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Aubreville M, Stathonikos N, Donovan TA, Klopfleisch R, Ammeling J, Ganz J, Wilm F, Veta M, Jabari S, Eckstein M, Annuscheit J, Krumnow C, Bozaba E, Çayır S, Gu H, Chen X'A, Jahanifar M, Shephard A, Kondo S, Kasai S, Kotte S, Saipradeep VG, Lafarge MW, Koelzer VH, Wang Z, Zhang Y, Yang S, Wang X, Breininger K, Bertram CA. Domain generalization across tumor types, laboratories, and species - Insights from the 2022 edition of the Mitosis Domain Generalization Challenge. Med Image Anal 2024; 94:103155. [PMID: 38537415 DOI: 10.1016/j.media.2024.103155] [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] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Recognition of mitotic figures in histologic tumor specimens is highly relevant to patient outcome assessment. This task is challenging for algorithms and human experts alike, with deterioration of algorithmic performance under shifts in image representations. Considerable covariate shifts occur when assessment is performed on different tumor types, images are acquired using different digitization devices, or specimens are produced in different laboratories. This observation motivated the inception of the 2022 challenge on MItosis Domain Generalization (MIDOG 2022). The challenge provided annotated histologic tumor images from six different domains and evaluated the algorithmic approaches for mitotic figure detection provided by nine challenge participants on ten independent domains. Ground truth for mitotic figure detection was established in two ways: a three-expert majority vote and an independent, immunohistochemistry-assisted set of labels. This work represents an overview of the challenge tasks, the algorithmic strategies employed by the participants, and potential factors contributing to their success. With an F1 score of 0.764 for the top-performing team, we summarize that domain generalization across various tumor domains is possible with today's deep learning-based recognition pipelines. However, we also found that domain characteristics not present in the training set (feline as new species, spindle cell shape as new morphology and a new scanner) led to small but significant decreases in performance. When assessed against the immunohistochemistry-assisted reference standard, all methods resulted in reduced recall scores, with only minor changes in the order of participants in the ranking.
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Affiliation(s)
| | | | - Taryn A Donovan
- Department of Anatomic Pathology, The Schwarzman Animal Medical Center, NY, USA
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | | | - Jonathan Ganz
- Technische Hochschule Ingolstadt, Ingolstadt, Germany
| | - Frauke Wilm
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mitko Veta
- Computational Pathology Group, Radboud UMC Nijmegen, The Netherlands
| | - Samir Jabari
- Institute of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nünberg, Erlangen, Germany
| | | | | | - Engin Bozaba
- Artificial Intelligence Research Team, Virasoft Corporation, NY, USA
| | - Sercan Çayır
- Artificial Intelligence Research Team, Virasoft Corporation, NY, USA
| | - Hongyan Gu
- University of California, Los Angeles, USA
| | | | | | | | | | - Satoshi Kasai
- Niigata University of Health and Welfare, Niigata, Japan
| | - Sujatha Kotte
- TCS Research, Tata Consultancy Services Ltd, Hyderabad, India
| | - V G Saipradeep
- TCS Research, Tata Consultancy Services Ltd, Hyderabad, India
| | - Maxime W Lafarge
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ziyue Wang
- Harbin Institute of Technology, Shenzhen, China
| | | | - Sen Yang
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Xiyue Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, USA
| | - Katharina Breininger
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christof A Bertram
- Institute of Pathology, University of Veterinary Medicine, Vienna, Austria
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2
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Lafarge MW, Domingo E, Sirinukunwattana K, Wood R, Samuel L, Murray G, Richman SD, Blake A, Sebag-Montefiore D, Gollins S, Klieser E, Neureiter D, Huemer F, Greil R, Dunne P, Quirke P, Weiss L, Rittscher J, Maughan T, Koelzer VH. Image-based consensus molecular subtyping in rectal cancer biopsies and response to neoadjuvant chemoradiotherapy. NPJ Precis Oncol 2024; 8:89. [PMID: 38594327 PMCID: PMC11003957 DOI: 10.1038/s41698-024-00580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
The development of deep learning (DL) models to predict the consensus molecular subtypes (CMS) from histopathology images (imCMS) is a promising and cost-effective strategy to support patient stratification. Here, we investigate whether imCMS calls generated from whole slide histopathology images (WSIs) of rectal cancer (RC) pre-treatment biopsies are associated with pathological complete response (pCR) to neoadjuvant long course chemoradiotherapy (LCRT) with single agent fluoropyrimidine. DL models were trained to classify WSIs of colorectal cancers stained with hematoxylin and eosin into one of the four CMS classes using a multi-centric dataset of resection and biopsy specimens (n = 1057 WSIs) with paired transcriptional data. Classifiers were tested on a held out RC biopsy cohort (ARISTOTLE) and correlated with pCR to LCRT in an independent dataset merging two RC cohorts (ARISTOTLE, n = 114 and SALZBURG, n = 55 patients). DL models predicted CMS with high classification performance in multiple comparative analyses. In the independent cohorts (ARISTOTLE, SALZBURG), cases with WSIs classified as imCMS1 had a significantly higher likelihood of achieving pCR (OR = 2.69, 95% CI 1.01-7.17, p = 0.048). Conversely, imCMS4 was associated with lack of pCR (OR = 0.25, 95% CI 0.07-0.88, p = 0.031). Classification maps demonstrated pathologist-interpretable associations with high stromal content in imCMS4 cases, associated with poor outcome. No significant association was found in imCMS2 or imCMS3. imCMS classification of pre-treatment biopsies is a fast and inexpensive solution to identify patient groups that could benefit from neoadjuvant LCRT. The significant associations between imCMS1/imCMS4 with pCR suggest the existence of predictive morphological features that could enhance standard pathological assessment.
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Affiliation(s)
- Maxime W Lafarge
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Enric Domingo
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Korsuk Sirinukunwattana
- Ground Truth Labs, Oxford, UK
- Department of Engineering Science, Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, UK
| | - Ruby Wood
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Leslie Samuel
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Graeme Murray
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Susan D Richman
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Andrew Blake
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Simon Gollins
- North Wales Cancer Treatment Centre, Besti Cadwaladr University Health Board, Bodelwyddan, UK
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Philip Dunne
- The Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Philip Quirke
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jens Rittscher
- Department of Engineering Science, Institute of Biomedical Engineering (IBME), University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tim Maughan
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.
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3
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Wu J, Koelzer VH. SST-editing: in silico spatial transcriptomic editing at single-cell resolution. Bioinformatics 2024; 40:btae077. [PMID: 38341653 PMCID: PMC10914437 DOI: 10.1093/bioinformatics/btae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/27/2023] [Accepted: 02/09/2024] [Indexed: 02/12/2024] Open
Abstract
MOTIVATION Generative Adversarial Nets (GAN) achieve impressive performance for text-guided editing of natural images. However, a comparable utility of GAN remains understudied for spatial transcriptomics (ST) technologies with matched gene expression and biomedical image data. RESULTS We propose In Silico Spatial Transcriptomic editing that enables gene expression-guided editing of immunofluorescence images. Using cell-level spatial transcriptomics data extracted from normal and tumor tissue slides, we train the approach under the framework of GAN (Inversion). To simulate cellular state transitions, we then feed edited gene expression levels to trained models. Compared to normal cellular images (ground truth), we successfully model the transition from tumor to normal tissue samples, as measured with quantifiable and interpretable cellular features. AVAILABILITY AND IMPLEMENTATION https://github.com/CTPLab/SST-editing.
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Affiliation(s)
- Jiqing Wu
- Department of Pathology and Molecular Pathology, Computational and Translational Pathology Laboratory (CTP), University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, Computational and Translational Pathology Laboratory (CTP), University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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4
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Malla SB, Byrne RM, Lafarge MW, Corry SM, Fisher NC, Tsantoulis PK, Mills ML, Ridgway RA, Lannagan TRM, Najumudeen AK, Gilroy KL, Amirkhah R, Maguire SL, Mulholland EJ, Belnoue-Davis HL, Grassi E, Viviani M, Rogan E, Redmond KL, Sakhnevych S, McCooey AJ, Bull C, Hoey E, Sinevici N, Hall H, Ahmaderaghi B, Domingo E, Blake A, Richman SD, Isella C, Miller C, Bertotti A, Trusolino L, Loughrey MB, Kerr EM, Tejpar S, Maughan TS, Lawler M, Campbell AD, Leedham SJ, Koelzer VH, Sansom OJ, Dunne PD. Pathway level subtyping identifies a slow-cycling biological phenotype associated with poor clinical outcomes in colorectal cancer. Nat Genet 2024; 56:458-472. [PMID: 38351382 PMCID: PMC10937375 DOI: 10.1038/s41588-024-01654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/03/2024] [Indexed: 02/29/2024]
Abstract
Molecular stratification using gene-level transcriptional data has identified subtypes with distinctive genotypic and phenotypic traits, as exemplified by the consensus molecular subtypes (CMS) in colorectal cancer (CRC). Here, rather than gene-level data, we make use of gene ontology and biological activation state information for initial molecular class discovery. In doing so, we defined three pathway-derived subtypes (PDS) in CRC: PDS1 tumors, which are canonical/LGR5+ stem-rich, highly proliferative and display good prognosis; PDS2 tumors, which are regenerative/ANXA1+ stem-rich, with elevated stromal and immune tumor microenvironmental lineages; and PDS3 tumors, which represent a previously overlooked slow-cycling subset of tumors within CMS2 with reduced stem populations and increased differentiated lineages, particularly enterocytes and enteroendocrine cells, yet display the worst prognosis in locally advanced disease. These PDS3 phenotypic traits are evident across numerous bulk and single-cell datasets, and demark a series of subtle biological states that are currently under-represented in pre-clinical models and are not identified using existing subtyping classifiers.
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Affiliation(s)
- Sudhir B Malla
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Ryan M Byrne
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Maxime W Lafarge
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shania M Corry
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Natalie C Fisher
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | | | | | | | | | | | | | - Raheleh Amirkhah
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Sarah L Maguire
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | | | | | - Elena Grassi
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Marco Viviani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Emily Rogan
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Keara L Redmond
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Svetlana Sakhnevych
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Aoife J McCooey
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Courtney Bull
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Emily Hoey
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Nicoleta Sinevici
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Holly Hall
- Cancer Research UK Scotland Institute, Glasgow, UK
| | - Baharak Ahmaderaghi
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, UK
| | - Enric Domingo
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Andrew Blake
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Susan D Richman
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Claudio Isella
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Crispin Miller
- Cancer Research UK Scotland Institute, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Andrea Bertotti
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Livio Trusolino
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Torino, Italy
- Department of Oncology, University of Torino, Candiolo, Torino, Italy
| | - Maurice B Loughrey
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Emma M Kerr
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Sabine Tejpar
- Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Timothy S Maughan
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Mark Lawler
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | | | | | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Owen J Sansom
- Cancer Research UK Scotland Institute, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Philip D Dunne
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
- Cancer Research UK Scotland Institute, Glasgow, UK.
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Nasreddin N, Jansen M, Loughrey MB, Wang LM, Koelzer VH, Rodriguez-Justo M, Novelli M, Fisher J, Brown MW, Al Bakir I, Hart AL, Dunne P, Graham TA, Leedham SJ. Poor Diagnostic Reproducibility in the Identification of Nonconventional Dysplasia in Colitis Impacts the Application of Histologic Stratification Tools. Mod Pathol 2024; 37:100419. [PMID: 38158125 DOI: 10.1016/j.modpat.2023.100419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/10/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
Due to their increased cancer risk, patients with longstanding inflammatory bowel disease are offered endoscopic surveillance with concomitant histopathologic assessments, aimed at identifying dysplasia as a precursor lesion of colitis-associated colorectal cancer. However, this strategy is beset with difficulties and limitations. Recently, a novel classification criterion for colitis-associated low-grade dysplasia has been proposed, and an association between nonconventional dysplasia and progression was reported, suggesting the possibility of histology-based stratification of patients with colitis-associated lesions. Here, a cohort of colitis-associated lesions was assessed by a panel of 6 experienced pathologists to test the applicability of the published classification criteria and try and validate the association between nonconventional dysplasia and progression. While confirming the presence of different morphologic patterns of colitis-associated dysplasia, the study demonstrated difficulties concerning diagnostic reproducibility between pathologists and was unable to validate the association of nonconventional dysplasia with cancer progression. Our study highlights the overall difficulty of using histologic assessment of precursor lesions for cancer risk prediction in inflammatory bowel disease patients and suggests the need for a different diagnostic strategy that can objectively identify high-risk phenotypes.
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Affiliation(s)
- Nadia Nasreddin
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, United Kingdom
| | - Marnix Jansen
- Department of Pathology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Maurice B Loughrey
- Department of Cellular Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Lai Mun Wang
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital Zürich, Zürich, Switzerland
| | - Manuel Rodriguez-Justo
- Department of Pathology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Marco Novelli
- Department of Pathology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Jennifer Fisher
- Centre for Evolution and Cancer, Institute of Cancer Research, London, United Kingdom
| | - Matthew W Brown
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, United Kingdom
| | | | - Ailsa L Hart
- IBD Unit, St Mark's Hospital, Harrow, London, United Kingdom
| | - Philip Dunne
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
| | - Trevor A Graham
- Centre for Evolution and Cancer, Institute of Cancer Research, London, United Kingdom
| | - Simon J Leedham
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, United Kingdom.
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6
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Frei AL, McGuigan A, Sinha RRAK, Jabbar F, Gneo L, Tomasevic T, Harkin A, Iveson T, Saunders MP, Oien KA, Maka N, Pezzella F, Campo L, Browne M, Glaire M, Kildal W, Danielsen HE, Hay J, Edwards J, Sansom O, Kelly C, Tomlinson I, Kerr R, Kerr D, Domingo E, Church DN, Koelzer VH. Multiplex analysis of intratumoural immune infiltrate and prognosis in patients with stage II-III colorectal cancer from the SCOT and QUASAR 2 trials: a retrospective analysis. Lancet Oncol 2024; 25:198-211. [PMID: 38301689 DOI: 10.1016/s1470-2045(23)00560-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Tumour-infiltrating CD8+ cytotoxic T cells confer favourable prognosis in colorectal cancer. The added prognostic value of other infiltrating immune cells is unclear and so we sought to investigate their prognostic value in two large clinical trial cohorts. METHODS We used multiplex immunofluorescent staining of tissue microarrays to assess the densities of CD8+, CD20+, FoxP3+, and CD68+ cells in the intraepithelial and intrastromal compartments from tumour samples of patients with stage II-III colorectal cancer from the SCOT trial (ISRCTN59757862), which examined 3 months versus 6 months of adjuvant oxaliplatin-based chemotherapy, and from the QUASAR 2 trial (ISRCTN45133151), which compared adjuvant capecitabine with or without bevacizumab. Both trials included patients aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-1. Immune marker predictors were analysed by multiple regression, and the prognostic and predictive values of markers for colorectal cancer recurrence-free interval by Cox regression were assessed using the SCOT cohort for discovery and QUASAR 2 cohort for validation. FINDINGS After exclusion of cases without tissue microarrays and with technical failures, and following quality control, we included 2340 cases from the SCOT trial and 1069 from the QUASAR 2 trial in our analysis. Univariable analysis of associations with recurrence-free interval in cases from the SCOT trial showed a strong prognostic value of intraepithelial CD8 (CD8IE) as a continuous variable (hazard ratio [HR] for 75th vs 25th percentile [75vs25] 0·73 [95% CI 0·68-0·79], p=2·5 × 10-16), and of intrastromal FoxP3 (FoxP3IS; 0·71 [0·64-0·78], p=1·5 × 10-13) but not as strongly in the epithelium (FoxP3IE; 0·89 [0·84-0·96], p=1·5 × 10-4). Associations of other markers with recurrence-free interval were moderate. CD8IE and FoxP3IS retained independent prognostic value in bivariable and multivariable analysis, and, compared with either marker alone, a composite marker including both markers (CD8IE-FoxP3IS) was superior when assessed as a continuous variable (adjusted [a]HR75 vs 25 0·70 [95% CI 0·63-0·78], p=5·1 × 10-11) and when categorised into low, intermediate, and high density groups using previously published cutpoints (aHR for intermediate vs high 1·68 [95% CI 1·29-2·20], p=1·3 × 10-4; low vs high 2·58 [1·91-3·49], p=7·9 × 10-10), with performance similar to the gold-standard Immunoscore. The prognostic value of CD8IE-FoxP3IS was confirmed in cases from the QUASAR 2 trial, both as a continuous variable (aHR75 vs 25 0·84 [95% CI 0·73-0·96], p=0·012) and as a categorical variable for low versus high density (aHR 1·80 [95% CI 1·17-2·75], p=0·0071) but not for intermediate versus high (1·30 [0·89-1·88], p=0·17). INTERPRETATION Combined evaluation of CD8IE and FoxP3IS could help to refine risk stratification in colorectal cancer. Investigation of FoxP3IS cells as an immunotherapy target in colorectal cancer might be merited. FUNDING Medical Research Council, National Institute for Health Research, Cancer Research UK, Swedish Cancer Society, Roche, and Promedica Foundation.
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Affiliation(s)
- Anja L Frei
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Life Science Zurich Graduate School, PhD Program in Biomedicine, University of Zurich, Zurich, Switzerland
| | - Anthony McGuigan
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ritik R A K Sinha
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Faiz Jabbar
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Luciana Gneo
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tijana Tomasevic
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrea Harkin
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | | | | | - Karin A Oien
- School of Cancer Sciences, University of Glasgow, Glasgow, UK; Glasgow Tissue Research Facility, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Noori Maka
- Glasgow Tissue Research Facility, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Francesco Pezzella
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, UK
| | - Leticia Campo
- Department of Oncology, University of Oxford, Oxford, UK
| | - Molly Browne
- Department of Oncology, University of Oxford, Oxford, UK
| | - Mark Glaire
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wanja Kildal
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Havard E Danielsen
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, UK; Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Jennifer Hay
- Glasgow Tissue Research Facility, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Joanne Edwards
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Owen Sansom
- School of Cancer Sciences, University of Glasgow, Glasgow, UK; Cancer Research UK Beatson Institute of Cancer Research, Glasgow, UK; Cancer Research UK Scotland Centre, Glasgow and Edinburgh, UK
| | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Ian Tomlinson
- Department of Oncology, University of Oxford, Oxford, UK
| | - Rachel Kerr
- Department of Oncology, University of Oxford, Oxford, UK
| | - David Kerr
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, UK
| | - Enric Domingo
- Department of Oncology, University of Oxford, Oxford, UK; Cancer Research UK Scotland Centre, Glasgow and Edinburgh, UK
| | - David N Church
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford NIHR Comprehensive Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Oncology, University of Oxford, Oxford, UK
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7
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Janowczyk A, Zlobec I, Walker C, Berezowska S, Huschauer V, Tinguely M, Kupferschmid J, Mallet T, Merkler D, Kreutzfeldt M, Gasic R, Rau TT, Mazzucchelli L, Eyberg I, Cathomas G, Mertz KD, Koelzer VH, Soldini D, Jochum W, Rössle M, Henkel M, Grobholz R. Swiss digital pathology recommendations: results from a Delphi process conducted by the Swiss Digital Pathology Consortium of the Swiss Society of Pathology. Virchows Arch 2023:10.1007/s00428-023-03712-5. [PMID: 38112792 DOI: 10.1007/s00428-023-03712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/23/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023]
Abstract
Integration of digital pathology (DP) into clinical diagnostic workflows is increasingly receiving attention as new hardware and software become available. To facilitate the adoption of DP, the Swiss Digital Pathology Consortium (SDiPath) organized a Delphi process to produce a series of recommendations for DP integration within Swiss clinical environments. This process saw the creation of 4 working groups, focusing on the various components of a DP system (1) scanners, quality assurance and validation of scans, (2) integration of Whole Slide Image (WSI)-scanners and DP systems into the Pathology Laboratory Information System, (3) digital workflow-compliance with general quality guidelines, and (4) image analysis (IA)/artificial intelligence (AI), with topic experts for each recruited for discussion and statement generation. The work product of the Delphi process is 83 consensus statements presented here, forming the basis for "SDiPath Recommendations for Digital Pathology". They represent an up-to-date resource for national and international hospitals, researchers, device manufacturers, algorithm developers, and all supporting fields, with the intent of providing expectations and best practices to help ensure safe and efficient DP usage.
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Affiliation(s)
- Andrew Janowczyk
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, USA.
- Department of Oncology, Division of Precision Oncology, Geneva University Hospitals, Geneva, Switzerland.
- Department of Diagnostics, Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland.
| | - Inti Zlobec
- Institute for Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Cedric Walker
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Sabina Berezowska
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Marianne Tinguely
- Institute of Pathology Enge, Zurich, Switzerland
- Medical Faculty, University of Zürich, Zurich, Switzerland
| | | | - Thomas Mallet
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Doron Merkler
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Mario Kreutzfeldt
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | | | - Tilman T Rau
- Institute of Pathology, University Hospital and Heinrich-Heine University, Düsseldorf, Germany
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Isgard Eyberg
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Gieri Cathomas
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital of Zürich, Zurich, Switzerland
| | | | - Wolfram Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Matthias Rössle
- Pathologie Luzerner Kantonsspital (Pathology Cantonal Hospital Lucerne), Spitalstrasse, Switzerland
| | - Maurice Henkel
- Research & Analytic Services University Hospital Basel, Basel, Switzerland
- Institute of Radiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rainer Grobholz
- Medical Faculty, University of Zürich, Zurich, Switzerland
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
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8
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Berezowska S, Cathomas G, Grobholz R, Henkel M, Jochum W, Koelzer VH, Kreutzfeldt M, Mertz KD, Rössle M, Soldini D, Zlobec I, Janowczyk A. Digital image analysis and artificial intelligence in pathology diagnostics-the Swiss view. Pathologie (Heidelb) 2023; 44:222-224. [PMID: 37987817 PMCID: PMC10739393 DOI: 10.1007/s00292-023-01262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
Digital pathology (DP) is increasingly entering routine clinical pathology diagnostics. As digitization of the routine caseload advances, implementation of digital image analysis algorithms and artificial intelligence tools becomes not only attainable, but also desirable in daily sign out. The Swiss Digital Pathology Consortium (SDiPath) has initiated a Delphi process to generate best-practice recommendations for various phases of the process of digitization in pathology for the local Swiss environment, encompassing the following four topics: i) scanners, quality assurance, and validation of scans; ii) integration of scanners and systems into the pathology laboratory information system; iii) the digital workflow; and iv) digital image analysis (DIA)/artificial intelligence (AI). The current article focuses on the DIA-/AI-related recommendations generated and agreed upon by the working group and further verified by the Delphi process among the members of SDiPath. Importantly, they include the view and the currently perceived needs of practicing pathologists from multiple academic and cantonal hospitals as well as private practices.
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Affiliation(s)
- Sabina Berezowska
- Institut Universitaire de Pathologie, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 25, 1011, Lausanne, Switzerland.
| | - Gieri Cathomas
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Rainer Grobholz
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Maurice Henkel
- Research & Analytic Services, University Hospital Basel, Basel, Switzerland
- Institute of Radiology, University Hospital Basel, Basel, Switzerland
- University Basel, Basel, Switzerland
| | - Wolfram Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, 9007, St. Gallen, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Mario Kreutzfeldt
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Matthias Rössle
- Pathologie, Luzerner Kantonsspital, Spitalstr., 6000, Luzern 16, Switzerland
| | - Davide Soldini
- Pathologie Zentrum Zürich medica, Hottingerstr. 9, 8024, Zürich, Switzerland
| | - Inti Zlobec
- Institute of Tissue Medicine and Pathology, University of Bern, Murtenstr. 31, 3008, Bern, Switzerland
| | - Andrew Janowczyk
- Department of Biomedical Engineering, Emory University, Atlanta, USA
- Department of Oncology, Division of Precision Oncology, Geneva University Hospitals, Geneva, Switzerland
- Department of Diagnostics, Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland
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9
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Grobholz R, Janowczyk A, Frei AL, Kreutzfeldt M, Koelzer VH, Zlobec I. National digital pathology projects in Switzerland: A 2023 update. Pathologie (Heidelb) 2023; 44:225-228. [PMID: 37987815 PMCID: PMC10739407 DOI: 10.1007/s00292-023-01259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
The Swiss Digital Pathology Consortium (SDiPath) was founded in 2018 as a working group of the Swiss Society for Pathology with the aim of networking, training, and promoting digital pathology (DP) at a national level. Since then, two national surveys have been carried out on the level of knowledge, dissemination, use, and needs in DP, which have resulted in clear fields of action. In addition to organizing symposia and workshops, national guidelines were drawn up and an initiative for a national DP platform actively codesigned. With the growing use of digital image processing and artificial intelligence tools, continuous monitoring, evaluation, and exchange of experiences will be pursued, along with best practices.
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Affiliation(s)
- Rainer Grobholz
- Medical Faculty, University of Zurich, Zurich, Switzerland.
- Institute of Pathology, Kantonsspital Aarau, Tellstr. 25, 5001, Aarau, Switzerland.
| | - Andrew Janowczyk
- Department of Biomedical Engineering, Emory University, Atlanta, GA, USA
- Department of Oncology, Division of Precision Oncology, University Hospital of Geneva, Geneva, Switzerland
- Department of Diagnostics, Division of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Ana Leni Frei
- Institute for Tissue Medicine and Pathology, University Bern, Bern, Switzerland
| | - Mario Kreutzfeldt
- Department of Pathology and Immunology, Division of Clinical Pathology, University & University Hospitals of Geneva, Geneva, Switzerland
| | - Viktor H Koelzer
- Department of Pathology und Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Inti Zlobec
- Institute for Tissue Medicine and Pathology, University Bern, Bern, Switzerland
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10
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Frei AL, McGuigan A, Sinha RRAK, Glaire MA, Jabbar F, Gneo L, Tomasevic T, Harkin A, Iveson TJ, Saunders M, Oein K, Maka N, Pezella F, Campo L, Hay J, Edwards J, Sansom OJ, Kelly C, Tomlinson I, Kildal W, Kerr RS, Kerr DJ, Danielsen HE, Domingo E, Church DN, Koelzer VH. Accounting for intensity variation in image analysis of large-scale multiplexed clinical trial datasets. J Pathol Clin Res 2023; 9:449-463. [PMID: 37697694 PMCID: PMC10556275 DOI: 10.1002/cjp2.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
Multiplex immunofluorescence (mIF) imaging can provide comprehensive quantitative and spatial information for multiple immune markers for tumour immunoprofiling. However, application at scale to clinical trial samples sourced from multiple institutions is challenging due to pre-analytical heterogeneity. This study reports an analytical approach to the largest multi-parameter immunoprofiling study of clinical trial samples to date. We analysed 12,592 tissue microarray (TMA) spots from 3,545 colorectal cancers sourced from more than 240 institutions in two clinical trials (QUASAR 2 and SCOT) stained for CD4, CD8, CD20, CD68, FoxP3, pan-cytokeratin, and DAPI by mIF. TMA slides were multi-spectrally imaged and analysed by cell-based and pixel-based marker analysis. We developed an adaptive thresholding method to account for inter- and intra-slide intensity variation in TMA analysis. Applying this method effectively ameliorated inter- and intra-slide intensity variation improving the image analysis results compared with methods using a single global threshold. Correlation of CD8 data derived by our mIF analysis approach with single-plex chromogenic immunohistochemistry CD8 data derived from subsequent sections indicates the validity of our method (Spearman's rank correlation coefficients ρ between 0.63 and 0.66, p ≪ 0.01) as compared with the current gold standard analysis approach. Evaluation of correlation between cell-based and pixel-based analysis results confirms equivalency (ρ > 0.8, p ≪ 0.01, except for CD20 in the epithelial region) of both analytical approaches. These data suggest that our adaptive thresholding approach can enable analysis of mIF-stained clinical trial TMA datasets by digital pathology at scale for precision immunoprofiling.
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Affiliation(s)
- Anja L Frei
- Department of Pathology and Molecular PathologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
- Life Science Zurich Graduate School, PhD Program in BiomedicineUniversity of ZurichZurichSwitzerland
| | | | | | - Mark A Glaire
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Faiz Jabbar
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Luciana Gneo
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | | | - Andrea Harkin
- Cancer Research UK Glasgow Clinical Trials UnitUniversity of GlasgowGlasgowUK
| | - Tim J Iveson
- Southampton University Hospital NHS Foundation TrustSouthamptonUK
| | | | - Karin Oein
- Glasgow Tissue Research FacilityUniversity of Glasgow, Queen Elizabeth University HospitalGlasgowUK
| | - Noori Maka
- Glasgow Tissue Research FacilityUniversity of Glasgow, Queen Elizabeth University HospitalGlasgowUK
| | - Francesco Pezella
- Nuffield Division of Clinical Laboratory SciencesUniversity of OxfordOxfordUK
| | | | - Jennifer Hay
- Glasgow Tissue Research FacilityUniversity of Glasgow, Queen Elizabeth University HospitalGlasgowUK
| | | | - Owen J Sansom
- School of Cancer SciencesUniversity of GlasgowGlasgowUK
- Cancer Research UK Beatson InstituteGlasgowUK
- Cancer Research UK Scotland CentreEdinburgh and GlasgowUK
| | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials UnitUniversity of GlasgowGlasgowUK
| | | | - Wanja Kildal
- Institute for Cancer Genetics and InformaticsOslo University HospitalOsloNorway
| | | | - David J Kerr
- Nuffield Division of Clinical Laboratory SciencesUniversity of OxfordOxfordUK
| | - Håvard E Danielsen
- Nuffield Division of Clinical Laboratory SciencesUniversity of OxfordOxfordUK
- Institute for Cancer Genetics and InformaticsOslo University HospitalOsloNorway
- Department of InformaticsUniversity of OsloOsloNorway
| | - Enric Domingo
- Department of OncologyUniversity of OxfordOxfordUK
- Cancer Research UK Scotland CentreEdinburgh and GlasgowUK
| | | | - David N Church
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
- Oxford NIHR Comprehensive Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Viktor H Koelzer
- Department of Pathology and Molecular PathologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
- Department of OncologyUniversity of OxfordOxfordUK
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11
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Marques-Maggio E, Maccio U, Marx A, Galli S, Schwab N, Frank A, Hamelin B, Varga Z, Nombela-Arrieta C, Mertz KD, Theocharides AP, Koelzer VH. Bone marrow haematopoiesis in patients with COVID-19. Histopathology 2023; 83:582-590. [PMID: 37317636 DOI: 10.1111/his.14969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
AIMS Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection broadly affects organ homeostasis, including the haematopoietic system. Autopsy studies are a crucial tool for investigation of organ-specific pathologies. Here we perform an in-depth analysis of the impact of severe coronavirus disease 2019 (COVID-19) on bone marrow haematopoiesis in correlation with clinical and laboratory parameters. METHODS AND RESULTS Twenty-eight autopsy cases and five controls from two academic centres were included in the study. We performed a comprehensive analysis of bone marrow pathology and microenvironment features with clinical and laboratory parameters and assessed SARS-CoV-2 infection of the bone marrow by quantitative polymerase chain reaction (qPCR) analysis. In COVID-19 patients, bone marrow specimens showed a left-shifted myelopoiesis (19 of 28, 64%), increased myeloid-erythroid ratio (eight of 28, 28%), increased megakaryopoiesis (six of 28, 21%) and lymphocytosis (four of 28, 14%). Strikingly, a high proportion of COVID-19 specimens showed erythrophagocytosis (15 of 28, 54%) and the presence of siderophages (11 of 15, 73%) compared to control cases (none of five, 0%). Clinically, erythrophagocytosis correlated with lower haemoglobin levels and was more frequently observed in patients from the second wave. Analysis of the immune environment showed a strong increase in CD68+ macrophages (16 of 28, 57%) and a borderline lymphocytosis (five of 28, 18%). The stromal microenvironment showed oedema (two of 28, 7%) and severe capillary congestion (one of 28, 4%) in isolated cases. No stromal fibrosis or microvascular thrombosis was found. While all cases had confirmed positive testing of SARS-CoV-2 in the respiratory system, SARS-CoV-2 was not detected in the bone marrow by high-sensitivity PCR, suggesting that SARS-CoV-2 does not commonly replicate in the haematopoietic microenvironment. CONCLUSIONS SARS-CoV-2 infection indirectly impacts the haematological compartment and the bone marrow immune environment. Erythrophagocytosis is frequent and associated with lower haemoglobin levels in patients with severe COVID-19.
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Affiliation(s)
- Ewerton Marques-Maggio
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
- Medica Pathologie Zentrum Zürich, Zürich, Switzerland
| | - Umberto Maccio
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
| | - Alexandra Marx
- Stadtspital Zürich Waid, Klinik für Innere Medizin, Zürich, Switzerland
| | - Serena Galli
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zürich, Zürich, Switzerland
| | - Nathalie Schwab
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Angela Frank
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Baptiste Hamelin
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
| | - César Nombela-Arrieta
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zürich, Zürich, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Alexandre Pa Theocharides
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zürich, Zürich, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
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12
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Wagner SJ, Reisenbüchler D, West NP, Niehues JM, Zhu J, Foersch S, Veldhuizen GP, Quirke P, Grabsch HI, van den Brandt PA, Hutchins GGA, Richman SD, Yuan T, Langer R, Jenniskens JCA, Offermans K, Mueller W, Gray R, Gruber SB, Greenson JK, Rennert G, Bonner JD, Schmolze D, Jonnagaddala J, Hawkins NJ, Ward RL, Morton D, Seymour M, Magill L, Nowak M, Hay J, Koelzer VH, Church DN, Matek C, Geppert C, Peng C, Zhi C, Ouyang X, James JA, Loughrey MB, Salto-Tellez M, Brenner H, Hoffmeister M, Truhn D, Schnabel JA, Boxberg M, Peng T, Kather JN. Transformer-based biomarker prediction from colorectal cancer histology: A large-scale multicentric study. Cancer Cell 2023; 41:1650-1661.e4. [PMID: 37652006 PMCID: PMC10507381 DOI: 10.1016/j.ccell.2023.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/18/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
Deep learning (DL) can accelerate the prediction of prognostic biomarkers from routine pathology slides in colorectal cancer (CRC). However, current approaches rely on convolutional neural networks (CNNs) and have mostly been validated on small patient cohorts. Here, we develop a new transformer-based pipeline for end-to-end biomarker prediction from pathology slides by combining a pre-trained transformer encoder with a transformer network for patch aggregation. Our transformer-based approach substantially improves the performance, generalizability, data efficiency, and interpretability as compared with current state-of-the-art algorithms. After training and evaluating on a large multicenter cohort of over 13,000 patients from 16 colorectal cancer cohorts, we achieve a sensitivity of 0.99 with a negative predictive value of over 0.99 for prediction of microsatellite instability (MSI) on surgical resection specimens. We demonstrate that resection specimen-only training reaches clinical-grade performance on endoscopic biopsy tissue, solving a long-standing diagnostic problem.
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Affiliation(s)
- Sophia J Wagner
- Helmholtz Munich - German Research Center for Environment and Health, Munich, Germany; School of Computation, Information and Technology, Technical University of Munich, Munich, Germany; Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | - Daniel Reisenbüchler
- Helmholtz Munich - German Research Center for Environment and Health, Munich, Germany
| | - Nicholas P West
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Jan Moritz Niehues
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | - Jiefu Zhu
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | - Sebastian Foersch
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | | | - Philip Quirke
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Heike I Grabsch
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gordon G A Hutchins
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Susan D Richman
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Tanwei Yuan
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rupert Langer
- Institute of Pathology und Molecular Pathology, Johannes Kepler University Hospital Linz, Linz, Österreich
| | - Josien C A Jenniskens
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Kelly Offermans
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - Richard Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stephen B Gruber
- Center for Precision Medicine and Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Joel K Greenson
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Gad Rennert
- Department of Community Medicine & Epidemiology, Lady Davis Carmel Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Steve and Cindy Rasmussen Institute for Genomic Medicine, Lady Davis Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa, Israel
| | - Joseph D Bonner
- Department of Community Medicine & Epidemiology, Lady Davis Carmel Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Schmolze
- Center for Precision Medicine and Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jitendra Jonnagaddala
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Nicholas J Hawkins
- School of Medical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Robyn L Ward
- School of Medical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dion Morton
- University Hospital Birmingham, Birmingham, UK
| | | | - Laura Magill
- University of Birmingham Clinical Trials Unit, Birmingham, UK
| | - Marta Nowak
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jennifer Hay
- Glasgow Tissue Research Facility, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Oncology, University of Oxford, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford, UK
| | - David N Church
- Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford, UK; Oxford NIHR Comprehensive Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christian Matek
- Helmholtz Munich - German Research Center for Environment and Health, Munich, Germany; Institute of Pathology, University Hospital Erlangen, FAU Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC), University Hospital Erlangen, FAU Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, University Hospital Erlangen, FAU Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC), University Hospital Erlangen, FAU Erlangen-Nuremberg, Erlangen, Germany
| | - Chaolong Peng
- Medical School, Jianggang Shan University, Jiangxi, China
| | - Cheng Zhi
- Department of Pathology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoming Ouyang
- Department of Pathology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jacqueline A James
- Precision Medicine Centre of Excellence, Health Sciences Building, The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Regional Molecular Diagnostic Service, Belfast Health and Social Care Trust, Belfast, UK; The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Maurice B Loughrey
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Department of Cellular Pathology, Belfast Health and Social Care Trust, Belfast, UK; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Manuel Salto-Tellez
- Precision Medicine Centre of Excellence, Health Sciences Building, The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Regional Molecular Diagnostic Service, Belfast Health and Social Care Trust, Belfast, UK; Integrated Pathology Unit, Institute for Cancer Research and Royal Marsden Hospital, London, UK
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia A Schnabel
- Helmholtz Munich - German Research Center for Environment and Health, Munich, Germany; School of Computation, Information and Technology, Technical University of Munich, Munich, Germany; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Melanie Boxberg
- Institute of Pathology, Technical University Munich, Munich, Germany; Institute of Pathology Munich-North, Munich, Germany
| | - Tingying Peng
- Helmholtz Munich - German Research Center for Environment and Health, Munich, Germany.
| | - Jakob Nikolas Kather
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany; Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg.
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13
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Kleeman SO, Thakir TM, Demestichas B, Mourikis N, Loiero D, Ferrer M, Bankier S, Riazat-Kesh YJ, Lee H, Chantzichristos D, Regan C, Preall J, Sinha S, Rosin N, Yipp B, de Almeida LG, Biernaskie J, Dufour A, Tober-Lau P, Ruusalepp A, Bjorkegren JL, Ralser M, Kurth F, Demichev V, Heywood T, Gao Q, Johannsson G, Koelzer VH, Walker BR, Meyer HV, Janowitz T. Cystatin C is glucocorticoid responsive, directs recruitment of Trem2+ macrophages, and predicts failure of cancer immunotherapy. Cell Genom 2023; 3:100347. [PMID: 37601967 PMCID: PMC10435381 DOI: 10.1016/j.xgen.2023.100347] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/23/2023] [Accepted: 05/30/2023] [Indexed: 08/22/2023]
Abstract
Cystatin C (CyC), a secreted cysteine protease inhibitor, has unclear biological functions. Many patients exhibit elevated plasma CyC levels, particularly during glucocorticoid (GC) treatment. This study links GCs with CyC's systemic regulation by utilizing genome-wide association and structural equation modeling to determine CyC production genetics in the UK Biobank. Both CyC production and a polygenic score (PGS) capturing predisposition to CyC production were associated with increased all-cause and cancer-specific mortality. We found that the GC receptor directly targets CyC, leading to GC-responsive CyC secretion in macrophages and cancer cells. CyC-knockout tumors displayed significantly reduced growth and diminished recruitment of TREM2+ macrophages, which have been connected to cancer immunotherapy failure. Furthermore, the CyC-production PGS predicted checkpoint immunotherapy failure in 685 patients with metastatic cancer from combined clinical trial cohorts. In conclusion, CyC may act as a GC effector pathway via TREM2+ macrophage recruitment and may be a potential target for combination cancer immunotherapy.
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Affiliation(s)
- Sam O. Kleeman
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | | | | | | | - Dominik Loiero
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Miriam Ferrer
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Sean Bankier
- BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Computational Biology Unit, Department of Informatics, University of Bergen, Bergen, Norway
| | | | - Hassal Lee
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Dimitrios Chantzichristos
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology Diabetes and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claire Regan
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | | | - Sarthak Sinha
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Nicole Rosin
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Bryan Yipp
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Luiz G.N. de Almeida
- Department of Biochemistry and Molecular Biology and Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Jeff Biernaskie
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Antoine Dufour
- Department of Biochemistry and Molecular Biology and Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
| | | | - Arno Ruusalepp
- Department of Cardiac Surgery, Tartu University Hospital, Tartu, Estonia
| | - Johan L.M. Bjorkegren
- Department of Genetics & Genomic Sciences, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Markus Ralser
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Kurth
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Todd Heywood
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Qing Gao
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology Diabetes and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Viktor H. Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Brian R. Walker
- BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Tobias Janowitz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
- Cancer Institute, Northwell Health, New Hyde Park, NY, USA
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14
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Freiberger SN, Holzmann D, Morand GB, Hüllner M, Levesque MP, Dummer R, Koelzer VH, Rupp NJ. Combinational expression of tumor testis antigens NY-ESO-1, MAGE-A3, and MAGE-A4 predicts response to immunotherapy in mucosal melanoma patients. J Cancer Res Clin Oncol 2023; 149:5645-5653. [PMID: 36527482 PMCID: PMC10356647 DOI: 10.1007/s00432-022-04514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Immunotherapy using immune checkpoint inhibitors (ICI) has revolutionized cancer treatment in recent years, particularly in melanoma. While response to immunotherapy is associated with high tumor mutational burden (TMB), PD-L1 expression, and microsatellite instability in several cancers, tumors lacking these biomarkers can still respond to this treatment. Especially, mucosal melanoma, commonly exhibiting low TMB compared to cutaneous melanoma, may respond to immunotherapy with immune checkpoint inhibitors. Therefore, the aim of our study was to investigate novel biomarkers in mucosal melanoma that predict response to combined ipilimumab and nivolumab. METHODS We investigated 10 tumor samples from 10 patients (three responders, seven non-responders) before treatment and six tumor samples from five patients after progression using a targeted Next Generation Sequencing (NGS) gene expression panel. The findings were corroborated with an independent method (i.e., immunohistochemical staining) on the same 10 tumor samples before treatment and, to increase the cohort, in addition on three tumor samples before treatment of more recent patients (one responder, two non-responders). RESULTS With the targeted gene expression panel, we found the three tumor testis antigens CTAG1B (NY-ESO-1), MAGE-A3, and MAGE-A4 to be predominantly expressed in responding tumors. This marker panel was either not or not completely expressed in non-responders (p < 0.01). Using immunohistochemistry for all three markers, we could confirm the elevated expression in tumors responding to the ipilimumab/nivolumab combination therapy. CONCLUSION In conclusion, these three biomarkers await validation in a larger patient cohort and could be easily used in future routine diagnostics to predict the outcome of ipilimumab/nivolumab combination therapy in mucosal melanoma patients.
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Affiliation(s)
- Sandra N Freiberger
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - David Holzmann
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Grégoire B Morand
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- Department of Otolaryngology - Head and Neck Surgery, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Martin Hüllner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Mitchell P Levesque
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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15
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Couto JP, Vulin M, Jehanno C, Coissieux MM, Hamelin B, Schmidt A, Ivanek R, Sethi A, Bräutigam K, Frei AL, Hager C, Manivannan M, Gómez-Miragaya J, Obradović MM, Varga Z, Koelzer VH, Mertz KD, Bentires-Alj M. Nicotinamide N-methyltransferase sustains a core epigenetic program that promotes metastatic colonization in breast cancer. EMBO J 2023:e112559. [PMID: 37259596 DOI: 10.15252/embj.2022112559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 06/02/2023] Open
Abstract
Metastatic colonization of distant organs accounts for over 90% of deaths related to solid cancers, yet the molecular determinants of metastasis remain poorly understood. Here, we unveil a mechanism of colonization in the aggressive basal-like subtype of breast cancer that is driven by the NAD+ metabolic enzyme nicotinamide N-methyltransferase (NNMT). We demonstrate that NNMT imprints a basal genetic program into cancer cells, enhancing their plasticity. In line, NNMT expression is associated with poor clinical outcomes in patients with breast cancer. Accordingly, ablation of NNMT dramatically suppresses metastasis formation in pre-clinical mouse models. Mechanistically, NNMT depletion results in a methyl overflow that increases histone H3K9 trimethylation (H3K9me3) and DNA methylation at the promoters of PR/SET Domain-5 (PRDM5) and extracellular matrix-related genes. PRDM5 emerged in this study as a pro-metastatic gene acting via induction of cancer-cell intrinsic transcription of collagens. Depletion of PRDM5 in tumor cells decreases COL1A1 deposition and impairs metastatic colonization of the lungs. These findings reveal a critical activity of the NNMT-PRDM5-COL1A1 axis for cancer cell plasticity and metastasis in basal-like breast cancer.
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Affiliation(s)
- Joana Pinto Couto
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Milica Vulin
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Charly Jehanno
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Marie-May Coissieux
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Baptiste Hamelin
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Alexander Schmidt
- Proteomics Core Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - Robert Ivanek
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Atul Sethi
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
- Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Konstantin Bräutigam
- Computational and Translational Pathology Group, Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Anja L Frei
- Computational and Translational Pathology Group, Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Carolina Hager
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Madhuri Manivannan
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Jorge Gómez-Miragaya
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Milan Ms Obradović
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
| | - Zsuzsanna Varga
- Computational and Translational Pathology Group, Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Viktor H Koelzer
- Computational and Translational Pathology Group, Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Mohamed Bentires-Alj
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Surgery, University Hospital Basel, Basel, Switzerland
- Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland
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16
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Fremond S, Andani S, Wolf JB, Ørtoft G, Høgdall E, Dijkstra J, Jobsen JJ, Jürgenliemk-Schulz IM, Lutgens LCHW, Powell ME, Singh N, Mileshkin LR, Mackay HJ, Leary A, Katsaros D, Nijman HW, de Boer SM, Nout RA, Smit VT, Creutzberg CL, Horeweg N, Koelzer VH, Bosse T. Abstract 5695: Deep learning risk prediction model of distant recurrence from H&E endometrial cancer slides. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Accurate risk prediction of distant recurrence (DR) is crucial for personalized adjuvant systemic therapy of endometrial cancer (EC) stage I-III patients, as DR is associated with a 5-year overall survival of 10-20%. Risk stratification and treatment recommendation are currently based on histopathological and molecular markers, which is challenging due to high inter-observer variability and testing costs respectively. Deep Learning (DL) models can predict prognosis by identifying relevant visual features from H&E whole slide images (WSIs) at different resolutions without prior assumptions. Here, we developed and tested the first interpretable state-of-the-art DL model for WSI-based risk prediction of DR of stage I-III EC (DeREC) from the randomized PORTEC-1/-2/-3 trials and three clinical cohorts with long-term follow-up data. We used one representative H&E WSI each from 1761 EC patients, excluding those who received adjuvant chemotherapy as it lowers the risk of DR. We randomly sampled 20% as a held-out internal test set (N=353 with 62 events; 8.45 year median follow-up) and performed a 5-fold cross-validation on the training set (N=1408). WSIs were partitioned into 360 micron patches at 40x magnification. DeREC combined self-supervised representation learning of patches using a multi-resolution vision transformer and a WSI-level graph attention-based time-to-event prediction model. The model performance of correctly ranking patients by predicted risk scores and true time to DR was measured with the concordance-index and compared with a Cox’ Proportional Hazards (CPH) model fitted on histopathological variables (histotype, grade, lymphovascular space invasion, stage). Discriminative quality of the predicted risk groups was investigated with Kaplan-Meier analysis and the log-rank test. Most predictive patches by predicted risk groups were reviewed by an expert gynecopathologist for identification of prognostic morphological features. DeREC achieved a concordance-index of 0.764 [95%CI 0.754-0.773] on 5-fold cross validation and 0.757 on the test set, as compared to 0.704 [95%CI 0.662-0.746] with CPH. Predicted risk groups around quartiles 1 and 3 accurately stratified patients between low (N=89), intermediate (N=175), high (N=89) risk of DR (p<0.0001). Among the predicted low-risk group only 3 (3.37%) patients relapsed whereas intermediate and high-risk groups counted 27 (15.43%) and 32 (35.96%) events respectively. DeREC is the first DL model accurately distinguishing EC patients at high risk of DR from those at low risk using one H&E WSI, which would aid decisions on adjuvant treatment. DeREC outperformed standard statistical prediction methods using histopathological variables, indicating that it identified prognostic visual features which can be further investigated. Future development includes the integration of clinicopathological and molecular information.
Citation Format: Sarah Fremond, Sonali Andani, Jurriaan Barkey Wolf, Gitte Ørtoft, Estrid Høgdall, Jouke Dijkstra, Jan J. Jobsen, Ina M. Jürgenliemk-Schulz, Ludy CHW Lutgens, Melanie E. Powell, Naveena Singh, Linda R. Mileshkin, Helen J. Mackay, Alexandra Leary, Dionyssios Katsaros, Hans W. Nijman, Stephanie M. de Boer, Remi A. Nout, Vincent T.H.B.M Smit, Carien L. Creutzberg, Nanda Horeweg, Viktor H. Koelzer, Tjalling Bosse. Deep learning risk prediction model of distant recurrence from H&E endometrial cancer slides. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5695.
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Affiliation(s)
- Sarah Fremond
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Sonali Andani
- 2ETH Zurich, University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Gitte Ørtoft
- 3Copenhagen University Hospital, Copenhagen, Denmark
| | - Estrid Høgdall
- 4Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Dijkstra
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | | | | | | | - Naveena Singh
- 9Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Helen J. Mackay
- 11Odette Cancer Center Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | | | | | - Hans W. Nijman
- 14University Medical Center Groningen, Groningen, Netherlands
| | | | - Remi A. Nout
- 15Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Nanda Horeweg
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Viktor H. Koelzer
- 16University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tjalling Bosse
- 1Leiden University Medical Center (LUMC), Leiden, Netherlands
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17
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Eichhoff OM, Stoffel CI, Käsler J, Briker L, Turko P, Karsai G, Zila N, Paulitschke V, Cheng PF, Leitner A, Bileck A, Zamboni N, Irmisch A, Balazs Z, Tastanova A, Pascoal S, Johansen P, Wegmann R, Mena J, Othman A, Viswanathan VS, Wenzina J, Aloia A, Saltari A, Dzung A, Aebersold R, Ak M, Al-Quaddoomi FS, Albert SI, Albinus J, Alborelli I, Andani S, Attinger PO, Bacac M, Baumhoer D, Beck-Schimmer B, Beerenwinkel N, Beisel C, Bernasconi L, Bertolini A, Bodenmiller B, Bonilla X, Bosshard L, Calgua B, Casanova R, Chevrier S, Chicherova N, Coelho R, D'Costa M, Danenberg E, Davidson N, Drãgan MA, Dummer R, Engler S, Erkens M, Eschbach K, Esposito C, Fedier A, Ferreira P, Ficek J, Frei AL, Frey B, Goetze S, Grob L, Gut G, Günther D, Haberecker M, Haeuptle P, Heinzelmann-Schwarz V, Herter S, Holtackers R, Huesser T, Immer A, Irmisch A, Jacob F, Jacobs A, Jaeger TM, Jahn K, James AR, Jermann PM, Kahles A, Kahraman A, Koelzer VH, Kuebler W, Kuipers J, Kunze CP, Kurzeder C, Lehmann KV, Levesque M, Lischetti U, Lugert S, Maass G, Manz MG, Markolin P, Mehnert M, Mena J, Metzler JM, Miglino N, Milani ES, Moch H, Muenst S, Murri R, Ng CK, Nicolet S, Nowak M, Lopez MN, Pedrioli PG, Pelkmans L, Piscuoglio S, Prummer M, Rimmer N, Ritter M, Rommel C, Rosano-González ML, Rätsch G, Santacroce N, Del Castillo JS, Schlenker R, Schwalie PC, Schwan S, Schär T, Senti G, Shao W, Singer F, Sivapatham S, Snijder B, Sobottka B, Sreedharan VT, Stark S, Stekhoven DJ, Tanna T, Theocharides AP, Thomas TM, Tolnay M, Tosevski V, Toussaint NC, Tuncel MA, Tusup M, Van Drogen A, Vetter M, Vlajnic T, Weber S, Weber WP, Wegmann R, Weller M, Wendt F, Wey N, Wicki A, Wildschut MH, Wollscheid B, Yu S, Ziegler J, Zimmermann M, Zoche M, Zuend G, Krauthammer M, Schreiber SL, Hornemann T, Distel M, Snijder B, Dummer R, Levesque MP. ROS Induction Targets Persister Cancer Cells with Low Metabolic Activity in NRAS-Mutated Melanoma. Cancer Res 2023; 83:1128-1146. [PMID: 36946761 DOI: 10.1158/0008-5472.can-22-1826] [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] [Received: 06/03/2022] [Revised: 10/04/2022] [Accepted: 01/24/2023] [Indexed: 03/23/2023]
Abstract
Clinical management of melanomas with NRAS mutations is challenging. Targeting MAPK signaling is only beneficial to a small subset of patients due to resistance that arises through genetic, transcriptional, and metabolic adaptation. Identification of targetable vulnerabilities in NRAS-mutated melanoma could help improve patient treatment. Here, we used multiomics analyses to reveal that NRAS-mutated melanoma cells adopt a mesenchymal phenotype with a quiescent metabolic program to resist cellular stress induced by MEK inhibition. The metabolic alterations elevated baseline reactive oxygen species (ROS) levels, leading these cells to become highly sensitive to ROS induction. In vivo xenograft experiments and single-cell RNA sequencing demonstrated that intratumor heterogeneity necessitates the combination of a ROS inducer and a MEK inhibitor to inhibit both tumor growth and metastasis. Ex vivo pharmacoscopy of 62 human metastatic melanomas confirmed that MEK inhibitor-resistant tumors significantly benefited from the combination therapy. Finally, oxidative stress response and translational suppression corresponded with ROS-inducer sensitivity in 486 cancer cell lines, independent of cancer type. These findings link transcriptional plasticity to a metabolic phenotype that can be inhibited by ROS inducers in melanoma and other cancers. SIGNIFICANCE Metabolic reprogramming in drug-resistant NRAS-mutated melanoma cells confers sensitivity to ROS induction, which suppresses tumor growth and metastasis in combination with MAPK pathway inhibitors.
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Affiliation(s)
- Ossia M Eichhoff
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Corinne I Stoffel
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Jan Käsler
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Luzia Briker
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Turko
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Gergely Karsai
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Nina Zila
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Phil F Cheng
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | | | - Andrea Bileck
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, Vienna, Austria
- Department of Analytical Chemistry, University of Vienna, Vienna, Austria
| | - Nicola Zamboni
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Anja Irmisch
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Balazs
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Biomedical Informatics, University Hospital of Zurich, Zurich, Switzerland
| | - Aizhan Tastanova
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Susana Pascoal
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Pål Johansen
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Rebekka Wegmann
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Julien Mena
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Alaa Othman
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | | | - Judith Wenzina
- Skin and Endothelium Research Division, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Andrea Aloia
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Annalisa Saltari
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Dzung
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michael Krauthammer
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Biomedical Informatics, University Hospital of Zurich, Zurich, Switzerland
| | | | - Thorsten Hornemann
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Martin Distel
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Berend Snijder
- Institute for Molecular Systems Biology, ETH Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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18
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Fremond S, Andani S, Barkey Wolf J, Dijkstra J, Melsbach S, Jobsen JJ, Brinkhuis M, Roothaan S, Jurgenliemk-Schulz I, Lutgens LCHW, Nout RA, van der Steen-Banasik EM, de Boer SM, Powell ME, Singh N, Mileshkin LR, Mackay HJ, Leary A, Nijman HW, Smit VTHBM, Creutzberg CL, Horeweg N, Koelzer VH, Bosse T. Interpretable deep learning model to predict the molecular classification of endometrial cancer from haematoxylin and eosin-stained whole-slide images: a combined analysis of the PORTEC randomised trials and clinical cohorts. Lancet Digit Health 2023; 5:e71-e82. [PMID: 36496303 DOI: 10.1016/s2589-7500(22)00210-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endometrial cancer can be molecularly classified into POLEmut, mismatch repair deficient (MMRd), p53 abnormal (p53abn), and no specific molecular profile (NSMP) subgroups. We aimed to develop an interpretable deep learning pipeline for whole-slide-image-based prediction of the four molecular classes in endometrial cancer (im4MEC), to identify morpho-molecular correlates, and to refine prognostication. METHODS This combined analysis included diagnostic haematoxylin and eosin-stained slides and molecular and clinicopathological data from 2028 patients with intermediate-to-high-risk endometrial cancer from the PORTEC-1 (n=466), PORTEC-2 (n=375), and PORTEC-3 (n=393) randomised trials and the TransPORTEC pilot study (n=110), the Medisch Spectrum Twente cohort (n=242), a case series of patients with POLEmut endometrial cancer in the Leiden Endometrial Cancer Repository (n=47), and The Cancer Genome Atlas-Uterine Corpus Endometrial Carcinoma cohort (n=395). PORTEC-3 was held out as an independent test set and a four-fold cross validation was performed. Performance was measured with the macro and class-wise area under the receiver operating characteristic curve (AUROC). Whole-slide images were segmented into tiles of 360 μm resized to 224 × 224 pixels. im4MEC was trained to learn tile-level morphological features with self-supervised learning and to molecularly classify whole-slide images with an attention mechanism. The top 20 tiles with the highest attention scores were reviewed to identify morpho-molecular correlates. Predictions of a nuclear classification deep learning model serve to derive interpretable morphological features. We analysed 5-year recurrence-free survival and explored prognostic refinement by molecular class using the Kaplan-Meier method. FINDINGS im4MEC attained macro-average AUROCs of 0·874 (95% CI 0·856-0·893) on four-fold cross-validation and 0·876 on the independent test set. The class-wise AUROCs were 0·849 for POLEmut (n=51), 0·844 for MMRd (n=134), 0·883 for NSMP (n=120), and 0·928 for p53abn (n=88). POLEmut and MMRd tiles had a high density of lymphocytes, p53abn tiles had strong nuclear atypia, and the morphology of POLEmut and MMRd endometrial cancer overlapped. im4MEC highlighted a low tumour-to-stroma ratio as a potentially novel characteristic feature of the NSMP class. 5-year recurrence-free survival was significantly different between im4MEC predicted molecular classes in PORTEC-3 (log-rank p<0·0001). The ten patients with aggressive p53abn endometrial cancer that was predicted as MMRd showed inflammatory morphology and appeared to have a better prognosis than patients with correctly predicted p53abn endometrial cancer (p=0·30). The four patients with NSMP endometrial cancer that was predicted as p53abn showed higher nuclear atypia and appeared to have a worse prognosis than patients with correctly predicted NSMP (p=0·13). Patients with MMRd endometrial cancer predicted as POLEmut had an excellent prognosis, as do those with true POLEmut endometrial cancer. INTERPRETATION We present the first interpretable deep learning model, im4MEC, for haematoxylin and eosin-based prediction of molecular endometrial cancer classification. im4MEC robustly identified morpho-molecular correlates and could enable further prognostic refinement of patients with endometrial cancer. FUNDING The Hanarth Foundation, the Promedica Foundation, and the Swiss Federal Institutes of Technology.
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Affiliation(s)
- Sarah Fremond
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Sonali Andani
- Department of Computer Science, ETH Zurich, Zurich, Switzerland; Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Jouke Dijkstra
- Department of Vascular and Molecular Imaging, Leiden University Medical Center, Leiden, Netherlands
| | - Sinéad Melsbach
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan J Jobsen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, Netherlands
| | | | | | - Ina Jurgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ludy C H W Lutgens
- Department of Radiation Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Remi A Nout
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, UK
| | - Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Helen J Mackay
- Department of Medical Oncology and Hematology, Odette Cancer Center Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Alexandra Leary
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, Netherlands
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
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19
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Aubreville M, Stathonikos N, Bertram CA, Klopfleisch R, Ter Hoeve N, Ciompi F, Wilm F, Marzahl C, Donovan TA, Maier A, Breen J, Ravikumar N, Chung Y, Park J, Nateghi R, Pourakpour F, Fick RHJ, Ben Hadj S, Jahanifar M, Shephard A, Dexl J, Wittenberg T, Kondo S, Lafarge MW, Koelzer VH, Liang J, Wang Y, Long X, Liu J, Razavi S, Khademi A, Yang S, Wang X, Erber R, Klang A, Lipnik K, Bolfa P, Dark MJ, Wasinger G, Veta M, Breininger K. Mitosis domain generalization in histopathology images - The MIDOG challenge. Med Image Anal 2023; 84:102699. [PMID: 36463832 DOI: 10.1016/j.media.2022.102699] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 04/06/2022] [Revised: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
The density of mitotic figures (MF) within tumor tissue is known to be highly correlated with tumor proliferation and thus is an important marker in tumor grading. Recognition of MF by pathologists is subject to a strong inter-rater bias, limiting its prognostic value. State-of-the-art deep learning methods can support experts but have been observed to strongly deteriorate when applied in a different clinical environment. The variability caused by using different whole slide scanners has been identified as one decisive component in the underlying domain shift. The goal of the MICCAI MIDOG 2021 challenge was the creation of scanner-agnostic MF detection algorithms. The challenge used a training set of 200 cases, split across four scanning systems. As test set, an additional 100 cases split across four scanning systems, including two previously unseen scanners, were provided. In this paper, we evaluate and compare the approaches that were submitted to the challenge and identify methodological factors contributing to better performance. The winning algorithm yielded an F1 score of 0.748 (CI95: 0.704-0.781), exceeding the performance of six experts on the same task.
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Affiliation(s)
| | | | - Christof A Bertram
- Institute of Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | | | - Francesco Ciompi
- Computational Pathology Group, Radboud UMC, Nijmegen, The Netherlands
| | - Frauke Wilm
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Marzahl
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Taryn A Donovan
- Department of Anatomic Pathology, Schwarzman Animal Medical Center, NY, USA
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jack Breen
- CISTIB Center for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- CISTIB Center for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Youjin Chung
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jinah Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Ramin Nateghi
- Electrical and Electronics Engineering Department, Shiraz University of Technology, Shiraz, Iran
| | - Fattaneh Pourakpour
- Iranian Brain Mapping Biobank (IBMB), National Brain Mapping Laboratory (NBML), Tehran, Iran
| | | | | | - Mostafa Jahanifar
- Tissue Image Analytics Centre, Department of Computer Science, University of Warwick, Warwick, UK
| | - Adam Shephard
- Tissue Image Analytics Centre, Department of Computer Science, University of Warwick, Warwick, UK
| | - Jakob Dexl
- Fraunhofer-Institute for Integrated Circuits IIS, Erlangen, Germany
| | | | | | - Maxime W Lafarge
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jingtang Liang
- School of Life Science and Technology, Xidian University, Shannxi, China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, Shannxi, China
| | - Xi Long
- Histo Pathology Diagnostic Center, Shanghai, China
| | - Jingxin Liu
- Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Salar Razavi
- Image Analysis in Medicine Lab (IAMLAB), Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada
| | - April Khademi
- Image Analysis in Medicine Lab (IAMLAB), Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada
| | - Sen Yang
- Tencent AI Lab, Shenzhen 518057, China
| | - Xiyue Wang
- College of Computer Science, Sichuan University, Chengdu 610065, China
| | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Klang
- Institute of Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Karoline Lipnik
- Institute of Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Pompei Bolfa
- Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Michael J Dark
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Gabriel Wasinger
- Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria
| | - Mitko Veta
- Medical Image Analysis Group, TU Eindhoven, Eindhoven, The Netherlands
| | - Katharina Breininger
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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20
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Hummelink K, van der Noort V, Muller M, Schouten RD, Lalezari F, Peters D, Theelen WS, Koelzer VH, Mertz KD, Zippelius A, van den Heuvel MM, Broeks A, Haanen JB, Schumacher TN, Meijer GA, Smit EF, Monkhorst K, Thommen DS. PD-1T TILs as a Predictive Biomarker for Clinical Benefit to PD-1 Blockade in Patients with Advanced NSCLC. Clin Cancer Res 2022; 28:4893-4906. [PMID: 35852792 PMCID: PMC9762332 DOI: 10.1158/1078-0432.ccr-22-0992] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/31/2022] [Accepted: 07/15/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Durable clinical benefit to PD-1 blockade in non-small cell lung cancer (NSCLC) is currently limited to a small fraction of patients, underlining the need for predictive biomarkers. We recently identified a tumor-reactive tumor-infiltrating T lymphocyte (TIL) pool, termed PD-1T TILs, with predictive potential in NSCLC. Here, we examined PD-1T TILs as biomarker in NSCLC. EXPERIMENTAL DESIGN PD-1T TILs were digitally quantified in 120 baseline samples from advanced NSCLC patients treated with PD-1 blockade. Primary outcome was disease control (DC) at 6 months. Secondary outcomes were DC at 12 months and survival. Exploratory analyses addressed the impact of lesion-specific responses, tissue sample properties, and combination with other biomarkers on the predictive value of PD-1T TILs. RESULTS PD-1T TILs as a biomarker reached 77% sensitivity and 67% specificity at 6 months, and 93% and 65% at 12 months, respectively. Particularly, a patient group without clinical benefit was reliably identified, indicated by a high negative predictive value (NPV) (88% at 6 months, 98% at 12 months). High PD-1T TILs related to significantly longer progression-free (HR 0.39, 95% CI, 0.24-0.63, P < 0.0001) and overall survival (HR 0.46, 95% CI, 0.28-0.76, P < 0.01). Predictive performance was increased when lesion-specific responses and samples obtained immediately before treatment were assessed. Notably, the predictive performance of PD-1T TILs was superior to PD-L1 and tertiary lymphoid structures in the same cohort. CONCLUSIONS This study established PD-1T TILs as predictive biomarker for clinical benefit to PD-1 blockade in patients with advanced NSCLC. Most importantly, the high NPV demonstrates an accurate identification of a patient group without benefit. See related commentary by Anagnostou and Luke, p. 4835.
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Affiliation(s)
- Karlijn Hummelink
- Department of Pathology, Division of Diagnostic Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Thoracic Oncology, Division of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Vincent van der Noort
- Department of Biometrics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mirte Muller
- Department of Thoracic Oncology, Division of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Robert D. Schouten
- Department of Thoracic Oncology, Division of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ferry Lalezari
- Department of Radiology, Division of Diagnostic Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dennis Peters
- Core Facility Molecular Pathology and Biobanking, Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Willemijn S.M.E. Theelen
- Department of Thoracic Oncology, Division of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Viktor H. Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Kirsten D. Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Alfred Zippelius
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Michel M. van den Heuvel
- Department of Thoracic Oncology, Division of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - John B.A.G. Haanen
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ton N. Schumacher
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Oncode Institute, Amsterdam, the Netherlands
| | - Gerrit A. Meijer
- Department of Pathology, Division of Diagnostic Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Egbert F. Smit
- Department of Thoracic Oncology, Division of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kim Monkhorst
- Department of Pathology, Division of Diagnostic Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.,Corresponding Authors: Daniela S. Thommen, Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, the Netherlands. E-mail: ; and Kim Monkhorst,
| | - Daniela S. Thommen
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.,Corresponding Authors: Daniela S. Thommen, Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, the Netherlands. E-mail: ; and Kim Monkhorst,
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21
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Gil Vazquez E, Nasreddin N, Valbuena GN, Mulholland EJ, Belnoue-Davis HL, Eggington HR, Schenck RO, Wouters VM, Wirapati P, Gilroy K, Lannagan TR, Flanagan DJ, Najumudeen AK, Omwenga S, McCorry AM, Easton A, Koelzer VH, East JE, Morton D, Trusolino L, Maughan T, Campbell AD, Loughrey MB, Dunne PD, Tsantoulis P, Huels DJ, Tejpar S, Sansom OJ, Leedham SJ. Dynamic and adaptive cancer stem cell population admixture in colorectal neoplasia. Cell Stem Cell 2022; 29:1612. [PMID: 36332574 PMCID: PMC9807457 DOI: 10.1016/j.stem.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Fisher NC, Byrne RM, Leslie H, Wood C, Legrini A, Cameron AJ, Ahmaderaghi B, Corry SM, Malla SB, Amirkhah R, McCooey AJ, Rogan E, Redmond KL, Sakhnevych S, Domingo E, Jackson J, Loughrey MB, Leedham S, Maughan T, Lawler M, Sansom OJ, Lamrock F, Koelzer VH, Jamieson NB, Dunne PD. Biological Misinterpretation of Transcriptional Signatures in Tumor Samples Can Unknowingly Undermine Mechanistic Understanding and Faithful Alignment with Preclinical Data. Clin Cancer Res 2022; 28:4056-4069. [PMID: 35792866 PMCID: PMC9475248 DOI: 10.1158/1078-0432.ccr-22-1102] [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: 04/07/2022] [Revised: 06/08/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Precise mechanism-based gene expression signatures (GES) have been developed in appropriate in vitro and in vivo model systems, to identify important cancer-related signaling processes. However, some GESs originally developed to represent specific disease processes, primarily with an epithelial cell focus, are being applied to heterogeneous tumor samples where the expression of the genes in the signature may no longer be epithelial-specific. Therefore, unknowingly, even small changes in tumor stroma percentage can directly influence GESs, undermining the intended mechanistic signaling. EXPERIMENTAL DESIGN Using colorectal cancer as an exemplar, we deployed numerous orthogonal profiling methodologies, including laser capture microdissection, flow cytometry, bulk and multiregional biopsy clinical samples, single-cell RNA sequencing and finally spatial transcriptomics, to perform a comprehensive assessment of the potential for the most widely used GESs to be influenced, or confounded, by stromal content in tumor tissue. To complement this work, we generated a freely-available resource, ConfoundR; https://confoundr.qub.ac.uk/, that enables users to test the extent of stromal influence on an unlimited number of the genes/signatures simultaneously across colorectal, breast, pancreatic, ovarian and prostate cancer datasets. RESULTS Findings presented here demonstrate the clear potential for misinterpretation of the meaning of GESs, due to widespread stromal influences, which in-turn can undermine faithful alignment between clinical samples and preclinical data/models, particularly cell lines and organoids, or tumor models not fully recapitulating the stromal and immune microenvironment. CONCLUSIONS Efforts to faithfully align preclinical models of disease using phenotypically-designed GESs must ensure that the signatures themselves remain representative of the same biology when applied to clinical samples.
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Affiliation(s)
- Natalie C. Fisher
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Ryan M. Byrne
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Holly Leslie
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Colin Wood
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Assya Legrini
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andrew J. Cameron
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Baharak Ahmaderaghi
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, United Kingdom
| | - Shania M. Corry
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Sudhir B. Malla
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Raheleh Amirkhah
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Aoife J. McCooey
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Emily Rogan
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Keara L. Redmond
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Svetlana Sakhnevych
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | | | - James Jackson
- Information Services, Queen's University Belfast, Belfast, United Kingdom
| | - Maurice B. Loughrey
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
- Department of Cellular Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | | | - Tim Maughan
- University of Oxford, Oxford, United Kingdom
| | - Mark Lawler
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Owen J. Sansom
- Cancer Research UK Beatson Institute, Glasgow, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Felicity Lamrock
- School of Mathematics and Physics, Queen's University Belfast, Belfast, United Kingdom
| | - Viktor H. Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital of Zürich, Zürich, Switzerland
| | - Nigel B. Jamieson
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Philip D. Dunne
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
- Cancer Research UK Beatson Institute, Glasgow, United Kingdom
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23
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Schumacher J, Gutschow CA, Inci I, Koelzer VH, Opitz I. Case report: Surgical repair of a large tracheo-esophageal fistula in a patient with post-transplant esophageal lymphoproliferative disorder. Int J Surg Case Rep 2022; 98:107537. [PMID: 36027833 PMCID: PMC9424936 DOI: 10.1016/j.ijscr.2022.107537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance The management of large malignant tracheo-esophageal fistulas (TEF) is not standardized. Herein, we report a case with a malignant TEF associated with esophageal post-transplant lymphoproliferative disorder (PTLD) for whom we successfully performed a surgical repair. This contributes to the knowledge on how to treat large acquired malignant TEFs. Case presentation A 69-year old male presented with a one-week history of fever, productive cough and bilateral coarse crackles. In addition, he described a weight loss of 10 kg during the past three months. The patient's history included a kidney transplantation twenty years ago. Esophagogastroduodenoscopy with a biopsy of the esophagus was performed nine days before. Histopathology showed a PTLD of diffuse large B-cell lymphoma subtype. Subsequent diagnostics revealed a progressive TEF (approx. 2.0 × 1.5 cm) 3.0 cm above the carina. PET-CT scan showed an esophagus with slight tracer uptake in the middle third (approx. 11.5 cm length, SUV max 7.4). After decision against stenting, transthoracic subtotal esophagectomy with closure of the tracheal mouth of the fistula by a pedicled flap was performed. PTLD was treated with prednisone and rituximab. Tumor progression (brain metastasis) led to death 95 days after surgery. Clinical discussion The treatment of a malignant TEF is complex and personalized while both the consequences of the esophago-tracheal connection and those of the underlying responsible diagnosis have to be considered concurrently. In this case, we considered surgery as the best treatment option due to a relatively good prognosis of the underlying diagnosis (PTLD) and a large fistula. Esophageal or dual stenting, the treatment of choice for small malignant TEF, would have been associated with a high risk of failure due to the wide trachea, extensively dilated esophagus, proximal location and large diameter of the fistula. Conclusion Surgery can be considered for patients with a large acquired malignant TEF and positive long-term prognosis of the underlying diagnosis. Due to the complexity of TEF management, immediate pre-operative multidisciplinary discussion is advised. Surgical repair of a large malignant tracheo-esophageal fistula Immediate pre-operative multidisciplinary discussion is needed for large malignant trachea-esophageal fistulas. Esophageal post-transplant lymphoproliferative disorder (PTLD) of diffuse large B-cell lymphoma (DLBCL) subtype Esophagectomy and closure of the trachea by a pedicled deepithelized muscle flap
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24
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Gil Vazquez E, Nasreddin N, Valbuena GN, Mulholland EJ, Belnoue-Davis HL, Eggington HR, Schenck RO, Wouters VM, Wirapati P, Gilroy K, Lannagan TR, Flanagan DJ, Najumudeen AK, Omwenga S, McCorry AM, Easton A, Koelzer VH, East JE, Morton D, Trusolino L, Maughan T, Campbell AD, Loughrey MB, Dunne PD, Tsantoulis P, Huels DJ, Tejpar S, Sansom OJ, Leedham SJ. Dynamic and adaptive cancer stem cell population admixture in colorectal neoplasia. Cell Stem Cell 2022; 29:1213-1228.e8. [PMID: 35931031 PMCID: PMC9592560 DOI: 10.1016/j.stem.2022.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 07/19/2022] [Indexed: 12/13/2022]
Abstract
Intestinal homeostasis is underpinned by LGR5+ve crypt-base columnar stem cells (CBCs), but following injury, dedifferentiation results in the emergence of LGR5-ve regenerative stem cell populations (RSCs), characterized by fetal transcriptional profiles. Neoplasia hijacks regenerative signaling, so we assessed the distribution of CBCs and RSCs in mouse and human intestinal tumors. Using combined molecular-morphological analysis, we demonstrate variable expression of stem cell markers across a range of lesions. The degree of CBC-RSC admixture was associated with both epithelial mutation and microenvironmental signaling disruption and could be mapped across disease molecular subtypes. The CBC-RSC equilibrium was adaptive, with a dynamic response to acute selective pressure, and adaptability was associated with chemoresistance. We propose a fitness landscape model where individual tumors have equilibrated stem cell population distributions along a CBC-RSC phenotypic axis. Cellular plasticity is represented by position shift along this axis and is influenced by cell-intrinsic, extrinsic, and therapeutic selective pressures.
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Affiliation(s)
- Ester Gil Vazquez
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Nadia Nasreddin
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Gabriel N. Valbuena
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Eoghan J. Mulholland
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | | | - Holly R. Eggington
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Ryan O. Schenck
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Valérie M. Wouters
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 Amsterdam, the Netherlands,Oncode Institute, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Pratyaksha Wirapati
- Swiss Institute for Bioinformatics, University of Lausanne, Lausanne, Switzerland
| | | | | | | | | | - Sulochana Omwenga
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Amy M.B. McCorry
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Alistair Easton
- Department of Oncology, Old Road Campus Research Building, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Viktor H. Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital Zürich, Rämistrasse 100, 8006 Zürich, Switzerland
| | - James E. East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Livio Trusolino
- Candiolo Cancer Institute FPO IRCCS, 10060 Candiolo, Torino, Italy
| | - Timothy Maughan
- Department of Oncology, Old Road Campus Research Building, Roosevelt Drive, University of Oxford, Oxford, UK
| | | | - Maurice B. Loughrey
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Philip D. Dunne
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Petros Tsantoulis
- University of Geneva and Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - David J. Huels
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 Amsterdam, the Netherlands,Oncode Institute, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Sabine Tejpar
- Molecular Digestive Oncology Unit, KU Leuven, Leuven, Belgium
| | - Owen J. Sansom
- Cancer Research UK Beatson Institute, Glasgow, UK,Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow, UK
| | - Simon J. Leedham
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK,Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK,Corresponding author
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25
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Quintavalle C, Meyer‐Schaller N, Roessler S, Calabrese D, Marone R, Riedl T, Picco‐Rey S, Panagiotou OA, Uzun S, Piscuoglio S, Boldanova T, Bian CB, Semela D, Jochum W, Cathomas G, Mertz KD, Diebold J, Mazzucchelli L, Koelzer VH, Weber A, Decaens T, Terracciano LM, Heikenwalder M, Hoshida Y, Andersen JB, Thorgeirsson SS, Matter MS. miR-579-3p Controls Hepatocellular Carcinoma Formation by Regulating the Phosphoinositide 3-Kinase-Protein Kinase B Pathway in Chronically Inflamed Liver. Hepatol Commun 2022; 6:1467-1481. [PMID: 35132819 PMCID: PMC9134798 DOI: 10.1002/hep4.1894] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 12/02/2022] Open
Abstract
Chronic liver inflammation causes continuous liver damage with progressive liver fibrosis and cirrhosis, which may eventually lead to hepatocellular carcinoma (HCC). Whereas the 10-year incidence for HCC in patients with cirrhosis is approximately 20%, many of these patients remain tumor free for their entire lives. Clarifying the mechanisms that define the various outcomes of chronic liver inflammation is a key aspect in HCC research. In addition to a wide variety of contributing factors, microRNAs (miRNAs) have also been shown to be engaged in promoting liver cancer. Therefore, we wanted to characterize miRNAs that are involved in the development of HCC, and we designed a longitudinal study with formalin-fixed and paraffin-embedded liver biopsy samples from several pathology institutes from Switzerland. We examined the miRNA expression by nCounterNanostring technology in matched nontumoral liver tissue from patients developing HCC (n = 23) before and after HCC formation in the same patient. Patients with cirrhosis (n = 26) remaining tumor free within a similar time frame served as a control cohort. Comparison of the two cohorts revealed that liver tissue from patients developing HCC displayed a down-regulation of miR-579-3p as an early step in HCC development, which was further confirmed in a validation cohort. Correlation with messenger RNA expression profiles further revealed that miR-579-3p directly attenuated phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) expression and consequently protein kinase B (AKT) and phosphorylated AKT. In vitro experiments and the use of clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 technology confirmed that miR-579-3p controlled cell proliferation and cell migration of liver cancer cell lines. Conclusion: Liver tissues from patients developing HCC revealed changes in miRNA expression. miR-579-3p was identified as a novel tumor suppressor regulating phosphoinositide 3-kinase-AKT signaling at the early stages of HCC development.
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Affiliation(s)
- Cristina Quintavalle
- Institute of PathologyUniversity Hospital of BaselUniversity of BaselBaselSwitzerland
| | | | | | - Diego Calabrese
- Department of BiomedicineUniversity of BaselBaselSwitzerland
- Division of Hepatology and GastroenterologyUniversity Hospital of BaselBaselSwitzerland
| | - Romina Marone
- Department of BiomedicineUniversity Hospital of Basel, University of BaselBaselSwitzerland
| | - Tobias Riedl
- Division of Chronic Inflammation and CancerGerman Cancer Research CenterHeidelbergGermany
| | - Silvia Picco‐Rey
- Institute of PathologyUniversity Hospital of BaselUniversity of BaselBaselSwitzerland
| | - Orestis A. Panagiotou
- Department of Health Services, Policy and PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Sarp Uzun
- Institute of PathologyUniversity Hospital of BaselUniversity of BaselBaselSwitzerland
| | - Salvatore Piscuoglio
- Institute of PathologyUniversity Hospital of BaselUniversity of BaselBaselSwitzerland
| | - Tuyana Boldanova
- Department of BiomedicineUniversity of BaselBaselSwitzerland
- Division of Hepatology and GastroenterologyUniversity Hospital of BaselBaselSwitzerland
| | - Chaoran B. Bian
- Department of Genetics and Genomic SciencesGraduate School of Biomedical SciencesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - David Semela
- Division of GastroenterologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Wolfram Jochum
- Institute of PathologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Gieri Cathomas
- Institute of PathologyKantonsspital BasellandLiestalSwitzerland
| | | | - Joachim Diebold
- Institute of PathologyLuzerner KantonsspitalLucerneSwitzerland
| | | | - Viktor H. Koelzer
- Department of Pathology and Molecular PathologyUniversity and University Hospital ZurichZurichSwitzerland
| | - Achim Weber
- Department of Pathology and Molecular PathologyUniversity and University Hospital ZurichZurichSwitzerland
| | - Thomas Decaens
- Institute for Advanced BiosciencesINSERM U1209/CNRS UMR 5309/Université Grenoble‐AlpesGrenobleFrance
- Université Grenoble AlpesGrenobleFrance
- Clinique Universitaire d'Hépato‐gastroentérologie, Pôle DigiduneCentre Hospitalier UniversitaireGrenobleFrance
| | - Luigi M. Terracciano
- Institute of PathologyUniversity Hospital of BaselUniversity of BaselBaselSwitzerland
| | - Mathias Heikenwalder
- Division of Chronic Inflammation and CancerGerman Cancer Research CenterHeidelbergGermany
| | - Yujin Hoshida
- Liver Tumor ProgramSimmons Comprehensive Cancer CenterDivision of Digestive and Liver DiseasesUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Jesper B. Andersen
- Biotech Research and Innovation CenterDepartment of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Snorri S. Thorgeirsson
- Laboratory of Experimental CarcinogenesisCenter for Cancer ResearchNational Cancer Institute‐National Institutes of HealthBethesdaMDUSA
| | - Matthias S. Matter
- Institute of PathologyUniversity Hospital of BaselUniversity of BaselBaselSwitzerland
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26
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Palles C, West HD, Chew E, Galavotti S, Flensburg C, Grolleman JE, Jansen EAM, Curley H, Chegwidden L, Arbe-Barnes EH, Lander N, Truscott R, Pagan J, Bajel A, Sherwood K, Martin L, Thomas H, Georgiou D, Fostira F, Goldberg Y, Adams DJ, van der Biezen SAM, Christie M, Clendenning M, Thomas LE, Deltas C, Dimovski AJ, Dymerska D, Lubinski J, Mahmood K, van der Post RS, Sanders M, Weitz J, Taylor JC, Turnbull C, Vreede L, van Wezel T, Whalley C, Arnedo-Pac C, Caravagna G, Cross W, Chubb D, Frangou A, Gruber AJ, Kinnersley B, Noyvert B, Church D, Graham T, Houlston R, Lopez-Bigas N, Sottoriva A, Wedge D, Jenkins MA, Kuiper RP, Roberts AW, Cheadle JP, Ligtenberg MJL, Hoogerbrugge N, Koelzer VH, Rivas AD, Winship IM, Ponte CR, Buchanan DD, Power DG, Green A, Tomlinson IPM, Sampson JR, Majewski IJ, de Voer RM. Germline MBD4 deficiency causes a multi-tumor predisposition syndrome. Am J Hum Genet 2022; 109:953-960. [PMID: 35460607 PMCID: PMC9118112 DOI: 10.1016/j.ajhg.2022.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
We report an autosomal recessive, multi-organ tumor predisposition syndrome, caused by bi-allelic loss-of-function germline variants in the base excision repair (BER) gene MBD4. We identified five individuals with bi-allelic MBD4 variants within four families and these individuals had a personal and/or family history of adenomatous colorectal polyposis, acute myeloid leukemia, and uveal melanoma. MBD4 encodes a glycosylase involved in repair of G:T mismatches resulting from deamination of 5'-methylcytosine. The colorectal adenomas from MBD4-deficient individuals showed a mutator phenotype attributable to mutational signature SBS1, consistent with the function of MBD4. MBD4-deficient polyps harbored somatic mutations in similar driver genes to sporadic colorectal tumors, although AMER1 mutations were more common and KRAS mutations less frequent. Our findings expand the role of BER deficiencies in tumor predisposition. Inclusion of MBD4 in genetic testing for polyposis and multi-tumor phenotypes is warranted to improve disease management.
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Affiliation(s)
- Claire Palles
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Hannah D West
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Edward Chew
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
| | - Sara Galavotti
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | - Judith E Grolleman
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Erik A M Jansen
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Helen Curley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Laura Chegwidden
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Edward H Arbe-Barnes
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Nicola Lander
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Rebekah Truscott
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Judith Pagan
- Molecular Genetics Laboratory, South East Scotland Genetic Service, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Ashish Bajel
- Peter MacCallum Cancer Center and Royal Melbourne Hospital, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Kitty Sherwood
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Crewe Road, Edinburgh EH4 2XR, UK
| | - Lynn Martin
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Huw Thomas
- St Mark's Hospital, Imperial College London, London, UK
| | - Demetra Georgiou
- Genomic Medicine, Imperial College Healthcare Trust and North West Thames Regional Genetics Service, Northwick Park, Harrow, UK
| | | | - Yael Goldberg
- Raphael Recanati Genetic Institute, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David J Adams
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Simone A M van der Biezen
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Michael Christie
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Mark Clendenning
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Laura E Thomas
- Institute of Life Sciences, Swansea University, Swansea SA28PP, UK
| | - Constantinos Deltas
- Center of Excellence in Biobanking and Biomedical Research and Molecular Medicine Research Center, University of Cyprus Medical School, Nicosia, Cyprus
| | - Aleksandar J Dimovski
- Center for Biomolecular Pharmaceutical Analyzes, UKIM Faculty of Pharmacy, 1000 Skopje, Republic of Macedonia
| | - Dagmara Dymerska
- Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Jan Lubinski
- Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Khalid Mahmood
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Rachel S van der Post
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Mathijs Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jürgen Weitz
- Department of Surgical Research, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Jenny C Taylor
- Oxford NIHR Biomedical Research Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Clare Turnbull
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Lilian Vreede
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, 2300 Leiden, the Netherlands
| | - Celina Whalley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Claudia Arnedo-Pac
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Giulio Caravagna
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - William Cross
- Cancer Institute, University College London, 72 Huntley Street, London WC1E 6BT, UK
| | - Daniel Chubb
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Anna Frangou
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Andreas J Gruber
- Manchester Interdisciplinary Biocentre, University of Manchester, Manchester M1 7DN, UK
| | - Ben Kinnersley
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Boris Noyvert
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - David Church
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK
| | - Trevor Graham
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard Houlston
- Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Nuria Lopez-Bigas
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Andrea Sottoriva
- Cancer Institute, University College London, 72 Huntley Street, London WC1E 6BT, UK
| | - David Wedge
- Manchester Interdisciplinary Biocentre, University of Manchester, Manchester M1 7DN, UK
| | - Mark A Jenkins
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Roland P Kuiper
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands; Princess Máxima Center for Pediatric Oncology, 3584 Utrecht, the Netherlands
| | - Andrew W Roberts
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Molecular Genetics Laboratory, South East Scotland Genetic Service, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia; University of Melbourne, Department of Medical Biology, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Jeremy P Cheadle
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands; Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Andres Dacal Rivas
- Servicio de Digestivo, Hospital Lucus Augusti, Instituto de Investigación Sanitaria de Santiago, Lugo, Galicia, Spain
| | - Ingrid M Winship
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Clara Ruiz Ponte
- Fundación Pública Galega de Medicina Xenómica SERGAS, Grupo de Medicina Xenómica-USC, Instituto de Investigación Sanitaria de Santiago, Centro de Investigación Biomédica en Red de Enfermedades Raras, Santiago de Compostela, Galicia, Spain
| | - Daniel D Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia; Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Andrew Green
- Department of Clinical Genetics, Children's Health Ireland, Dublin, Ireland; School of Medicine University College, Dublin, Ireland
| | - Ian P M Tomlinson
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Crewe Road, Edinburgh EH4 2XR, UK.
| | - Julian R Sampson
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University, School of Medicine, Cardiff, UK.
| | - Ian J Majewski
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Richarda M de Voer
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 Nijmegen, the Netherlands
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27
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Horeweg N, Workel HH, Loiero D, Church DN, Vermij L, Léon-Castillo A, Krog RT, de Boer SM, Nout RA, Powell ME, Mileshkin LR, MacKay H, Leary A, Singh N, Jürgenliemk-Schulz IM, Smit VTHBM, Creutzberg CL, Koelzer VH, Nijman HW, Bosse T, de Bruyn M. Tertiary lymphoid structures critical for prognosis in endometrial cancer patients. Nat Commun 2022; 13:1373. [PMID: 35296668 PMCID: PMC8927106 DOI: 10.1038/s41467-022-29040-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/23/2022] [Indexed: 02/07/2023] Open
Abstract
B-cells play a key role in cancer suppression, particularly when aggregated in tertiary lymphoid structures (TLS). Here, we investigate the role of B-cells and TLS in endometrial cancer (EC). Single cell RNA-sequencing of B-cells shows presence of naïve B-cells, cycling/germinal center B-cells and antibody-secreting cells. Differential gene expression analysis shows association of TLS with L1CAM overexpression. Immunohistochemistry and co-immunofluorescence show L1CAM expression in mature TLS, independent of L1CAM expression in the tumor. Using L1CAM as a marker, 378 of the 411 molecularly classified ECs from the PORTEC-3 biobank are evaluated, TLS are found in 19%. L1CAM expressing TLS are most common in mismatch-repair deficient (29/127, 23%) and polymerase-epsilon mutant EC (24/47, 51%). Multivariable Cox regression analysis shows strong favorable prognostic impact of TLS, independent of clinicopathological and molecular factors. Our data suggests a pivotal role of TLS in outcome of EC patients, and establishes L1CAM as a simple biomarker.
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Affiliation(s)
- Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hagma H Workel
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Dominik Loiero
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David N Church
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Oxford NIHR Comprehensive Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Lisa Vermij
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alicia Léon-Castillo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ricki T Krog
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Department Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephanie M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Helen MacKay
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | | | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hans W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marco de Bruyn
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
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28
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Sobottka B, Nienhold R, Nowak M, Hench J, Haeuptle P, Frank A, Sachs M, Kahraman A, Moch H, Koelzer VH, Mertz KD. Integrated Analysis Of Immunotherapy Treated Clear Cell Renal Cell Carcinomas: An Exploratory Study. J Immunother 2022; 45:35-42. [PMID: 34406159 PMCID: PMC8654255 DOI: 10.1097/cji.0000000000000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
Molecular or immunological differences between responders and nonresponders to immune checkpoint inhibitors (ICIs) of clear cell renal cell carcinomas (ccRCCs) remain incompletely understood. To address this question, we performed next-generation sequencing, methylation analysis, genome wide copy number analysis, targeted RNA sequencing and T-cell receptor sequencing, and we studied frequencies of tumor-infiltrating CD8+ T cells, presence of tertiary lymphoid structures (TLS) and PD-L1 expression in 8 treatment-naive ccRCC patients subsequently treated with ICI (3 responders, 5 nonresponders). Unexpectedly, we identified decreased frequencies of CD8+ tumor-infiltrating T cells and TLS, and a decreased expression of PD-L1 in ICI responders when compared with nonresponders. However, neither tumor-specific genetic alterations nor gene expression profiles correlated with response to ICI or the observed immune features. Our results underline the challenge to stratify ccRCC patients for immunotherapy based on routinely available pathologic primary tumor material, even with advanced technologies. Our findings emphasize the analysis of pretreated metastatic tissue in line with recent observations describing treatment effects on the tumor microenvironment. In addition, our data call for further investigation of additional parameters in a larger ccRCC cohort to understand the mechanistic implications of the observed differences in tumor-infiltrating CD8+ T cells, TLS, and PD-L1 expression.
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Affiliation(s)
- Bettina Sobottka
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich
| | | | - Marta Nowak
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich
| | | | | | | | | | - Abdullah Kahraman
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich
| | - Viktor H. Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich
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Koppens MAJ, Davis H, Valbuena GN, Mulholland EJ, Nasreddin N, Colombe M, Antanaviciute A, Biswas S, Friedrich M, Lee L, Wang LM, Koelzer VH, East JE, Simmons A, Winton DJ, Leedham SJ. Bone Morphogenetic Protein Pathway Antagonism by Grem1 Regulates Epithelial Cell Fate in Intestinal Regeneration. Gastroenterology 2021; 161:239-254.e9. [PMID: 33819486 PMCID: PMC7613733 DOI: 10.1053/j.gastro.2021.03.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/07/2021] [Accepted: 03/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS In homeostasis, intestinal cell fate is controlled by balanced gradients of morphogen signaling. The bone morphogenetic protein (BMP) pathway has a physiological, prodifferentiation role, predominantly inferred through previous experimental pathway inactivation. Intestinal regeneration is underpinned by dedifferentiation and cell plasticity, but the signaling pathways that regulate this adaptive reprogramming are not well understood. We assessed the BMP signaling landscape and investigated the impact and therapeutic potential of pathway manipulation in homeostasis and regeneration. METHODS A novel mouse model was generated to assess the effect of the autocrine Bmp4 ligand on individual secretory cell fate. We spatiotemporally mapped BMP signaling in mouse and human regenerating intestine. Transgenic models were used to explore the functional impact of pathway manipulation on stem cell fate and intestinal regeneration. RESULTS In homeostasis, ligand exposure reduced proliferation, expedited terminal differentiation, abrogated secretory cell survival, and prevented dedifferentiation. After ulceration, physiological attenuation of BMP signaling arose through upregulation of the secreted antagonist Grem1 from topographically distinct populations of fibroblasts. Concomitant expression supported functional compensation after Grem1 deletion from tissue-resident cells. BMP pathway manipulation showed that antagonist-mediated BMP attenuation was obligatory but functionally submaximal, because regeneration was impaired or enhanced by epithelial overexpression of Bmp4 or Grem1, respectively. Mechanistically, Bmp4 abrogated regenerative stem cell reprogramming despite a convergent impact of YAP/TAZ on cell fate in remodeled wounds. CONCLUSIONS BMP signaling prevents epithelial dedifferentiation, and pathway attenuation through stromal Grem1 upregulation was required for adaptive reprogramming in intestinal regeneration. This intercompartmental antagonism was functionally submaximal, raising the possibility of therapeutic pathway manipulation in inflammatory bowel disease.
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Affiliation(s)
- Martijn A J Koppens
- Intestinal Stem Cell Biology Lab, Wellcome Centre Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Hayley Davis
- Intestinal Stem Cell Biology Lab, Wellcome Centre Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Gabriel N Valbuena
- Intestinal Stem Cell Biology Lab, Wellcome Centre Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Eoghan J Mulholland
- Intestinal Stem Cell Biology Lab, Wellcome Centre Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Nadia Nasreddin
- Intestinal Stem Cell Biology Lab, Wellcome Centre Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Mathilde Colombe
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Agne Antanaviciute
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom; Medical Research Council Weatherall Institute of Molecular Medicine Centre for Computational Biology, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Sujata Biswas
- Intestinal Stem Cell Biology Lab, Wellcome Centre Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Matthias Friedrich
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, United Kingdom
| | - Lennard Lee
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Lai Mun Wang
- Department of Laboratory Medicine, Changi General Hospital, SingHealth, Singapore, Singapore
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland; Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Alison Simmons
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom; Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Douglas J Winton
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Leedham
- Intestinal Stem Cell Biology Lab, Wellcome Centre Human Genetics, University of Oxford, Oxford, United Kingdom; Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford National Institute for Health Research Biomedical Research Centre, Oxford, United Kingdom.
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30
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Jones HJS, Cunningham C, Askautrud HA, Danielsen HE, Kerr DJ, Domingo E, Maughan T, Leedham SJ, Koelzer VH. Stromal composition predicts recurrence of early rectal cancer after local excision. Histopathology 2021; 79:947-956. [PMID: 34174109 PMCID: PMC8845517 DOI: 10.1111/his.14438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
AIMS After local excision of early rectal cancer, definitive lymph node status is not available. An alternative means for accurate assessment of recurrence risk is required to determine the most appropriate subsequent management. Currently used measures are suboptimal. We assess three measures of tumour stromal content to determine their predictive value after local excision in a well-characterised cohort of rectal cancer patients without prior radiotherapy. METHODS AND RESULTS A total of 143 patients were included. Haematoxylin and eosin (H&E) sections were scanned for (i) deep neural network (DNN, a machine-learning algorithm) tumour segmentation into compartments including desmoplastic stroma and inflamed stroma; and (ii) digital assessment of tumour stromal fraction (TSR) and optical DNA ploidy analysis. 3' mRNA sequencing was performed to obtain gene expression data from which stromal and immune scores were calculated using the ESTIMATE method. Full results were available for 139 samples and compared with disease-free survival. All three methods were prognostic. Most strongly predictive was a DNN-determined ratio of desmoplastic to inflamed stroma >5.41 (P < 0.0001). A ratio of ESTIMATE stromal to immune score <1.19 was also predictive of disease-free survival (P = 0.00051), as was stromal fraction >36.5% (P = 0.037). CONCLUSIONS The DNN-determined ratio of desmoplastic to inflamed ratio is a novel and powerful predictor of disease recurrence in locally excised early rectal cancer. It can be assessed on a single H&E section, so could be applied in routine clinical practice to improve the prognostic information available to patients and clinicians to inform the decision concerning further management.
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Affiliation(s)
- Helen J S Jones
- Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Hanne A Askautrud
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Håvard E Danielsen
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway.,Department of Informatics, University of Oslo, Oslo, Norway.,Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - David J Kerr
- Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Enric Domingo
- Department of Oncology, MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Tim Maughan
- Department of Oncology, MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Simon J Leedham
- Intestinal Stem Cell Biology Laboratory, Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital Zürich, Zürich, Switzerland.,Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, UK
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31
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Irmisch A, Bonilla X, Chevrier S, Lehmann KV, Singer F, Toussaint NC, Esposito C, Mena J, Milani ES, Casanova R, Stekhoven DJ, Wegmann R, Jacob F, Sobottka B, Goetze S, Kuipers J, Sarabia Del Castillo J, Prummer M, Tuncel MA, Menzel U, Jacobs A, Engler S, Sivapatham S, Frei AL, Gut G, Ficek J, Miglino N, Aebersold R, Bacac M, Beerenwinkel N, Beisel C, Bodenmiller B, Dummer R, Heinzelmann-Schwarz V, Koelzer VH, Manz MG, Moch H, Pelkmans L, Snijder B, Theocharides APA, Tolnay M, Wicki A, Wollscheid B, Rätsch G, Levesque MP. The Tumor Profiler Study: integrated, multi-omic, functional tumor profiling for clinical decision support. Cancer Cell 2021; 39:288-293. [PMID: 33482122 DOI: 10.1016/j.ccell.2021.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 01/02/2023]
Abstract
The application and integration of molecular profiling technologies create novel opportunities for personalized medicine. Here, we introduce the Tumor Profiler Study, an observational trial combining a prospective diagnostic approach to assess the relevance of in-depth tumor profiling to support clinical decision-making with an exploratory approach to improve the biological understanding of the disease.
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Affiliation(s)
- Anja Irmisch
- University Hospital Zurich, Department of Dermatology, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Ximena Bonilla
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland
| | - Stéphane Chevrier
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Kjong-Van Lehmann
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland
| | - Franziska Singer
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Nora C Toussaint
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Cinzia Esposito
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Julien Mena
- ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Emanuela S Milani
- ETH Zurich, Department of Health Sciences and Technology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Ruben Casanova
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Daniel J Stekhoven
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Rebekka Wegmann
- ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Francis Jacob
- University Hospital Basel and University of Basel, Department of Biomedicine, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Bettina Sobottka
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Sandra Goetze
- ETH Zurich, Department of Health Sciences and Technology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Jack Kuipers
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Jacobo Sarabia Del Castillo
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Michael Prummer
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, NEXUS Personalized Health Technologies, John-von-Neumann-Weg 9, 8093 Zurich, Switzerland
| | - Mustafa A Tuncel
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Ulrike Menzel
- ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Andrea Jacobs
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Stefanie Engler
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Sujana Sivapatham
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Anja L Frei
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Gabriele Gut
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Joanna Ficek
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland
| | - Nicola Miglino
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland
| | | | - Rudolf Aebersold
- ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Marina Bacac
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Zurich, Wagistrasse 10, 8952 Schlieren, Switzerland
| | - Niko Beerenwinkel
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Christian Beisel
- ETH Zurich, Department of Biosystems Science and Engineering, Mattenstrasse 26, 4058 Basel, Switzerland
| | - Bernd Bodenmiller
- University of Zurich, Department of Quantitative Biomedicine, Winterthurerstrasse 190, 8057 Zurich, Switzerland; ETH Zurich, Institute of Molecular Health Sciences, Otto-Stern-Weg 7, 8093 Zurich, Switzerland
| | - Reinhard Dummer
- University Hospital Zurich, Department of Dermatology, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Viola Heinzelmann-Schwarz
- University Hospital Basel and University of Basel, Department of Biomedicine, Hebelstrasse 20, 4031 Basel, Switzerland; University Hospital Basel, Gynecological Cancer Center, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Viktor H Koelzer
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Markus G Manz
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Holger Moch
- University Hospital Zurich, Department of Pathology and Molecular Pathology, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Lucas Pelkmans
- University of Zurich, Department of Molecular Life Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Berend Snijder
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; ETH Zurich, Department of Biology, Institute of Molecular Systems Biology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Alexandre P A Theocharides
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Markus Tolnay
- University Hospital Basel, Institute of Medical Genetics and Pathology, Schönbeinstrasse 40, 4031 Basel, Switzerland
| | - Andreas Wicki
- University Hospital Zurich, Department of Medical Oncology and Hematology, Rämistrasse 100, 8091 Zurich, Switzerland; University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Bernd Wollscheid
- ETH Zurich, Department of Health Sciences and Technology, Otto-Stern-Weg 3, 8093 Zurich, Switzerland
| | - Gunnar Rätsch
- ETH Zurich, Department of Computer Science, Institute of Machine Learning, Universitätstrasse 6, 8092 Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland; University Hospital Zurich, Biomedical Informatics, Schmelzbergstrasse 26, 8006 Zurich, Switzerland; ETH Zurich, Department of Biology, Wolfgang-Pauli-Strasse 27, 8093 Zurich, Switzerland.
| | - Mitchell P Levesque
- University Hospital Zurich, Department of Dermatology, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.
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Sirinukunwattana K, Domingo E, Richman SD, Redmond KL, Blake A, Verrill C, Leedham SJ, Chatzipli A, Hardy C, Whalley CM, Wu CH, Beggs AD, McDermott U, Dunne PD, Meade A, Walker SM, Murray GI, Samuel L, Seymour M, Tomlinson I, Quirke P, Maughan T, Rittscher J, Koelzer VH. Image-based consensus molecular subtype (imCMS) classification of colorectal cancer using deep learning. Gut 2021; 70:544-554. [PMID: 32690604 PMCID: PMC7873419 DOI: 10.1136/gutjnl-2019-319866] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Complex phenotypes captured on histological slides represent the biological processes at play in individual cancers, but the link to underlying molecular classification has not been clarified or systematised. In colorectal cancer (CRC), histological grading is a poor predictor of disease progression, and consensus molecular subtypes (CMSs) cannot be distinguished without gene expression profiling. We hypothesise that image analysis is a cost-effective tool to associate complex features of tissue organisation with molecular and outcome data and to resolve unclassifiable or heterogeneous cases. In this study, we present an image-based approach to predict CRC CMS from standard H&E sections using deep learning. DESIGN Training and evaluation of a neural network were performed using a total of n=1206 tissue sections with comprehensive multi-omic data from three independent datasets (training on FOCUS trial, n=278 patients; test on rectal cancer biopsies, GRAMPIAN cohort, n=144 patients; and The Cancer Genome Atlas (TCGA), n=430 patients). Ground truth CMS calls were ascertained by matching random forest and single sample predictions from CMS classifier. RESULTS Image-based CMS (imCMS) accurately classified slides in unseen datasets from TCGA (n=431 slides, AUC)=0.84) and rectal cancer biopsies (n=265 slides, AUC=0.85). imCMS spatially resolved intratumoural heterogeneity and provided secondary calls correlating with bioinformatic prediction from molecular data. imCMS classified samples previously unclassifiable by RNA expression profiling, reproduced the expected correlations with genomic and epigenetic alterations and showed similar prognostic associations as transcriptomic CMS. CONCLUSION This study shows that a prediction of RNA expression classifiers can be made from H&E images, opening the door to simple, cheap and reliable biological stratification within routine workflows.
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Affiliation(s)
- Korsuk Sirinukunwattana
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Enric Domingo
- Department of Oncology, University of Oxford, Oxford, UK
| | - Susan D Richman
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Keara L Redmond
- Centre for Cancer Research and Cell Biology, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | - Andrew Blake
- Department of Oncology, University of Oxford, Oxford, UK
| | - Clare Verrill
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Simon J Leedham
- Gastrointestinal Stem-cell Biology Laboratory, Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, Oxford, UK
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | | | - Celina M Whalley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Chieh-Hsi Wu
- Department of Statistics, University of Oxford, Oxford, UK
| | - Andrew D Beggs
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | | | - Philip D Dunne
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Angela Meade
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Graeme I Murray
- Department of Pathology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Leslie Samuel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Matthew Seymour
- Department of Oncology, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Ian Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Edinburgh Cancer Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Phil Quirke
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Timothy Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Jens Rittscher
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Viktor H Koelzer
- Department of Oncology, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
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Malla SB, Fisher DJ, Domingo E, Blake A, Hassanieh S, Redmond KL, Richman SD, Youdell M, Walker SM, Logan GE, Chatzipli A, Amirkhah R, Humphries MP, Craig SG, McDermott U, Seymour MT, Morton DG, Quirke P, West NP, Salto-Tellez M, Kennedy RD, Johnston PG, Tomlinson I, Koelzer VH, Campo L, Kaplan RS, Longley DB, Lawler M, Maughan TS, Brown LC, Dunne PD. In-depth Clinical and Biological Exploration of DNA Damage Immune Response as a Biomarker for Oxaliplatin Use in Colorectal Cancer. Clin Cancer Res 2021; 27:288-300. [PMID: 33028592 PMCID: PMC7614625 DOI: 10.1158/1078-0432.ccr-20-3237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The DNA damage immune response (DDIR) assay was developed in breast cancer based on biology associated with deficiencies in homologous recombination and Fanconi anemia pathways. A positive DDIR call identifies patients likely to respond to platinum-based chemotherapies in breast and esophageal cancers. In colorectal cancer, there is currently no biomarker to predict response to oxaliplatin. We tested the ability of the DDIR assay to predict response to oxaliplatin-based chemotherapy in colorectal cancer and characterized the biology in DDIR-positive colorectal cancer. EXPERIMENTAL DESIGN Samples and clinical data were assessed according to DDIR status from patients who received either 5-fluorouracil (5-FU) or 5FUFA (bolus and infusion 5-FU with folinic acid) plus oxaliplatin (FOLFOX) within the FOCUS trial (n = 361, stage IV), or neoadjuvant FOLFOX in the FOxTROT trial (n = 97, stage II/III). Whole transcriptome, mutation, and IHC data of these samples were used to interrogate the biology of DDIR in colorectal cancer. RESULTS Contrary to our hypothesis, DDIR-negative patients displayed a trend toward improved outcome for oxaliplatin-based chemotherapy compared with DDIR-positive patients. DDIR positivity was associated with microsatellite instability (MSI) and colorectal molecular subtype 1. Refinement of the DDIR signature, based on overlapping IFN-related chemokine signaling associated with DDIR positivity across colorectal cancer and breast cancer cohorts, further confirmed that the DDIR assay did not have predictive value for oxaliplatin-based chemotherapy in colorectal cancer. CONCLUSIONS DDIR positivity does not predict improved response following oxaliplatin treatment in colorectal cancer. However, data presented here suggest the potential of the DDIR assay in identifying immune-rich tumors that may benefit from immune checkpoint blockade, beyond current use of MSI status.
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Affiliation(s)
- Sudhir B Malla
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - David J Fisher
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Enric Domingo
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Andrew Blake
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Sylvana Hassanieh
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Keara L Redmond
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Susan D Richman
- Pathology and data analytics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Michael Youdell
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | | | - Gemma E Logan
- Almac Diagnostic Services, Craigavon, United Kingdom
| | - Aikaterina Chatzipli
- Cancer, Ageing and Somatic Mutation (CASM), Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Raheleh Amirkhah
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Matthew P Humphries
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Stephanie G Craig
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Ultan McDermott
- Cancer, Ageing and Somatic Mutation (CASM), Wellcome Sanger Institute, Cambridge, United Kingdom
- AstraZeneca, United Kingdom
| | | | - Dion G Morton
- University of Birmingham, Birmingham, United Kingdom
| | - Philip Quirke
- Cancer, Ageing and Somatic Mutation (CASM), Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Nicholas P West
- Cancer, Ageing and Somatic Mutation (CASM), Wellcome Sanger Institute, Cambridge, United Kingdom
| | - Manuel Salto-Tellez
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Richard D Kennedy
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Patrick G Johnston
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | | | | | - Letitia Campo
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Richard S Kaplan
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Daniel B Longley
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Timothy S Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom.
| | - Louise C Brown
- MRC Clinical Trials Unit, University College London, London, United Kingdom
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Horeweg N, de Bruyn M, Nout RA, Stelloo E, Kedziersza K, León-Castillo A, Plat A, Mertz KD, Osse M, Jürgenliemk-Schulz IM, Lutgens LCHW, Jobsen JJ, van der Steen-Banasik EM, Smit VT, Creutzberg CL, Bosse T, Nijman HW, Koelzer VH, Church DN. Prognostic Integrated Image-Based Immune and Molecular Profiling in Early-Stage Endometrial Cancer. Cancer Immunol Res 2020; 8:1508-1519. [PMID: 32999003 DOI: 10.1158/2326-6066.cir-20-0149] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/02/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Optimum risk stratification in early-stage endometrial cancer combines clinicopathologic factors and the molecular endometrial cancer classification defined by The Cancer Genome Atlas (TCGA). It is unclear whether analysis of intratumoral immune infiltrate improves this. We developed a machine-learning, image-based algorithm to quantify density of CD8+ and CD103+ immune cells in tumor epithelium and stroma in 695 stage I endometrioid endometrial cancers from the PORTEC-1 and -2 trials. The relationship between immune cell density and clinicopathologic/molecular factors was analyzed by hierarchical clustering and multiple regression. The prognostic value of immune infiltrate by cell type and location was analyzed by univariable and multivariable Cox regression, incorporating the molecular endometrial cancer classification. Tumor-infiltrating immune cell density varied substantially between cases, and more modestly by immune cell type and location. Clustering revealed three groups with high, intermediate, and low densities, with highly significant variation in the proportion of molecular endometrial cancer subgroups between them. Univariable analysis revealed intraepithelial CD8+ cell density as the strongest predictor of endometrial cancer recurrence; multivariable analysis confirmed this was independent of pathologic factors and molecular subgroup. Exploratory analysis suggested this association was not uniform across molecular subgroups, but greatest in tumors with mutant p53 and absent in DNA mismatch repair-deficient cancers. Thus, this work identified that quantification of intraepithelial CD8+ cells improved upon the prognostic utility of the molecular endometrial cancer classification in early-stage endometrial cancer.
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Affiliation(s)
- Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marco de Bruyn
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen Stelloo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Katarzyna Kedziersza
- Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| | - Alicia León-Castillo
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annechien Plat
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Kirsten D Mertz
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
| | - Michelle Osse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Jan J Jobsen
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Vincent T Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
- Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David N Church
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
- Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Oxford NIHR Comprehensive Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Nienhold R, Ciani Y, Koelzer VH, Tzankov A, Haslbauer JD, Menter T, Schwab N, Henkel M, Frank A, Zsikla V, Willi N, Kempf W, Hoyler T, Barbareschi M, Moch H, Tolnay M, Cathomas G, Demichelis F, Junt T, Mertz KD. Two distinct immunopathological profiles in autopsy lungs of COVID-19. Nat Commun 2020; 11:5086. [PMID: 33033248 PMCID: PMC7546638 DOI: 10.1038/s41467-020-18854-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus Disease 19 (COVID-19) is a respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has grown to a worldwide pandemic with substantial mortality. Immune mediated damage has been proposed as a pathogenic factor, but immune responses in lungs of COVID-19 patients remain poorly characterized. Here we show transcriptomic, histologic and cellular profiles of post mortem COVID-19 (n = 34 tissues from 16 patients) and normal lung tissues (n = 9 tissues from 6 patients). Two distinct immunopathological reaction patterns of lethal COVID-19 are identified. One pattern shows high local expression of interferon stimulated genes (ISGhigh) and cytokines, high viral loads and limited pulmonary damage, the other pattern shows severely damaged lungs, low ISGs (ISGlow), low viral loads and abundant infiltrating activated CD8+ T cells and macrophages. ISGhigh patients die significantly earlier after hospitalization than ISGlow patients. Our study may point to distinct stages of progression of COVID-19 lung disease and highlights the need for peripheral blood biomarkers that inform about patient lung status and guide treatment.
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Affiliation(s)
- Ronny Nienhold
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Yari Ciani
- Laboratory of Computational and Functional Oncology, Department for Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Trento, Italy
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
- Department of Oncology and Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Jasmin D Haslbauer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Thomas Menter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Nathalie Schwab
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Maurice Henkel
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Angela Frank
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Veronika Zsikla
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Niels Willi
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Thomas Hoyler
- Novartis Institutes for BioMedical Research (NIBR), Basel, Switzerland
| | - Mattia Barbareschi
- Anatomia ed Istologia Patologica, Ospedale S. Chiara di Trento, Trento, Italy
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Markus Tolnay
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Gieri Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Francesca Demichelis
- Laboratory of Computational and Functional Oncology, Department for Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Trento, Italy
- Caryl and Israel Englander Institute for Precision Medicine, Institute for Computational Biomedicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Tobias Junt
- Novartis Institutes for BioMedical Research (NIBR), Basel, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland.
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Kleeman SO, Koelzer VH, Jones HJ, Vazquez EG, Davis H, East JE, Arnold R, Koppens MA, Blake A, Domingo E, Cunningham C, Beggs AD, Pestinger V, Loughrey MB, Wang LM, Lannagan TR, Woods SL, Worthley D, Consortium SC, Tomlinson I, Dunne PD, Maughan T, Leedham SJ. Exploiting differential Wnt target gene expression to generate a molecular biomarker for colorectal cancer stratification. Gut 2020; 69:1092-1103. [PMID: 31563876 PMCID: PMC7212029 DOI: 10.1136/gutjnl-2019-319126] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/20/2019] [Accepted: 09/07/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pathological Wnt pathway activation is a conserved hallmark of colorectal cancer. Wnt-activating mutations can be divided into: i) ligand-independent (LI) alterations in intracellular signal transduction proteins (Adenomatous polyposis coli, β-catenin), causing constitutive pathway activation and ii) ligand-dependent (LD) mutations affecting the synergistic R-Spondin axis (RNF43, RSPO-fusions) acting through amplification of endogenous Wnt signal transmembrane transduction. Our aim was to exploit differential Wnt target gene expression to generate a mutation-agnostic biomarker for LD tumours. DESIGN We undertook harmonised multi-omic analysis of discovery (n=684) and validation cohorts (n=578) of colorectal tumours collated from publicly available data and the Stratification in Colorectal Cancer Consortium. We used mutation data to establish molecular ground truth and subdivide lesions into LI/LD tumour subsets. We contrasted transcriptional, methylation, morphological and clinical characteristics between groups. RESULTS Wnt disrupting mutations were mutually exclusive. Desmoplastic stromal upregulation of RSPO may compensate for absence of epithelial mutation in a subset of stromal-rich tumours. Key Wnt negative regulator genes were differentially expressed between LD/LI tumours, with targeted hypermethylation of some genes (AXIN2, NKD1) occurring even in CIMP-negative LD cancers. AXIN2 mRNA expression was used as a discriminatory molecular biomarker to distinguish LD/LI tumours (area under the curve >0.93). CONCLUSIONS Epigenetic suppression of appropriate Wnt negative feedback loops is selectively advantageous in LD tumours and differential AXIN2 expression in LD/LI lesions can be exploited as a molecular biomarker. Distinguishing between LD/LI tumour types is important; patients with LD tumours retain sensitivity to Wnt ligand inhibition and may be stratified at diagnosis to clinical trials of Porcupine inhibitors.
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Affiliation(s)
- Sam O Kleeman
- Intestinal Stem Cell Biology Lab, Wellcome Trust Centre Human Genetics, University of Oxford, Oxford, UK
| | - Viktor H Koelzer
- Intestinal Stem Cell Biology Lab, Wellcome Trust Centre Human Genetics, University of Oxford, Oxford, UK
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zurich, Switzerland
| | - Helen Js Jones
- Intestinal Stem Cell Biology Lab, Wellcome Trust Centre Human Genetics, University of Oxford, Oxford, UK
- Oxford Colorectal Surgery Department, Nuffield Department of Surgery, Churchill Hospital, Oxford, Oxfordshire, UK
| | - Ester Gil Vazquez
- Intestinal Stem Cell Biology Lab, Wellcome Trust Centre Human Genetics, University of Oxford, Oxford, UK
| | - Hayley Davis
- Intestinal Stem Cell Biology Lab, Wellcome Trust Centre Human Genetics, University of Oxford, Oxford, UK
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Roland Arnold
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Martijn Aj Koppens
- Intestinal Stem Cell Biology Lab, Wellcome Trust Centre Human Genetics, University of Oxford, Oxford, UK
| | - Andrew Blake
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Enric Domingo
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Chris Cunningham
- Oxford Colorectal Surgery Department, Nuffield Department of Surgery, Churchill Hospital, Oxford, Oxfordshire, UK
| | - Andrew D Beggs
- Surgical Research Laboratory, Institute of Cancer & Genomic Science, University of Birmingham, Birminghaam, United Kingdom
| | - Valerie Pestinger
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Maurice B Loughrey
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Tamsin Rm Lannagan
- South Australian Health & Medical Research Institute & School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Susan L Woods
- South Australian Health & Medical Research Institute & School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Daniel Worthley
- South Australian Health & Medical Research Institute & School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ian Tomlinson
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Philip D Dunne
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Timothy Maughan
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Simon J Leedham
- Intestinal Stem Cell Biology Lab, Wellcome Trust Centre Human Genetics, University of Oxford, Oxford, UK
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37
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Domingo E, Chatzipli A, Richman S, Blake A, Hardy C, Whalley C, Redmon K, Tomlinson I, Dunne P, Walker S, Beggs A, McDermott U, Murray GI, Samuel LM, Seymour M, Quirke P, Maughan T, Koelzer VH. Abstract 4446: Assessment of tissue composition with digital pathology in colorectal cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The tumor microenvironment is a key feature to understand cancer biology and may be used clinically. Quantification of tissue composition is usually based either on visual pathological review (VPR) or deconvolution of whole genome molecular data. Although the former is a direct measurement it has modest reproducibility while the latter is an indirect measurement of unclear accuracy, expensive and not always available. Here we test digital pathology coupled with machine learning as a new tool to assess tissue composition.
Methods: As part of the Stratification in COloRecTal cancer (S:CORT) programme, a set of over 500 colorectal cancer (CRC) archival paraffin blocks from resections and biopsies were sequentially sectioned for Hematoxylin and Eosin staining (H&E), RNA extraction, a second H&E and DNA extraction. RNA expression microarrays, targeted DNA sequencing and DNA methylation arrays were applied. Tissue composition from the H&Es was obtained by VPR of expert pathologists and by a deep neural net (DNN) algorithm after supervised training on >1,500 tissue areas from S:CORT, TCGA, TEM and CORGI CRC cohorts. Tumor purity estimates were obtained from RNA and methylation arrays.
Results: DNN estimates including area and cell counts were obtained for tumor, desmoplastic stroma, inflamed stroma, mucin/hypocellular stroma, muscle, necrosis and white space. An average of 6.8x105 total cells (range: 1.2x104-2.8x106) and 1.2x105 (range: 7.2x104-1.8x106) were classified for resections and biopsies respectively. Analyses performed twice on the same H&Es obtained matching results (r=1.0). Comparison of the paired first and second H&E showed very high correlations (r~0.9) and total cell counts correlated with DNA and RNA extraction yields (r~0.6). Tumor purity estimates by VPR mildly correlated with DNN (r~0.5) but they were underestimated and very variable. As a result, copy number adjusted by VPR purity tended to be overestimated compared to adjustment with DNN estimates. The improved performance of DNN is reflected in an accurate capture of non-linear association between area and cell counts in invasive cancer. In contrast, tumor purity estimates derived from RNA or DNA methylation arrays showed better correlations compared with DNN (r~0.6) but both overestimated purity in cases with low cell counts by up to a three-fold difference.
Conclusions: Tissue composition analysis with DNN allows analytical robustness, automatization and standardization and provides very high reproducibility at single cell resolution. DNN-based estimation of tumor purity is more accurate than VPR or extrapolation from molecular data derived from genome-wide omic platforms which tend to under and overestimate tumor purity respectively. DNN could be used to better plan and asses downstream molecular analyses and to investigate tissue-based metrics as potential clinical biomarkers in clinical trials.
Citation Format: Enric Domingo, Aikaterini Chatzipli, Susan Richman, Andrew Blake, Claire Hardy, Celina Whalley, Keara Redmon, Ian Tomlinson, Philip Dunne, Steven Walker, Andrew Beggs, Ultan McDermott, Graeme I. Murray, Leslie M. Samuel, Matthew Seymour, Philip Quirke, Tim Maughan, Viktor H. Koelzer. Assessment of tissue composition with digital pathology in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4446.
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Affiliation(s)
| | | | - Susan Richman
- 3Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | | | - Claire Hardy
- 2Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | | | | | - Ian Tomlinson
- 4University of Birmingham, Birmingham, United Kingdom
| | | | | | - Andrew Beggs
- 4University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Matthew Seymour
- 3Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Philip Quirke
- 3Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
| | - Tim Maughan
- 1University of Oxford, Oxford, United Kingdom
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Bolck HA, Corrò C, Kahraman A, von Teichman A, Toussaint NC, Kuipers J, Chiovaro F, Koelzer VH, Pauli C, Moritz W, Bode PK, Rechsteiner M, Beerenwinkel N, Schraml P, Moch H. Tracing Clonal Dynamics Reveals that Two- and Three-dimensional Patient-derived Cell Models Capture Tumor Heterogeneity of Clear Cell Renal Cell Carcinoma. Eur Urol Focus 2019; 7:152-162. [PMID: 31266731 DOI: 10.1016/j.euf.2019.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/16/2019] [Accepted: 06/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Extensive DNA sequencing has led to an unprecedented view of the diversity of individual genomes and their evolution among patients with clear cell renal cell carcinoma (ccRCC). OBJECTIVE To understand subclonal architecture and dynamics of patient-derived two-dimensional (2D) and three-dimensional (3D) ccRCC models in vitro, in order to determine whether they mirror ccRCC inter- and intratumor heterogeneity. DESIGN, SETTING, AND PARTICIPANTS We have established a comprehensive platform of living renal cancer cell models from ccRCC surgical specimens. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We confirmed the concordance of 2D and 3D patient-derived cell (PDC) models with the original tumor tissue in terms of histology, biomarker expression, cancer driver mutations, and copy number alterations. We addressed inter- and intrapatient heterogeneity by analyzing clonal dynamics during serial passaging. RESULTS AND LIMITATIONS In-depth genetic characterization verified the presence of heterogeneous cell populations, and revealed a high degree of similarity between subclonal compositions of monolayer and organoid cell cultures and the corresponding parental ccRCCs. Clonal dynamics were evident during serial passaging of cells in vitro, suggesting that PDC cultures can offer insights into evolutionary potential and treatment susceptibility of ccRCC subclones in vivo. Proof-of-concept drug profiling using selected ccRCC-targeted therapy agents highlighted patient-specific vulnerabilities in PDC models that could not be anticipated by interrogating commercially available cell lines. CONCLUSIONS We demonstrate that PDC models mirror inter- and intratumor heterogeneity of ccRCC in vitro. Based on our findings, we envision that the use of these models will advance our understanding of the trajectories that cause genetic diversity and their consequences for treatment on an individual level. PATIENT SUMMARY In this study, we developed two- and three-dimensional patient-derived models from clear cell renal cell carcinoma (ccRCC) as "mini-tumors in a dish." We show that these cell models retain important features of the human ccRCCs such as the profound tumor heterogeneity, thus highlighting their importance for cancer research and precision medicine.
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Affiliation(s)
- Hella A Bolck
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Claudia Corrò
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Abdullah Kahraman
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Adriana von Teichman
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nora C Toussaint
- NEXUS Personalized Health Technologies, ETH Zurich, Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Jack Kuipers
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland; Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | | | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Chantal Pauli
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Peter K Bode
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus Rechsteiner
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Niko Beerenwinkel
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland; Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - Peter Schraml
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
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Koelzer VH, Glatz K, Bubendorf L, Weber A, Gaspert A, Cathomas G, Lugli A, Zippelius A, Kempf W, Mertz KD. [The pathology of adverse events with immune checkpoint inhibitors]. Pathologe 2019; 38:197-208. [PMID: 28421272 DOI: 10.1007/s00292-017-0281-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Immunotherapy has gained importance with the development of new effective cancer treatments. Immune checkpoint inhibitors (ICI) are monoclonal antibodies that promote T‑cell mediated tumor immune rejection. Checkpoint blockade also carries the risk of inducing autoimmune reactions ("immune related adverse events", irAEs). The diagnosis and classification of irAEs constitute a new and important field in pathology. AIM Practice-oriented review of the diagnosis and classification of irAEs. MATERIALS AND METHODS Structured, selective literature review based on PubMed und UpToDate ® online. RESULTS The most common irAEs affect the skin, the gastrointestinal tract, the liver, and the respiratory system. The correct diagnosis and classification of irAEs by an interdisciplinary care team is essential for appropriate therapy and the prevention of long-term sequelae. Other important irAEs affect the endocrine organs, the heart, the joints, the kidneys and the nervous system. Because of their rarity and/or limited options for bioptic diagnosis, only limited data on the morphology and pathophysiology of these irAEs are currently available. Autopsies carried out after ICI therapy constitute an important element of quality control and allow better documentation of the incidence and pathogenesis of irAEs. DISCUSSION Pathology plays a central role in the diagnosis and treatment of irAEs. Future studies may contribute to a better mechanistic understanding of irAEs for individualized knowledge-based risk assessment.
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Affiliation(s)
- V H Koelzer
- Institut für Pathologie, Kantonsspital Baselland, Mühlemattstraße 11, 4410, Liestal, Schweiz.,Translational Research Unit (TRU), Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - K Glatz
- Institut für Pathologie, Universitätsspital Basel, Basel, Schweiz
| | - L Bubendorf
- Institut für Pathologie, Universitätsspital Basel, Basel, Schweiz
| | - A Weber
- Institut für Pathologie und Molekularpathologie, Universität Zürich und Universitätsspital Zürich, Zürich, Schweiz
| | - A Gaspert
- Institut für Pathologie und Molekularpathologie, Universität Zürich und Universitätsspital Zürich, Zürich, Schweiz
| | - G Cathomas
- Institut für Pathologie, Kantonsspital Baselland, Mühlemattstraße 11, 4410, Liestal, Schweiz
| | - A Lugli
- Klinische Pathologie, Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - A Zippelius
- Klinik für Onkologie, Universitätsspital Basel, Basel, Schweiz
| | - W Kempf
- Kempf und Pfaltz Histologische Diagnostik, Research Unit, Zürich, Schweiz
| | - K D Mertz
- Institut für Pathologie, Kantonsspital Baselland, Mühlemattstraße 11, 4410, Liestal, Schweiz.
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40
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Thommen DS, Koelzer VH, Herzig P, Bruijn MD, Voabil P, Braber MVD, Hummelink K, Monkhorst K, Mertz KD, Zippelius A, Haanen JB, Schumacher TN. Abstract B050: Identification of PD-1T TILs and CXCL13 as determinants for response to anti-PD-1 treatment using human tumor explants. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-b050] [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
Reinvigoration of tumor-specific T-cells by cancer immunotherapies, in particular PD-1/PD-L1 blocking agents, has greatly improved clinical outcome in multiple cancer types. Nevertheless, durable clinical benefit is currently limited to a small number of patients. To achieve a better understanding of the immunologic determinants of response to anti-PD-1 therapy, we assessed transcriptional and functional profiles of tumor-infiltrating lymphocyte (TIL) subsets from non-small cell lung cancer specimens. Thereby, we identified a transcriptionally distinct CD8 TIL pool with enriched capacity for tumor recognition. This TIL pool, termed PD-1T TILs, is characterized by bright PD-1 expression and constitutive CXCL13 secretion, which can mediate immune cell recruitment to tertiary lymphoid structures. Notably, the presence of PD-1T TILs correlates with response and survival in a small cohort of lung cancer patients treated with PD-1 blockade. To assess the role of PD-1T TILs and CXCL13 for response to PD-1 blockade in other cancer types, we developed a platform using human tumor explants to visualize immunologic responses to anti-PD-1 on a patient-specific level. Analysis of the cellular and soluble tumor microenvironment composition as well as of treatment-induced changes in tumor-infiltrating immune cells revealed immunologic responses to anti-PD-1 in 5 different cancer types. Of note, responding tumors in different tumor types were characterized by a clear enrichment in both PD-1T TILs and CXCL13 production. Collectively, our data reveal a distinct state of PD-1 bright lymphocytes that are enriched for tumor-reactivity in human cancer, making them an attractive proxy for the antitumor potential of the intratumoral T-cell pool. Furthermore, we established technology using human tumor explants to measure the immunologic response to T-cell checkpoint inhibition on a personalized basis. Finally, with this approach we identified PD-1T TILs and CXCL13 as determinants for response to anti-PD-1 in multiple cancer types, opening potential new avenues for therapeutic intervention and improved patient selection.
Citation Format: Daniela S. Thommen, Viktor H. Koelzer, Petra Herzig, Marjolein de Bruijn, Paula Voabil, Marlous van den Braber, Karlijn Hummelink, Kim Monkhorst, Kirsten D. Mertz, Alfred Zippelius, John B.A.G. Haanen, Ton N.M. Schumacher. Identification of PD-1T TILs and CXCL13 as determinants for response to anti-PD-1 treatment using human tumor explants [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr B050.
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Affiliation(s)
- Daniela S. Thommen
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Viktor H. Koelzer
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Petra Herzig
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Marjolein de Bruijn
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Paula Voabil
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Marlous van den Braber
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Karlijn Hummelink
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Kim Monkhorst
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Kirsten D. Mertz
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Alfred Zippelius
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - John B.A.G. Haanen
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
| | - Ton N.M. Schumacher
- The Netherlands Cancer Institute, Amsterdam, The Netherlands; University of Oxford, Oxford, United Kingdom; University Hospital Basel, Basel, Switzerland; Cantonal Hospital Basellland, Liestal, Switzerland
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Cheng WC, Tsui YC, Ragusa S, Koelzer VH, Mina M, Franco F, Läubli H, Tschumi B, Speiser D, Romero P, Zippelius A, Petrova TV, Mertz K, Ciriello G, Ho PC. Uncoupling protein 2 reprograms the tumor microenvironment to support the anti-tumor immune cycle. Nat Immunol 2019; 20:206-217. [DOI: 10.1038/s41590-018-0290-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022]
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Cross W, Kovac M, Mustonen V, Temko D, Davis H, Baker AM, Biswas S, Arnold R, Chegwidden L, Gatenbee C, Anderson AR, Koelzer VH, Martinez P, Jiang X, Domingo E, Woodcock DJ, Feng Y, Kovacova M, Maughan T, Jansen M, Rodriguez-Justo M, Ashraf S, Guy R, Cunningham C, East JE, Wedge DC, Wang LM, Palles C, Heinimann K, Sottoriva A, Leedham SJ, Graham TA, Tomlinson IPM. The evolutionary landscape of colorectal tumorigenesis. Nat Ecol Evol 2018; 2:1661-1672. [PMID: 30177804 PMCID: PMC6152905 DOI: 10.1038/s41559-018-0642-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 01/19/2023]
Abstract
The evolutionary events that cause colorectal adenomas (benign) to progress to carcinomas (malignant) remain largely undetermined. Using multi-region genome and exome sequencing of 24 benign and malignant colorectal tumours, we investigate the evolutionary fitness landscape occupied by these neoplasms. Unlike carcinomas, advanced adenomas frequently harbour sub-clonal driver mutations-considered to be functionally important in the carcinogenic process-that have not swept to fixation, and have relatively high genetic heterogeneity. Carcinomas are distinguished from adenomas by widespread aneusomies that are usually clonal and often accrue in a 'punctuated' fashion. We conclude that adenomas evolve across an undulating fitness landscape, whereas carcinomas occupy a sharper fitness peak, probably owing to stabilizing selection.
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Affiliation(s)
- William Cross
- Evolution and Cancer Laboratory, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Michal Kovac
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Bone Tumour Reference Center at the Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Ville Mustonen
- Organismal and Evolutionary Biology Research Programme, Department of Computer Science, Institute of Biotechnology, Helsinki Institute for Information Technology HIIT, University of Helsinki, Helsinki, Finland
| | - Daniel Temko
- Evolution and Cancer Laboratory, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- CoMPLEX, Department of Computer Science, University College London, London, UK
| | - Hayley Davis
- Gastrointestinal Stem Cell Biology Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ann-Marie Baker
- Evolution and Cancer Laboratory, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sujata Biswas
- Gastrointestinal Stem Cell Biology Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Roland Arnold
- Cancer Bioinfomatics Group, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura Chegwidden
- Gastrointestinal Cancer Genetics Laboratory, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Chandler Gatenbee
- Integrated Mathematical Oncology Department, Moffitt Comprehensive Cancer Centre, Tampa, FL, USA
| | - Alexander R Anderson
- Integrated Mathematical Oncology Department, Moffitt Comprehensive Cancer Centre, Tampa, FL, USA
| | - Viktor H Koelzer
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Pierre Martinez
- Evolution and Cancer Laboratory, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Xiaowei Jiang
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Enric Domingo
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - Yun Feng
- Molecular and Population Genetics Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Monika Kovacova
- Institute of Mathematics and Physics, Faculty of Mechanical Engineering, Slovak University of Technology in Bratislava, Bratislava, Slovakia
| | - Tim Maughan
- Department of Oncology, University of Oxford, Oxford, UK
| | - Marnix Jansen
- Department of Research Pathology, Cancer Institute, University College London, London, UK
| | - Manuel Rodriguez-Justo
- Department of Research Pathology, Cancer Institute, University College London, London, UK
| | - Shazad Ashraf
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Richard Guy
- Department of Colorectal Surgery, Cancer Centre, Churchill Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Christopher Cunningham
- Department of Colorectal Surgery, Cancer Centre, Churchill Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - James E East
- Translational Gastroenterology Unit, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - David C Wedge
- Big Data Institute, University of Oxford, Oxford, UK
| | - Lai Mun Wang
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Claire Palles
- Gastrointestinal Cancer Genetics Laboratory, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Andrea Sottoriva
- Evolutionary Genomics and Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Simon J Leedham
- Gastrointestinal Stem Cell Biology Laboratory, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Trevor A Graham
- Evolution and Cancer Laboratory, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Ian P M Tomlinson
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Department of Histopathology, University Hospitals Birmingham, Birmingham, UK.
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Wyss J, Dislich B, Koelzer VH, Galván JA, Dawson H, Hädrich M, Inderbitzin D, Lugli A, Zlobec I, Berger MD. Stromal PD-1/PD-L1 Expression Predicts Outcome in Colon Cancer Patients. Clin Colorectal Cancer 2018; 18:e20-e38. [PMID: 30389315 DOI: 10.1016/j.clcc.2018.09.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/19/2018] [Accepted: 09/17/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) axis plays an important role in controlling immune suppression by down-regulating T effector cell activities, enabling tumor cells to escape from the host's antitumor immunsurveillance. While only a small part of colon cancer cells express PD-L1, we sought to evaluate the differential impact of stromal and epithelial PD-L1 expression of primary tumors and liver metastasis on overall survival (OS) in colon cancer patients. PATIENTS AND METHODS Using a next-generation tissue microarray approach, we assessed both epithelial and stromal PD-L1 expression levels in primary tumors (n = 279) and corresponding liver metastases (n = 14) of colon cancer patients. PD-L1 positivity was graded according to the percentage (0.1%-1%, > 1%, > 5%, > 50%) of tumor cells with membranous PD-L1 expression or as the percentage of positive stroma cells and associated inflammatory infiltrates. We also assessed the interplay between stromal PD-1/PD-L1 and both intratumoral and stromal CD8 count and their impact on outcome. The primary end point was OS. RESULTS Stromal PD-L1 and PD-1 expression were both associated with less aggressive tumor behavior in colon cancer patients, which translated into better OS and disease-free survival, respectively. Conversely, PD-L1 staining in the tumor cells was less frequent than stromal staining and was associated with features of aggressive tumor biology, although without impact on outcome. Interestingly, the PD-L1 staining pattern remained similar between primary tumors and corresponding liver metastases. Stromal PD-1 expression correlated significantly with stromal PD-L1 staining and both intratumoral and stromal CD8 expression. CONCLUSION Stromal PD-1/PD-L1 expression might serve as a prognostic marker in colon cancer patients.
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Affiliation(s)
- Jacqueline Wyss
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Bastian Dislich
- Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Viktor H Koelzer
- Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland; Molecular and Population Genetics Laboratory, University of Oxford, Oxford, UK
| | - José A Galván
- Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Heather Dawson
- Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Marion Hädrich
- Departments of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Inderbitzin
- Departments of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Surgery, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Alessandro Lugli
- Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Inti Zlobec
- Division of Clinical Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Martin D Berger
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Koelzer VH, Gisler A, Hanhart JC, Griss J, Wagner SN, Willi N, Cathomas G, Sachs M, Kempf W, Thommen DS, Mertz KD. Digital image analysis improves precision of PD-L1 scoring in cutaneous melanoma. Histopathology 2018; 73:397-406. [PMID: 29660160 DOI: 10.1111/his.13528] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/06/2018] [Indexed: 01/01/2023]
Abstract
AIMS Immune checkpoint inhibitors have become a successful treatment in metastatic melanoma. The high response rates in a subset of patients suggest that a sensitive companion diagnostic test is required. The predictive value of programmed death ligand 1 (PD-L1) staining in melanoma has been questioned due to inconsistent correlation with clinical outcome. Whether this is due to predictive irrelevance of PD-L1 expression or inaccurate assessment techniques remains unclear. The aim of this study was to develop a standardised digital protocol for the assessment of PD-L1 staining in melanoma and to compare the output data and reproducibility to conventional assessment by expert pathologists. METHODS AND RESULTS In two cohorts with a total of 69 cutaneous melanomas, a highly significant correlation was found between pathologist-based consensus reading and automated PD-L1 analysis (r = 0.97, P < 0.0001). Digital scoring captured the full diagnostic spectrum of PD-L1 expression at single cell resolution. An average of 150 472 melanoma cells (median 38 668 cells; range = 733-1 078 965) were scored per lesion. Machine learning was used to control for heterogeneity introduced by PD-L1-positive inflammatory cells in the tumour microenvironment. The PD-L1 image analysis protocol showed excellent reproducibility (r = 1.0, P < 0.0001) when carried out on independent workstations and reduced variability in PD-L1 scoring of human observers. When melanomas were grouped by PD-L1 expression status, we found a clear correlation of PD-L1 positivity with CD8-positive T cell infiltration, but not with tumour stage, metastasis or driver mutation status. CONCLUSION Digital evaluation of PD-L1 reduces scoring variability and may facilitate patient stratification in clinical practice.
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Affiliation(s)
- Viktor H Koelzer
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
- Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland
| | - Aline Gisler
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
| | - Jonathan C Hanhart
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
| | - Johannes Griss
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Stephan N Wagner
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Niels Willi
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
| | - Gieri Cathomas
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
| | - Melanie Sachs
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Research Unit, Zürich, Switzerland
| | - Daniela S Thommen
- Cancer Immunology, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
- Division of Molecular Oncology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kirsten D Mertz
- Cantonal Hospital Baselland, Institute of Pathology, Liestal, Switzerland
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Berger MD, Zlobec I, Yang D, Cao S, Sunakawa Y, Matsusaka S, Koelzer VH, Inderbitzin D, Ning Y, Okazaki S, Miyamoto Y, Suenaga M, Schirripa M, Soni S, Puccini A, Tokunaga R, Naseem M, Zhang W, Lugli A, Lenz HJ. Association of genetic variations within the PD-L2 immune checkpoint gene with outcome in stage II and III colon cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
626 Background: Immune checkpoints can either inhibit or stimulate T-cell responses and therefore play a key role in maintaining an equilibrium between self tolerance and autoimmunity. Targeting immune checkpoint molecules can result in increased antitumor immunity by stimulation of the immune system. We hypothesize, that variations in genes encoding for both inhibitory or stimulatory immune checkpoint proteins may predict outcome in stage II and III colon cancer patients. Methods: The impact of 6 functional single nucleotide polymorphisms (SNPs) within the PD1, PD-L1, PD-L2, TIM3, OX40 and CD27 genes on time to recurrence was evaluated in 201 patients with stage II and III colon cancer. Genomic DNA was extracted from formalin-fixed paraffin embedded tissue and the SNPs were analyzed by PCR-based direct sequencing. Results: Baseline characteristics were as follows: female/male ratio = 42.8% / 57.2%; median age = 70y (19-91); median follow-up = 43months. The PD-L2 rs16923189 SNP showed significant association with recurrence rate. Patients with a G/G genotype had a higher 3-years recurrence rate compared to those harboring any A allele (41% vs 19%) in both univariate (HR 2.68, 95% Confidence interval (CI) 1.28-5.61, p = 0.006) and multivariate analyses (HR 3.13, 95% CI 1.42-6.28, p = 0.003). The high recurrence rate was most evident among patients with stage III and left-sided tumors carrying the G/G genotype (53% vs 24% and 65% vs 18%) in both univariate (HR 2.87, 95% CI 1.24-6.66, p = 0.009 and HR 5.28, 95% CI 2.24-12.44, p < 0.0001) and multivariate analyses (HR 4.32, 95% CI 1.76-9.91, p = 0.001 and HR 5.20, 95% CI 2.02-12.75, p = 0.001). Conclusions: Our results provide the first evidence, that polymorphisms within the PD-L2 gene might serve as prognostic markers in patients with stage II and III colon cancer. Interestingly, the prognostic effect is most significant among patients with stage III and left-sided colon cancers. Targeting PD-L2 might be a promising approach to further optimize treatment options and to improve outcome of colon cancer patients in the adjuvant setting.
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Affiliation(s)
| | | | - Dongyun Yang
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Shu Cao
- USC Keck School of Medicine, Los Angeles, CA
| | - Yu Sunakawa
- Norris Comprehensive Cancer Center, USC Keck School of Medicine, Los Angeles, CA
| | - Satoshi Matsusaka
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Yan Ning
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Satoshi Okazaki
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Yuji Miyamoto
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - Marta Schirripa
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, Italy
| | | | | | | | | | - Wu Zhang
- USC Keck School of Medicine, Los Angeles, CA
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Lawler M, Alsina D, Adams RA, Anderson AS, Brown G, Fearnhead NS, Fenwick SW, Halloran SP, Hochhauser D, Hull MA, Koelzer VH, McNair AGK, Monahan KJ, Näthke I, Norton C, Novelli MR, Steele RJC, Thomas AL, Wilde LM, Wilson RH, Tomlinson I. Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer. Gut 2018; 67:179-193. [PMID: 29233930 PMCID: PMC5754857 DOI: 10.1136/gutjnl-2017-315333] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes. DESIGN RG analysis was conducted by a multidisciplinary panel of patients, clinicians and researchers (n=71). Eight working groups (WG) were constituted: discovery science; risk; prevention; early diagnosis and screening; pathology; curative treatment; stage IV disease; and living with and beyond CRC. A series of discussions led to development of draft papers by each WG, which were evaluated by a 20-strong patient panel. A final list of RGs and research recommendations (RR) was endorsed by all participants. RESULTS Fifteen critical RGs are summarised below: RG1: Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment; RG2: Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk; RG3: Pressing need for prevention trials; RG4: Lack of integration of different prevention approaches; RG5: Lack of optimal strategies for CRC screening; RG6: Lack of effective triage systems for invasive investigations; RG7: Imprecise pathological assessment of CRC; RG8: Lack of qualified personnel in genomics, data sciences and digital pathology; RG9: Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices; RG10: Need for novel technologies/interventions to improve curative outcomes; RG11: Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment; RG12: Lack of reliable biomarkers to guide stage IV treatment; RG13: Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution; RG14: Lack of coordination of CRC research/funding; RG15: Lack of effective communication between relevant stakeholders. CONCLUSION Prioritising research activity and funding could have a significant impact on reducing CRC disease burden over the next 5 years.
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Affiliation(s)
- Mark Lawler
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | | | | | - Annie S Anderson
- Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Gina Brown
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | | | - Stephen W Fenwick
- Hepatobiliary Surgery Unit, Aintree University Hospital, Liverpool, UK
| | - Stephen P Halloran
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Daniel Hochhauser
- Department of Oncology, University College London Cancer Institute, London, UK
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Viktor H Koelzer
- Molecular and Population Genetics Laboratory, University of Oxford, Oxford, UK
| | - Angus G K McNair
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Kevin J Monahan
- Family History of Bowel Cancer Clinic, Imperial College London, London, UK
| | - Inke Näthke
- School of Life Sciences, University of Dundee, Dundee, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Marco R Novelli
- Research Department of Pathology, University College London Medical School, London, UK
| | - Robert J C Steele
- Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Anne L Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Lisa M Wilde
- Bowel Cancer UK, London, UK
- Atticus Consultants Ltd, Croydon, UK
| | - Richard H Wilson
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Ian Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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47
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Läubli H, Koelzer VH, Matter MS, Herzig P, Dolder Schlienger B, Wiese MN, Lardinois D, Mertz KD, Zippelius A. The T cell repertoire in tumors overlaps with pulmonary inflammatory lesions in patients treated with checkpoint inhibitors. Oncoimmunology 2017; 7:e1386362. [PMID: 29308309 DOI: 10.1080/2162402x.2017.1386362] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 02/01/2023] Open
Abstract
Cancer immunotherapy with antibodies targeting immune checkpoints such as the PD-1/PD-L1 pathway have emerged as breakthrough treatment for multiple solid tumors with high response rates and durable remissions. Despite the benefit for patients and encouraging safety profile, severe inflammatory reactions are observed in some patients. Such immune-related adverse events (irAEs) frequently lead to temporary or permanent cessation of the treatment and require systemic immunosuppression yet underlying mechanisms of irAEs are not known in detail. Here, we describe the T cell-mediated immune reaction in irAE lesions of four patients that developed pneumonitis during therapy with a PD-1 blocking antibody. Immunohistochemical analysis was performed to map the environment of the inflammatory lesions. Tumor infiltrating T cell clones were identified by sequencing the T cell receptor, and comparison with clones from peripheral blood or secondary lymphoid organs. A significant overlap of clones infiltrating irAE lesions and tumors was found. The most prevalent clones were also expanded in peripheral blood, but only a minor fraction of clonal overlap was found. Our findings suggest that irAE lesions in patients under PD-1 blockade are infiltrated by T cells with similar specificity as tumor-infiltrating T cells. These results raise the possibility that the immune response is elicited in these patients against antigens shared by the tumor and distant organs affected by irAEs.
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Affiliation(s)
- Heinz Läubli
- Laboratory of Cancer Immunology, Department of Biomedicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Medical Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Viktor H Koelzer
- Department of Pathology, Cantonal Hospital Liestal, Liestal, Switzerland
| | - Matthias S Matter
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Petra Herzig
- Laboratory of Cancer Immunology, Department of Biomedicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Medical Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Béatrice Dolder Schlienger
- Laboratory of Cancer Immunology, Department of Biomedicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Medical Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Kirsten D Mertz
- Department of Pathology, Cantonal Hospital Liestal, Liestal, Switzerland
| | - Alfred Zippelius
- Laboratory of Cancer Immunology, Department of Biomedicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Medical Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
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48
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Diem S, Hasan Ali O, Ackermann CJ, Bomze D, Koelzer VH, Jochum W, Speiser DE, Mertz KD, Flatz L. Tumor infiltrating lymphocytes in lymph node metastases of stage III melanoma correspond to response and survival in nine patients treated with ipilimumab at the time of stage IV disease. Cancer Immunol Immunother 2017; 67:39-45. [PMID: 28894934 DOI: 10.1007/s00262-017-2061-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 09/03/2017] [Indexed: 02/08/2023]
Abstract
Prognosis of metastatic melanoma improved with the development of checkpoint inhibitors. The role of tumor infiltrating lymphocytes (TILs) in lymph node metastases of stage III melanoma remains unclear. We retrospectively characterized TILs in primary melanomas and matched lymph node metastases (stage III melanoma) of patients treated with the checkpoint inhibitor ipilimumab. Tumor infiltrating lymphocytes were characterized for CD3, CD4, and CD8 expressions by immunohistochemistry. 4/9 patients (44%) responded to treatment with ipilimumab (1 complete and 2 partial remissions, 1 stable disease). All responders exhibited CD4 and CD8 T-cell infiltration in their lymph node metastases, whereas all non-responders did not show an infiltration of the lymph node metastasis with TILs. The correlation between the presence and absence of TILs in responders vs. non-responders was statistically significant (p = 0.008). Median distant metastases free survival, i.e., progression from stage III to stage IV melanoma, was similar in responders and non-responders (22.1 vs. 19.3 months; p = 0.462). Median progression free and overall survival show a trend in favor of the patients having TIL rich lymph node metastases (6.8 vs. 3.3 months, p = 0.09; and all alive at last follow-up vs. 8.2 months, respectively, p = 0.08). Our data suggest a correlation between the T-cell infiltration of the lymph node metastases in stage III melanoma and the response to ipilimumab once these patients progress to stage IV disease.
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Affiliation(s)
- Stefan Diem
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Oncology and Hematology, Hospital Grabs, Grabs, Switzerland
| | - Omar Hasan Ali
- Department of Dermatology/Allergology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.,Institute of Immunobiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph J Ackermann
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - David Bomze
- Institute of Immunobiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Viktor H Koelzer
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland.,Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland
| | - Wolfram Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniel E Speiser
- Department of Oncology, Lausanne University Hospital Center (CHUV) and University of Lausanne, Epalinges, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Lukas Flatz
- Department of Dermatology/Allergology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. .,Institute of Immunobiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. .,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
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49
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Koelzer VH, Assarzadegan N, Dawson H, Mitrovic B, Grin A, Messenger DE, Kirsch R, Riddell RH, Lugli A, Zlobec I. Cytokeratin-based assessment of tumour budding in colorectal cancer: analysis in stage II patients and prospective diagnostic experience. J Pathol Clin Res 2017; 3:171-178. [PMID: 28770101 PMCID: PMC5527316 DOI: 10.1002/cjp2.73] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/06/2017] [Indexed: 01/15/2023]
Abstract
Tumour budding in colorectal cancer is an important prognostic factor. A recent consensus conference elaborated recommendations and key issues for future studies, among those the use of pan‐cytokeratin stains, especially in stage II patients. We report the first prospective diagnostic experience using pan‐cytokeratin for tumour budding assessment. Moreover, we evaluate tumour budding using pan‐cytokeratin stains and disease‐free survival (DFS) in stage II patients. To this end, tumour budding on pan‐cytokeratin‐stained sections was evaluated by counting the number of tumour buds in 10 high‐power fields (0.238 mm2), then categorizing counts as low/high‐grade at a cut‐off of 10 buds, in two cohorts. Cohort 1: prospective setting with 236 unselected primary resected colorectal cancers analysed by 17 pathologists during diagnostic routine. Cohort 2: retrospective cohort of 150 stage II patients with information on DFS. In prospective analysis of cohort 1, tumour budding counts correlated with advanced pT, lymph node metastasis, lymphovascular invasion, perineural invasion (all p < 0.0001), and distant metastasis (p = 0.0128). In cohort 2, tumour budding was an independent predictor of worse DFS using counts [p = 0.037, HR (95% CI): 1.007 (1.0–1.014)] and the low‐grade/high‐grade scoring approach [p = 0.02; HR (95% CI): 3.04 (1.2–7.77), 90.7 versus 73%, respectively]. In conclusion, tumour budding assessed on pan‐cytokeratin slides is feasible in a large pathology institute and leads to expected associations with clinicopathological features. Additionally, it is an independent predictor of poor prognosis in stage II patients and should be considered for risk stratification in future clinical studies.
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Affiliation(s)
| | - Naziheh Assarzadegan
- Department of Pathology, Immunology and Laboratory Medicine, College of MedicineUniversity of FloridaGainesvilleFLUSA
| | | | - Bojana Mitrovic
- Department of Pathology and Laboratory MedicineMount Sinai Hospital and University of TorontoTorontoOntarioCanada
| | - Andrea Grin
- Department of Laboratory Medicine and the Li Ka Shing Knowledge InstituteSt. Michael's Hospital, University of TorontoTorontoOntarioCanada
| | - David E Messenger
- Colorectal Surgical UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Richard Kirsch
- Department of Laboratory Medicine and the Li Ka Shing Knowledge InstituteSt. Michael's Hospital, University of TorontoTorontoOntarioCanada
| | - Robert H Riddell
- Department of Laboratory Medicine and the Li Ka Shing Knowledge InstituteSt. Michael's Hospital, University of TorontoTorontoOntarioCanada
| | | | - Inti Zlobec
- Institute of PathologyUniversity of BernBernSwitzerland
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50
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Malesci A, Bianchi P, Celesti G, Basso G, Marchesi F, Grizzi F, Di Caro G, Cavalleri T, Rimassa L, Palmqvist R, Lugli A, Koelzer VH, Roncalli M, Mantovani A, Ogino S, Laghi L. Tumor-associated macrophages and response to 5-fluorouracil adjuvant therapy in stage III colorectal cancer. Oncoimmunology 2017; 6:e1342918. [PMID: 29209561 PMCID: PMC5706531 DOI: 10.1080/2162402x.2017.1342918] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 12/11/2022] Open
Abstract
Tumor-associated macrophages (TAMs) play a role in tumor development and progression. We hypothesized that abundance of TAMs might modify efficacy of 5-fluorouracil chemotherapy in colorectal cancer. We measured the density of CD68+ TAMs at the invasive front of primary tumor of colorectal carcinoma (PT-TAMs; n = 208), at available matched metastatic lymph node (LN-TAMs; n = 149), and in an independent set of primary colorectal cancers (PT-TAMs, n = 111). The hazard ratios for disease-free survival were computed by Cox proportional-hazards model. In exploratory analysis, the interaction between TAMs and 5-fluorouracil adjuvant therapy was significant (PT-TAMs, p = 0.02; LN-TAMs, p = 0.005). High TAMs were independently associated with better disease-free survival only in 5-fluorouracil-treated patients (PT-TAMs, HR 0.23; 95%CI, 0.08–0.65; p = 0.005; LN-TAMs, HR 0.13; 95%CI, 0.04–0.43; p = 0.001). The independent predictive value of PT-TAMs was replicated in the external set (HR, 0.14; 95%CI 0.02–1.00; p = 0.05). In an in vitro experiment, 5-fluorouracil and macrophages showed a synergistic effect and increased colorectal cancer cell death. High densities of TAMs, particularly in metastatic lymph-nodes, identify stage III colorectal cancer patients benefitting from 5-fluorouracil adjuvant therapy.
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Affiliation(s)
- Alberto Malesci
- Department of Biotechnologies and Translational Medicine, University of Milan, via Manzoni 56, 20089 Rozzano (Milan), Italy.,Department of Gastroenterology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Paolo Bianchi
- Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy.,Clinical Investigation Laboratory, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Giuseppe Celesti
- Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Gianluca Basso
- Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy.,Clinical Investigation Laboratory, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Federica Marchesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, via Manzoni 113, Rozzano (Milan), Italy
| | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, via Manzoni 113, Rozzano (Milan), Italy
| | - Giuseppe Di Caro
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, via Manzoni 113, Rozzano (Milan), Italy
| | - Tommaso Cavalleri
- Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Lorenza Rimassa
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano 20089 (Milan), Italy
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Alessandro Lugli
- Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland.,Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Viktor H Koelzer
- Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Massimo Roncalli
- Department of Pathology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy.,Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Rozzano (Milan), Italy
| | - Alberto Mantovani
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, via Manzoni 113, Rozzano (Milan), Italy.,Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Rozzano (Milan), Italy
| | - Shuji Ogino
- Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02215 USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA 02215 USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02215 USA
| | - Luigi Laghi
- Department of Gastroenterology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy.,Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
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