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Virk S, Arora H, Patil P, Sarang B, Khajanchi M, Bains L, Kizhakke DV, Jain S, Nathani P, Dev Y, Gadgil A, Roy N. An Indian surgeon's perspective on management of asymptomatic gallstones. Asian J Endosc Surg 2024; 17:e13297. [PMID: 38439130 DOI: 10.1111/ases.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Cholelithiasis is widely prevalent in India, with a majority of patients being asymptomatic while a small proportion experiencing mild complications. In the laparoscopic era, the rate of cholecystectomies has increased owing to early recovery and fewer complications. In asymptomatic patients, the risk of complications must be balanced against the treatment benefit. Recent guidelines suggest no prophylactic cholecystectomy in asymptomatic patients. We aimed to find out the Indian surgeons' perspective on asymptomatic gallstone management. METHODS A cross-sectional e-survey was conducted of practicing surgeons, onco-surgeons and gastrointestinal-surgeons in India. The survey had questions regarding their perspective on laparoscopic cholecystectomy and treatment modalities in asymptomatic gallstones. RESULTS A total of 196 surgeons responded to the survey. Their mean age was 42.3 years. Overall, 111 (57%) respondents worked in the private sector. Most surgeons (164) agreed that the rate of cholecystectomy has increased since the advent of laparoscopy; 137 (70%) respondents agreed that they would not operate on patients without risk factors. Common bile duct stones, chronic hemolytic diseases, transplant recipients, and diabetes mellitus were the risk factors. Majority of the participants agreed on not performing a cholecystectomy in patients with asymptomatic gallstones. CONCLUSION There exists a lack of consensus among Indian surgeons on asymptomatic gallstone management in India. Where the majority of cases are asymptomatic and do not require surgery, certain comorbidities can influence the line of treatment in individual patients. Currently, the treatment guidelines for asymptomatic patients need to be established as cholecystectomies may be overperformed due to the fear of development of complications.
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Affiliation(s)
- Sargun Virk
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Anesthesiology, Weill Cornell School of Medicine, New York, New York, USA
| | - Harshit Arora
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Priti Patil
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Bhabha Atomic Research Centre (BARC) and Hospital, Mumbai, India
| | - Bhakti Sarang
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Terna Medical College, Navi Mumbai, India
| | - Monty Khajanchi
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
| | - Lovenish Bains
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Deepa Veetil Kizhakke
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Surgery, Manipal Hospital, New Delhi, India
| | - Samarvir Jain
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, India
| | - Priyansh Nathani
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
| | - Ya Dev
- Department of Surgery, Government Medical College, Trivandrum, India
| | - Anita Gadgil
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of General Surgery, Bhabha Atomic Research Centre (BARC) and Hospital, Mumbai, India
| | - Nobhojit Roy
- Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Raykar NP, Raguveer V, Abdella YE, Ali-Awadh A, Arora H, Asamoah-Akuoko L, Barnes LS, Cap AP, Chowdhury A, Cooper Z, Delaney M, DelSignore M, Inam S, Ismavel VA, Jensen K, Kumar N, Lokoel G, Mammen JJ, Nathani P, Nisingizwe MP, Puyana JC, Riviello R, Roy N, Salim A, Tayou-Tagny C, Virk S, Wangamati CW. Innovative blood transfusion strategies to address global blood deserts: a consensus statement from the Blood Delivery via Emerging Strategies for Emergency Remote Transfusion (Blood DESERT) Coalition. Lancet Glob Health 2024; 12:e522-e529. [PMID: 38365422 PMCID: PMC10882207 DOI: 10.1016/s2214-109x(23)00564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
In rural settings worldwide, many people live in effective blood deserts without access to any blood transfusion. The traditional system of blood banking is logistically complex and expensive for many resource-restricted settings and demands innovative and multidisciplinary solutions. 17 international experts in medicine, industry, and policy participated in an exploratory process with a 2-day hybrid seminar centred on three promising innovative strategies for blood transfusions in blood deserts: civilian walking blood banks, intraoperative autotransfusion, and drone-based blood delivery. Participant working groups conducted literature reviews and interviews to develop three white papers focused on the current state and knowledge gaps of each innovation. Seminar discussion focused on defining blood deserts and developing innovation-specific implementation agendas with key research and policy priorities for future work. Moving forward, advocates should prioritise the identification of blood deserts and address the context-specific challenges for these innovations to alleviate the ongoing crisis in blood deserts.
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Affiliation(s)
- Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Asma Ali-Awadh
- Sub-county Langata and Kibera, Nairobi Metropolitan Health Services, Nairobi, Kenya; Sisu Global Health, Baltimore, MD, USA
| | - Harshit Arora
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Asamoah-Akuoko
- Department of Research, Planning, Monitoring, and Evaluation, National Blood Service, Accra, Ghana
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, Houston, TX, USA
| | - Aulina Chowdhury
- Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Meghan Delaney
- Department of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | | | - Sidra Inam
- Allied Hospital Faisalabad, Faisalabad, Pakistan
| | | | - Kennedy Jensen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nikathan Kumar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, USA
| | - Gilchrist Lokoel
- Department of Medical Services, Turkana County Government, Lodwar, Kenya
| | - Joy John Mammen
- Department of Transfusion Medicine, Christian Medical College, Vellore, India
| | - Priyansh Nathani
- Dr RN Cooper Municipal Medical College and General Hospital: Hinduhridaysamrat Balasaheb Thackeray Medical College and Rustom Narsi Cooper Municipal General Hospital, Mumbai, India; WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
| | - Marie Paul Nisingizwe
- Department of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nobhojit Roy
- Operative Care, Clinical Services and Systems, WHO, Geneva, Switzerland
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Claude Tayou-Tagny
- Department of Haematology and Transfusion Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - Sargun Virk
- WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
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Dutta R, Mahajan A, Patil P, Bhandoria G, Sarang B, Virk S, Khajanchi M, Jain S, Bains L, Bhandarkar P, Chatterjee S, Roy N, Gadgil A. Breast Conservative Surgery for Breast Cancer: Indian Surgeon's Preferences and Factors Influencing Them. Indian J Surg Oncol 2023; 14:11-17. [PMID: 36891421 PMCID: PMC9986359 DOI: 10.1007/s13193-022-01601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient's choice, availability and accessibility of infrastructure, and surgeon's choice. We aimed to elucidate the Indian surgeons' perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS. Methods We conducted a survey-based cross-sectional study in January-February 2021. Indian surgeons with general surgical or specialised oncosurgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS. Results A total of 347 responses were included. The mean age of the participants was 43 ± 11 years. Sixty-three of the surgeons were in the 25-44 years age group with the majority (80%) being males. 66.4% of surgeons 'almost always' offered BCS to oncologically eligible patients. Surgeons who had undergone specialised training in oncosurgery or breast conservation surgery were 35 times more likely to offer BCS (p < 0.01). Surgeons working in hospitals with in-house radiation oncology facilities were 9 times more likely to offer BCS (p < 0.05). Surgeons' years of practice, age, sex and hospital setting did not influence the surgery offered. Conclusion Two-thirds of Indian surgeons preferred BCS over mastectomy. Lack of radiotherapy facilities and specialised surgical training were deterrents to offering BCS to eligible women. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01601-y.
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Affiliation(s)
- Rohini Dutta
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Christian Medical College and Hospital, Ludhiana, Punjab India
| | - Anshul Mahajan
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Government Medical College Amritsar, Punjab, India
| | - Priti Patil
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Geetu Bhandoria
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Bhakti Sarang
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Sargun Virk
- Sri Guru Ram Das Institute of Health and Science, Amritsar, Punjab India
| | - Monty Khajanchi
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Samarvir Jain
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Lovenish Bains
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Maulana Azad Medical College, New Delhi, India
| | - Prashant Bhandarkar
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - Shamita Chatterjee
- Institute of Post-Graduate Medical Education & Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Nobhojit Roy
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,Department of Public Health Systems, Karolinska Institute, 171 77 Stockholm, Sweden.,The George Institute for Global Health, New Delhi, India
| | - Anita Gadgil
- World Health Organisation Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.,The George Institute for Global Health, New Delhi, India
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Virk S, Yiannikas J. An Unusual Tricuspid Annular Mass in an Adult With Eisenmenger Syndrome Secondary to Uncorrected Aorto-Pulmonary Window. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.217] [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: 11/25/2022]
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Virk S, Saxena A, Henham P, Jeremy R, Bannon P. The Impact of Pre-Existing Atrial Fibrillation on Outcomes after Percutaneous Mitral Valve Repair. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wu CA, Dutta R, Virk S, Roy N, Ranganathan K. The need for craniofacial trauma and oncologic reconstruction in global surgery. J Oral Biol Craniofac Res 2021; 11:563-567. [PMID: 34430193 DOI: 10.1016/j.jobcr.2021.07.013] [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: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022] Open
Abstract
The global burden of surgical disease is concentrated in low- and middle-income countries and primarily consists of injuries and malignancies. While global reconstructive surgery has a long and well-established history, efforts thus far have been focused on addressing congenital anomalies. Craniofacial trauma and oncologic reconstruction are comparatively neglected despite their higher prevalence. This review explores the burden, management, and treatment gaps of craniofacial trauma and head and neck cancer reconstruction in low-resource settings. We also highlight successful alternative treatments used in low-resource settings and pearls that can be learned from these areas.
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Affiliation(s)
| | - Rohini Dutta
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India.,Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Sargun Virk
- Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Government of India), Mumbai, India
| | - Kavitha Ranganathan
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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Liu X, Robbins S, Eyles J, Fedorova T, Virk S, Deveza LA, McLachlan AJ, Hunter DJ. Efficacy and safety of a supplement combination on hand pain among people with symptomatic hand osteoarthritis an internet-based, randomised clinical trial the RADIANT study. Osteoarthritis Cartilage 2021; 29:667-677. [PMID: 33617972 DOI: 10.1016/j.joca.2021.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/10/2020] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The RADIANT study aimed to investigate the efficacy and safety of a complementary medicine supplement combination in people with hand osteoarthritis (HOA). METHOD This was an internet-based, double-blind, randomised, placebo-controlled trial. Participants aged over 40 years with symptomatic HOA with radiographic confirmation (Kellgren Lawrence grade ≥ 2) throughout Australia were recruited and randomly assigned (1:1) to receive either a supplement combination composed of Boswellia serrata extract 250 mg/day, pine bark extract 100 mg/day, methylsulfonylmethane 1,500 mg/day and curcumin 168 mg/day or placebo for 12 weeks. The primary outcome was change in hand pain assessed using a visual analogue scale (VAS 0-100) from baseline to week 12. A range of secondary outcomes and additional measures were recorded. Adverse events were monitored weekly. RESULTS One hundred and six participants were included with mean age 65.6 years and 81% were women. 45% of the participants were graded as KLG 4, 40% KLG three and 39 (37%) had erosive OA. There was no significant difference in pain VAS reduction between groups. The adjusted between group difference in means (95%CI) was 5.34 (-2.39 to 13.07). Five participants (10%) in the supplement combination group discontinued study treatment due to AE vs four participants (7%) in the placebo group. CONCLUSION There were no significant differences in symptomatic relief between the two groups over 12 weeks. These findings do not support the use of the supplement combination for treating hand pain in people with HOA. REGISTRATION Prospectively registered (Australian New Zealand Clinical Trials Registry ACTRN12619000835145, 31/05/2019).
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Affiliation(s)
- X Liu
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia.
| | - S Robbins
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia.
| | - J Eyles
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia.
| | - T Fedorova
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia.
| | - S Virk
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia.
| | - L A Deveza
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia.
| | - A J McLachlan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia; Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Acs B, Leung SC, Pelekanou V, Bai Y, Martinez-Morilla S, Toki M, Chang MC, Gholap A, Jadhav A, Hugh JC, Bigras G, Laurinavicius A, Augulis R, Levenson R, Todd A, Piper T, Virk S, van der Vegt B, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Abstract P4-02-01: Analytical validation of an automated digital scoring protocol for Ki67: International multicenter collaboration study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background/Goal: Ki67 expression has been a valuable prognostic marker in breast cancer, but has not seen broad adoption due to lack of standardization between institutions. Automation could represent a solution. Here we tested 3 automated digital image analysis (DIA) platforms including an open source platform to: (i) Investigate the reproducibility of Ki67 measurement across platforms with supervised classifiers performed by the same operator and by multiple operators. (ii) Compare accuracy of the 3 DIA platforms against outcome (prognostic potential). (iii) Assess inter-laboratory reproducibility of a calibrated DIA tool to evaluate Ki67 in breast cancer among 10 participating labs of the International Ki67 in Breast Cancer Working Group (IKWG).
Methods: The Mib-1 antibody (Dako) was used to detect Ki67 (dilution 1:100). HALO (H) (IndicaLabs), QuantCenter (QC) (3DHistech), QuPath (QP) (open-source software) digital image analysis (DIA) platforms were used to evaluate Ki67 expression. As a ground truth, we evaluated Ki67 LI with meticulous manual tissue segmentation using the Spectrum Webscope (SW) (Aperio). Calibration was performed using 30 ER+ breast cancer cases from phase 3 of the IKWG initiative where blocks were centrally cut and stained for Ki67. The inter-laboratory analysis was done with 10 participating laboratories divided into 2 groups where members within the same group were given the same set of images. The outcome cohort consisted of 149 breast cancer cases from the Yale Pathology archives in tissue microarray format. Intra-class correlation coefficient (ICC) was used to measure reproducibility with the pre-specified criterion for success being to exceed 0.80. Kaplan-Meier analysis supported with log-rank test was performed to assess prognostic potential.
Results: All 3 DIA platforms showed excellent inter-platform reproducibility (ICC: 0.933, CI: 0.879-0.966). Also, excellent reproducibility was found between all DIA platforms and the reference standard Ki67 values of SW (QP ICC: 0.970, CI: 0.936-0.986; H ICC: 0.968, CI: 0.933-0.985; QC ICC: 0.964, CI: 0.919-0.983). The intra-DIA reproducibility was also excellent for all platforms (QP ICC: 0.992, CI: 0.986-0.996; H ICC: 0.972, CI: 0.924-0.988; QC ICC: 0.978, CI: 0.932-0.991). Comparing each DIA against outcome, the hazard ratios were similar (QP=3.309, H=3.077, QC=3.731). The inter-operator reproducibility was particularly high (ICC: 0.962-0.995). As QP is open source software and also showed the lowest intra-DIA platform variability, we selected the QP platform to investigate inter-laboratory reproducibility among 10 IKWG labs. The different-section ICC across the 10 labs was 0.974 (CI: 0.954 - 0.986). The same-section ICC estimate was 0.984 (CI: 0.971-0.992) for group 1 and 0.978 (CI: 0.956-0.989) for group 2.
Conclusions: Our results showed outstanding reproducibility both within and between DIA platforms. We also found the platforms essentially indistinguishable with respect to prediction of breast cancer patient outcome. Automated Ki67 evaluation using a calibrated, open-source DIA platform (QuPath) met the pre-specified criterion of success in the multi-institutional setting. Assessment of clinical utility is planned.
Citation Format: Acs B, Leung SC, Pelekanou V, Bai Y, Martinez-Morilla S, Toki M, Chang MC, Gholap A, Jadhav A, Hugh JC, Bigras G, Laurinavicius A, Augulis R, Levenson R, Todd A, Piper T, Virk S, van der Vegt B, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Analytical validation of an automated digital scoring protocol for Ki67: International multicenter collaboration study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-01.
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Affiliation(s)
- B Acs
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - SC Leung
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - V Pelekanou
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - Y Bai
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - S Martinez-Morilla
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - M Toki
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - MC Chang
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Gholap
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Jadhav
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - JC Hugh
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - G Bigras
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Laurinavicius
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - R Augulis
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - R Levenson
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Todd
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - T Piper
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - S Virk
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - B van der Vegt
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - DF Hayes
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - M Dowsett
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - TO Nielsen
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - DL Rimm
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
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Moku PR, Shepherd LE, Ali SM, Leitzel K, Parulekar WE, Zhu L, Virk S, Nomikos D, Aparicio S, Gelmon KA, Drabick JJ, Cream L, Halstead SE, Umstead T, Mckeone D, Maddukuri A, Polimera HV, Ali A, Poulose J, Pancholy N, Spiegel H, Nagabhairu V, Chen BE, Lipton A. Abstract PD3-10: Higher serum PD-L1 predicts for increased overall survival to lapatinib vs trastuzumab in the phase 3 CCTG MA.31 trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd3-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the CCTG (Canadian Clinical Trials Group) MA.31 randomized phase 3 trial, the trastuzumab-taxane combination led to longer PFS than lapatinib-taxane in HER2-positive metastatic breast cancer (MBC). We previously reported the prognostic utility of pretreatment serum PD-L1 in the trastuzumab arm of MA.31 (ASCO 2018, #1031), and here we evaluate serum PD-L1 in the lapatinib arm, and in the whole trial. Higher serum PD-L1 has been reported to be associated with reduced response to treatment with the immune checkpoint inhibitors in melanoma and lung cancer.
Methods: MA.31 accrued 652 centrally and/or locally-identified HER2-positivepatients; 186 in the trastuzumab arm, and 202 in the lapatinib armhad pretreatment serum available. TheELLA immunoassay platform (ProteinSimple, San Jose, CA) was used to quantitate serum PD-L1. Step-wise forward Cox multivariate analysis was used for PFS and OS, and testing for treatment-biomarker interaction was based on the local partial-likelihood method (Liu Y, Jiang W, and Chen BE, Statistics in Medicine 34, 3516-3530, 2015).
Results: In the total study population, pretreatment serum PD-L1 concentration had a median of 86.2 pg/ml, and 25% and 75% interquartiles of 64.1 and 134.3 pg/ml, respectively. In univariate analysis in the whole trial, and within both treatment arms, serum PD-L1 was not a significant biomarker for PFS. For OS, higher serum PD-L1 (as a continuous variable) was significant for shorter OS within the trastuzumab arm (HR=3.84, p=0.04), but was not associated with OS in the lapatinib arm (p=0.37). In the whole trial, in multivariate analysis for OS [15 covariates included: age, race, ECOG status, anthracyclines, other chemo, endocrine, radio, other prior adjuvant therapy, disease status, ER status, PR status, Ki67 (log transformed), CK5, EGFR, treatment arm, and serum PD-L1 (with median cut point)], serum PD-L1 remained a significant independent covariate (HR= 2.27, p= 0.001 (Table).There was significant interaction between treatment arm and continuous serum PD-L1 (Bootstrap method, p=0.0025); above 214.2 pg/ml serum PD-L1 (89% percentile), higher pretreatment serum PD-L1 was associated with a shorter OS to trastuzumab treatment, but longer OS to lapatinib treatment.
Conclusions: In the CCTG MA.31 trial, serum PD-L1 was a significant predictive factor: higher pretreatment serum PD-L1 was associated with a shorter OS to trastuzumab treatment, but longer OS to lapatinib treatment. Immune evasion may decrease the effectiveness of trastuzumab therapy. Further evaluation of elevated serum PD-L1 in the advanced breast cancer setting is warranted to identify HER2-positive MBC patients who may benefit from novel immune-targeted therapies in addition to trastuzumab.
Multivariate Analysis (whole trial): Significant Independent CovariatesCovariateP-ValueHRLower 95% CIHigher 95% CISerum PD-L1 (pretreatment) (>median vs <median)0.0012.271.403.68EGFR Status (continuous IHC score)0.0031.0121.0041.019Other Chemotherapy (yes vs no)0.0081.911.193.07Treatment Arm (trastuzumab vs. lapatinib)0.0100.530.330.86ECOG Performance Status (0 vs 1 or 2)0.0250.590.370.94Ki67 (log)0.0461.451.0062.081
Citation Format: Moku PR, Shepherd LE, Ali SM, Leitzel K, Parulekar WE, Zhu L, Virk S, Nomikos D, Aparicio S, Gelmon KA, Drabick JJ, Cream L, Halstead SE, Umstead T, Mckeone D, Maddukuri A, Polimera HV, Ali A, Poulose J, Pancholy N, Spiegel H, Nagabhairu V, Chen BE, Lipton A. Higher serum PD-L1 predicts for increased overall survival to lapatinib vs trastuzumab in the phase 3 CCTG MA.31 trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD3-10.
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Affiliation(s)
- PR Moku
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - LE Shepherd
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - SM Ali
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - K Leitzel
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - WE Parulekar
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - L Zhu
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - S Virk
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - D Nomikos
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - S Aparicio
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - KA Gelmon
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - JJ Drabick
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - L Cream
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - SE Halstead
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - T Umstead
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - D Mckeone
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - A Maddukuri
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - HV Polimera
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - A Ali
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - J Poulose
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - N Pancholy
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - H Spiegel
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - V Nagabhairu
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - BE Chen
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
| | - A Lipton
- Penn State Hershey Medical Center, Hershey, PA; Queen's University, Canadian Cancer Trials Group, Kingston, ON, Canada; Lebanon VA Medical Center, Lebanon, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; ProteinSimple, San Jose, CA; Pinnacle Health System, Harrisburg, PA
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Virk S, Kumar S. Meta-Analysis of Remote Magnetic Versus Manual Catheter Navigation for Atrial Fibrillation Ablation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Virk S, Ariyaratnam J, Bennett R, Kumar S. Impact of Contact Force Sensing Technology on the Safety and Efficacy of Atrial Fibrillation Ablation: a Meta-Analysis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Virk S, Shrosbree J, White C, Cranney G, Indraratna P. Management of Amiodarone-Induced Thyrotoxicosis in Patients with Ventricular Arrhythmias: A Series of Case Reports. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Virk S, Kumar S. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation in Patients with Heart Failure: A Meta-Analysis of Randomised Controlled Trials. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.248] [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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Rimm DL, McShane LM, Leung SCY, Bai Y, Bane AL, Bartlett JMS, Bayani J, Chang MC, Dean M, Denkert C, Enwere E, Galderisi C, Gholap A, Hugh JC, Jadhav A, Kornaga E, Laurinavicius A, Levenson R, Lima J, Miller K, Pantanowitz L, Piper T, Ruan J, Srinivasan M, Virk S, Wu Y, Yang H, Hayes DF, Nielsen TO, Dowsett M. Abstract P1-03-01: An international multicenter study to evaluate reproducibility of automated scoring methods for assessment of Ki67 in breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-03-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including prognosis-based decisions, but unacceptable between-laboratory variability has limited its clinical value. The International Ki67 Working Group (IKWG) has undertaken a systematic program to determine whether Ki67 immunohistochemistry can be analytically validated and standardized across laboratories. Technological advances and broader availability of devices for automated assessment of stained slides raise the possibility that these machines may improve on reproducibility of traditional pathologist-based visual Ki67 assessment.
Aims: To characterize reproducibility of automated machine-measured Ki67 expression using slides previously analyzed in the IKWG phase 3 study that evaluated reproducibility of visual Ki67 assessment.
Methods: Two sets of 30 previously stained slides containing core-cut biopsy sections of breast tumors were circulated to 14 laboratories for scanning and automated assessment of Ki67 expression. Sites were instructed to return average and maximum percentage of tumor cells positive for Ki67 for each slide, where maximum is designed to reflect “hot spot” analysis. Two laboratories returned scores from 2 operators; not all laboratories reported values for maximum Ki67 scores. Different operators were treated as distinct laboratories in analyses. Sixteen and 10 score sets were available for average and maximum Ki67 analyses, respectively, encompassing 7 unique scanner and 10 software platforms. Pre-specified analyses included evaluation of reproducibility across all laboratories as well as within a subgroup limited to those using Aperio scanners. The primary reproducibility metric was intraclass correlation coefficient between laboratories (ICC), regardless of device platform or software.
Results: Geometric means across 30 cases for 16 operators ranged from 11.06% to 38.11% with overall mean 16.75% (95% CI:14.45-19.42) for average scores. Geometric means for 10 operators ranged from 16.44% to 68.73% with overall mean 25.16% (95% CI: 18.71-33.84) for maximum scores. ICC for automated average scores across 16 operators was 0.83 (95% CI: 0.73-0.91) and ICC for maximum scores across 10 operators was 0.63 (95% CI: 0.44-0.80) although one outlier lab dramatically affected results. For the laboratories using the Aperio platform (8 score sets), ICC for automated average scores was 0.89 (95% CI; 0.81-0.96). These results are similar to ICC of 0.87 (95%CI; 0.81-0.93) reported using these same slides in the Phase 3 visual assessment reproducibility study in which observers counted 500 cells per slide (Leung et al, NPJBrCancer, in press).
Conclusions: Between-laboratory reproducibility for automated machine assessment of average Ki67 is similar to that for pathologist-based visual assessment of Ki67. However, the observed ICC was markedly numerically lower for the maximum score method compared to the average method, suggesting that the maximum score may not be useful as a reproducible measure of proliferation. Automated average scoring methods show promise for standardization of Ki67 scoring, supporting future studies to clinically validate Ki67.
Citation Format: Rimm DL, McShane LM, Leung SCY, Bai Y, Bane AL, Bartlett JMS, Bayani J, Chang MC, Dean M, Denkert C, Enwere E, Galderisi C, Gholap A, Hugh JC, Jadhav A, Kornaga E, Laurinavicius A, Levenson R, Lima J, Miller K, Pantanowitz L, Piper T, Ruan J, Srinivasan M, Virk S, Wu Y, Yang H, Hayes DF, Nielsen TO, Dowsett M. An international multicenter study to evaluate reproducibility of automated scoring methods for assessment of Ki67 in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-03-01.
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Affiliation(s)
- DL Rimm
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - LM McShane
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - SCY Leung
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - Y Bai
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - AL Bane
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - JMS Bartlett
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - J Bayani
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - MC Chang
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - M Dean
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - C Denkert
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - E Enwere
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - C Galderisi
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - A Gholap
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - JC Hugh
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - A Jadhav
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - E Kornaga
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - A Laurinavicius
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - R Levenson
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - J Lima
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - K Miller
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - L Pantanowitz
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - T Piper
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - J Ruan
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - M Srinivasan
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - S Virk
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - Y Wu
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - H Yang
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - DF Hayes
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - TO Nielsen
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - M Dowsett
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
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Liu S, Chen B, Burugu S, Leung S, Gao D, Virk S, Kos Z, Parulekar WR, Shepherd L, Gelmon K, Nielsen TO. Abstract P1-09-08: Predictive effect of cytotoxic tumor infiltrating lymphocytes in HER2-positive metastatic breast cancer: A correlative study with CCTG MA.31. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and Objectives: The presence of tumor infiltrating lymphocytes (TILs), particularly CD8+ cytotoxic T-cells, has been associated with improved prognosis in patients with HER2+ breast cancer. Increasing levels of TILs also appear to predict response to adjuvant trastuzumab in early breast cancer, although they did not predict benefit of combined trastuzumab-lapatinib neoadjuvant dual therapy over monotherapy in NeoALLTO. CCTG MA.31 randomized 652 women with HER2+ metastatic breast cancer to treatment with trastuzumab (T) vs. lapatinib (L), in combination with taxane (Tax) chemotherapy for 24 weeks, followed by the same HER2-targeted monotherapy. Final results from MA.31 found trastuzumab was superior to lapatinib for the primary endpoint of progression free survival (PFS): the hazard ratio (HR) for lapatinib to trastuzumab was 1.37 (95% CI, 1.13-1.65). Although both agents block HER2 signaling, trastuzumab has additional mechanisms of action via the immune system. We hypothesized that TIL levels may predict response to HER2-targeted therapy (trastuzumab vs. lapatinib).
Methods: MA.31 included HER2+ metastatic breast cancer patients, median age 55 years, and median follow-up 21.5 months. Overall TILs were counted per published guidelines on the original H&E stained sections used for pathology review at study entry. Immunohistochemistry (IHC) was performed on unstained sections from tissue microarrays or individual formalin-fixed paraffin-embedded blocks to test expression of lymphocyte biomarkers CD8, FOXP3, CD56 and PD-1 on stromal and intra-tumoral TILs (sTILs, iTILs). Statistical analysis was conducted by CCTG for a total of 9 prespecified biomarker tests. Associations of TILs with PFS were evaluated by univariate stratified log-rank test with graphical Kaplan-Meier curves, and by stratified multivariate Cox proportional hazards regression analysis. Predictive effect was examined with a test of interaction between treatment allocation and biomarker classification (high vs. low, using pre-established cutpoints).
Results: Of the 652 cases, 614 had slides for overall TIL assessment and 427 for IHC biomarker assessments. In this correlative study set, superiority of trastuzumab over lapatinib for PFS was confirmed in multivariate analysis (LTax/T vs. TTax/L: HR = 2.55, 95% CI = 1.43-4.55, p = 0.001). TIL counts by H&E were neither prognostic nor predictive in this set of metastatic HER2+ breast cancers. Lymphocyte IHC markers were not prognostic. However, prespecified stratified univariate analysis detected a significantly higher risk for lapatinib over trastuzumab (HR = 2.94, 95% CI = 1.40-6.17, p = 0.003) in patients with low CD8+ sTIL (< 3) than was observed among those with high CD8+ sTIL (HR = 1.36, 95% CI = 1.05-1.75, p = 0.019). This differential effect was confirmed in multivariate analysis (interaction test p = 0.042). The other tested biomarkers did not demonstrate significant predictive effects.
Conclusions: In this correlative study of metastatic HER2+ breast cancer, a low level of pre-existing stromal cytotoxic T cell infiltration predicts women who benefit most from trastuzumab over lapatinib. Overall TIL counts were neither prognostic nor predictive.
Citation Format: Liu S, Chen B, Burugu S, Leung S, Gao D, Virk S, Kos Z, Parulekar WR, Shepherd L, Gelmon K, Nielsen TO. Predictive effect of cytotoxic tumor infiltrating lymphocytes in HER2-positive metastatic breast cancer: A correlative study with CCTG MA.31 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-08.
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Affiliation(s)
- S Liu
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - B Chen
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - S Burugu
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - S Leung
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - D Gao
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - S Virk
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - Z Kos
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - WR Parulekar
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - L Shepherd
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - K Gelmon
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - TO Nielsen
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
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Virk S, Bowman S, Bannon P, Saxena A. Impact of Preoperative Atrial Fibrillation on Short- and Long-Term Outcomes After Mitral Valve Surgery. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Virk S, Bowman S, Bannon P, Saxena A. Equivalent Outcomes After Coronary Artery Bypass Graft Surgery Performed by Consultant and Trainee Surgeons: A Systematic Review and Meta-Analysis. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Virk S, Bowman S, Bannon P, Saxena A. Impact of Preoperative Atrial Fibrillation on Short- and Long-Term Outcomes After Aortic Valve Surgery. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Virk S, Bowman S, Bannon P, Saxena A. Impact of Preoperative Atrial Fibrillation on Outcomes Following Isolated Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weberpals JI, Amin MS, Chen BE, Tu D, Spaans JN, Squire JA, Eisenhauer EA, Virk S, Ma D, Duciaume M, Hoskins P, LeBrun DP. First application of the Automated QUantitative Analysis (AQUA) technique to quantify PTEN protein expression in ovarian cancer: A correlative study of NCIC CTG OV.16. Gynecol Oncol 2016; 140:486-93. [PMID: 26775196 DOI: 10.1016/j.ygyno.2016.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Platinum resistance is a dominant cause of poor outcomes in advanced ovarian cancer (OC). A mechanism of platinum resistance is the inhibition of apoptosis through phosphatidylinositol 3 kinase (PI3K) pathway activation. The role of phosphatase and tensin homolog (PTEN), a negative regulator of this pathway, as a tumor biomarker is unclear. Quantitative analysis of PTEN expression as an alternative to immunohistochemistry has not been considered. PATIENTS AND METHODS In 238 patient tumors from the NCIC-CTG trial OV.16, PTEN protein expression was quantified by Automated QUantitative Analysis (AQUA). Cox model was used to study the association between PTEN expression and clinical outcomes using a minimum p-value approach in univariate analysis. Multivariate analysis was used to adjust for clinical and pathological parameters. RESULTS PTEN scores (range 13.9-192.3) of the 202 samples that passed quality control were analyzed. In univariate analysis, there was a trend suggesting an association between PTEN expression by AQUA as a binary variable (low ≤61 vs high >61) and progression free survival (HR=0.77, p=0.083), and in multivariate analysis, this association approached significance (HR=0.74, p=0.059). The relationship between quantitative PTEN expression and PFS differed (p=0.01 for interaction) by the extent of surgical debulking (residual disease (RD) <1cm or ≥1cm), with a numerically superior PFS in patients with high PTEN (23.5 vs 14.9m) only when RD<1cm (p=0.19). There was no association between PTEN levels and overall survival. CONCLUSIONS AQUA is a novel method to measure PTEN expression. Further study of PTEN as a biomarker in OC is warranted.
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Affiliation(s)
- J I Weberpals
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada; Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - M S Amin
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - B E Chen
- NCIC-CTG, Kingston, Ontario, Canada
| | - D Tu
- NCIC-CTG, Kingston, Ontario, Canada
| | - J N Spaans
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada
| | - J A Squire
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - E A Eisenhauer
- NCIC-CTG, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - S Virk
- NCIC-CTG, Kingston, Ontario, Canada; Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - D Ma
- Department of Mathematics and Statistics, Queen's University, Kingston, Ontario, Canada
| | - M Duciaume
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada
| | - P Hoskins
- BC Cancer Centre, Vancouver, British Columbia, Canada
| | - D P LeBrun
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
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Cao C, Virk S, Liou K, Pathan F, Wilcox C, Novis E, Yan T. A systematic review and meta-analysis of clinical and cost-effective outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.346] [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: 10/23/2022]
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Cao C, Tian D, Ang S, Virk S, Novis E, Wilcox C, Yan T. A meta-analysis of endoscopic versus conventional open radial artery harvesting for coronary artery bypass graft surgery. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cao C, Virk S, Novis E, Wilcox C, Yan T. A meta-analysis of robotic versus conventional mitral valve surgery. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Virk S, Tian D, Liou K, Pathan F, Novis E, Wilcox C, Cao C. Systematic review of percutaneous coronary intervention and transcatheter aortic valve implantation for concomitant aortic stenosis and coronary artery disease. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Virk S, Gibson R, Barnholtz-Sloan J, Quinones-Mateu M. BI-29 * VARIANT ANALYSIS OF PRIMARY AND RECURRENT GLIOBLASTOMA USING ION AMPLISEQTM COMPREHENSIVE CANCER PANEL AND WHOLE EXOME SEQUENCING. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou239.29] [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: 11/12/2022] Open
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Kim H, Zheng S, Amini S, Virk S, Mikkelsen T, Brat D, Sougnez C, Muller F, Hu J, Sloan A, Cohen M, Van Meir E, Scarpace L, Lander E, Gabriel S, Getz G, Meyerson M, Chin L, Barnholtz-Sloan J, Verhaak R. GE-17 * ALTERATION OF THE p53 PATHWAY AND ANCESTRAL PROGENITORS ARE ASSOCIATED WITH TUMOR RECURRENCE IN GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou256.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Berens M, Armstrong B, Peng S, Ross J, Salhia B, Byron S, Virk S, Dhruv H, Tran N, Sloan A, Ostrom Q, Barnholtz-Sloan J. GE-03 * GENOMIC CHARACTERIZATION OF SURVIVAL OUTLIERS IN GLIOBLASTOMA MULTIFORME. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou256.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Adachi K, Sasaki H, Nagahisa S, Yoshida K, Hattori N, Nishiyama Y, Kawase T, Hasegawa M, Abe M, Hirose Y, Alentorn A, Marie Y, Poggioli S, Alshehhi H, Boisselier B, Carpentier C, Mokhtari K, Capelle L, Figarella-Branger D, Hoang-Xuan K, Sanson M, Delattre JY, Idbaih A, Yust-Katz S, Anderson M, Olar A, Eterovic A, Ezzeddine N, Chen K, Zhao H, Fuller G, Aldape K, de Groot J, Andor N, Harness J, Lopez SG, Fung TL, Mewes HW, Petritsch C, Arivazhagan A, Somasundaram K, Thennarasu K, Pandey P, Anandh B, Santosh V, Chandramouli B, Hegde A, Kondaiah P, Rao M, Bell R, Kang R, Hong C, Song J, Costello J, Bell R, Nagarajan R, Zhang B, Diaz A, Wang T, Song J, Costello J, Bie L, Li Y, Li Y, Liu H, Luyo WFC, Carnero MH, Iruegas MEP, Morell AR, Figueiras MC, Lopez RL, Valverde CF, Chan AKY, Pang JCS, Chung NYF, Li KKW, Poon WS, Chan DTM, Wang Y, Ng HAK, Chaumeil M, Larson P, Yoshihara H, Vigneron D, Nelson S, Pieper R, Phillips J, Ronen S, Clark V, Omay ZE, Serin A, Gunel J, Omay B, Grady C, Youngblood M, Bilguvar K, Baehring J, Piepmeier J, Gutin P, Vortmeyer A, Brennan C, Pamir MN, Kilic T, Krischek B, Simon M, Yasuno K, Gunel M, Cohen AL, Sato M, Aldape KD, Mason C, Diefes K, Heathcock L, Abegglen L, Shrieve D, Couldwell W, Schiffman JD, Colman H, D'Alessandris QG, Cenci T, Martini M, Ricci-Vitiani L, De Maria R, Larocca LM, Pallini R, de Groot J, Theeler B, Aldape K, Lang F, Rao G, Gilbert M, Sulman E, Luthra R, Eterovic K, Chen K, Routbort M, Verhaak R, Mills G, Mendelsohn J, Meric-Bernstam F, Yung A, MacArthur K, Hahn S, Kao G, Lustig R, Alonso-Basanta M, Chandrasekaran S, Wileyto EP, Reyes E, Dorsey J, Fujii K, Kurozumi K, Ichikawa T, Onishi M, Ishida J, Shimazu Y, Kaur B, Chiocca EA, Date I, Geisenberger C, Mock A, Warta R, Schwager C, Hartmann C, von Deimling A, Abdollahi A, Herold-Mende C, Gevaert O, Achrol A, Gholamin S, Mitra S, Westbroek E, Loya J, Mitchell L, Chang S, Steinberg G, Plevritis S, Cheshier S, Gevaert O, Mitchell L, Achrol A, Xu J, Steinberg G, Cheshier S, Napel S, Zaharchuk G, Plevritis S, Gevaert O, Achrol A, Chang S, Harsh G, Steinberg G, Cheshier S, Plevritis S, Gutman D, Holder C, Colen R, Dunn W, Jain R, Cooper L, Hwang S, Flanders A, Brat D, Hayes J, Droop A, Thygesen H, Boissinot M, Westhead D, Short S, Lawler S, Bady P, Kurscheid S, Delorenzi M, Hegi ME, Crosby C, Faulkner C, Smye-Rumsby T, Kurian K, Williams M, Hopkins K, Faulkner C, Palmer A, Williams H, Wragg C, Haynes HR, Williams M, Hopkins K, Kurian KM, Haynes HR, Crosby C, Williams H, White P, Hopkins K, Williams M, Kurian KM, Ishida J, Kurozumi K, Ichikawa T, Onishi M, Fujii K, Shimazu Y, Oka T, Date I, Jalbert L, Elkhaled A, Phillips J, Chang S, Nelson S, Jensen R, Salzman K, Schabel M, Gillespie D, Mumert M, Johnson B, Mazor T, Hong C, Barnes M, Yamamoto S, Ueda H, Tatsuno K, Aihara K, Jalbert L, Nelson S, Bollen A, Hirst M, Marra M, Mukasa A, Saito N, Aburatani H, Berger M, Chang S, Taylor B, Costello J, Popov S, Mackay A, Ingram W, Burford A, Jury A, Vinci M, Jones C, Jones DTW, Hovestadt V, Picelli S, Wang W, Northcott PA, Kool M, Reifenberger G, Pietsch T, Sultan M, Lehrach H, Yaspo ML, Borkhardt A, Landgraf P, Eils R, Korshunov A, Zapatka M, Radlwimmer B, Pfister SM, Lichter P, Joy A, Smirnov I, Reiser M, Shapiro W, Mills G, Kim S, Feuerstein B, Jungk C, Mock A, Geisenberger C, Warta R, Friauf S, Unterberg A, Herold-Mende C, Juratli TA, McElroy J, Meng W, Huebner A, Geiger KD, Krex D, Schackert G, Chakravarti A, Lautenschlaeger T, Kim BY, Jiang W, Beiko J, Prabhu S, DeMonte F, Lang F, Gilbert M, Aldape K, Sawaya R, Cahill D, McCutcheon I, Lau C, Wang L, Terashima K, Yamaguchi S, Burstein M, Sun J, Suzuki T, Nishikawa R, Nakamura H, Natsume A, Terasaka S, Ng HK, Muzny D, Gibbs R, Wheeler D, Lautenschlaeger T, Juratli TA, McElroy J, Meng W, Huebner A, Geiger KD, Krex D, Schackert G, Chakravarti A, Zhang XQ, Sun S, Lam KF, Kiang KMY, Pu JKS, Ho ASW, Leung GKK, Loebel F, Curry WT, Barker FG, Lelic N, Chi AS, Cahill DP, Lu D, Yin J, Teo C, McDonald K, Madhankumar A, Weston C, Slagle-Webb B, Sheehan J, Patel A, Glantz M, Connor J, Maire C, Francis J, Zhang CZ, Jung J, Manzo V, Adalsteinsson V, Homer H, Blumenstiel B, Pedamallu CS, Nickerson E, Ligon A, Love C, Meyerson M, Ligon K, Mazor T, Johnson B, Hong C, Barnes M, Jalbert LE, Nelson SJ, Bollen AW, Smirnov IV, Song JS, Olshen AB, Berger MS, Chang SM, Taylor BS, Costello JF, Mehta S, Armstrong B, Peng S, Bapat A, Berens M, Melendez B, Mollejo M, Mur P, Hernandez-Iglesias T, Fiano C, Ruiz J, Rey JA, Mock A, Stadler V, Schulte A, Lamszus K, Schichor C, Westphal M, Tonn JC, Unterberg A, Herold-Mende C, Morozova O, Katzman S, Grifford M, Salama S, Haussler D, Nagarajan R, Zhang B, Johnson B, Bell R, Olshen A, Fouse S, Diaz A, Smirnov I, Kang R, Wang T, Costello J, Nakamizo S, Sasayama T, Tanaka H, Tanaka K, Mizukawa K, Yoshida M, Kohmura E, Northcott P, Hovestadt V, Jones D, Kool M, Korshunov A, Lichter P, Pfister S, Otani R, Mukasa A, Takayanagi S, Saito K, Tanaka S, Shin M, Saito N, Ozawa T, Riester M, Cheng YK, Huse J, Helmy K, Charles N, Squatrito M, Michor F, Holland E, Perrech M, Dreher L, Rohn G, Goldbrunner R, Timmer M, Pollo B, Palumbo V, Calatozzolo C, Patane M, Nunziata R, Farinotti M, Silvani A, Lodrini S, Finocchiaro G, Lopez E, Rioscovian A, Ruiz R, Siordia G, de Leon AP, Rostomily C, Rostomily R, Silbergeld D, Kolstoe D, Chamberlain M, Silber J, Roth P, Keller A, Hoheisel J, Codo P, Bauer A, Backes C, Leidinger P, Meese E, Thiel E, Korfel A, Weller M, Saito K, Mukasa A, Nagae G, Nagane M, Aihara K, Takayanagi S, Tanaka S, Aburatani H, Saito N, Salama S, Sanborn JZ, Grifford M, Brennan C, Mikkelsen T, Jhanwar S, Chin L, Haussler D, Sasayama T, Tanaka K, Nakamizo S, Nishihara M, Tanaka H, Mizukawa K, Kohmura E, Schliesser M, Grimm C, Weiss E, Claus R, Weichenhan D, Weiler M, Hielscher T, Sahm F, Wiestler B, Klein AC, Blaes J, Weller M, Plass C, Wick W, Stragliotto G, Rahbar A, Soderberg-Naucler C, Sulman E, Won M, Ezhilarasan R, Sun P, Blumenthal D, Vogelbaum M, Colman H, Jenkins R, Chakravarti A, Jeraj R, Brown P, Jaeckle K, Schiff D, Dignam J, Atkins J, Brachman D, Werner-Wasik M, Gilbert M, Mehta M, Aldape K, Terashima K, Shen J, Luan J, Yu A, Suzuki T, Nishikawa R, Matsutani M, Liang Y, Man TK, Lau C, Trister A, Tokita M, Mikheeva S, Mikheev A, Friend S, Rostomily R, van den Bent M, Erdem L, Gorlia T, Taphoorn M, Kros J, Wesseling P, Dubbink H, Ibdaih A, Sanson M, French P, van Thuijl H, Mazor T, Johnson B, Fouse S, Heimans J, Wesseling P, Ylstra B, Reijneveld J, Taylor B, Berger M, Chang S, Costello J, Prabowo A, van Thuijl H, Scheinin I, van Essen H, Spliet W, Ferrier C, van Rijen P, Veersema T, Thom M, Meeteren ASV, Reijneveld J, Ylstra B, Wesseling P, Aronica E, Kim H, Zheng S, Mikkelsen T, Brat DJ, Virk S, Amini S, Sougnez C, Chin L, Barnholtz-Sloan J, Verhaak RGW, Watts C, Sottoriva A, Spiteri I, Piccirillo S, Touloumis A, Collins P, Marioni J, Curtis C, Tavare S, Weiss E, Grimm C, Schliesser M, Hielscher T, Claus R, Sahm F, Wiestler B, Klein AC, Blaes J, Tews B, Weiler M, Weichenhan D, Hartmann C, Weller M, Plass C, Wick W, Yeung TPC, Al-Khazraji B, Morrison L, Hoffman L, Jackson D, Lee TY, Yartsev S, Bauman G, Zheng S, Fu J, Vegesna R, Mao Y, Heathcock LE, Torres-Garcia W, Ezhilarasan R, Wang S, McKenna A, Chin L, Brennan CW, Yung WKA, Weinstein JN, Aldape KD, Sulman EP, Chen K, Koul D, Verhaak RGW. OMICS AND PROGNSTIC MARKERS. Neuro Oncol 2013; 15:iii136-iii155. [PMCID: PMC3823898 DOI: 10.1093/neuonc/not183] [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: 09/21/2023] Open
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Shapiro JD, Siu LL, Zalcberg JR, Moore MJ, Ringash J, Mittmann N, Simes J, O'Callaghan CJ, Tu D, Walters IB, Magoski N, Smith P, Nomikos D, Zhu L, Savoie M, Virk S, El-Tahche F, Gill R, Price TJ, Jonker DJ. A phase III study of cetuximab (CET) plus either brivanib alaninate (BRIV) versus placebo in patients with chemotherapy-refractory KRAS wild-type (WT) advanced colorectal cancer (aCRC): The NCIC CTG/AGITG CO.20 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps163] [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: 11/20/2022] Open
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Allahbadia G, Gandhi G, Kadam K, Parab S, Nagwekar A, Virk S. P-261. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.614] [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: 11/25/2022]
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Allahbadia G, Gandhi G, Kadam K, Arora S, Mhatre Y, Virk S. P-322. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Allahbadia G, Gandhi G, Kadam K, Allahbadia S, Virk S, Kaur K. O-169. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.195] [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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Allahbadia G, Gandhi G, Kadam K, Nagwekar A, Virk S, Kaur K. P-260. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allahbadia G, Gandhi G, Kadam K, Parab S, Virk S, Kaur K. P-897. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Allahbadia G, Gandhi G, Virk S, Singh A, Kadam K, Kaur K. Reducing the Exposure of Oocytes to Spermatozoa Improves Embryo Viability. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Allahbadia G, Athavale U, Gandhi G, Kadam K, Gosrani S, Virk S. The Final Position of Embryo-Associated Air at Time of Embryo Transfer (ET) is Unlikely To Be a Factor in Predicting Success in Donor Egg IVF Recipient Treatment Cycles. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.702] [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: 10/25/2022]
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Abstract
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. The authors undertook a comprehensive literature review in order to provide a better understanding of novel treatment options in regards to alleviating weight gained by use of antidepressants, antipsychotics, and mood stabilizers. There are no agents for management of this weight gain approved by the Food and Drug Administration (FDA), and existing studies on options are mainly uncontrolled, small-scale projects with limited power to produce coherent conclusions. There is a clear need for larger studies on existing options, and future psychotropics without these side-effects are currently in the pipeline.
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Affiliation(s)
- T L Schwartz
- SUNY Upstate Medical University, Department of Psychiatry, Syracuse, NY 13210, USA.
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Allahbadia G, Kaur K, Kadam K, Virk S, Gandhi G, Gosrani S. The comparison of pregnancy outcomes of intramuscular progesterone versus oral dydrogesterone for luteal phase support in donor egg IVF recipient cycles. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.513] [Citation(s) in RCA: 2] [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: 10/26/2022]
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Allahbadia G, Athavale U, Kadam K, Gandhi G, Kaur K, Virk S. Does the embryo transfer (ET) associated air-bubble movement in donor egg IVF recipients predict a successful outcome? Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kaur K, Allahbadia G, Kadam K, Virk S, Digra G, Gandhi G. The impact of low dose depot Leuprolide Acetate administration in ART patients—A multicentric study. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.303] [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: 11/16/2022]
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Abstract
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment, but consensus shows that weight gain is prominent. The present review looked at the aetiology and cause of weight gain associated with psychotropic use and presents hypotheses as to why patients gain weight on antipsychotics, mood stabilizers and antidepressants. It is found that most psychotropic medications induce some weight gain, and clinicians are encouraged to utilize active interventions to alleviate the weight gain in order to prevent more serious obesity related comorbidities.
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Affiliation(s)
- S Virk
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
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Abstract
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the aetiology of this weight gain and the potential treatments being used to alleviate this side-effect. We found solid evidence that weight gain is often associated with the mood stabilizers, and antipsychotics and antidepressants. Only few weight neutral or weight loss producing psychotropics are available, and weight gain, outside of an immediate side-effect, may generate secondary side-effects and medical comorbidity. Weight gain may cause hypertension, diabetes, osteoarthritis, sedentary lifestyle, coronary artery disease, etc. Given the likelihood of inducing weight gain with psychotropic medications and the longitudinal impact on physical health, a thorough literature review is warranted to determine the epidemiology, aetiology and treatment options of psychotropic-induced weight gain.
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Affiliation(s)
- T L Schwartz
- SUNY Upstate Medical University, Department of Psychiatry, Syracuse, NY 13210, USA.
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Virk S, Sharma A. Alterations in the biochemical constituents of muscles of Cirrhinus mrigala following exposure to and withdrawal from metals. Bull Environ Contam Toxicol 2003; 70:106-111. [PMID: 12478431 DOI: 10.1007/s00128-002-0162-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- S Virk
- Department of Fisheries, Punjab Agricultural University, Ludhiana (Pb.) 141 004, India
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Masand PS, Arora M, Schwartz TL, Sharma A, Wang X, Bhatia S, Manjooran J, Hardoby W, Virk S, Kuhles DJ, Agharkar B, Gupta S. Prescribing conventional antipsychotics at two Veterans Administration hospitals: are there geographical differences? CNS Spectr 2001; 6:894-6. [PMID: 15328470 DOI: 10.1017/s1092852900000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The medical records of 110 patients receiving conventional antipsychotics at two geographically distinct Veterans Administration hospitals (Syracuse, New York, and Omaha, Nebraska) were reviewed. The most common reasons for continuation of conventional antipsychotics were good response and patient or physician choice. Frequently, physicians did not discuss the reasons for continuing conventional antipsychotics or the availability of alternative therapies with their patients. Geographic differences in physicians' prescribing practices of conventional antipsychotics were apparent.
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Affiliation(s)
- P S Masand
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA.
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Virk S, Kaur K. Impact of mixture of nickel and chromium on the protein content of flesh and liver of Cyprinus carpio during spawning and post-spawning phases. Bull Environ Contam Toxicol 1999; 63:499-502. [PMID: 10501728 DOI: 10.1007/s001289901008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- S Virk
- Department of Fisheries, Punjab Agricultural University, Ludhiana(Pb) 141 004, India
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Abstract
We have discovered transposase sequences in the bull frog (Rana catesbeiana) and in the clawed frog (Xenopus laevis), which demonstrates that there are DNA-mediated transposons in Amphibia. The DNA sequences of 11 new Xenopus elements describe two new vertebrate transposon families. Phylogenetic analysis, using these sequences along with previously defined vertebrate and invertebrate elements, reveals at least five families of Tc1-like elements in Vertebrata. Some of these families co-exist in the same genome. Furthermore, the grouping of one of the amphibian transposon families with a branch of the teleost transposons raises the possibility of horizontal transfer.
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Affiliation(s)
- W L Lam
- Department of Molecular and Cellular Biology, The Biological Laboratories, Harvard University, Cambridge, Massachusetts 02138, USA
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Nagaratnam N, Virk S, Brdarevic O. Musical hallucinations associated with recurrence of a right occipital meningioma. Br J Clin Pract 1996; 50:56-7. [PMID: 8729606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The case of an 84-year-old woman who experienced musical and visual hallucinations after recurrence of a right occipital meningioma is reported.
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Otterstad JE, Davies M, Ball SG, Erikssen J, Birkin E, Virk S, Rynning SE, Rodevand O, Hansson L, Bergbrandt A. Left ventricular hypertrophy and myocardial ischaemia in hypertension: the THAMES Study. Eur Heart J 1993; 14:1622-8. [PMID: 8131759 DOI: 10.1093/eurheartj/14.12.1622] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A multicentre epidemiological study to detect the prevalence of myocardial ischaemia in hypertensive left ventricular hypertrophy (LVH) was performed in 188 asymptomatic male hypertensives (131 treated). The mean age was 55 (range 40-82) years with blood pressure (BP) > or = 160/100 mmHg or a systolic BP > or = 180 mmHg. The participants were screened with echocardiography, and left ventricular hypertrophy (LVH), defined as LV mass index (LVMI) > or = 130 g.m-2, was found in 127 (68%), of whom 95 were on antihypertensive treatment. Patients with LVH underwent a maximal bicycle ergometer exercise test and significant ST depression, indicating possible stress-induced ischaemia, was found in 29 men (23%). These subjects were subjected to exercise thallium-201 scintigraphy, which was normal in 14 but showed reversible perfusion defects in 15. Thus, a high prevalence of LVH (70%) was detected in male hypertensives selected only on age and BP. In addition, although chest pain on exertion excluded patients from entry, a substantial portion had signs of ischaemia (23% on exercise ECG alone, and in 52% confirmed by thallium scan). The prevalence of these risk factors should be considered when evaluating hypertensive patients.
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Affiliation(s)
- J E Otterstad
- Medical Department, Vestfold Central Hospital, Toensberg, Norway
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