively. CONCLUSION A rectosigmoid waist occurs at the junction of the mesorectum and mesocolon, and is a mesenteric landmark for the rectum that is present on both radiology and pathology.
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Affiliation(s)
- N D'Souza
- Croydon University Hospital, Croydon, UK.,Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - A C Lord
- Croydon University Hospital, Croydon, UK.,Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - A Shaw
- Croydon University Hospital, Croydon, UK.,Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - A Patel
- Royal Marsden Hospital, Sutton, UK
| | - S Balyasnikova
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | | | - M Abulafi
- Croydon University Hospital, Croydon, UK
| | - B Moran
- Basingstoke Hospital, Basingstoke, UK
| | - S Rasheed
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - P Tekkis
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
| | - J C Coffey
- University Hospital Limerick and University of Limerick, Limerick, Ireland
| | | | - N P West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - P Quirke
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - G Brown
- Royal Marsden Hospital, Sutton, UK.,Imperial College London, London, UK
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19
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West N, Murakami K, Magill L, Gray R, Handley K, Seymour M, Morton D, Quirke P. Pre-operative FOLFOX chemotherapy in advanced colon cancer: Pathology analysis of the FOxTROT trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Barrow P, Richman SD, Wallace AJ, Handley K, Hutchins GGA, Kerr D, Magill L, Evans DG, Gray R, Quirke P, Hill J. Confirmation that somatic mutations of beta-2 microglobulin correlate with a lack of recurrence in a subset of stage II mismatch repair deficient colorectal cancers from the QUASAR trial. Histopathology 2019; 75:236-246. [PMID: 31062389 PMCID: PMC6772160 DOI: 10.1111/his.13895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 01/05/2023]
Abstract
Aims Beta2‐microglobulin (B2M) forms part of the HLA class I complex and plays a role in metastatic biology. B2M mutations occur frequently in mismatch repair‐deficient colorectal cancer (dMMR CRC), with limited data suggesting they may protect against recurrence. Our experimental study tested this hypothesis by investigating B2M mutation status and B2M protein expression and recurrence in patients in the stage II QUASAR clinical trial. Methods and results Sanger sequencing was performed for the three coding exons of B2M on 121 dMMR and a subsample of 108 pMMR tumours; 52 with recurrence and 56 without. B2M protein expression was assessed by immunohistochemistry. Mutation status and protein expression were correlated with recurrence and compared to proficient mismatch repair (pMMR) CRCs. Deleterious B2M mutations were detected in 39 of 121 (32%) dMMR tumours. Five contained missense B2M‐variants of unknown significance, so were excluded from further analyses. With median follow‐up of 7.4 years, none of the 39 B2M‐mutant tumours recurred, compared with 14 of 77 (18%) B2M‐wild‐type tumours (P = 0.005); six at local and eight at distant sites. Sensitivity and specificity of IHC in detecting B2M mutations was 87 and 71%, respectively. Significantly (P < 0.0001) fewer (three of 104, 2.9%) of the 108 pMMR CRCs demonstrated deleterious B2M mutations. One pMMR tumour, containing a frameshift mutation, later recurred. Conclusion B2M mutations were detected in nearly one‐third of dMMR cancers, none of which recurred. B2M mutation status has potential clinical utility as a prognostic biomarker in stage II dMMR CRC. The mechanism of protection against recurrence and whether this protection extends to stage III disease remains unclear.
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Affiliation(s)
- Paul Barrow
- Department of Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, UK
| | - Susan D Richman
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James' University Hospital, Leeds, UK
| | - Andrew J Wallace
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Kelly Handley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gordon G A Hutchins
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James' University Hospital, Leeds, UK
| | - David Kerr
- Cancer Medicine, University of Oxford, Oxford, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | | | - Phil Quirke
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James' University Hospital, Leeds, UK
| | - James Hill
- Department of Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, UK
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21
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Brown PJ, Rossington H, Taylor J, Lambregts DMJ, Morris EJA, West NP, Quirke P, Tolan D. Radiologist and multidisciplinary team clinician opinions on the quality of MRI rectal cancer staging reports: how are we doing? Clin Radiol 2019; 74:637-642. [PMID: 31084973 DOI: 10.1016/j.crad.2019.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the current opinion of magnetic resonance imaging (MRI) reports amongst specialist clinicians involved in colorectal cancer multidisciplinary teams (CRC MDTs). MATERIALS AND METHODS Active participants at 16 UK CRC MDTs across a population of 5.7 million were invited to complete a questionnaire, this included 22 closed and three open questions. Closed questions used ordinal (Likert) scales to judge the subjective inclusion of tumour descriptors and impressions on the clarity and consistency of the MRI report. Open (free-text) questions allowed overall feedback and suggestions. RESULTS A total of 69 participants completed the survey (21 radiologists and 48 other CRC MDT clinicians). Both groups highlighted that reports commonly omit the status of the circumferential resection margin (CRM; 83% versus 81% inclusion, other clinicians and radiologists, respectively, p>0.05), presence or absence of extra-mural venous invasion (EMVI; 67% versus 57% inclusion, p>0.05), and lymph node status (90% inclusion in both groups). Intra-radiologist agreement across MRI examinations is reported as 75% by other clinicians. Free-text comments included suggestions for template-style reports. CONCLUSION Both groups recognise a proportion of MRI reports are suboptimal with key tumour descriptors omitted. There are also concerns around the presentation style of MRI reports and inter- and intra-radiologist report variability. The widespread implementation of standardised report templates may improve completeness and clarity of MRI reports for rectal cancer and thus clinical management and outcomes in rectal cancer.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - H Rossington
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - J Taylor
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, Netherlands
| | - E J A Morris
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - N P West
- Pathology, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - P Quirke
- Pathology, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D Tolan
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
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22
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Marks KM, West NP, Morris E, Quirke P. Clinicopathological, genomic and immunological factors in colorectal cancer prognosis. Br J Surg 2018; 105:e99-e109. [PMID: 29341159 DOI: 10.1002/bjs.10756] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Numerous factors affect the prognosis of colorectal cancer (CRC), many of which have long been identified, such as patient demographics and the multidisciplinary team. In more recent years, molecular and immunological biomarkers have been shown to have a significant influence on patient outcomes. Whilst some of these biomarkers still require ongoing validation, if proven to be worthwhile they may change our understanding and future management of CRC. The aim of this review was to identify the key prognosticators of CRC, including new molecular and immunological biomarkers, and outline how these might fit into the whole wider context for patients. METHODS Relevant references were identified through keyword searches of PubMed and Embase Ovid SP databases. RESULTS In recent years there have been numerous studies outlining molecular markers of prognosis in CRC. In particular, the Immunoscore® has been shown to hold strong prognostic value. Other molecular biomarkers are useful in guiding treatment decisions, such as mutation testing of genes in the epidermal growth factor receptor pathway. However, epidemiological studies continue to show that patient demographics are fundamental in predicting outcomes. CONCLUSION Current strategies for managing CRC are strongly dependent on clinicopathological staging, although molecular testing is increasingly being implemented into routine clinical practice. As immunological biomarkers are further validated, their testing may also become routine. To obtain clinically useful information from new biomarkers, it is important to implement them into a model that includes all underlying fundamental factors, as this will enable the best possible outcomes and deliver true precision medicine.
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Affiliation(s)
- K M Marks
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
| | - N P West
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
| | - E Morris
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
| | - P Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
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23
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Watson H, Mitra S, Croden FC, Taylor M, Wood HM, Perry SL, Spencer JA, Quirke P, Toogood GJ, Lawton CL, Dye L, Loadman PM, Hull MA. A randomised trial of the effect of omega-3 polyunsaturated fatty acid supplements on the human intestinal microbiota. Gut 2018; 67:1974-1983. [PMID: 28951525 DOI: 10.1136/gutjnl-2017-314968] [Citation(s) in RCA: 266] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Omega-3 polyunsaturated fatty acids (PUFAs) have anticolorectal cancer (CRC) activity. The intestinal microbiota has been implicated in colorectal carcinogenesis. Dietary omega-3 PUFAs alter the mouse intestinal microbiome compatible with antineoplastic activity. Therefore, we investigated the effect of omega-3 PUFA supplements on the faecal microbiome in middle-aged, healthy volunteers (n=22). DESIGN A randomised, open-label, cross-over trial of 8 weeks' treatment with 4 g mixed eicosapentaenoic acid/docosahexaenoic acid in two formulations (soft-gel capsules and Smartfish drinks), separated by a 12-week 'washout' period. Faecal samples were collected at five time-points for microbiome analysis by 16S ribosomal RNA PCR and Illumina MiSeq sequencing. Red blood cell (RBC) fatty acid analysis was performed by liquid chromatography tandem mass spectrometry. RESULTS Both omega-3 PUFA formulations induced similar changes in RBC fatty acid content, except that drinks were associated with a larger, and more prolonged, decrease in omega-6 PUFA arachidonic acid than the capsule intervention (p=0.02). There were no significant changes in α or β diversity, or phyla composition, associated with omega-3 PUFA supplementation. However, a reversible increased abundance of several genera, including Bifidobacterium, Roseburia and Lactobacillus was observed with one or both omega-3 PUFA interventions. Microbiome changes did not correlate with RBC omega-3 PUFA incorporation or development of omega-3 PUFA-induced diarrhoea. There were no treatment order effects. CONCLUSION Omega-3 PUFA supplementation induces a reversible increase in several short-chain fatty acid-producing bacteria, independently of the method of administration. There is no simple relationship between the intestinal microbiome and systemic omega-3 PUFA exposure. TRIAL REGISTRATION NUMBER ISRCTN18662143.
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Affiliation(s)
- Henry Watson
- Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, UK
| | - Suparna Mitra
- Institute of Biomedical and Clinical Sciences, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - Fiona C Croden
- Human Appetite Research Unit (Nutrition and Behaviour Research Group), School of Psychology, University of Leeds, Leeds, UK
| | - Morag Taylor
- Institute of Cancer and Pathology, St James's University Hospital, University of Leeds, Leeds, UK
| | - Henry M Wood
- Institute of Cancer and Pathology, St James's University Hospital, University of Leeds, Leeds, UK
| | - Sarah L Perry
- Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, UK
| | - Jade A Spencer
- Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Phil Quirke
- Institute of Cancer and Pathology, St James's University Hospital, University of Leeds, Leeds, UK
| | - Giles J Toogood
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK
| | - Clare L Lawton
- Human Appetite Research Unit (Nutrition and Behaviour Research Group), School of Psychology, University of Leeds, Leeds, UK
| | - Louise Dye
- Human Appetite Research Unit (Nutrition and Behaviour Research Group), School of Psychology, University of Leeds, Leeds, UK
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Mark A Hull
- Institute of Biomedical and Clinical Sciences, St James's University Hospital, University of Leeds, Leeds, UK
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Glynne-Jones R, Hall M, Lopes A, Pearce S, Goh V, Bosompem S, Bridgewater J, Chau I, Wasan H, Moran B, Melcher L, West N, Quirke P, Wong WL, Beare S, Hava N, Duggan M, Harrison M. BACCHUS: A randomised non-comparative phase II study of neoadjuvant chemotherapy (NACT) in patients with locally advanced rectal cancer (LARC). Heliyon 2018; 4:e00804. [PMID: 30258994 PMCID: PMC6151852 DOI: 10.1016/j.heliyon.2018.e00804] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/06/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chemoradiation (CRT) or short-course radiotherapy (SCRT) are standard treatments for locally advanced rectal cancer (LARC). We evaluated the efficacy/safety of two neoadjuvant chemotherapy (NACT) regimens as an alternative prior to total mesorectal excision (TME). METHODS/DESIGN This multi-centre, phase II trial in patients with magnetic resonance imaging (MRI) defined high-risk LARC (>cT3b, cN2+ or extramural venous invasion) randomised patients (1:1) to FOLFOX + Bevacizumab (Arm 1) or FOLFOXIRI + bevacizumab (Arm 2) every 14 days for 6 cycles prior to surgery. Patients were withdrawn if positron emission tomography (PET) standardised uptake value (SUV) after 3 cycles failed to decrease by >30% or increased compared to baseline. Primary endpoint was pathological complete response rate (pCR). Secondary endpoints included adverse events (AE) and toxicity. Neoadjuvant rectal (NAR) scores based on "T" and "N" downstaging were calculated. FINDINGS Twenty patients aged 18-75 years were randomised. The trial stopped early because of poor accrual. Seventeen patients completed all 6 cycles of NACT. One stopped due to myocardial infarction, 1 poor response on PET (both received CRT) and 1 committed suicide. 11 patients had G3 AE, 1 G4 AE (neutropenia), and 1 G5 (suicide). pCR (the primary endpoint) was 0/10 for Arm 1 and 2/10 for Arm 2 i.e. 2/20 (10%) overall. Median NAR score was 14·9 with 5 (28%), 7 (39%), and 6 (33%) having low, intermediate, or high scores. Surgical morbidity was acceptable (1/18 wound infection, no anastomotic leak/pelvic sepsis/fistulae). The 24-month progression-free survival rate was 75% (95% CI: 60%-85%). INTERPRETATION The primary endpoint (pCR rate) was not met. However, FOLFOXIRI and bevacizumab achieved promising pCR rates, low NAR scores and was well-tolerated. This regimen is suitable for testing as the novel arm against current standards of SCRT and/or CRT in a future trial.
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Affiliation(s)
- R. Glynne-Jones
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - M.R. Hall
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - A. Lopes
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - S. Pearce
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - V. Goh
- Division of Imaging Sciences & Biomedical Engineering, Kings College London, Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, SE1 7EH, UK
| | - S. Bosompem
- Pharmacy Department, Milton Keynes University Hospital NHS Trust, Milton Keynes, United Kingdom
| | - J. Bridgewater
- University College, London Cancer Institute, 72 Huntley St., London, WC1E 6AA, UK
| | - I. Chau
- Department of Medical Oncology, Royal Marsden Hospital, London & Surrey, UK
| | - H. Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - B. Moran
- Department of Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - L. Melcher
- Radiotherapy Department, North Middlesex Hospital, Sterling Way, London, N18 1QX, UK
| | - N.P. West
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - P. Quirke
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - W.-L. Wong
- Department of Radiology, Paul Strickland Scanner Centre, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - S. Beare
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - N. Hava
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M. Duggan
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M. Harrison
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
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25
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Armstrong G, Croft J, Corrigan N, Brown JM, Goh V, Quirke P, Hulme C, Tolan D, Kirby A, Cahill R, O'Connell PR, Miskovic D, Coleman M, Jayne D. IntAct: intra-operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Dis 2018; 20:O226-O234. [PMID: 29751360 PMCID: PMC6099475 DOI: 10.1111/codi.14257] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
Abstract
AIM Anastomotic leak (AL) is a major complication of rectal cancer surgery. Despite advances in surgical practice, the rates of AL have remained static, at around 10-15%. The aetiology of AL is multifactorial, but one of the most crucial risk factors, which is mostly under the control of the surgeon, is blood supply to the anastomosis. The MRC/NIHR IntAct study will determine whether assessment of anastomotic perfusion using a fluorescent dye (indocyanine green) and near-infrared laparoscopy can minimize the rate of AL leak compared with conventional white-light laparoscopy. Two mechanistic sub-studies will explore the role of the rectal microbiome in AL and the predictive value of CT angiography/perfusion studies. METHOD IntAct is a prospective, unblinded, parallel-group, multicentre, European, randomized controlled trial comparing surgery with intra-operative fluorescence angiography (IFA) against standard care (surgery with no IFA). The primary end-point is rate of clinical AL at 90 days following surgery. Secondary end-points include all AL (clinical and radiological), change in planned anastomosis, complications and re-interventions, use of stoma, cost-effectiveness of the intervention and quality of life. Patients should have a diagnosis of adenocarcinoma of the rectum suitable for potentially curative surgery by anterior resection. Over 3 years, 880 patients from 25 European centres will be recruited and followed up for 90 days. DISCUSSION IntAct will rigorously evaluate the use of IFA in rectal cancer surgery and explore the role of the microbiome in AL and the predictive value of preoperative CT angiography/perfusion scanning.
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Affiliation(s)
| | - J. Croft
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - N. Corrigan
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - J. M. Brown
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - V. Goh
- School of Biomedical Engineering and Imaging SciencesKing's College London and Honorary Consultant RadiologistGuy's and St Thomas’ Hospitals NHS Foundation TrustLondonUK
| | | | - C. Hulme
- Academic Unit of Health EconomicsLeeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - D. Tolan
- Leeds Teaching Hospital TrustLeedsUK
| | | | - R. Cahill
- University College DublinDublinIreland
| | | | | | - M. Coleman
- Derriford HospitalPlymouth NHS TrustPlymouthUK
| | - D. Jayne
- Leeds Institute of Biological and Clinical SciencesSt James's University HospitalLeedsUK
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26
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Nicholson AM, Olpe C, Hoyle A, Thorsen AS, Rus T, Colombé M, Brunton-Sim R, Kemp R, Marks K, Quirke P, Malhotra S, Ten Hoopen R, Ibrahim A, Lindskog C, Myers MB, Parsons B, Tavaré S, Wilkinson M, Morrissey E, Winton DJ. Fixation and Spread of Somatic Mutations in Adult Human Colonic Epithelium. Cell Stem Cell 2018; 22:909-918.e8. [PMID: 29779891 PMCID: PMC5989058 DOI: 10.1016/j.stem.2018.04.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/16/2018] [Accepted: 04/23/2018] [Indexed: 12/21/2022]
Abstract
We investigated the means and timing by which mutations become fixed in the human colonic epithelium by visualizing somatic clones and mathematical inference. Fixation requires two sequential steps. First, one of approximately seven active stem cells residing within each colonic crypt has to be mutated. Second, the mutated stem cell has to replace neighbors to populate the entire crypt in a process that takes several years. Subsequent clonal expansion due to crypt fission is infrequent for neutral mutations (around 0.7% of all crypts undergo fission in a single year). Pro-oncogenic mutations subvert both stem cell replacement to accelerate fixation and clonal expansion by crypt fission to achieve high mutant allele frequencies with age. The benchmarking of these behaviors allows the advantage associated with different gene-specific mutations to be compared irrespective of the cellular mechanisms by which they are conferred.
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Affiliation(s)
- Anna M Nicholson
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Cora Olpe
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK; Wellcome Trust-Medical Research Council, Cambridge Stem Cell Institute, Cambridge, UK
| | - Alice Hoyle
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Ann-Sofie Thorsen
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Teja Rus
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Mathilde Colombé
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | | | - Richard Kemp
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Kate Marks
- Pathology and Tumour Biology, Level 4, Wellcome Trust Brenner Building, St. James University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Phil Quirke
- Pathology and Tumour Biology, Level 4, Wellcome Trust Brenner Building, St. James University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | | | | | - Ashraf Ibrahim
- Department of Histopathology, Box 235, CUHFT, Cambridge, UK
| | - Cecilia Lindskog
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Rudbeck Laboratory, Uppsala University, Uppsala 751 85, Sweden
| | - Meagan B Myers
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, HFT-120, 3900 NCTR Road, Jefferson, AR 72079, USA
| | - Barbara Parsons
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, HFT-120, 3900 NCTR Road, Jefferson, AR 72079, USA
| | - Simon Tavaré
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Mark Wilkinson
- Norwich Research Park BioRepository, James Watson Road, Norwich NR4 7UQ, UK
| | - Edward Morrissey
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK.
| | - Douglas J Winton
- Cancer Research-UK Cambridge Institute, Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK.
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Abstract
A careful overview of the classical appearances of Kaposi's sarcoma (KS) as well as of its variants were reviewed from the clinical and pathological point of view. The growth phases (stages) and the cellular patterns were histopathologically compared with emphasis on the developmental progression of disease as well as mitotic activity. Other morphological aspects were also assessed such as the features of the early phases and the incidence of hyaline bodies. One hundred and forty-three lesions from 96 patients mostly of the Italian sporadic type were investigated. A complete list of those entities which should be considered in differential diagnosis is shown and the dilemma of whether KS is a neoplasia or a hyperplasia is discussed.
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Affiliation(s)
- M Bisceglia
- Anatomic Pathology Department, Casa Sollievo della Sofferenza Hospital, Istituto di Ricovero e Cure a Carattere Scientifico (I.R.C.C.S.), S. Giovanni Rotondo Foggia, Italy
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28
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Adams R, Brown E, Brown L, Butler R, Falk S, Fisher D, Kaplan R, Quirke P, Richman S, Samuel L, Seligmann J, Seymour M, Shiu KK, Wasan H, Wilson R, Maughan T. Inhibition of EGFR, HER2, and HER3 signalling in patients with colorectal cancer wild-type for BRAF, PIK3CA, KRAS, and NRAS (FOCUS4-D): a phase 2-3 randomised trial. Lancet Gastroenterol Hepatol 2018; 3:162-171. [PMID: 29254887 PMCID: PMC6125825 DOI: 10.1016/s2468-1253(17)30394-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/25/2017] [Accepted: 11/09/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND A substantial change in trial methodology for solid tumours has taken place, in response to increased understanding of cancer biology. FOCUS4 is a phase 2-3 trial programme testing targeted agents in patients with advanced colorectal cancer in molecularly stratified cohorts. Here, we aimed to test the hypothesis that combined inhibition of EGFR, HER2, and HER3 signalling with the tyrosine kinase inhibitor AZD8931 will control growth of all wild-type tumours. METHODS In FOCUS4-D, we included patients from 18 hospitals in the UK with newly diagnosed advanced or metastatic colorectal cancer whose tumour was wild-type for BRAF, PIK3CA, KRAS, and NRAS. After 16 weeks of first-line therapy, patients with stable or responding tumours were randomised to oral AZD8931 (40 mg twice a day) or placebo. Randomisation was done by minimisation with a random element of 20%, minimisation by hospital site, site of primary tumour, WHO performance status, 16-week CT scan result, number of metastatic sites, and first-line chemotherapy regimen. The primary outcome was progression-free-survival. CT scans were assessed by local radiologists according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. Preplanned interim analyses were assessed per protocol and were agreed using multiarm multistage (MAMS) trial design methodology triggered by occurrence of progression-free survival events in the placebo group. The final analysis was assessed by intention to treat. This trial is registered at controlled-trials.com, ISRCTN 90061546. FINDINGS Between July 7, 2014, and March 7, 2016, 32 patients were randomised to study treatment, 16 to AZD8931 and 16 to placebo. At the first preplanned interim analysis (March, 2016), the independent data monitoring committee (IDMC) recommended closure of FOCUS4-D because of a lack of activity. At the final analysis (Aug 1, 2016), 31 patients had had a progression-free survival event (15 with AZD8931 and 16 with placebo). Median progression-free survival was 3·48 months (95% CI 1·51-5·09) in the placebo group and 2·96 months (1·94-5·62) in the AZD8931 group. No progression-free survival benefit of AZD8931 compared with placebo was noted (hazard ratio [HR] 1·10, 95% CI 0·47-3·57; p=0·95). The most common grade 3 adverse event in the AZD8931 group was skin rash (three [20%] of 15 patients with available data vs none of 16 patients in the placebo group), and in the placebo group it was diarrhoea (one [7%] vs one [6%]). No grade 4 adverse events were recorded and no treatment-related deaths were reported. INTERPRETATION The MAMS trial design for FOCUS4 has shown efficiency and effectiveness in trial outcome delivery, informing the decision to proceed or stop clinical evaluation of a targeted treatment within a molecularly defined cohort of patients. The overarching FOCUS4 trial is now aiming to open a replacement arm in the cohort with all wild-type tumours. FUNDING Medical Research Council (MRC) and National Institute for Health Research (NIHR) Efficacy and Mechanism Evaluation programme, Cancer Research UK, NIHR Clinical Trials Research Network, Health and Care Research Wales, and AstraZeneca.
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Affiliation(s)
- Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK.
| | - Ewan Brown
- Edinburgh Cancer Centre NHS Lothian, Edinburgh, UK
| | - Louise Brown
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK.
| | - Rachel Butler
- All Wales Genetics Laboratory University Hospital of Wales, Cardiff, UK
| | - Stephen Falk
- University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - David Fisher
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Richard Kaplan
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Phil Quirke
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Susan Richman
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Jenny Seligmann
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Matt Seymour
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | | | - Richard Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Tim Maughan
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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29
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Sheehan-Dare GE, Marks KM, Tinkler-Hundal E, Ingeholm P, Bertelsen CA, Quirke P, West NP. The effect of a multidisciplinary regional educational programme on the quality of colon cancer resection. Colorectal Dis 2018; 20:105-115. [PMID: 28755446 DOI: 10.1111/codi.13830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 06/19/2017] [Indexed: 12/12/2022]
Abstract
AIM Mesocolic plane surgery with central vascular ligation produces an oncologically superior specimen following colon cancer resection and appears to be related to optimal outcomes. We aimed to assess whether a regional educational programme in optimal mesocolic surgery led to an improvement in the quality of specimens. METHOD Following an educational programme in the Capital and Zealand areas of Denmark, 686 cases of primary colon cancer resected across six hospitals were assessed by grading the plane of surgery and undertaking tissue morphometry. These were compared to 263 specimens resected prior to the educational programme. RESULTS Across the region, the mesocolic plane rate improved from 58% to 77% (P < 0.001). One hospital had previously implemented optimal surgery as standard prior to the educational programme and continued to produce a high rate of mesocolic plane specimens (68%) with a greater distance between the tumour and the high tie (median for all fresh cases: 113 vs 82 mm) and lymph node yield (33 vs 18) compared to the other hospitals. Three of the other hospitals showed a significant improvement in the plane of surgical resection. CONCLUSION A multidisciplinary regional educational programme in optimal mesocolic surgery improved the oncological quality of colon cancer specimens as assessed by mesocolic planes; however, there was no significant effect on the amount of tissue resected centrally. Surgeons who attempt central vascular ligation continue to produce more radical specimens suggesting that such educational programmes alone are not sufficient to increase the amount of tissue resected around the tumour.
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Affiliation(s)
- G E Sheehan-Dare
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
| | - K M Marks
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
| | - E Tinkler-Hundal
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
| | - P Ingeholm
- Department of Pathology, Herlev University Hospital, University of Copenhagen, Herlev, Denmark
| | - C A Bertelsen
- Department of Surgery, Hillerød University Hospital, University of Copenhagen, Hillerød, Denmark
| | - P Quirke
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
| | - N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, UK
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Stelzner S, Böttner M, Kupsch J, Kneist W, Quirke P, West NP, Witzigmann H, Wedel T. Internal anal sphincter nerves - a macroanatomical and microscopic description of the extrinsic autonomic nerve supply of the internal anal sphincter. Colorectal Dis 2018; 20:O7-O16. [PMID: 29068554 DOI: 10.1111/codi.13942] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022]
Abstract
AIM The internal anal sphincter (IAS) contributes substantially to anorectal functions. While its autonomic nerve supply has been studied at the microscopic level, little information is available concerning the macroscopic topography of extrinsic nerve fibres. This study was designed to identify neural connections between the pelvic plexus and the IAS, provide a detailed topographical description, and give histological proof of autonomic nerve tissue. METHODS Macroscopic dissection of pelvic autonomic nerves was performed under magnification in seven (five male, two female) hemipelvises obtained from body donors (67-92 years). Candidate structures were investigated by histological and immunohistochemical staining protocols to visualize nerve tissue. RESULTS Nerve fibres could be traced from the anteroinferior edge of the pelvic plexus to the anorectal junction running along the neurovascular bundle anterolaterally to the rectum and posterolaterally to the prostate/vagina. Nerve fibres penetrated the longitudinal rectal muscle layer just above the fusion with the levator ani muscle (conjoint longitudinal muscle) and entered the intersphincteric space to reach the IAS. Histological and immunohistochemical findings confirmed the presence of nerve tissue. CONCLUSIONS Autonomic nerve fibres supplying the IAS emerge from the pelvic plexus and are distinct to nerves entering the rectum via the lateral pedicles. Thus, they should be classified as IAS nerves. The identification and precise topographical location described provides a basis for nerve-sparing rectal resection procedures and helps to prevent postoperative functional anorectal disorders.
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Affiliation(s)
- S Stelzner
- Department of General, Visceral and Thoracic Surgery, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - M Böttner
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | - J Kupsch
- Department of General, Visceral and Thoracic Surgery, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - W Kneist
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - P Quirke
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - H Witzigmann
- Department of General, Visceral and Thoracic Surgery, Dresden-Friedrichstadt General Hospital, Dresden, Germany
| | - T Wedel
- Institute of Anatomy, Center of Clinical Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
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Sclafani F, Gollins S, Cunningham D, Hulkki Wilson S, Kouvelakis K, Lopes A, West N, Quirke P, Begum R, Valeri N, Beare S, Hughes L, Gonzalez De Castro D, Chau I. FCγRIIa and FCγRIIIa single nucleotide polymorphisms (SNPs) and cetuximab benefit in the EXCITE trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx659.046] [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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32
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Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J. Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA 2017; 318:1569-1580. [PMID: 29067426 PMCID: PMC5818805 DOI: 10.1001/jama.2017.7219] [Citation(s) in RCA: 727] [Impact Index Per Article: 103.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy. OBJECTIVE To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons. Recruitment of patients was from January 7, 2011, to September 30, 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on June 16, 2015. INTERVENTIONS Patients were randomized to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection, performed by either high (upper rectum) or low (total rectum) anterior resection or abdominoperineal resection (rectum and perineum). MAIN OUTCOMES AND MEASURES The primary outcome was conversion to open laparotomy. Secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity (CRM+) and other pathological outcomes, quality of life (36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory), bladder and sexual dysfunction (International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index), and oncological outcomes. RESULTS Among 471 randomized patients (mean [SD] age, 64.9 [11.0] years; 320 [67.9%] men), 466 (98.9%) completed the study. The overall rate of conversion to open laparotomy was 10.1%: 19 of 236 patients (8.1%) in the robotic-assisted laparoscopic group and 28 of 230 patients (12.2%) in the conventional laparoscopic group (unadjusted risk difference = 4.1% [95% CI, -1.4% to 9.6%]; adjusted odds ratio = 0.61 [95% CI, 0.31 to 1.21]; P = .16). The overall CRM+ rate was 5.7%; CRM+ occurred in 14 (6.3%) of 224 patients in the conventional laparoscopic group and 12 (5.1%) of 235 patients in the robotic-assisted laparoscopic group (unadjusted risk difference = 1.1% [95% CI, -3.1% to 5.4%]; adjusted odds ratio = 0.78 [95% CI, 0.35 to 1.76]; P = .56). Of the other 8 reported prespecified secondary end points, including intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction, none showed a statistically significant difference between groups. CONCLUSIONS AND RELEVANCE Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of conversion to open laparotomy. These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN80500123.
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Affiliation(s)
- David Jayne
- Department of Academic Surgery, Leeds Institute of Biological and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Helen Marshall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Neil Corrigan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Joanne Copeland
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Phil Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Nick West
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Tero Rautio
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
| | | | | | | | | | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
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Gollins S, West N, Sebag-Montefiore D, Myint AS, Saunders M, Susnerwala S, Quirke P, Essapen S, Samuel L, Sizer B, Worlding J, Southward K, Hemmings G, Tinkler-Hundal E, Taylor M, Bottomley D, Chambers P, Lawrie E, Lopes A, Beare S. Preoperative chemoradiation with capecitabine, irinotecan and cetuximab in rectal cancer: significance of pre-treatment and post-resection RAS mutations. Br J Cancer 2017; 117:1286-1294. [PMID: 28859058 PMCID: PMC5672930 DOI: 10.1038/bjc.2017.294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The influence of EGFR pathway mutations on cetuximab-containing rectal cancer preoperative chemoradiation (CRT) is uncertain. METHODS In a prospective phase II trial (EXCITE), patients with magnetic resonance imaging (MRI)-defined non-metastatic rectal adenocarinoma threatening/involving the surgical resection plane received pelvic radiotherapy with concurrent capecitabine, irinotecan and cetuximab. Resection was recommended 8 weeks later. The primary endpoint was histopathologically clear (R0) resection margin. Pre-planned retrospective DNA pyrosequencing (PS) and next generation sequencing (NGS) of KRAS, NRAS, PIK3CA and BRAF was performed on the pre-treatment biopsy and resected specimen. RESULTS Eighty-two patients were recruited and 76 underwent surgery, with R0 resection in 67 (82%, 90%CI: 73-88%) (four patients with clinical complete response declined surgery). Twenty-four patients (30%) had an excellent clinical or pathological response (ECPR). Using NGS 24 (46%) of 52 matched biopsies/resections were discrepant: ten patients (19%) gained 13 new resection mutations compared to biopsy (12 KRAS, one PIK3CA) and 18 (35%) lost 22 mutations (15 KRAS, 7 PIK3CA). Tumours only ever testing RAS wild-type had significantly greater ECPR than tumours with either biopsy or resection RAS mutations (14/29 [48%] vs 10/51 [20%], P=0.008), with a trend towards increased overall survival (HR 0.23, 95% CI 0.05-1.03, P=0.055). CONCLUSIONS This regimen was feasible and the primary study endpoint was met. For the first time using pre-operative rectal CRT, emergence of clinically important new resection mutations is described, likely reflecting intratumoural heterogeneity manifesting either as treatment-driven selective clonal expansion or a geographical biopsy sampling miss.
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Affiliation(s)
- Simon Gollins
- Department of Oncology, North Wales Cancer Treatment Centre, Bodelwyddan, Denbighshire LL18 5UJ, UK
| | - Nick West
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | | | - Arthur Sun Myint
- Clatterbridge Cancer Centre, Clatterbridge Road, Wirral CH63 4JY, UK
| | - Mark Saunders
- The Christie NHS Foundation Trust, Withington, Manchester M20 4BX, UK
| | | | - Phil Quirke
- Pathology and Tumour Biology, Level 4 Wellcome Trust Brenner Building, St James University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | | | - Leslie Samuel
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - Bruce Sizer
- Colchester General Hospital, Turner Road, Colchester CO4 5JL, UK
| | - Jane Worlding
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Katie Southward
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Gemma Hemmings
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Emma Tinkler-Hundal
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Morag Taylor
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Daniel Bottomley
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Philip Chambers
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - Emma Lawrie
- Cancer Research UK & UCL Cancer Trials Centre, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Andre Lopes
- Cancer Research UK & UCL Cancer Trials Centre, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK
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Mitra S, Chilton C, Freeman J, Wood H, Quirke P, Taylor M, Vickers R, Wilcox M. Preservation of Gut Microbiome Following Ridinilazole vs. Fidaxomicin Treatment of Clostridium difficile Infection. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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Seligmann J, Wood H, Richman S, Elliott F, Taylor M, Tinkler-Hundal E, Barrett J, Seymour M, Quirke P. Epidermal growth factor receptor (EGFR) copy number (CN) as a biomarker of prognosis and panitumumab (Pan) benefit in RAS-wt advanced colorectal cancer (aCRC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Lugli A, Kirsch R, Ajioka Y, Bosman F, Cathomas G, Dawson H, El Zimaity H, Fléjou JF, Hansen TP, Hartmann A, Kakar S, Langner C, Nagtegaal I, Puppa G, Riddell R, Ristimäki A, Sheahan K, Smyrk T, Sugihara K, Terris B, Ueno H, Vieth M, Zlobec I, Quirke P. Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016. Mod Pathol 2017; 30:1299-1311. [PMID: 28548122 DOI: 10.1038/modpathol.2017.46] [Citation(s) in RCA: 571] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 02/07/2023]
Abstract
Tumor budding is a well-established independent prognostic factor in colorectal cancer but a standardized method for its assessment has been lacking. The primary aim of the International Tumor Budding Consensus Conference (ITBCC) was to reach agreement on an international, evidence-based standardized scoring system for tumor budding in colorectal cancer. The ITBCC included nine sessions with presentations, a pre-meeting survey and an e-book covering the key publications on tumor budding in colorectal cancer. The 'Grading of Recommendation Assessment, Development and Evaluation' method was used to determine the strength of recommendations and quality of evidence. The following 10 statements achieved consensus: tumor budding is defined as a single tumor cell or a cell cluster consisting of four tumor cells or less (22/22, 100%). Tumor budding is an independent predictor of lymph node metastases in pT1 colorectal cancer (23/23, 100%). Tumor budding is an independent predictor of survival in stage II colorectal cancer (23/23, 100%). Tumor budding should be taken into account along with other clinicopathological features in a multidisciplinary setting (23/23, 100%). Tumor budding is counted on H&E (19/22, 86%). Intratumoral budding exists in colorectal cancer and has been shown to be related to lymph node metastasis (22/22, 100%). Tumor budding is assessed in one hotspot (in a field measuring 0.785 mm2) at the invasive front (22/22, 100%). A three-tier system should be used along with the budding count in order to facilitate risk stratification in colorectal cancer (23/23, 100%). Tumor budding and tumor grade are not the same (23/23, 100%). Tumor budding should be included in guidelines/protocols for colorectal cancer reporting (23/23, 100%). Members of the ITBCC were able to reach strong consensus on a single international, evidence-based method for tumor budding assessment and reporting. It is proposed that this method be incorporated into colorectal cancer guidelines/protocols and staging systems.
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Affiliation(s)
| | - Richard Kirsch
- Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Fred Bosman
- University Institute of Pathology, Lausanne University Medical Center, Lausanne, Switzerland
| | - Gieri Cathomas
- Institute of Pathology, Kantonsspital Liestal, Liestal, Switzerland
| | - Heather Dawson
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Jean-François Fléjou
- Pathology Department, Saint-Antoine Hospital, Pierre et Marie Curie University, Paris, France
| | - Tine Plato Hansen
- Department of Pathology, Copenhagen University Hospital, Herlev, Denmark
| | - Arndt Hartmann
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Sanjay Kakar
- Department of Anatomic Pathology, University of California, San Francisco, CA, USA
| | - Cord Langner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Iris Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giacomo Puppa
- Department of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Robert Riddell
- Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ari Ristimäki
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kieran Sheahan
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - Thomas Smyrk
- Divisions of Anatomic Pathology and Mayo Clinic, Rochester, MN, USA
| | - Kenichi Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Benoît Terris
- Pathology Department, Hôpital Cochin and Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Phil Quirke
- Pathology and Tumour Biology, University of Leeds, St James's University Hospital, Leeds, UK
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Glynne-Jones R, Hall M, Pearce S, Bosompem S, Bridgewater J, Chau I, Wasan H, Moran B, Beare S, Lopes A, West N, Quirke P, Wong WL, Harrison M. BACCHUS: A randomised study of neoadjuvant chemotherapy alone in patients with high-risk locally advanced rectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Monahan KJ, Alsina D, Bach S, Buchanan J, Burn J, Clark S, Dawson P, De Souza B, Din FVN, Dolwani S, Dunlop MG, East J, Evans DG, Fearnhead N, Frayling IM, Glynne-Jones R, Hill J, Houlston R, Hull M, Lalloo F, Latchford A, Lishman S, Quirke P, Rees C, Rutter M, Sasieni P, Senapati A, Speake D, Thomas H, Tomlinson I. Urgent improvements needed to diagnose and manage Lynch syndrome. BMJ 2017; 356:j1388. [PMID: 28320700 DOI: 10.1136/bmj.j1388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kevin J Monahan
- Family History of Bowel Cancer Clinic, West Middlesex University Hospital, Chelsea and Westminster Hospitals NHS Trust; Imperial College London, London, UK
| | | | | | | | | | | | - Peter Dawson
- Association of Coloproctology for Great Britain and Ireland
| | | | | | - Sunil Dolwani
- Cardiff University and Welsh Association of Gastroenterology and Endoscopy
| | - Malcolm G Dunlop
- Colon Cancer Genetics Group and Academic Coloproctology, Institute of Genetics and Molecular Medicine
| | | | | | - Nicola Fearnhead
- Cambridge University Hospitals NHS Foundation Trust and Association of Coloproctology of Great Britain and Ireland
| | | | | | | | | | - Mark Hull
- University of Leeds and Leeds Teaching Hospitals NHS Trust
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - Huw Thomas
- St Mark's Hospital, Imperial College London
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Seligmann JF, Fisher D, Smith CG, Richman SD, Elliott F, Brown S, Adams R, Maughan T, Quirke P, Cheadle J, Seymour M, Middleton G. Investigating the poor outcomes of BRAF-mutant advanced colorectal cancer: analysis from 2530 patients in randomised clinical trials. Ann Oncol 2017; 28:562-568. [PMID: 27993800 DOI: 10.1093/annonc/mdw645] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To improve strategies for the treatment of BRAF-mutant advanced colorectal cancer (aCRC) patients, we examined individual data from patients treated with chemotherapy alone in three randomised trials to identify points on the treatment pathway where outcomes differ from BRAF wild-types. Patients and methods 2530 aCRC patients were assessed from three randomised trials. End-points were progression-free survival, response rate, disease control rate, post-progression survival (P-PS) and overall survival. Treatments included first-line oxaliplatin/fluorouracil (OxFU) and second-line irinotecan. Clinicians were unaware of BRAF-status. Results 231 patients (9.1%) had BRAF-mutant tumours. BRAF-mutation conferred significantly worse survival independent of associated clinicopathological factors known to be prognostic. Compared with wild-type, BRAF-mutant patients treated with first-line OxFU had similar DCR (59.2% versus 72%; adjusted OR = 0.76, P = 0.24) and PFS (5.7 versus 6.3 months; adjusted HR = 1.14, P = 0.26). Following progression on first-line chemotherapy, BRAF-mutant patients had a markedly shorter P-PS (4.2 versus 9.2 months, adjusted HR = 1.69, P < 0.001). Fewer BRAF-mutant patients received second-line treatment (33% versus 51%, P < 0.001), but BRAF-mutation was not associated with inferior second-line outcomes (RR adjusted OR = 0.56, P = 0.45; PFS adjusted HR = 1.01, P = 0.93). Significant clinical heterogeneity within the BRAF-mutant population was observed: a proportion (24.3%) had good first-line PFS and P-PS (both >6 months; OS = 24.0 months); however, 36.5% progressed rapidly through first-line chemotherapy and thereafter, with OS = 4.7 months. Conclusions BRAF-mutant aCRC confers a markedly worse prognosis independent of associated clinicopathological features. Chemotherapy provides meaningful improvements in outcome throughout treatment lines. Post-progression survival is markedly worse and vigilance is required to ensure appropriate delivery of treatment after first-line progression.
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Affiliation(s)
- J F Seligmann
- Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Leeds, UK
| | - D Fisher
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - C G Smith
- Institute of Medical Genetics, Institute of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - S D Richman
- Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Leeds, UK
| | - F Elliott
- Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Leeds, UK
| | - S Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - R Adams
- Institute of Medical Genetics, Institute of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - P Quirke
- Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Leeds, UK
| | - J Cheadle
- Institute of Medical Genetics, Institute of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - M Seymour
- Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Leeds, UK
| | - G Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham and University Hospital Birmingham, UK
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Harris DA, Thorne K, Hutchings H, Islam S, Holland G, Hatcher O, Gwynne S, Jenkins I, Coyne P, Duff M, Feldman M, Winter DC, Gollins S, Quirke P, West N, Brown G, Fitzsimmons D, Brown A, Beynon J. Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR). BMJ Open 2016; 6:e012496. [PMID: 27872117 PMCID: PMC5129046 DOI: 10.1136/bmjopen-2016-012496] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION There are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT. A more selective approach to RT may be appropriate given the associated toxicity. METHODS AND ANALYSIS This trial will explore the feasibility of a definitive trial evaluating the omission of RT in resectable low rectal cancer requiring APER. It will test the feasibility of randomising patients to (1) standard care (neoadjuvant long course RT±chemotherapy and APER, or (2) APER surgery alone for cT2/T3ab N0/1 low rectal cancer with clear predicted resection margins on MRI. RT schedule will be 45 Gy over 5 weeks as current standard, with restaging and surgery after 8-12 weeks. Recruitment will be for 24 months with a minimum 12-month follow-up. OBJECTIVES Objectives include testing the ability to recruit, consent and retain patients, to quantify the number of patients eligible for a definitive trial and to test feasibility of outcomes measures. These include locoregional recurrence rates, distance to circumferential resection margin, toxicity and surgical complications including perineal wound healing, quality of life and economic analysis. The quality of MRI staging, RT delivery and surgical specimen quality will be closely monitored. ETHICS AND DISSEMINATION The trial is approved by the Regional Ethics Committee and Health Research Authority (HRA) or equivalent. Written informed consent will be obtained. Serious adverse events will be reported to Swansea Trials Unit (STU), the ethics committee and trial sites. Trial results will be submitted for peer review publication and to trial participants. TRIAL REGISTRATION NUMBER ISRCTN02406823.
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Affiliation(s)
- Dean A Harris
- Department of Colorectal Surgery, Singleton Hospital, Swansea, UK
| | | | | | - Saiful Islam
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Gail Holland
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Olivia Hatcher
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - Sarah Gwynne
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - Ian Jenkins
- Department of Colorectal Surgery, St Marks Hospital, London, UK
| | - Peter Coyne
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle, UK
| | - Michael Duff
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - Melanie Feldman
- Department of Colorectal Surgery, Royal Cornwall Hospital, Truro, UK
| | - Des C Winter
- Department of Colorectal Surgery, St Vincent's Hospital, Dublin, Ireland
| | - Simon Gollins
- Department of Oncology, North Wales Cancer Treatment Centre, Rhyl, UK
| | - Phil Quirke
- Pathology and Tumour Biology, Leeds Institute of Oncology and Pathology, Wellcome Trust Brenner Building, St James Hospital, Leeds, UK
| | - Nick West
- Pathology and Tumour Biology, Leeds Institute of Oncology and Pathology, Wellcome Trust Brenner Building, St James Hospital, Leeds, UK
| | - Gina Brown
- Department of Radiology, Royal Marsden Hospital, London, UK
| | | | - Alan Brown
- Involving People Network, Health and Care Research Wales
| | - John Beynon
- Department of Colorectal Surgery, Singleton Hospital, Swansea, UK
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Aravani A, Samy EF, Thomas JD, Quirke P, Morris EJ, Finan PJ. A retrospective observational study of length of stay in hospital after colorectal cancer surgery in England (1998-2010). Medicine (Baltimore) 2016; 95:e5064. [PMID: 27893655 PMCID: PMC5134848 DOI: 10.1097/md.0000000000005064] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The National Health Service (NHS) is facing financial constraints and thus there is considerable interest in ensuring the shortest but optimal hospital stays possible. The aim of this study was to investigate patterns of postoperative length of stay (LOS) stay across the English NHS and to identify factors that significantly influence both optimal and prolonged LOS.Data were obtained from the National Cancer Data Repository (NCDR). National patterns of LOS were examined and multilevel mixed effects logistic regression was used to study factors associated with an "ideal" (≤5 days) or a prolonged (≥21 days) LOS in hospital after major resection. Funnel plots were used to examine variation across hospitals in both risk-adjusted and unadjusted LOS.All 240,873 individuals who underwent major resection for colorectal cancer were diagnosed between 1998 and 2010 in the English NHS. The overall median LOS was 10 (interquartile range [IQR] 7-14 days) days, but it fell over time from 11 (IQR 9-15) days in 1998 to 7 (IQR 5-12) days in 2010. The proportion of people experiencing "ideal" LOS increased dramatically from 4.9% in 1998 to 34.2% in 2010, but the decrease in the proportion of patients who experienced a prolonged LOS was less marked falling from 11.2% to 8.4%, respectively. Control charts showed that there was significant variation in short and prolonged LOS across NHS trusts even after adjustment for case-mix.Significant variation in LOS existed between NHS hospitals in England throughout period 1998 to 2010. Understanding the underlying causes of this variation between surgical providers will make it possible to identify and spread best practice, improve services, and ultimately reduce LOS following colorectal cancer surgery.
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Affiliation(s)
- Ariadni Aravani
- Cancer Epidemiology Group, Section of Epidemiology and Biostatistics, Leeds Institute of Cancer & Pathology, University of Leeds
| | | | - James D. Thomas
- National Cancer Registration Service (Northern & Yorkshire), Public Health England
| | - Phil Quirke
- Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - Eva J.A. Morris
- Cancer Epidemiology Group, Section of Epidemiology and Biostatistics, Leeds Institute of Cancer & Pathology, University of Leeds
| | - Paul J. Finan
- Cancer Epidemiology Group, Section of Epidemiology and Biostatistics, Leeds Institute of Cancer & Pathology, University of Leeds
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Adams R, Brown E, Brown L, Butler R, Falk S, Fisher D, Kaplan R, Quirke P, Richman S, Samuel L, Seligmann J, Seymour M, Shiu K, Wasan H, Wilson R, Maughan T. FOCUS4-D: Results from a randomised, placebo controlled trial (RCT) of AZD8931 (an inhibitor of signalling by HER1, 2, and 3) in patients (pts) with advanced or metastatic colorectal cancer (aCRC) in tumours that are wildtype (wt) for BRAF, PIK3CA, KRAS & NRAS. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Morris EJA, Finan PJ, Spencer K, Geh I, Crellin A, Quirke P, Thomas JD, Lawton S, Adams R, Sebag-Montefiore D. Wide Variation in the Use of Radiotherapy in the Management of Surgically Treated Rectal Cancer Across the English National Health Service. Clin Oncol (R Coll Radiol) 2016; 28:522-531. [PMID: 26936609 PMCID: PMC4944647 DOI: 10.1016/j.clon.2016.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
Abstract
AIMS Radiotherapy is an important treatment modality in the multidisciplinary management of rectal cancer. It is delivered both in the neoadjuvant setting and postoperatively, but, although it reduces local recurrence, it does not influence overall survival and increases the risk of long-term complications. This has led to a variety of international practice patterns. These variations can have a significant effect on commissioning, but also future clinical research. This study explores its use within the large English National Health Service (NHS). MATERIALS AND METHODS Information on all individuals diagnosed with a surgically treated rectal cancer between April 2009 and December 2010 were extracted from the Radiotherapy Dataset linked to the National Cancer Data Repository. Individuals were grouped into those receiving no radiotherapy, short-course radiotherapy with immediate surgery (SCRT-I), short-course radiotherapy with delayed surgery (SCRT-D), long-course chemoradiotherapy (LCCRT), other radiotherapy (ORT) and postoperative radiotherapy (PORT). Patterns of use were then investigated. RESULTS The study consisted of 9201 individuals; 4585 (49.3%) received some form of radiotherapy. SCRT-I was used in 12.1%, SCRT-D in 1.2%, LCCRT in 29.5%, ORT in 4.7% and PORT in 2.3%. Radiotherapy was used more commonly in men and in those receiving an abdominoperineal excision and less commonly in the elderly and those with comorbidity. Significant and substantial variations were also seen in its use across all the multidisciplinary teams managing this disease. CONCLUSION Despite the same evidence base, wide variation exists in both the use of and type of radiotherapy delivered in the management of rectal cancer across the English NHS. Prospective population-based collection of local recurrence and patient-reported early and late toxicity information is required to further improve patient selection for preoperative radiotherapy.
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Affiliation(s)
- E J A Morris
- Cancer Epidemiology Group, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK.
| | - P J Finan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK; National Cancer Intelligence Network, London, UK
| | - K Spencer
- Cancer Epidemiology Group, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK; Non-Surgical Oncology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - I Geh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham, UK
| | - A Crellin
- Non-Surgical Oncology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - P Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - J D Thomas
- National Cancer Registration Service, Northern and Yorkshire Office, St James's Institute of Oncology, St James's University Hospital, Leeds, UK; Knowledge and Intelligence Team (Northern and Yorkshire), St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - S Lawton
- Knowledge and Intelligence Team (Northern and Yorkshire), St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - R Adams
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - D Sebag-Montefiore
- Section of Clinical Oncology, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
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Kraima AC, West NP, Treanor D, Magee D, Roberts N, van de Velde CJH, DeRuiter MC, Quirke P, Rutten HJT. The anatomy of the perineal body in relation to abdominoperineal excision for low rectal cancer. Colorectal Dis 2016; 18:688-95. [PMID: 26407538 DOI: 10.1111/codi.13138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/24/2015] [Indexed: 02/08/2023]
Abstract
AIM Dissection of the perineal body (PB) during abdominoperineal excision (APE) for low rectal cancer is often difficult due to the lack of a natural plane of dissection. Understanding the PB and its relation to the anorectum is essential to permit safe dissection during the perineal phase of the operation and avoid damage to the anorectum and urogenital organs. This study describes the anatomy and histology of the PB relevant to APE. METHOD Six human adult cadaver pelvic exenteration specimens (three male, three female) from the Leeds GIFT Research Tissue Programme were studied. Paraffin-embedded mega-blocks were produced and serially sectioned at 50- and 250-μm intervals. Sections were stained by immunohistochemistry to show collagen, elastin and smooth muscle. RESULTS The PB was cylindrically shaped in the male specimens and wedge-shaped in the female ones. Although centrally located between the anal and urogenital triangles, it was nearly completely formed by muscle fibres derived from the rectal muscularis propria. Thick bundles of smooth muscle, mostly arising from the longitudinal muscle, inserted into the PB and levator ani muscle (LAM). The recto-urethralis muscle originated from the PB and separated the anterolateral PB from the urogenital organs. CONCLUSION Smooth muscle fibres derived from the rectal muscularis propria extend into the PB and LAM and appear to fix the anorectum. Dissection of the PB during APE is safe only when the smooth muscle fibres that extend into the PB are divided.
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Affiliation(s)
- A C Kraima
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D Treanor
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D Magee
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - N Roberts
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - P Quirke
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - H J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Hill EJ, Roberts C, Franklin JM, Enescu M, West N, MacGregor TP, Chu KY, Boyle L, Blesing C, Wang LM, Mukherjee S, Anderson EM, Brown G, Dutton S, Love SB, Schnabel JA, Quirke P, Muschel R, McKenna WG, Partridge M, Sharma RA. Clinical Trial of Oral Nelfinavir before and during Radiation Therapy for Advanced Rectal Cancer. Clin Cancer Res 2016; 22:1922-31. [PMID: 26861457 PMCID: PMC4835023 DOI: 10.1158/1078-0432.ccr-15-1489] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/28/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Nelfinavir, a PI3K pathway inhibitor, is a radiosensitizer that increases tumor blood flow in preclinical models. We conducted an early-phase study to demonstrate the safety of nelfinavir combined with hypofractionated radiotherapy (RT) and to develop biomarkers of tumor perfusion and radiosensitization for this combinatorial approach. EXPERIMENTAL DESIGN Ten patients with T3-4 N0-2 M1 rectal cancer received 7 days of oral nelfinavir (1,250 mg b.i.d.) and a further 7 days of nelfinavir during pelvic RT (25 Gy/5 fractions/7 days). Perfusion CT (p-CT) and DCE-MRI scans were performed pretreatment, after 7 days of nelfinavir and prior to the last fraction of RT. Biopsies taken pretreatment and 7 days after the last fraction of RT were analyzed for tumor cell density (TCD). RESULTS There were 3 drug-related grade 3 adverse events: diarrhea, rash, and lymphopenia. On DCE-MRI, there was a mean 42% increase in medianKtrans, and a corresponding median 30% increase in mean blood flow on p-CT during RT in combination with nelfinavir. Median TCD decreased from 24.3% at baseline to 9.2% in biopsies taken 7 days after RT (P= 0.01). Overall, 5 of 9 evaluable patients exhibited good tumor regression on MRI assessed by tumor regression grade (mrTRG). CONCLUSIONS This is the first study to evaluate nelfinavir in combination with RT without concurrent chemotherapy. It has shown that nelfinavir-RT is well tolerated and is associated with increased blood flow to rectal tumors. The efficacy of nelfinavir-RT versus RT alone merits clinical evaluation, including measurement of tumor blood flow.
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Affiliation(s)
- Esme J Hill
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Corran Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie M Franklin
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Monica Enescu
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Nicholas West
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Thomas P MacGregor
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Kwun-Ye Chu
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Lucy Boyle
- Oncology Clinical Trials Office (OCTO), Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Claire Blesing
- Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom
| | - Lai-Mun Wang
- Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom
| | - Somnath Mukherjee
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ewan M Anderson
- Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom
| | - Gina Brown
- Radiology Department, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Susan Dutton
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sharon B Love
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Julia A Schnabel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Phil Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Ruth Muschel
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - William G McKenna
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Michael Partridge
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Ricky A Sharma
- Oxford Cancer Imaging Centre and NIHR Oxford Biomedical Research Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom.
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Richman SD, Adams R, Quirke P, Butler R, Hemmings G, Chambers P, Roberts H, James MD, Wozniak S, Bathia R, Pugh C, Maughan T, Jasani B. Pre-trial inter-laboratory analytical validation of the FOCUS4 personalised therapy trial. J Clin Pathol 2016; 69:35-41. [PMID: 26350752 PMCID: PMC4717430 DOI: 10.1136/jclinpath-2015-203097] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/03/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Molecular characterisation of tumours is increasing personalisation of cancer therapy, tailored to an individual and their cancer. FOCUS4 is a molecularly stratified clinical trial for patients with advanced colorectal cancer. During an initial 16-week period of standard first-line chemotherapy, tumour tissue will undergo several molecular assays, with the results used for cohort allocation, then randomisation. Laboratories in Leeds and Cardiff will perform the molecular testing. The results of a rigorous pre-trial inter-laboratory analytical validation are presented and discussed. METHODS Wales Cancer Bank supplied FFPE tumour blocks from 97 mCRC patients with consent for use in further research. Both laboratories processed each sample according to an agreed definitive FOCUS4 laboratory protocol, reporting results directly to the MRC Trial Management Group for independent cross-referencing. RESULTS Pyrosequencing analysis of mutation status at KRAS codons12/13/61/146, NRAS codons12/13/61, BRAF codon600 and PIK3CA codons542/545/546/1047, generated highly concordant results. Two samples gave discrepant results; in one a PIK3CA mutation was detected only in Leeds, and in the other, a PIK3CA mutation was only detected in Cardiff. pTEN and mismatch repair (MMR) protein expression was assessed by immunohistochemistry (IHC) resulting in 6/97 discordant results for pTEN and 5/388 for MMR, resolved upon joint review. Tumour heterogeneity was likely responsible for pyrosequencing discrepancies. The presence of signet-ring cells, necrosis, mucin, edge-effects and over-counterstaining influenced IHC discrepancies. CONCLUSIONS Pre-trial assay analytical validation is essential to ensure appropriate selection of patients for targeted therapies. This is feasible for both mutation testing and immunohistochemical assays and must be built into the workup of such trials. TRIAL REGISTRATION NUMBER ISRCTN90061564.
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Affiliation(s)
- Susan D Richman
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Richard Adams
- Institute of Cancer & Genetics, Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Phil Quirke
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Rachel Butler
- Cardiff and Vale UHB-Medical Genetics University Hospital of Wales, Heath Park, Cardiff, UK
| | - Gemma Hemmings
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Phil Chambers
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Helen Roberts
- Cardiff and Vale UHB-Medical Genetics University Hospital of Wales, Heath Park, Cardiff, UK
| | - Michelle D James
- Cardiff and Vale UHB- Histopathology University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sue Wozniak
- Cardiff and Vale UHB- Histopathology University Hospital of Wales, Heath Park, Cardiff, UK
| | | | | | - Timothy Maughan
- Gray Laboratories, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Bharat Jasani
- Institute of Cancer and Genetics, Heath Park, Cardiff, UK
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Glynne-Jones R, Hava N, Goh V, Bosompem S, Bridgewater J, Chau I, Gaya A, Wasan H, Moran B, Melcher L, MacDonald A, Osborne M, Beare S, Jitlal M, Lopes A, Hall M, West N, Quirke P, Wong WL, Harrison M. Bevacizumab and Combination Chemotherapy in rectal cancer Until Surgery (BACCHUS): a phase II, multicentre, open-label, randomised study of neoadjuvant chemotherapy alone in patients with high-risk cancer of the rectum. BMC Cancer 2015; 15:764. [PMID: 26493588 PMCID: PMC4619031 DOI: 10.1186/s12885-015-1764-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/10/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In locally advanced rectal cancer (LARC) preoperative chemoradiation (CRT) is the standard of care, but the risk of local recurrence is low with good quality total mesorectal excision (TME), although many still develop metastatic disease. Current challenges in treating rectal cancer include the development of effective organ-preserving approaches and the prevention of subsequent metastatic disease. Neoadjuvant systemic chemotherapy (NACT) alone may reduce local and systemic recurrences, and may be more effective than postoperative treatments which often have poor compliance. Investigation of intensified NACT is warranted to improve outcomes for patients with LARC. The objective is to evaluate feasibility and efficacy of a four-drug regimen containing bevacizumab prior to surgical resection. METHODS/DESIGN This is a multi-centre, randomized phase II trial. Eligible patients must have histologically confirmed LARC with distal part of the tumour 4-12 cm from anal verge, no metastases, and poor prognostic features on pelvic MRI. Sixty patients will be randomly assigned in a 1:1 ratio to receive folinic acid + flurourcil + oxaliplatin (FOLFOX) + bevacizumab (BVZ) or FOLFOX + irinotecan (FOLFOXIRI) + BVZ, given in 2 weekly cycles for up to 6 cycles prior to TME. Patients stop treatment if they fail to respond after 3 cycles (defined as ≥ 30 % decrease in Standardised Uptake Value (SUV) compared to baseline PET/CT). The primary endpoint is pathological complete response rate. Secondary endpoints include objective response rate, MRI tumour regression grade, involved circumferential resection margin rate, T and N stage downstaging, progression-free survival, disease-free survival, overall survival, local control, 1-year colostomy rate, acute toxicity, compliance to chemotherapy. DISCUSSION In LARC, a neoadjuvant chemotherapy regimen - if feasible, effective and tolerable would be suitable for testing as the novel arm against the current standards of short course preoperative radiotherapy (SCPRT) and/or fluorouracil (5FU)-based CRT in a future randomised phase III trial. TRIAL REGISTRATION Clinical trial identifier BACCHUS: NCT01650428.
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Affiliation(s)
- R Glynne-Jones
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
| | - N Hava
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - V Goh
- Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, SE1 7EH, UK
| | - S Bosompem
- Pharmacy, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - J Bridgewater
- University College, London Cancer Institute, 72 Huntley St., London, WC1E 6AA, UK
| | - I Chau
- Department of Medical Oncology, Royal Marsden Hospital, London & Surrey, UK
| | - A Gaya
- Radiotherapy Department, Guys and St Thomas's Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - H Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - B Moran
- Department of Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - L Melcher
- Radiotherapy Department, Beatson Oncology Centre, 1053 Great Western Rd, Glasgow G12 0YN, UK
| | - A MacDonald
- Radiotherapy Department, North Middlesex Hospital, Sterling Way, London N18 1QX, UK
| | - M Osborne
- Radiotherapy Department, Royal Devon & Exeter Hospital, Barrack Rd, Exeter, Devon EX2 5DW, UK
| | - S Beare
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M Jitlal
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - A Lopes
- Cancer Research UK & University College London Cancer Trials Centre, London, UK
| | - M Hall
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - N West
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - P Quirke
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Wai-Lup Wong
- Department of Radiology, Paul Strickland Scanner Centre, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - M Harrison
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
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Kraima AC, West NP, Treanor D, Magee DR, Bleys RLAW, Rutten HJT, van de Velde CJH, Quirke P, DeRuiter MC. Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves. Eur J Surg Oncol 2015; 41:1621-9. [PMID: 26422586 DOI: 10.1016/j.ejso.2015.08.166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 05/06/2015] [Revised: 08/07/2015] [Accepted: 08/17/2015] [Indexed: 12/13/2022] Open
Abstract
AIM Excellent understanding of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, fasciae anterolateral to the rectum and surrounding the low rectum are still poorly understood. We studied the perirectal fascia enfolding the extraperitoneally located part of the rectum in en-bloc cadaveric specimens and the University Medical Center Utrecht (UMCU) pelvic dataset, and describe implications for TME. METHODS Four donated human adult cadaveric specimens (two males, two females) were obtained through the Leeds GIFT Research Tissue Programme. Paraffin-embedded blocks were produced and serially sectioned at 50 and 250 μm intervals. Whole mount sections were stained with haematoxylin & eosin, Masson's trichrome and Millers' elastin. Additionally, the UMCU pelvic dataset including digitalised cryosections of a female pelvis in three axes was studied. RESULTS The mid and lower rectum were surrounded by a multi-layered perirectal fascia, of which the mesorectal fascia (MRF) and parietal fascia bordered the 'holy plane'. There was no extra constant fascia forming a potential surgical plane. Nerves ran laterally to the MRF. More caudally, the mesorectal fat strongly reduced and the MRF approached the rectal muscularis propria. The MRF had a variable appearance in terms of thickness and completeness, most prominently at the anterolateral lower rectum. CONCLUSION Dissection onto the MRF allows nerve preservation in TME. Rectal surgeons are challenged in doing so as the MRF varies in thickness and shows gaps, most prominently at the anterolateral lower rectum. At this site, the risk of entering the mesorectum is great and may result in an incomplete specimen.
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Affiliation(s)
- A C Kraima
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands; Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D Treanor
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D R Magee
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P Quirke
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - M C DeRuiter
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
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Kraima A, Smit N, Jansma D, Eisemann E, Park H, Chung M, West N, Quirke P, Rutten H, Vilanova A, Velde CVD, DeRuiter M. 2087 The development of a 3D anatomical atlas of the pelvis: Taking the next step in enhancing surgical anatomical education and clinical guidance. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31009-7] [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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Foster JM, Oumie A, Togneri FS, Taylor M, Alyas S, Wojtowicz P, Wood H, Tinkler-Hundal E, Southward K, McMullan D, Quirke P, Keating KE, Griffiths M, Spink KG, Brew F, Fung E, Schmidt J. Abstract 626: Cross-site reproducibility and orthogonal validation of copy number and somatic mutation calls of OncoScan® FFPE Assay Kit in solid tumors. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-626] [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
Objectives
Copy number (CN) and somatic mutation (SM) analysis in tumors is rapidly gaining importance in cancer management as a tool for differential diagnosis, determination of prognosis, and selection of therapeutic. Genome-wide copy number and LOH detection as well as a panel of frequently tested somatic mutations can be detected with OncoScan® FFPE Assay Kit. We report on a validation study of OncoScan FFPE Assay Kit CN and SM data by orthogonal technologies (FISH and NGS, respectively) to estimate the sensitivity and specificity parameters of the platform. In addition, we assessed the reproducibility of the platform across three different sites in the UK: Leeds Institute of Cancer and Pathology (LICP), West Midlands Regional Genetics Laboratory (WMRGL), and Almac Diagnostics (Almac).
Methods
Validation of CN data was performed on a cohort of cancer samples identified as Her2 positive/ambiguous by FISH. The panel of SMs available was validated by a custom targeted amplicon NGS panel on a diverse collection of samples derived from multiple cohorts across several tumor types sourced from both LICP and WMRGL. For the reproducibility study, 162 samples encompassing six different tumor types (breast, colorectal, lung, melanoma, prostate, and ovarian) were collected from LICP and WMRGL. DNA was extracted and plated in triplicate and distributed to the three testing sites: LICP, WMRGL, and Almac. Data from all sites was analyzed for reproducibility of genome-wide CN/LOH calls and SM calls.
Results
Cross-site comparisons of genome-wide CN and LOH profiles on 162 FFPE solid tumor samples showed greater than 95% average agreement between three sites (LICP, WMGRL, and Almac), while SM classification concordance between the sites averaged 97%. Initial orthogonal validation of Her2 amplification by FISH showed greater than 90% concordance, as did initial test samples used for validating OncoScan SM calls by a targeted amplicon NGS panel.
Conclusion
In this study we validated both CN and SM calls using OncoScan FFPE Assay Kit and demonstrated a high degree of agreement with orthogonal methods in all aspects. Reproducibility of whole-genome CN, LOH, and SM data using OncoScan FFPE Assay Kit has also been demonstrated for a range of FFPE samples, including highly degraded samples. This study is a step forward in evaluating the potential clinical utility of a platform combining genome-wide copy number and somatic mutation calls within the national health service of the UK.
Citation Format: Joseph M. Foster, Assa Oumie, Fiona S. Togneri, Morag Taylor, Sofia Alyas, Paula Wojtowicz, Henry Wood, Emma Tinkler-Hundal, Katie Southward, Dominic McMullan, Phil Quirke, Katherine E. Keating, Mike Griffiths, Karen G. Spink, Fiona Brew, Eric Fung, Jeanette Schmidt. Cross-site reproducibility and orthogonal validation of copy number and somatic mutation calls of OncoScan® FFPE Assay Kit in solid tumors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 626. doi:10.1158/1538-7445.AM2015-626
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Affiliation(s)
| | - Assa Oumie
- 1Affymetrix UK Ltd, Wooburn Green, United Kingdom
| | - Fiona S. Togneri
- 2West Midlands Regional Genetics Laboratory, Birmingham, United Kingdom
| | - Morag Taylor
- 3Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Sofia Alyas
- 2West Midlands Regional Genetics Laboratory, Birmingham, United Kingdom
| | - Paula Wojtowicz
- 2West Midlands Regional Genetics Laboratory, Birmingham, United Kingdom
| | - Henry Wood
- 3Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | | | - Katie Southward
- 3Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Dominic McMullan
- 2West Midlands Regional Genetics Laboratory, Birmingham, United Kingdom
| | - Phil Quirke
- 3Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | | | - Mike Griffiths
- 2West Midlands Regional Genetics Laboratory, Birmingham, United Kingdom
| | | | - Fiona Brew
- 1Affymetrix UK Ltd, Wooburn Green, United Kingdom
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