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Polack M, Smit MA, van Pelt GW, Roodvoets AGH, Meershoek-Klein Kranenbarg E, Putter H, Gelderblom H, Crobach ASLP, Terpstra V, Petrushevska G, Gašljević G, Kjær-Frifeldt S, de Cuba EMV, Bulkmans NWJ, Vink GR, Al Dieri R, Tollenaar RAEM, van Krieken JHJM, Mesker WE. Results from the UNITED study: a multicenter study validating the prognostic effect of the tumor-stroma ratio in colon cancer. ESMO Open 2024; 9:102988. [PMID: 38613913 PMCID: PMC11033069 DOI: 10.1016/j.esmoop.2024.102988] [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: 01/04/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND The TNM (tumor-node-metastasis) Evaluation Committee of Union for International Cancer Control (UICC) and College of American Pathologists (CAP) recommended to prospectively validate the cost-effective and robust tumor-stroma ratio (TSR) as an independent prognostic parameter, since high intratumor stromal percentages have previously predicted poor patient-related outcomes. PATIENTS AND METHODS The 'Uniform Noting for International application of Tumor-stroma ratio as Easy Diagnostic tool' (UNITED) study enrolled patients in 27 participating centers in 12 countries worldwide. The TSR, categorized as stroma-high (>50%) or stroma-low (≤50%), was scored through standardized microscopic assessment by certified pathologists, and effect on disease-free survival (DFS) was evaluated with 3-year median follow-up. Secondary endpoints were benefit assessment of adjuvant chemotherapy (ACT) and overall survival (OS). RESULTS A total of 1537 patients were included, with 1388 eligible stage II/III patients curatively operated between 2015 and 2021. DFS was significantly shorter in stroma-high (n = 428) than in stroma-low patients (n = 960) (3-year rates 70% versus 83%; P < 0.001). In multivariate analysis, TSR remained an independent prognosticator for DFS (P < 0.001, hazard ratio 1.49, 95% confidence interval 1.17-1.90). As secondary outcome, DFS was also worse in stage II and III stroma-high patients despite adjuvant treatment (3-year rates stage II 73% versus 92% and stage III 66% versus 80%; P = 0.008 and P = 0.011, respectively). In stage II patients not receiving ACT (n = 322), the TSR outperformed the American Society of Clinical Oncology (ASCO) criteria in identifying patients at risk of events (event rate 21% versus 9%), with a higher discriminatory 3-year DFS rate (stroma-high 80% versus ASCO high risk 91%). A trend toward worse 5-year OS in stroma-high was noticeable (74% versus 83% stroma-low; P = 0.102). CONCLUSION The multicenter UNITED study unequivocally validates the TSR as an independent prognosticator, confirming worse outcomes in stroma-high patients. The TSR improved current selection criteria for patients at risk of events, and stroma-high patients potentially experienced chemotherapy resistance. TSR implementation in pathology diagnostics and international guidelines is highly recommended as aid in personalized treatment.
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Affiliation(s)
- M Polack
- Department of Surgery, Leiden University Medical Center, Leiden
| | - M A Smit
- Department of Surgery, Leiden University Medical Center, Leiden
| | - G W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden
| | - A G H Roodvoets
- Clinical Research Center, Department of Surgery, Leiden University Medical Center, Leiden
| | | | - H Putter
- Department of Biomedical Data Sciences, Leiden
| | | | - A S L P Crobach
- Department of Pathology, Leiden University Medical Center, Leiden
| | - V Terpstra
- Department of Pathology, Haaglanden Medical Center, The Hague, The Netherlands
| | - G Petrushevska
- Department of Pathology, Medical Faculty of Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - G Gašljević
- Department of Pathology, Onkološki inštitut-Institute of Oncology, Ljubljana, Slovenia
| | - S Kjær-Frifeldt
- Department of Pathology, Vejle Sygehus-Sygehus Lillebælt, Vejle, Denmark
| | | | | | - G R Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - R Al Dieri
- European Society of Pathology, Brussels, Belgium
| | | | - J H J M van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden.
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2
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Liu B, Polack M, Coudray N, Quiros AC, Sakellaropoulos T, Crobach ASLP, van Krieken JHJM, Yuan K, Tollenaar RAEM, Mesker WE, Tsirigos A. Self-Supervised Learning Reveals Clinically Relevant Histomorphological Patterns for Therapeutic Strategies in Colon Cancer. bioRxiv 2024:2024.02.26.582106. [PMID: 38496571 PMCID: PMC10942268 DOI: 10.1101/2024.02.26.582106] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Self-supervised learning (SSL) automates the extraction and interpretation of histopathology features on unannotated hematoxylin-and-eosin-stained whole-slide images (WSIs). We trained an SSL Barlow Twins-encoder on 435 TCGA colon adenocarcinoma WSIs to extract features from small image patches. Leiden community detection then grouped tiles into histomorphological phenotype clusters (HPCs). HPC reproducibility and predictive ability for overall survival was confirmed in an independent clinical trial cohort (N=1213 WSIs). This unbiased atlas resulted in 47 HPCs displaying unique and sharing clinically significant histomorphological traits, highlighting tissue type, quantity, and architecture, especially in the context of tumor stroma. Through in-depth analysis of these HPCs, including immune landscape and gene set enrichment analysis, and association to clinical outcomes, we shed light on the factors influencing survival and responses to treatments like standard adjuvant chemotherapy and experimental therapies. Further exploration of HPCs may unveil new insights and aid decision-making and personalized treatments for colon cancer patients.
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3
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Moran AB, Elgood-Hunt G, van der Burgt YEM, Wuhrer M, Mesker WE, Tollenaar RAEM, Spencer DIR, Lageveen-Kammeijer GSM. Serum N-Glycosylation RPLC-FD-MS Assay to Assess Colorectal Cancer Surgical Interventions. Biomolecules 2023; 13:896. [PMID: 37371476 DOI: 10.3390/biom13060896] [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: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
A newly developed analytical strategy was applied to profile the total serum N-glycome of 64 colorectal cancer (CRC) patients before and after surgical intervention. In this cohort, it was previously found that serum N-glycome alterations in CRC were associated with patient survival. Here, fluorescent labeling of serum N-glycans was applied using procainamide and followed by sialic acid derivatization specific for α2,6- and α2,3-linkage types via ethyl esterification and amidation, respectively. This strategy allowed efficient separation of specific positional isomers on reversed-phase liquid chromatography-fluorescence detection-mass spectrometry (RPLC-FD-MS) and complemented the previous glycomics data based on matrix-assisted laser desorption/ionization (MALDI)-MS that did not include such separations. The results from comparing pre-operative CRC to post-operative samples were in agreement with studies that identified a decrease in di-antennary structures with core fucosylation and an increase in sialylated tri- and tetra-antennary N-glycans in CRC patient sera. Pre-operative abundances of N-glycans showed good performance for the classification of adenocarcinoma and led to the revisit of the previous MALDI-MS dataset with regard to histological and clinical data. This strategy has the potential to monitor patient profiles before, during, and after clinical events such as treatment, therapy, or surgery and should also be further explored.
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Affiliation(s)
- Alan B Moran
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
- Ludger Ltd., Culham Science Centre, Abingdon OX14 3EB, UK
| | | | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | | | - Guinevere S M Lageveen-Kammeijer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
- Department of Analytical Biochemistry, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands
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4
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Karancsi Z, Hagenaars SC, Németh K, Mesker WE, Tőkés AM, Kulka J. Tumour-stroma ratio (TSR) in breast cancer: comparison of scoring core biopsies versus resection specimens. Virchows Arch 2023:10.1007/s00428-023-03555-0. [PMID: 37198327 DOI: 10.1007/s00428-023-03555-0] [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: 12/14/2022] [Revised: 03/29/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Tumour-stroma ratio (TSR) is an important prognostic and predictive factor in several tumour types. The aim of this study is to determine whether TSR evaluated in breast cancer core biopsies is representative of the whole tumour. METHOD Different TSR scoring methods, their reproducibility, and the association of TSR with clinicopathological characteristics were investigated in 178 breast carcinoma core biopsies and corresponding resection specimens. TSR was assessed by two trained scientists on the most representative H&E-stained digitised slides. Patients were treated primarily with surgery between 2010 and 2021 at Semmelweis University, Budapest. RESULTS Ninety-one percent of the tumours were hormone receptor (HR)-positive (luminal-like). Interobserver agreement was highest using 100 × magnification (κcore = 0.906, κresection specimen = 0.882). The agreement between TSR of core biopsies and resection specimens of the same patients was moderate (κ = 0.514). Differences between the two types of samples were most frequent in cases with TSR scores close to the 50% cut-off point. TSR was strongly correlated with age at diagnosis, pT category, histological type, histological grade, and surrogate molecular subtype. A tendency was identified for more recurrences among stroma-high (SH) tumours (p = 0.07). Significant correlation was detected between the TSR and tumour recurrence in grade 1 HR-positive breast cancer cases (p = 0.03). CONCLUSIONS TSR is easy to determine and reproducible on both core biopsies and in resection specimens and is associated with several clinicopathological characteristics of breast cancer. TSR scored on core biopsies is moderately representative for the whole tumour.
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Affiliation(s)
- Zsófia Karancsi
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Üllői út 93, 1091, Budapest, Hungary.
| | - Sophie C Hagenaars
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Kristóf Németh
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Üllői út 93, 1091, Budapest, Hungary
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Anna Mária Tőkés
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Üllői út 93, 1091, Budapest, Hungary
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Üllői út 93, 1091, Budapest, Hungary
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5
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Fan C, Wang Q, Kuipers TB, Cats D, Iyengar PV, Hagenaars SC, Mesker WE, Devilee P, Tollenaar RAEM, Mei H, Ten Dijke P. LncRNA LITATS1 suppresses TGF-β-induced EMT and cancer cell plasticity by potentiating TβRI degradation. EMBO J 2023; 42:e112806. [PMID: 36994542 PMCID: PMC10183827 DOI: 10.15252/embj.2022112806] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/31/2023] Open
Abstract
Epithelial cells acquire mesenchymal phenotypes through epithelial-mesenchymal transition (EMT) during cancer progression. However, how epithelial cells retain their epithelial traits and prevent malignant transformation is not well understood. Here, we report that the long noncoding RNA LITATS1 (LINC01137, ZC3H12A-DT) is an epithelial gatekeeper in normal epithelial cells and inhibits EMT in breast and non-small cell lung cancer cells. Transcriptome analysis identified LITATS1 as a TGF-β target gene. LITATS1 expression is reduced in lung adenocarcinoma tissues compared with adjacent normal tissues and correlates with a favorable prognosis in breast and non-small cell lung cancer patients. LITATS1 depletion promotes TGF-β-induced EMT, migration, and extravasation in cancer cells. Unbiased pathway analysis demonstrated that LITATS1 knockdown potently and selectively potentiates TGF-β/SMAD signaling. Mechanistically, LITATS1 enhances the polyubiquitination and proteasomal degradation of TGF-β type I receptor (TβRI). LITATS1 interacts with TβRI and the E3 ligase SMURF2, promoting the cytoplasmic retention of SMURF2. Our findings highlight a protective function of LITATS1 in epithelial integrity maintenance through the attenuation of TGF-β/SMAD signaling and EMT.
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Affiliation(s)
- Chuannan Fan
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
- Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Qian Wang
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
- Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas B Kuipers
- Department of Biomedical Data Sciences, Sequencing Analysis Support Core, Leiden University Medical Center, Leiden, The Netherlands
| | - Davy Cats
- Department of Biomedical Data Sciences, Sequencing Analysis Support Core, Leiden University Medical Center, Leiden, The Netherlands
| | - Prasanna Vasudevan Iyengar
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
- Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie C Hagenaars
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter Devilee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hailiang Mei
- Department of Biomedical Data Sciences, Sequencing Analysis Support Core, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Ten Dijke
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
- Oncode Institute, Leiden University Medical Center, Leiden, The Netherlands
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6
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Liu S, van Dinther M, Hagenaars SC, Gu Y, Kuipers TB, Mei H, Gomez-Puerto MC, Mesker WE, Ten Dijke P. Differential optineurin expression controls TGFβ signaling and is a key determinant for metastasis of triple negative breast cancer. Int J Cancer 2023; 152:2594-2606. [PMID: 36823950 DOI: 10.1002/ijc.34483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/06/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
Triple-negative breast cancer (TNBC) is the most challenging breast cancer subtype to treat due to its aggressive characteristics and low response to the existing clinical therapies. Distant metastasis is the main cause of death of TNBC patients. Better understanding of the mechanisms underlying TNBC metastasis may lead to new strategies of early diagnosis and more efficient treatment. In our study, we uncovered that the autophagy receptor optineurin (OPTN) plays an unexpected role in TNBC metastasis. Data mining of publicly available data bases revealed that the mRNA level of OPTN in TNBC patients positively correlates with relapse free and distance metastasis free survival. Importantly, in vitro and in vivo models demonstrated that OPTN suppresses TNBC metastasis. Mechanistically, OPTN inhibited the pro-oncogenic transforming growth factor-β (TGFβ) signaling in TNBC cells by interacting with TGFβ type I receptor (TβRI) and promoting its ubiquitination for degradation. Consistent with our experimental findings, the clinical TNBC samples displayed a negative correlation between OPTN mRNA expression and TGFβ gene response signature and expression of proto-typic TGFβ target genes. Altogether, our study demonstrates that OPTN is a negative regulator for TGFβ receptor/SMAD signaling and suppresses metastasis in TNBC.
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Affiliation(s)
- Sijia Liu
- Oncode Institute and Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands.,The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Maarten van Dinther
- Oncode Institute and Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie C Hagenaars
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Yuanzhuo Gu
- Oncode Institute and Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas B Kuipers
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Hailiang Mei
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Catalina Gomez-Puerto
- Oncode Institute and Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Ten Dijke
- Oncode Institute and Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
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7
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Polack M, Smit MA, Crobach SA, Terpstra V, Roodvoets AG, Meershoek-Klein Kranenbarg EM, Dequeker EM, van der Laak JA, Tollenaar RA, van Krieken HJ, Mesker WE. Uniform Noting for International application of the Tumor-stroma ratio as Easy Diagnostic tool: The UNITED study - An update. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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8
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Diederiks N, Ravensbergen CJ, Treep M, van Wezel M, Kuruc M, Renee Ruhaak L, Tollenaar RA, Cobbaert CM, van der Burgt YE, Mesker WE. Development of Tier 2 LC-MRM-MS protein quantification methods for liquid biopsies. J Mass Spectrom Adv Clin Lab 2022; 27:49-55. [PMID: 36619217 PMCID: PMC9811211 DOI: 10.1016/j.jmsacl.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
In the pursuit of personalized diagnostics and tailored treatments, quantitative protein tests contribute to a more precise definition of health and disease. The development of new quantitative protein tests should be driven by an unmet clinical need and performed in a collaborative effort that involves all stakeholders. With regard to the analytical part, mass spectrometry (MS)-based platforms are an excellent tool for quantification of specific proteins in body fluids, for example focused on cancer. The obtained readouts have great potential in determining tumor aggressiveness to facilitate treatment decisions, and can furthermore be used to monitor patient response. Internationally standardized TNM classifications of malignant tumors are beneficial for diagnosis, however treatment outcome and survival of cancer patients is poorly predicted. To this end, the importance of the tumor microenvironment has endorsed the introduction of the tumor-stroma ratio as a prognostic parameter in solid primary tumor types. Currently, the stromal content of tumor tissues is determined via routine diagnostic pathology slides. With the development of liquid chromatography (LC)-MS methods we aim at quantification of tumor-stroma specific proteins in body fluids. In this mini-review the analytical aspect of this developmental trajectory is further detailed.
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Affiliation(s)
- Nina Diederiks
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Cor J. Ravensbergen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Maxim Treep
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Madelein van Wezel
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Matt Kuruc
- Biotech Support Group LLC, 1 Deer Park Drive, Suite M, Monmouth Junction, NJ 08852, USA
| | - L. Renee Ruhaak
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Rob A.E.M. Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Christa M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Yuri E.M. van der Burgt
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Corresponding author.
| | - Wilma E. Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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9
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van de Weerd S, Smit MA, Roelands J, Mesker WE, Bedognetti D, Kuppen PJK, Putter H, Tollenaar RAEM, Roodhart JML, Hendrickx W, Medema JP, van Krieken JHJM. Correlation of Immunological and Histopathological Features with Gene Expression-Based Classifiers in Colon Cancer Patients. Int J Mol Sci 2022; 23:ijms232012707. [PMID: 36293565 PMCID: PMC9604175 DOI: 10.3390/ijms232012707] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the association between four distinct histopathological features: (1) tumor infiltrating lymphocytes, (2) mucinous differentiation, (3) tumor-stroma ratio, plus (4) tumor budding and two gene expression-based classifiers—(1) consensus molecular subtypes (CMS) plus (2) colorectal cancer intrinsic subtypes (CRIS). All four histopathological features were retrospectively scored on hematoxylin and eosin sections of the most invasive part of the primary tumor in 218 stage II and III colon cancer patients from two independent cohorts (AMC-AJCC-90 and AC-ICAM). RNA-based CMS and CRIS assignments were independently obtained for all patients. Contingency tables were constructed and a χ2 test was used to test for statistical significance. Odds ratios with 95% confidence intervals were calculated. The presence of tumor infiltrating lymphocytes and a mucinous phenotype (>50% mucinous surface area) were strongly correlated with CMS1 (p < 0.001 and p = 0.008) and CRIS-A (p = 0.006 and p < 0.001). The presence of mucus (≥ 10%) was associated with CMS3: mucus was present in 64.1% of all CMS3 tumors (p < 0.001). Although a clear association between tumor-stroma ratio and CMS4 was established in this study (p = 0.006), still 32 out of 61 (52.5%) CMS4 tumors were scored as stroma-low, indicating that CMS4 tumors cannot be identified solely based on stromal content. Higher budding counts were seen in CMS4 and CRIS-B tumors (p = 0.045 and p = 0.046). No other associations of the measured parameters were seen for any of the other CRIS subtypes. Our analysis revealed clear associations between histopathologic features and CMS or CRIS subtypes. However, identification of distinct molecular subtypes solely based on histopathology proved to be infeasible. Combining both molecular and morphologic features could potentially improve patient stratification.
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Affiliation(s)
- Simone van de Weerd
- Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Pathology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
- Oncode Institute, Amsterdam UMC, University of Amsterdam, 3521 AL Amsterdam, The Netherlands
| | - Marloes A. Smit
- Department of Surgery, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Jessica Roelands
- Department of Surgery, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
- Translational Medicine Department, Research Branch, Sidra Medicine, Doha 26999, Qatar
| | - Wilma E. Mesker
- Department of Surgery, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Davide Bedognetti
- Translational Medicine Department, Research Branch, Sidra Medicine, Doha 26999, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Peter J. K. Kuppen
- Department of Surgery, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Rob A. E. M. Tollenaar
- Department of Surgery, Leiden University Medical Center, 2333 ZD Leiden, The Netherlands
| | - Jeanine M. L. Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Wouter Hendrickx
- Translational Medicine Department, Research Branch, Sidra Medicine, Doha 26999, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Jan Paul Medema
- Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Oncode Institute, Amsterdam UMC, University of Amsterdam, 3521 AL Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-566-2368
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10
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Strous MTA, Faes TKE, Gubbels ALHM, van der Linden RLA, Mesker WE, Bosscha K, Bronkhorst CM, Janssen-Heijnen MLG, Vogelaar FJ, de Bruïne AP. A high tumour-stroma ratio (TSR) in colon tumours and its metastatic lymph nodes predicts poor cancer-free survival and chemo resistance. Clin Transl Oncol 2022; 24:1047-1058. [PMID: 35064453 DOI: 10.1007/s12094-021-02746-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite known high-risk features, accurate identification of patients at high risk of cancer recurrence in colon cancer remains a challenge. As tumour stroma plays an important role in tumour invasion and metastasis, the easy, low-cost and highly reproducible tumour-stroma ratio (TSR) could be a valuable prognostic marker, which is also believed to predict chemo resistance. METHODS Two independent series of patients with colon cancer were selected. TSR was estimated by microscopic analysis of 4 µm haematoxylin and eosin (H&E) stained tissue sections of the primary tumour and the corresponding metastatic lymph nodes. Patients were categorized as TSR-low (≤ 50%) or TSR-high (> 50%). Differences in overall survival and cancer-free survival were analysed by Kaplan-Meier curves and cox-regression analyses. Analyses were conducted for TNM-stage I-II, TNM-stage III and patients with an indication for chemotherapy separately. RESULTS We found that high TSR was associated with poor cancer-free survival in TNM-stage I-II colon cancer in two independent series, independent of other known high-risk features. This association was also found in TNM-stage III tumours, with an additional prognostic value of TSR in lymph node metastasis to TSR in the primary tumour alone. In addition, high TSR was found to predict chemo resistance in patients receiving adjuvant chemotherapy after surgical resection of a TNM-stage II-III colon tumour. CONCLUSION In colon cancer, the TSR of both primary tumour and lymph node metastasis adds significant prognostic value to current pathologic and clinical features used for the identification of patients at high risk of cancer recurrence, and also predicts chemo resistance.
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Affiliation(s)
- M T A Strous
- Department of Surgery, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands. .,Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - T K E Faes
- Department of Pathology, VieCuri Medical Centre, Venlo, The Netherlands
| | - A L H M Gubbels
- Department of Pathology, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - W E Mesker
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - C M Bronkhorst
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
| | - F J Vogelaar
- Department of Surgery, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - A P de Bruïne
- Department of Pathology, VieCuri Medical Centre, Venlo, The Netherlands
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11
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Levink IJM, Klatte DCF, Hanna-Sawires RG, Vreeker GCM, Ibrahim IS, van der Burgt YEM, Overbeek KA, Koopmann BDM, Cahen DL, Fuhler GM, Wuhrer M, Bonsing BA, Tollenaar RAEM, Vleggaar FP, Vasen HFA, van Leerdam ME, Bruno MJ, Mesker WE. Longitudinal changes of serum protein N-Glycan levels for earlier detection of pancreatic cancer in high-risk individuals. Pancreatology 2022; 22:497-506. [PMID: 35414481 DOI: 10.1016/j.pan.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surveillance of individuals at risk of developing pancreatic ductal adenocarcinoma (PDAC) has the potential to improve survival, yet early detection based on solely imaging modalities is challenging. We aimed to identify changes in serum glycosylation levels over time to earlier detect PDAC in high-risk individuals. METHODS Individuals with a hereditary predisposition to develop PDAC were followed in two surveillance programs. Those, of which at least two consecutive serum samples were available, were included. Mass spectrometry analysis was performed to determine the total N-glycome for each consecutive sample. Potentially discriminating N-glycans were selected based on our previous cross-sectional analysis and relative abundances were calculated for each glycosylation feature. RESULTS 165 individuals ("FPC-cohort" N = 119; Leiden cohort N = 46) were included. In total, 97 (59%) individuals had a genetic predisposition (77 CDKN2A, 15 BRCA1/2, 5 STK11) and 68 (41%) a family history of PDAC without a known genetic predisposition (>10-fold increased risk of developing PDAC). From each individual, a median number of 3 serum samples (IQR 3) was collected. Ten individuals (6%) developed PDAC during 35 months of follow-up; nine (90%) of these patients carried a CDKN2A germline mutation. In PDAC cases, compared to all controls, glycosylation characteristics were increased (fucosylation, tri- and tetra-antennary structures, specific sialic linkage types), others decreased (complex-type diantennary and bisected glycans). The largest change over time was observed for tri-antennary fucosylated glycans, which were able to differentiate cases from controls with a specificity of 92%, sensitivity of 49% and accuracy of 90%. CONCLUSION Serum N-glycan monitoring may support early detection in a pancreas surveillance program.
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Affiliation(s)
- I J M Levink
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - D C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - R G Hanna-Sawires
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - G C M Vreeker
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - I S Ibrahim
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Y E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - K A Overbeek
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B D M Koopmann
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - D L Cahen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - G M Fuhler
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - B A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - F P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - M E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - W E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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12
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Polack M, Hagenaars SC, Couwenberg A, Kool W, Tollenaar RAEM, Vogel WV, Snaebjornsson P, Mesker WE. Characteristics of tumour stroma in regional lymph node metastases in colorectal cancer patients: a theoretical framework for future diagnostic imaging with FAPI PET/CT. Clin Transl Oncol 2022; 24:1776-1784. [PMID: 35482276 PMCID: PMC9338005 DOI: 10.1007/s12094-022-02832-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/01/2022] [Indexed: 12/24/2022]
Abstract
Purpose The recently developed fibroblast activation protein inhibitor (FAPI) tracer for PET/CT, binding tumour-stromal cancer-associated fibroblasts, is a promising tool for detection of positive lymph nodes. This study provides an overview of features, including sizes and tumour-stromal content, of lymph nodes and their respective lymph node metastases (LNM) in colorectal cancer (CRC), since literature lacks on whether LNMs contain sufficient stroma to potentially allow FAPI-based tumour detection.
Methods Haematoxylin and eosin-stained tissue slides from 73 stage III colon cancer patients were included. Diameters and areas of all lymph nodes and their LNMs were assessed, the amount of stroma by measuring the stromal compartment area, the conventional and total tumour-stroma ratios (TSR-c and TSR-t, respectively), as well as correlations between these parameters. Also, subgroup analysis using a minimal diameter cut off of 5.0 mm was performed.
Results In total, 126 lymph nodes were analysed. Although positive correlations were observed between node and LNM for diameter and area (r = 0.852, p < 0.001 and r = 0.960, p < 0.001, respectively), and also between the LNM stromal compartment area and nodal diameter (r = 0.612, p < 0.001), nodal area (r = 0.747, p < 0.001) and LNM area (r = 0.746, p < 0.001), novel insight was that nearly all (98%) LNMs contained stroma, with median TSR-c scores of 35% (IQR 20–60%) and TSR-t of 20% (IQR 10–30%). Moreover, a total of 32 (25%) positive lymph nodes had a diameter of < 5.0 mm. Conclusion In LNMs, stroma is abundantly present, independent of size, suggesting a role for FAPI PET/CT in improved lymph node detection in CRC.
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Affiliation(s)
- Meaghan Polack
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Zuid-Holland, The Netherlands
| | - Sophie C Hagenaars
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Zuid-Holland, The Netherlands
| | - Alice Couwenberg
- Department of Radiation Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, The Netherlands
| | - Walter Kool
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, Noord-Holland, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Zuid-Holland, The Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Zuid-Holland, The Netherlands.
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13
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Ten Hoorn S, Waasdorp C, van Oijen MGH, Damhofer H, Trinh A, Zhao L, Smits LJH, Bootsma S, van Pelt GW, Mesker WE, Mol L, Goey KKH, Koopman M, Medema JP, Tuynman JB, Zlobec I, Punt CJA, Vermeulen L, Bijlsma MF. Serum-based measurements of stromal activation through ADAM12 associate with poor prognosis in colorectal cancer. BMC Cancer 2022; 22:394. [PMID: 35413826 PMCID: PMC9004139 DOI: 10.1186/s12885-022-09436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Recently it has been recognized that stromal markers could be used as a clinically relevant biomarker for therapy response and prognosis. Here, we report on a serum marker for stromal activation, A Disintegrin and Metalloprotease 12 (ADAM12) in colorectal cancer (CRC). Methods Using gene expression databases we investigated ADAM12 expression in CRC and delineated the source of ADAM12 expression. The clinical value of ADAM12 was retrospectively assessed in the CAIRO2 trial in metastatic CRC with 235 patients (31% of total cohort), and an independent rectal cancer cohort (n = 20). Results ADAM12 is expressed by activated CRC associated fibroblasts. In the CAIRO2 trial cohort, ADAM12 serum levels were prognostic (ADAM12 low versus ADAM12 high; median OS 25.3 vs. 17.1 months, HR 1.48 [95% CI 1.11–1.96], P = 0.007). The prognostic potential was specifically high for metastatic rectal cancer (HR 1.78 [95% CI 1.06–3.00], P = 0.030) and mesenchymal subtype tumors (HR 2.12 [95% CI 1.25–3.60], P = 0.004). ADAM12 also showed potential for predicting recurrence in an exploratory analysis of non-metastatic rectal cancers. Conclusions Here we describe a non-invasive marker for activated stroma in CRC which associates with poor outcome, especially for primary cancers located in the rectum. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09436-0.
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Affiliation(s)
- Sanne Ten Hoorn
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Cynthia Waasdorp
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Martijn G H van Oijen
- Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Helene Damhofer
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Cell Biology Program, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Anne Trinh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Lan Zhao
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong
| | - Lisanne J H Smits
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Sanne Bootsma
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Mol
- Department of Data Management, Netherlands Comprehensive Cancer Center (IKNL), Nijmegen, The Netherlands
| | - Kaitlyn K H Goey
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Paul Medema
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Jurriaan B Tuynman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Louis Vermeulen
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maarten F Bijlsma
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands. .,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands. .,Oncode Institute, Amsterdam, The Netherlands.
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14
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Huang Y, Liu S, Shan M, Hagenaars SC, Mesker WE, Cohen D, Wang L, Zheng Z, Devilee P, Tollenaar RAEM, Li Z, Song Y, Zhang L, Li D, Ten Dijke P. RNF12 is regulated by AKT phosphorylation and promotes TGF-β driven breast cancer metastasis. Cell Death Dis 2022; 13:44. [PMID: 35013159 PMCID: PMC8748510 DOI: 10.1038/s41419-021-04493-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
Transforming growth factor-β (TGF-β) acts as a pro-metastatic factor in advanced breast cancer. RNF12, an E3 ubiquitin ligase, stimulates TGF-β signaling by binding to the inhibitory SMAD7 and inducing its proteasomal degradation. How RNF12 activity is regulated and its exact role in cancer is incompletely understood. Here we report that RNF12 was overexpressed in invasive breast cancers and its high expression correlated with poor prognosis. RNF12 promoted breast cancer cell migration, invasion, and experimental metastasis in zebrafish and murine xenograft models. RNF12 levels were positively associated with the phosphorylated AKT/protein kinase B (PKB) levels, and both displayed significant higher levels in the basal-like subtype compared with the levels in luminal-like subtype of breast cancer cells. Mechanistically, AKT-mediated phosphorylation induced the nuclear localization of RNF12, maintained its stability, and accelerated the degradation of SMAD7 mediated by RNF12. Furthermore, we demonstrated that RNF12 and AKT cooperated functionally in breast cancer cell migration. Notably, RNF12 expression strongly correlated with both phosphorylated AKT and phosphorylated SMAD2 levels in breast cancer tissues. Thus, our results uncovered RNF12 as an important determinant in the crosstalk between the TGF-β and AKT signaling pathways during breast cancer progression.
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Affiliation(s)
- Yongsheng Huang
- Institute of Basic Medical Sciences and School of Basic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. .,Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Sijia Liu
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mengjie Shan
- Institute of Basic Medical Sciences and School of Basic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sophie C Hagenaars
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lin Wang
- Institute of Basic Medical Sciences and School of Basic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi Zheng
- Institute of Basic Medical Sciences and School of Basic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peter Devilee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Zhangfu Li
- Key Laboratory of Cancer and Microbiome, State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongmei Song
- Key Laboratory of Cancer and Microbiome, State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Long Zhang
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands. .,Life Sciences Institute, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Dan Li
- Key Laboratory of Cancer and Microbiome, State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Peter Ten Dijke
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
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15
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Hanna-Sawires RG, Groen JV, Hamming A, Tollenaar RAEM, Mesker WE, Luelmo SAC, Vahrmeijer AL, Bonsing BA, Versteeg HH, Klok FA, Mieog JSD. Incidence, timing and risk factors of venous thromboembolic events in patients with pancreatic cancer. Thromb Res 2021; 207:134-139. [PMID: 34628229 DOI: 10.1016/j.thromres.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Pancreatic cancer is associated with a high risk of venous thromboembolism (VTE). However, comprehensive data on incidence, timing and relevant determinants of VTE in this particular population are scarce. Current study assesses incidence, timing and predictors of VTE in pancreatic cancer through different phases of disease. METHODS All pancreatic cancer patients treated in our tertiary referral center between 2013 through 2017 were studied. Occurrence of VTE was evaluated from diagnosis through end of follow-up or death. Relevant determinants of VTE were identified in logistic regression models. Hazard ratios were calculated to evaluate impact of VTE on overall survival. RESULTS In total, 361 patients were followed for a median period of 43 months; 64 were diagnosed with VTE (18%). Most were tumor related thrombosis (59%), incidental (75%) and occurred after anti-cancer treatment had been stopped (80%), only 1.6% occurred during remission phase. Stage IV pancreatic cancer was a predictor for VTE (hazard ratio (HR) 2.46, 95% confidence interval (CI) 0.9-6.8). Biliary drainage (HR 0.52, 95%CI 0.28-0.98) and tumor resection (HR 0.45, 95%CI 0.45-1.83) were protective factors. VTE was not associated with worse survival (HR 1.3; 95% CI 0.97-1.74). CONCLUSIONS VTE in pancreatic cancer is disease-stage dependent, with 80% occurring in advanced phases of disease when patients no longer receive active treatment. We speculate that this is the main reason for the absence of a survival effect of VTE in our cohort. These practice-based findings should be taken into account when considering wide-spread introduction of primary thromboprophylaxis in patients with pancreatic cancer.
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Affiliation(s)
| | - Jesse V Groen
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Alexander Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Saskia A C Luelmo
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Henri H Versteeg
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, the Netherlands
| | - F A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
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16
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Ravensbergen CJ, Polack M, Roelands J, Crobach S, Putter H, Gelderblom H, Tollenaar RAEM, Mesker WE. Combined Assessment of the Tumor-Stroma Ratio and Tumor Immune Cell Infiltrate for Immune Checkpoint Inhibitor Therapy Response Prediction in Colon Cancer. Cells 2021; 10:2935. [PMID: 34831157 PMCID: PMC8616493 DOI: 10.3390/cells10112935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/29/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
The best current biomarker strategies for predicting response to immune checkpoint inhibitor (ICI) therapy fail to account for interpatient variability in response rates. The histologic tumor-stroma ratio (TSR) quantifies intratumoral stromal content and was recently found to be predictive of response to neoadjuvant therapy in multiple cancer types. In the current work, we predicted the likelihood of ICI therapy responsivity of 335 therapy-naive colon adenocarcinoma tumors from The Cancer Genome Atlas, using bioinformatics approaches. The TSR was scored on diagnostic tissue slides, and tumor-infiltrating immune cells (TIICs) were inferred from transcriptomic data. Tumors with high stromal content demonstrated increased T regulatory cell infiltration (p = 0.014) but failed to predict ICI therapy response. Consequently, we devised a hybrid tumor microenvironment classification of four stromal categories, based on histological stromal content and transcriptomic-deconvoluted immune cell infiltration, which was associated with previously established transcriptomic and genomic biomarkers for ICI therapy response. By integrating these biomarkers, stroma-low/immune-high tumors were predicted to be most responsive to ICI therapy. The framework described here provides evidence for expansion of current histological TIIC quantification to include the TSR as a novel, easy-to-use biomarker for the prediction of ICI therapy response.
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Affiliation(s)
- Cor J. Ravensbergen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands; (C.J.R.); (M.P.); (R.A.E.M.T.)
| | - Meaghan Polack
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands; (C.J.R.); (M.P.); (R.A.E.M.T.)
| | - Jessica Roelands
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands; (J.R.); (S.C.)
| | - Stijn Crobach
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands; (J.R.); (S.C.)
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands;
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands;
| | - Rob A. E. M. Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands; (C.J.R.); (M.P.); (R.A.E.M.T.)
| | - Wilma E. Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands; (C.J.R.); (M.P.); (R.A.E.M.T.)
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17
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Hagenaars SC, de Groot S, Cohen D, Dekker TJA, Charehbili A, Meershoek‐Klein Kranenbarg E, Duijm‐de Carpentier M, Pijl H, Putter H, Tollenaar RAEM, Kroep JR, Mesker WE. Tumor-stroma ratio is associated with Miller-Payne score and pathological response to neoadjuvant chemotherapy in HER2-negative early breast cancer. Int J Cancer 2021; 149:1181-1188. [PMID: 34043821 PMCID: PMC8362217 DOI: 10.1002/ijc.33700] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 01/03/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022]
Abstract
The tumor-stroma ratio (TSR) has proven to be a strong prognostic factor in breast cancer, demonstrating better survival for patients with stroma-low tumors. Since the role of the TSR as a predictive marker for neoadjuvant chemotherapy outcome is yet unknown, this association was evaluated for HER2-negative breast cancer in the prospective DIRECT and NEOZOTAC trials. The TSR was assessed on 375 hematoxylin and eosin-stained sections of pre-treatment biopsies. Associations between the TSR and chemotherapy response according to the Miller-Payne (MP) grading system, and between the TSR and pathological response were examined using Pearson's chi-square, Cochran-Armitage test for trend and regression analyses. A stroma-low tumor prior to neoadjuvant chemotherapy was significantly associated with a higher MP score (P = .005). This relationship remained significant in the estrogen receptor (ER)-negative subgroup (P = .047). The univariable odds ratio (OR) of a stroma-low tumor on pathological complete response (pCR) was 2.46 (95% CI 1.34-4.51, P = .004), which attenuated to 1.90 (95% CI 0.85-4.25, P = .119) after adjustment for relevant prognostic factors. Subgroup analyses revealed an OR of 5.91 in univariable analyses for ER-negativity (95% CI 1.19-29.48, P = .030) and 1.48 for ER-positivity (95% CI 0.73-3.01, P = .281). In conclusion, a low amount of stroma on pre-treatment biopsies is associated with a higher MP score and pCR rate. Therefore, the TSR is a promising biomarker in predicting neoadjuvant treatment outcome. Incorporating this parameter in routine pathological diagnostics could be worthwhile to prevent overtreatment and undertreatment.
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Affiliation(s)
| | - Stefanie de Groot
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Danielle Cohen
- Department of PathologyLeiden University Medical CenterLeidenThe Netherlands
| | - Tim J. A. Dekker
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Ayoub Charehbili
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Hanno Pijl
- Department of EndocrinologyLeiden University Medical CenterLeidenThe Netherlands
| | - Hein Putter
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands
| | | | - Judith R. Kroep
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Wilma E. Mesker
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
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18
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Smit MA, van Pelt GW, Dequeker EM, Al Dieri R, Tollenaar RA, van Krieken JHJ, Mesker WE. e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study. JMIR Form Res 2021; 5:e19408. [PMID: 33739293 PMCID: PMC8122297 DOI: 10.2196/19408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/14/2020] [Accepted: 03/03/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The amount of stroma in the primary tumor is an important prognostic parameter. The tumor-stroma ratio (TSR) was previously validated by international research groups as a robust parameter with good interobserver agreement. OBJECTIVE The Uniform Noting for International Application of the Tumor-Stroma Ratio as an Easy Diagnostic Tool (UNITED) study was developed to bring the TSR to clinical implementation. As part of the study, an e-Learning module was constructed to confirm the reproducibility of scoring the TSR after proper instruction. METHODS The e-Learning module consists of an autoinstruction for TSR determination (instruction video or written protocol) and three sets of 40 cases (training, test, and repetition sets). Scoring the TSR is performed on hematoxylin and eosin-stained sections and takes only 1-2 minutes. Cases are considered stroma-low if the amount of stroma is ≤50%, whereas a stroma-high case is defined as >50% stroma. Inter- and intraobserver agreements were determined based on the Cohen κ score after each set to evaluate the reproducibility. RESULTS Pathologists and pathology residents (N=63) with special interest in colorectal cancer participated in the e-Learning. Forty-nine participants started the e-Learning and 31 (63%) finished the whole cycle (3 sets). A significant improvement was observed from the training set to the test set; the median κ score improved from 0.72 to 0.77 (P=.002). CONCLUSIONS e-Learning is an effective method to instruct pathologists and pathology residents for scoring the TSR. The reliability of scoring improved from the training to the test set and did not fall back with the repetition set, confirming the reproducibility of the TSR scoring method. TRIAL REGISTRATION The Netherlands Trial Registry NTR7270; https://www.trialregister.nl/trial/7072. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13464.
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Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth Mc Dequeker
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium
| | | | - Rob Aem Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J Han Jm van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
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- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
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19
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Patuleia SIS, Hagenaars SC, Moelans CB, Ausems MGEM, van Gils CH, Tollenaar RAEM, van Diest PJ, Mesker WE, van der Wall E. Lessons Learned from Setting Up a Prospective, Longitudinal, Multicenter Study with Women at High Risk for Breast Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:441-449. [PMID: 33082203 DOI: 10.1158/1055-9965.epi-20-0770] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/30/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
Women identified with an increased risk of breast cancer due to mutations in cancer susceptibility genes or a familial history of breast cancer undergo tailored screening with the goal of detecting tumors earlier, when potential curative interventions are still possible. Ideally, screening would identify signs of carcinogenesis even before a tumor is detectable by imaging. This could be achieved by timely signaling of altered biomarker levels for precancerous processes in liquid biopsies. Currently, the Nipple Aspirate Fluid (NAF) and the Trial Early Serum Test BREAST cancer (TESTBREAST), both ongoing, prospective, multicenter studies, are investigating biomarkers in liquid biopsies to improve breast cancer screening in high-risk women. The NAF study focuses on changes over time in miRNA expression levels both in blood and NAF samples, whereas the TESTBREAST study analyzes changes in protein levels in blood samples at sequential interval timepoints. These within-subject changes are studied in relation to later occurrence of breast cancer using a nested case-control design. These longitudinal studies face their own challenges in execution, such as hindrances in logistics and in sample processing that were difficult to anticipate. This article offers insight into those challenges and concurrently aims to provide useful strategies for the set-up of similar studies.See related commentary by Sauter, p. 429.
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Affiliation(s)
- Susana I S Patuleia
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sophie C Hagenaars
- Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Cathy B Moelans
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Margreet G E M Ausems
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carla H van Gils
- Department of Epidemiology of the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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20
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Smit MA, van Pelt GW, Terpstra V, Putter H, Tollenaar RAEM, Mesker WE, van Krieken JHJM. Tumour-stroma ratio outperforms tumour budding as biomarker in colon cancer: a cohort study. Int J Colorectal Dis 2021; 36:2729-2737. [PMID: 34533595 PMCID: PMC8589816 DOI: 10.1007/s00384-021-04023-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
The tumour-stroma ratio (TSR) and tumour budding (TB) are two high-risk factors with potential to be implemented in the next TNM classification. The aim of the current study was to evaluate the practical application of the two biomarkers based on reproducibility, independency and prognostic value. Patients diagnosed with stage II or III colon cancer who underwent surgery between 2005 and 2016 were included. Both TSR and TB were scored on haematoxylin and eosin-stained tissue sections. The TSR, based on the relative amount of stroma, was scored in increments of 10%. TB was scored following the consensus guidelines; a bud was defined as ≤ 4 tumour cells. For analysis, three categories were used. Cohen's kappa was used for reproducibility. The prognostic value was determined with survival analysis. In total, 246 patients were included. The TSR distribution was N = 137 (56%) stroma-low and N = 109 (44%) stroma-high. The TB distribution was TB-low N = 194 (79%), TB-intermediate N = 35 (14%) and TB-high N = 17 (7%). The reproducibility of the TSR was good (interobserver agreement kappa = 0.83 and intraobserver agreement kappa = 0.82), whereas the inter- and intraobserver agreement for scoring TB was moderate (kappa 0.47 and 0.45, respectively). The survival analysis showed an independent prognostic value for disease-free survival for TSR (HR 1.57; 95% CI 1.01-2.44; p = 0.048) and for TB-high (HR 2.01; 95% CI 1.02-3.96; p = 0.043). Based on current results, we suggest the TSR is a more reliable parameter in daily practice due to better reproducibility and independent prognostic value for disease-free survival.
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Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Valeska Terpstra
- Department of Pathology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J Han J M van Krieken
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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21
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Smit MA, Philipsen MW, Postmus PE, Putter H, Tollenaar RA, Cohen D, Mesker WE. The prognostic value of the tumor-stroma ratio in squamous cell lung cancer, a cohort study. Cancer Treat Res Commun 2020; 25:100247. [PMID: 33249210 DOI: 10.1016/j.ctarc.2020.100247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The tumor-stroma ratio (TSR) is based on the relative amount of stroma in the primary tumor and has proven to be an independent prognostic factor in various solid tumors. The prognosis of patients and adjuvant treatment decision making in lung squamous cell carcinomas (SqCC) is based on the TNM classification. Currently, no other prognostic biomarkers are available. In this study we evaluated the prognostic value of the TSR in lung SqCC. MATERIAL AND METHODS Patients undergoing lung surgery because of lung SqCC between 2000 and 2018 at the Leiden University Medical Center were included. The TSR was scored on hematoxylin & eosin stained tissue sections. Based on the amount of tumor-stroma, two groups were defined: ≤50% was classified as a stroma-low tumor and >50% as stroma-high. The prognostic value of the TSR was determined with survival analysis. RESULTS A total of 174 stage I-III patients were included. Of them, 79 (45%) were stroma-low and 95 (55%) stroma-high. Separately analyzed for tumor stages, the TSR showed to be an independent prognostic biomarker in stage II (n = 68) for 5-year overall survival (HR=3.0; 95% CI, 1.1-8.6; p = 0.035) and 5-year disease free survival (DFS) (HR=3.6; 95% CI, 1.3-9.9; p = 0.014). Patients with a stroma-high tumor had a worse 5-year DFS in the whole cohort (HR 1.6; 95% CI, 1.0-2.4; p = 0.048), but no independent prognostic value was found. CONCLUSION In stage II lung SqCC patients, stroma-low tumors have a better prognosis compared to stroma-high tumors. Moreover, adjuvant chemotherapy could be spared for these stroma-low patients.
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Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Mark Wh Philipsen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Pieter E Postmus
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob Aem Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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22
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Dang H, van Pelt GW, Haasnoot KJC, Backes Y, Elias SG, Seerden TCJ, Schwartz MP, Spanier BWM, de Vos tot Nederveen Cappel WH, van Bergeijk JD, Kessels K, Geesing JMJ, Groen JN, ter Borg F, Wolfhagen FHJ, Seldenrijk CA, Raicu MG, Milne AN, van Lent AUG, Brosens LAA, Johan A. Offerhaus G, Siersema PD, Tollenaar RAEM, Hardwick JCH, Hawinkels LJAC, Moons LMG, Lacle MM, Mesker WE, Boonstra JJ. Tumour-stroma ratio has poor prognostic value in non-pedunculated T1 colorectal cancer: A multi-centre case-cohort study. United European Gastroenterol J 2020; 9:2050640620975324. [PMID: 33210982 PMCID: PMC8259249 DOI: 10.1177/2050640620975324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Current risk stratification models for early invasive (T1) colorectal cancer are not able to discriminate accurately between prognostic favourable and unfavourable tumours, resulting in over-treatment of a large (>80%) proportion of T1 colorectal cancer patients. The tumour-stroma ratio (TSR), which is a measure for the relative amount of desmoplastic tumour stroma, is reported to be a strong independent prognostic factor in advanced-stage colorectal cancer, with a high stromal content being associated with worse prognosis and survival. We aimed to investigate whether the TSR predicts clinical outcome in patients with non-pedunculated T1 colorectal cancer. METHODS Hematoxylin and eosin (H&E)-stained tumour tissue slides from a retrospective multi-centre case cohort of patients with non-pedunculated surgically treated T1 colorectal cancer were assessed for TSR by two independent observers who were blinded for clinical outcomes. The primary end point was adverse outcome, which was defined as the presence of lymph node metastasis in the resection specimen or colorectal cancer recurrence during follow-up. RESULTS All 261 patients in the case cohort had H&E slides available for TSR scoring. Of these, 183 were scored as stroma-low, and 78 were scored as stroma-high. There was moderate inter-observer agreement (κ = 0.42). In total, 41 patients had lymph node metastasis, 17 patients had recurrent cancer and five had both. Stroma-high tumours were not associated with an increased risk for an adverse outcome (adjusted hazard ratio = 0.66, 95% confidence interval 0.37-1.18; p = 0.163). CONCLUSIONS Our study emphasises that existing prognosticators may not be simply extrapolated to T1 colorectal cancers, even though their prognostic value has been widely validated in more advanced-stage tumours.
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Affiliation(s)
- Hao Dang
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Gabi W. van Pelt
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Krijn J. C. Haasnoot
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Yara Backes
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Sjoerd G. Elias
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Tom C. J. Seerden
- Department of Gastroenterology and HepatologyAmphia HospitalBredaThe Netherlands
| | - Matthijs P. Schwartz
- Department of Gastroenterology and HepatologyMeander Medical CentreAmersfoortThe Netherlands
| | | | | | | | - Koen Kessels
- Department of Gastroenterology and HepatologySint Antonius HospitalNieuwegeinThe Netherlands
| | - Joost M. J. Geesing
- Department of Gastroenterology and HepatologyDiakonessenhuisUtrechtThe Netherlands
| | - John N. Groen
- Department of Gastroenterology and HepatologySint JansdalHarderwijkThe Netherlands
| | - Frank ter Borg
- Department of Gastroenterology and HepatologyDeventer HospitalDeventerThe Netherlands
| | - Frank H. J. Wolfhagen
- Department of Gastroenterology and HepatologyAlbert Schweitzer HospitalDordrechtThe Netherlands
| | | | | | - Anya N. Milne
- Pathology DNASint Antonius HospitalNieuwegeinThe Netherlands
| | - Anja U. G. van Lent
- Department of Gastroenterology and HepatologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - Lodewijk A. A. Brosens
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - G. Johan A. Offerhaus
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
| | | | - James C. H. Hardwick
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Lukas J. A. C. Hawinkels
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Leon M. G. Moons
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Miangela M. Lacle
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Wilma E. Mesker
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Jurjen J. Boonstra
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
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23
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Zunder SM, Perez-Lopez R, de Kok BM, Raciti MV, van Pelt GW, Dienstmann R, Garcia-Ruiz A, Meijer CA, Gelderblom H, Tollenaar RA, Nuciforo P, Wasser MN, Mesker WE. Correlation of the tumour-stroma ratio with diffusion weighted MRI in rectal cancer. Eur J Radiol 2020; 133:109345. [PMID: 33120239 DOI: 10.1016/j.ejrad.2020.109345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/06/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the correlation between intratumoural stroma proportion, expressed as tumour-stroma ratio (TSR), and apparent diffusion coefficient (ADC) values in patients with rectal cancer. METHODS This multicentre retrospective study included all consecutive patients with rectal cancer, diagnostically confirmed by biopsy and MRI. The training cohort (LUMC, Netherlands) included 33 patients and the validation cohort (VHIO, Spain) 69 patients. Two observers measured the mean and minimum ADCs based on single-slice and whole-volume segmentations. The TSR was determined on diagnostic haematoxylin & eosin stained slides of rectal tumour biopsies. The correlation between TSR and ADC was assessed by Spearman correlation (rs). RESULTS The ADC values between stroma-low and stroma-high tumours were not significantly different. Intra-class correlation (ICC) demonstrated a good level of agreement for the ADC measurements, ranging from 0.84-0.86 for single slice and 0.86-0.90 for the whole-volume protocol. No correlation was observed between the TSR and ADC values, with ADCmeanrs= -0.162 (p= 0.38) and ADCminrs= 0.041 (p= 0.82) for the single-slice and rs= -0.108 (p= 0.55) and rs= 0.019 (p= 0.92) for the whole-volume measurements in the training cohort, respectively. Results from the validation cohort were consistent; ADCmeanrs= -0.022 (p= 0.86) and ADCminrs = 0.049 (p= 0.69) for the single-slice and rs= -0.064 (p= 0.59) and rs= -0.063 (p= 0.61) for the whole-volume measurements. CONCLUSIONS Reproducibility of ADC values is good. Despite positive reports on the correlation between TSR and ADC values in other tumours, this could not be confirmed for rectal cancer.
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Affiliation(s)
- Stéphanie M Zunder
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Bente M de Kok
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Maria Vittoria Raciti
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rodrigo Dienstmann
- Department of Oncology Data Science, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Alonso Garcia-Ruiz
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - C Arnoud Meijer
- Department of Radiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Paolo Nuciforo
- Department of Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Martin N Wasser
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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Smit MA, Mesker WE. The role of artificial intelligence to quantify the tumour-stroma ratio for survival in colorectal cancer. EBioMedicine 2020; 61:103070. [PMID: 33099089 PMCID: PMC7581865 DOI: 10.1016/j.ebiom.2020.103070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Centre, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, the Netherlands.
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25
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Vreeker GCM, Hanna-Sawires RG, Mohammed Y, Bladergroen MR, Nicolardi S, Dotz V, Nouta J, Bonsing BA, Mesker WE, van der Burgt YEM, Wuhrer M, Tollenaar RAEM. Serum N-Glycome analysis reveals pancreatic cancer disease signatures. Cancer Med 2020; 9:8519-8529. [PMID: 32898301 PMCID: PMC7666731 DOI: 10.1002/cam4.3439] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/08/2020] [Accepted: 08/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background &Aims Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer type with loco‐regional spread that makes the tumor surgically unresectable. Novel diagnostic tools are needed to improve detection of PDAC and increase patient survival. In this study we explore serum protein N‐glycan profiles from PDAC patients with regard to their applicability to serve as a disease biomarker panel. Methods Total serum N‐glycome analysis was applied to a discovery set (86 PDAC cases/84 controls) followed by independent validation (26 cases/26 controls) using in‐house collected serum specimens. Protein N‐glycan profiles were obtained using ultrahigh resolution mass spectrometry and included linkage‐specific sialic acid information. N‐glycans were relatively quantified and case‐control classification performance was evaluated based on glycosylation traits such as branching, fucosylation, and sialylation. Results In PDAC patients a higher level of branching (OR 6.19, P‐value 9.21 × 10−11) and (antenna)fucosylation (OR 13.27, P‐value 2.31 × 10−9) of N‐glycans was found. Furthermore, the ratio of α2,6‐ vs α2,3‐linked sialylation was higher in patients compared to healthy controls. A classification model built with three glycosylation traits was used for discovery (AUC 0.88) and independent validation (AUC 0.81), with sensitivity and specificity values of 0.85 and 0.71 for the discovery set and 0.75 and 0.72 for the validation set. Conclusion Serum N‐glycome analysis revealed glycosylation differences that allow classification of PDAC patients from healthy controls. It was demonstrated that glycosylation traits rather than single N‐glycan structures obtained in this clinical glycomics study can serve as a basis for further development of a blood‐based diagnostic test.
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Affiliation(s)
- Gerda C M Vreeker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Yassene Mohammed
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco R Bladergroen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Simone Nicolardi
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Viktoria Dotz
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Nouta
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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26
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Momčilović A, de Haan N, Hipgrave Ederveen AL, Bondt A, Koeleman CAM, Falck D, de Neef LA, Mesker WE, Tollenaar R, de Ru A, van Veelen P, Wuhrer M, Dotz V. Simultaneous Immunoglobulin A and G Glycopeptide Profiling for High-Throughput Applications. Anal Chem 2020; 92:4518-4526. [PMID: 32091889 PMCID: PMC7252899 DOI: 10.1021/acs.analchem.9b05722] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
![]()
Immunoglobulin (Ig)
glycosylation is recognized for its influence
on Ig turnover and effector functions. However, the large-scale profiling
of Ig glycosylation in a biomedical setting is challenged by the existence
of different Ig isotypes and subclasses, their varying serum concentrations,
and the presence of multiple glycosylation sites per Ig. Here, a high-throughput
nanoliquid chromatography (LC)- mass spectrometry (MS)-based method
for simultaneous analysis of IgG and IgA glycopeptides was developed
and applied on a serum sample set from 185 healthy donors. Sample
preparation from minute amounts of serum was performed in 96-well
plate format. Prior to trypsin digestion, IgG and IgA were enriched
simultaneously, followed by a one-step denaturation, reduction, and
alkylation. The obtained nanoLC-MS data were subjected to semiautomated,
targeted feature integration and quality control. The combined and
simplified protocol displayed high overall method repeatability, as
assessed using pooled plasma and serum standards. Taking all samples
together, 143 individual N- and O-glycopeptides were reliably quantified. These glycopeptides were
attributable to 11 different peptide backbones, derived from IgG1,
IgG2/3, IgG4, IgA1, IgA2, and the joining chain from dimeric IgA.
Using this method, novel associations were found between IgA N- and O-glycosylation and age. Furthermore,
previously reported associations of IgG Fc glycosylation with age
in healthy individuals were confirmed. In conclusion, the new method
paves the way for high-throughput multiprotein plasma glycoproteomics.
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Affiliation(s)
- Ana Momčilović
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Noortje de Haan
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Agnes L Hipgrave Ederveen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Albert Bondt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Carolien A M Koeleman
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - David Falck
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Louise A de Neef
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Rob Tollenaar
- Department of Surgery, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Arnoud de Ru
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Peter van Veelen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
| | - Viktoria Dotz
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300RC Leiden, The Netherlands
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27
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Rebello OD, Nicolardi S, Lageveen-Kammeijer GSM, Nouta J, Gardner RA, Mesker WE, Tollenaar RAEM, Spencer DIR, Wuhrer M, Falck D. A Matrix-Assisted Laser Desorption/Ionization-Mass Spectrometry Assay for the Relative Quantitation of Antennary Fucosylated N-Glycans in Human Plasma. Front Chem 2020; 8:138. [PMID: 32185163 PMCID: PMC7059190 DOI: 10.3389/fchem.2020.00138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/14/2020] [Indexed: 12/29/2022] Open
Abstract
Changes in the abundance of antennary fucosylated glycans in human total plasma N-glycome (TPNG) have been associated with several diseases ranging from diabetes to various forms of cancer. However, it is challenging to address this important part of the human glycome. Most commonly, time-consuming chromatographic separations are performed to differentially quantify core and antenna fucosylation. Obtaining sufficient resolution for larger, more complex glycans can be challenging. We introduce a matrix-assisted laser desorption/ionization—mass spectrometry (MALDI-MS) assay for the relative quantitation of antennary fucosylation in TPNG. N-linked glycans are released from plasma by PNGase F and further treated with a core fucosidase before performing a linkage-informative sialic acid derivatization. The core fucosylated glycans are thus depleted while the remaining antennary fucosylated glycans are quantitated. Simultaneous quantitation of α2,3-linked sialic acids and antennary fucosylation allows an estimation of the sialyl-Lewis x motif. The approach is feasible using either ultrahigh-resolution Fourier-transform ion cyclotron resonance mass spectrometry or time-of-flight mass spectrometry. The assay was used to investigate changes of antennary fucosylation as clinically relevant marker in 14 colorectal cancer patients. In accordance with a previous report, we found elevated levels of antennary fucosylation pre-surgery which decreased after tumor resection. The assay has the potential for revealing antennary fucosylation signatures in various conditions including diabetes and different types of cancer.
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Affiliation(s)
- Osmond D Rebello
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands.,Ludger Ltd, Culham Science Centre, Abingdon, United Kingdom
| | - Simone Nicolardi
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jan Nouta
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - David Falck
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
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28
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Vangangelt KMH, Green AR, Heemskerk IMF, Cohen D, van Pelt GW, Sobral-Leite M, Schmidt MK, Putter H, Rakha EA, Tollenaar RAEM, Mesker WE. The prognostic value of the tumor-stroma ratio is most discriminative in patients with grade III or triple-negative breast cancer. Int J Cancer 2020; 146:2296-2304. [PMID: 31901133 PMCID: PMC7065011 DOI: 10.1002/ijc.32857] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/11/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022]
Abstract
The tumor-stroma ratio (TSR) was evaluated as a promising parameter for breast cancer prognostication in clinically relevant subgroups of patients. The TSR was assessed on hematoxylin and eosin-stained tissue slides of 1,794 breast cancer patients from the Nottingham City Hospital. An independent second cohort of 737 patients from the Netherlands Cancer Institute to Antoni van Leeuwenhoek was used for evaluation. In the Nottingham Breast Cancer series, the TSR was an independent prognostic parameter for recurrence-free survival (RFS; HR 1.35, 95% CI 1.10-1.66, p = 0.004). The interaction term was statistically significant for grade and triple-negative status. Multivariate Cox regression analysis showed a more pronounced effect of the TSR for RFS in grade III tumors (HR 1.89, 95% CI 1.43-2.51, p < 0.001) and triple-negative tumors (HR 1.86, 95% CI 1.10-3.14, p = 0.020). Comparable hazard ratios and confidence intervals were observed for grade and triple-negative status in the ONCOPOOL study. The prognostic value of TSR was not modified by age, tumor size, histology, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status or lymph node status. In conclusion, patients with a stroma-high tumor had a worse prognosis compared to patients with a stroma-low tumor. The prognostic value of the TSR is most discriminative in grade III tumors and triple-negative tumors. The TSR was not modified by other clinically relevant parameters making it a potential factor to be included for improved risk stratification.
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Affiliation(s)
- Kiki M H Vangangelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew R Green
- Nottingham Breast Cancer Research Center, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom
| | | | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcelo Sobral-Leite
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Emad A Rakha
- Nottingham Breast Cancer Research Center, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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29
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Liu S, González-Prieto R, Zhang M, Geurink PP, Kooij R, Iyengar PV, van Dinther M, Bos E, Zhang X, Le Dévédec SE, van de Water B, Koning RI, Zhu HJ, Mesker WE, Vertegaal ACO, Ovaa H, Zhang L, Martens JWM, Ten Dijke P. Deubiquitinase Activity Profiling Identifies UCHL1 as a Candidate Oncoprotein That Promotes TGFβ-Induced Breast Cancer Metastasis. Clin Cancer Res 2019; 26:1460-1473. [PMID: 31857432 DOI: 10.1158/1078-0432.ccr-19-1373] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/30/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Therapies directed to specific molecular targets are still unmet for patients with triple-negative breast cancer (TNBC). Deubiquitinases (DUB) are emerging drug targets. The identification of highly active DUBs in TNBC may lead to novel therapies. EXPERIMENTAL DESIGN Using DUB activity probes, we profiled global DUB activities in 52 breast cancer cell lines and 52 patients' tumor tissues. To validate our findings in vivo, we employed both zebrafish and murine breast cancer xenograft models. Cellular and molecular mechanisms were elucidated using in vivo and in vitro biochemical methods. A specific inhibitor was synthesized, and its biochemical and biological functions were assessed in a range of assays. Finally, we used patient sera samples to investigate clinical correlations. RESULTS Two DUB activity profiling approaches identified UCHL1 as being highly active in TNBC cell lines and aggressive tumors. Functionally, UCHL1 promoted metastasis in zebrafish and murine breast cancer xenograft models. Mechanistically, UCHL1 facilitates TGFβ signaling-induced metastasis by protecting TGFβ type I receptor and SMAD2 from ubiquitination. We found that these responses are potently suppressed by the specific UCHL1 inhibitor, 6RK73. Furthermore, UCHL1 levels were significantly increased in sera of patients with TNBC, and highly enriched in sera exosomes as well as TNBC cell-conditioned media. UCHL1-enriched exosomes stimulated breast cancer migration and extravasation, suggesting that UCHL1 may act in a paracrine manner to promote tumor progression. CONCLUSIONS Our DUB activity profiling identified UCHL1 as a candidate oncoprotein that promotes TGFβ-induced breast cancer metastasis and may provide a potential target for TNBC treatment.
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Affiliation(s)
- Sijia Liu
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Oncode Institute, Leiden University Medical Center, Leiden, the Netherlands
| | - Román González-Prieto
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mengdi Zhang
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China
| | - Paul P Geurink
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Oncode Institute, Leiden University Medical Center, Leiden, the Netherlands
| | - Raymond Kooij
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Oncode Institute, Leiden University Medical Center, Leiden, the Netherlands
| | - Prasanna Vasudevan Iyengar
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Oncode Institute, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten van Dinther
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Oncode Institute, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Bos
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Xiaobing Zhang
- Division of Drug Discovery and Safety, Leiden Academic Center for Drug Research, Leiden, the Netherlands
| | - Sylvia E Le Dévédec
- Division of Drug Discovery and Safety, Leiden Academic Center for Drug Research, Leiden, the Netherlands
| | - Bob van de Water
- Division of Drug Discovery and Safety, Leiden Academic Center for Drug Research, Leiden, the Netherlands
| | - Roman I Koning
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hong-Jian Zhu
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Alfred C O Vertegaal
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Huib Ovaa
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Oncode Institute, Leiden University Medical Center, Leiden, the Netherlands
| | - Long Zhang
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China
| | | | - Peter Ten Dijke
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands. .,Oncode Institute, Leiden University Medical Center, Leiden, the Netherlands
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30
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Sandberg TP, Stuart MPME, Oosting J, Tollenaar RAEM, Sier CFM, Mesker WE. Increased expression of cancer-associated fibroblast markers at the invasive front and its association with tumor-stroma ratio in colorectal cancer. BMC Cancer 2019; 19:284. [PMID: 30922247 PMCID: PMC6440123 DOI: 10.1186/s12885-019-5462-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 11/19/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
Background The tumor microenvironment has a critical role in regulating cancer cell behavior. Tumors with high stromal content are associated with poor patient outcome. The tumor-stroma ratio (TSR) identifies colorectal cancers (CRC) with poor patient prognosis based on hematoxylin & eosin stained sections. The desmoplastic reaction consists to a great extent of cancer-associated fibroblasts (CAFs) of which different subtypes are known. The aim of this study is to investigate and quantify CAFs present in the tumor stroma of CRC stratified by the TSR to possibly add prognostic significance to the TSR. Methods The expression of established CAF markers was compared between stroma-low and stroma-high tumors using transcriptomic data of 71 stage I – III CRC. Based on literature, fibroblast and stromal markers were selected to perform multiplex immunofluorescent staining on formalin fixed, paraffin-embedded tumor sections of patients diagnosed with stage III colon cancer. Antibodies against the following markers were used: αSMA, PDGFR -β, FAP, FSP1 and the stromal markers CD45 and CD31 as reference. The markers were subsequently quantified in the stroma using the Vectra imaging microscope. Results The transcriptomic data showed that all CAF markers except one were higher expressed in stroma-high compared to stroma-low tumors. Histologically, stroma-high tumors showed a decreased number of FSP1+/CD45+ cells and a trend of an increased expression of FAP compared to stroma-low tumors. FAP was higher expressed at the invasive part compared to the tumor center in both stroma-high and stroma-low tumors. Conclusions The increased expression of FAP at the invasive part and in stroma-high tumors might contribute to the invasive behavior of cancer cells. Future functional experiments should investigate the contribution of FAP to cancer cell invasion. Combining the quantity of the stroma as defined by the TSR with the activity level of CAFs using the expression of FAP may result in an expanded stroma-based tool for patient stratification. Electronic supplementary material The online version of this article (10.1186/s12885-019-5462-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tessa P Sandberg
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands. .,Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands.
| | - Maaike P M E Stuart
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands
| | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands
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31
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Sandberg TP, Oosting J, van Pelt GW, Mesker WE, Tollenaar RAEM, Morreau H. Erratum: Molecular profiling of colorectal tumors stratified by the histological tumor-stroma ratio - Increased expression of galectin-1 in tumors with high stromal content. Oncotarget 2019; 10:2416. [PMID: 31040931 PMCID: PMC6481328 DOI: 10.18632/oncotarget.26820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
[This corrects the article DOI: 10.18632/oncotarget.25845.].
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Affiliation(s)
- Tessa P Sandberg
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
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32
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Sandberg TP, Sweere I, van Pelt GW, Putter H, Vermeulen L, Kuppen PJ, Tollenaar RAEM, Mesker WE. Prognostic value of low CDX2 expression in colorectal cancers with a high stromal content - a short report. Cell Oncol (Dordr) 2019; 42:397-403. [PMID: 30847807 DOI: 10.1007/s13402-019-00436-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Lack of expression of the intestinal transcription factor CDX2 in colorectal cancer (CRC) identifies patients with a poor prognosis. This biomarker has previously been suggested to be prognostic in CRCs with a high stromal content based on mRNA expression data. We investigated the prognostic value of CDX2 expression in microsatellite stable CRC stratified by stromal content using microscopy-based techniques. METHODS AND RESULTS The study included a cohort of 236 patients with stage I-IV CRC. We assessed by microscopy the tumour-stroma ratio (TSR) and the immunohistochemical CDX2 intensity. We found that patients of the stroma-high group had a worse prognosis compared to those of the stroma-low group [disease-free survival in a multivariate analysis (DFSmultivariate) HR 1.52 (95% CI 1.05-2.21)]. In our cohort, low CDX2 expression (14.6%) showed prognostic value for DFSmultivariate [HR 1.93 (95% CI 1.16-3.23)]. Interestingly, when stratifying the cohort by TSR, no prognostic difference was observed related to CDX2 expression in stroma-low tumours. However, CDX2 expression was found to be prognostic within the stroma-high group [DFSmultivariate HR 3.02 (95% CI 1.49-6.13)]. The p value for interaction between TSR and CDX2 status was borderline significant in DFS (p = 0.071). CONCLUSIONS The present study confirms a poor outcome of patients with stroma-high tumours. Low CDX2 expression in tumours with a high stromal content identified patients with a particularly poor prognosis. The present study did not reveal a clear difference in TSR associated with CDX2 status and survival. This method, solely based on microscopy, identifies patients who have a high risk of relapse and a poor outcome, and who may benefit from targeted therapy.
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Affiliation(s)
- Tessa P Sandberg
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands. .,Department of Pathology, Leiden University Medical Centrum, Leiden, The Netherlands.
| | - Iris Sweere
- Department of Pathology, Leiden University Medical Centrum, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centrum, Leiden, The Netherlands
| | - Louis Vermeulen
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peter J Kuppen
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
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33
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Hanna-Sawires RG, Groen JV, Klok FA, Tollenaar RAEM, Mesker WE, Swijnenburg RJ, Vahrmeijer AL, Bonsing BA, Mieog JSD. Outcomes following pancreatic surgery using three different thromboprophylaxis regimens. Br J Surg 2019; 106:765-773. [PMID: 30776085 PMCID: PMC6593975 DOI: 10.1002/bjs.11103] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/14/2018] [Revised: 10/17/2018] [Accepted: 12/06/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Postpancreatectomy haemorrhage (PPH) and venous thromboembolism (VTE) are serious complications following pancreatic surgery. The aim was to assess the timing, occurrence and predictors of PPH and VTE. METHODS Elective pancreatic resections undertaken in a single university hospital between November 2013 and September 2017 were assessed. Three intervals were reviewed, each with a different routine regimen of nadroparin: 2850 units once daily (single dose) administered in hospital only, or 5700 units once daily (double dose) or 2850 units twice daily (split dose) administered in hospital and continued for 6 weeks after surgery. Clinically relevant PPH (CR-PPH) was classified according to International Study Group of Pancreatic Surgery criteria. VTE was defined according to a number of key diagnostic criteria within 6 weeks of surgery. Cox regression analyses were performed to test the hypotheses that the double-dose group would experience more PPH than the other two groups, the single-dose group would experience more VTE than the other two groups, and the split-dose group would experience the fewest adverse events (PPH or VTE). RESULTS In total, 240 patients were included, 80 per group. The double-dose group experienced significantly more CR-PPH (hazard ratio (HR) 2·14, 95 per cent c.i. 1·16 to 3·94; P = 0·015). More relaparotomies due to CR-PPH were performed in the double-dose group (16 versus 3·8 per cent; P = 0·002). The single-dose group did not experience more VTE (HR 1·41, 0·43 to 4·62; P = 0·570). The split dose was not associated with fewer adverse events (HR 0·77, 0·41 to 1·46; P = 0·422). Double-dose low molecular weight heparin (LMWH), high BMI and pancreatic fistula were independent predictors of CR-PPH. CONCLUSION A double dose of LMWH prophylaxis continued for 6 weeks after pancreatic resection was associated with a twofold higher rate of CR-PPH, resulting in four times more relaparotomies. Patients receiving a single daily dose of LMWH in hospital only did not experience a higher rate of VTE.
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Affiliation(s)
- R G Hanna-Sawires
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J V Groen
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - F A Klok
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, the Netherlands
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - W E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - R J Swijnenburg
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - B A Bonsing
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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34
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Vangangelt KMH, Tollenaar LSA, van Pelt GW, de Kruijf EM, Dekker TJA, Kuppen PJK, Tollenaar RAEM, Mesker WE. The prognostic value of tumor-stroma ratio in tumor-positive axillary lymph nodes of breast cancer patients. Int J Cancer 2018; 143:3194-3200. [PMID: 29978463 DOI: 10.1002/ijc.31658] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022]
Abstract
The tumor-stroma ratio (TSR) has previously been found to be a strong prognostic parameter in primary breast cancer tumors. Since the presence of tumor cells in lymph nodes is important for clinical decision making, the influence of TSR in the primary breast tumor combined with the TSR in tumor-positive lymph nodes on prognosis was evaluated. Women with invasive breast cancer without distant metastasis who underwent an axillary lymph node dissection between 1985 and 1994 at the Leiden University Medical Center were retrospectively analyzed. TSR assessment was performed on hematoxylin and eosin stained tissue slides. In total, 87 (45.5%) primary tumors were scored as stroma-low and 104 (54.5%) as stroma-high. Patients with a high stromal percentage in the primary tumors had a statistically significant worse relapse free period (RFP) compared to stroma-low tumors (HR 1.97, 95% CI 1.37-2.82, p < 0.001). A total number of 915 lymph nodes were assessed for TSR. In 101 (52.9%) patients, heterogeneity was observed between stroma percentage category in primary tumor and lymph nodes. The combination of TSR of the primary tumor combined with TSR of tumor-positive lymph nodes strengthened each other as independent prognostic parameter for RFP (p = 0.019). Patients with primary tumor stroma-low/lymph nodes stroma-low tumors showed strongly improved RFP rates compared to patients with primary tumor stroma-high/lymph node stroma-high tumors with 10-year percentages of 58 versus 8%, respectively. Assessing the TSR on tumor-positive lymph nodes can provide additional prognostic information. Stromal activation strongly differs between primary tumors and lymph node metastasis.
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Affiliation(s)
- Kiki M H Vangangelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther M de Kruijf
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Tim J A Dekker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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35
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Vreeker GM, Nicolardi S, Bladergroen MR, van der Plas CJ, Mesker WE, Tollenaar RAEM, van der Burgt YEM, Wuhrer M. Automated Plasma Glycomics with Linkage-Specific Sialic Acid Esterification and Ultrahigh Resolution MS. Anal Chem 2018; 90:11955-11961. [PMID: 30230816 PMCID: PMC6209171 DOI: 10.1021/acs.analchem.8b02391] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 05/29/2018] [Accepted: 09/19/2018] [Indexed: 12/17/2022]
Abstract
High-throughput mass spectrometry (MS) glycomics is an emerging field driven by technological advancements including sample preparation and data processing. Previously, we reported an automated protocol for the analysis of N-glycans released from plasma proteins that included sialic acid derivatization with linkage-specificity, namely, ethylation of α2,6-linked sialic acid residues and lactone formation of α2,3-linked sialic acids. In the current study, each step in this protocol was further optimized. Method improvements included minimizing the extent of side-reaction during derivatization, an adjusted glycan purification strategy and mass analysis of the released N-glycans by ultrahigh resolution matrix-assisted laser desorption/ionization Fourier transform ion cyclotron resonance MS. The latter resolved peak overlap and simplified spectral alignment due to high mass measurement precision. Moreover, this resulted in more confident glycan assignments and improved signal-to-noise for low-abundant species. The performance of the protocol renders high-throughput applications feasible in the exciting field of clinical glycomics.
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Affiliation(s)
- Gerda
C. M. Vreeker
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, 2300 RC Leiden, The Netherlands
- Department
of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Simone Nicolardi
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, 2300 RC Leiden, The Netherlands
- Department
of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Marco R. Bladergroen
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, 2300 RC Leiden, The Netherlands
| | - Corné J. van der Plas
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, 2300 RC Leiden, The Netherlands
| | - Wilma E. Mesker
- Department
of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Rob A. E. M. Tollenaar
- Department
of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Yuri E. M. van der Burgt
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, 2300 RC Leiden, The Netherlands
| | - Manfred Wuhrer
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, 2300 RC Leiden, The Netherlands
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36
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Sandberg TP, Oosting J, van Pelt GW, Mesker WE, Tollenaar RAEM, Morreau H. Molecular profiling of colorectal tumors stratified by the histological tumor-stroma ratio - Increased expression of galectin-1 in tumors with high stromal content. Oncotarget 2018; 9:31502-31515. [PMID: 30140386 PMCID: PMC6101138 DOI: 10.18632/oncotarget.25845] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022] Open
Abstract
The tumor microenvironment is a dominant determinant of cancer cell behavior. Reactive tumor stroma is associated with poor outcome perspective. The tumor-stroma ratio (TSR) is a strong independent prognostic factor in colorectal cancer and is easily assessed using conventional hematoxylin and eosin (H&E) stained paraffin sections at the invasive margin of the tumor. We aim to understand the biology of the tumor stroma in colorectal cancer by investigating the transcriptomic profiles of tumors classified by the TSR method. The TSR was assessed in a cohort of 71 colorectal cancer patients undergoing surgery without (neo)adjuvant therapy. In the cohort, stroma-high tumors were distinguished from stroma-low tumors at gene expression level in the upregulation of biological pathways related to extracellular matrix (ECM) remodeling and myogenesis. The activated microenvironment in stroma-high tumors overexpressed different types of collagen genes, THBS2 and 4 as well as INHBA, COX71A and LGALS1/galectin-1. The upregulation of THBS2, COX7A1 and LGALS1/galectin-1. The upregulation of THBS2, COX7A1 and LGALS1/galectin-1 in stroma-high tumors was validated in The Cancer Genome Atlas. In conclusion, the gene expression data reflects the high stromal content of tumors assessed based on the histological method, the TSR. The composition of the microenvironment suggests an altered proteolysis resulting in ECM remodeling and invasive capacity of tumor cells.
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Affiliation(s)
- Tessa P Sandberg
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
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37
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de Vroome SW, Holst S, Girondo MR, van der Burgt YEM, Mesker WE, Tollenaar RAEM, Wuhrer M. Serum N-glycome alterations in colorectal cancer associate with survival. Oncotarget 2018; 9:30610-30623. [PMID: 30093973 PMCID: PMC6078140 DOI: 10.18632/oncotarget.25753] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/25/2018] [Indexed: 12/15/2022] Open
Abstract
Proteins are routinely measured in clinical laboratories for diagnosis, prognosis and therapy monitoring. Nevertheless, both test improvements (performance) and innovations (biomarkers) are needed, and protein N-glycosylation offers a rich source of potential markers. Here, we have analyzed the total serum N-glycome in a matched case-control study (124 cases versus 124 controls) of colorectal cancer patients. The results were validated in an independent sample cohort (both 61 cases versus 61 controls) and further tested in post-operative samples of cured patients. Our results revealed significant differences between patients and controls, with increased size (antennae) and sialylation of the N-glycans in the colorectal cancer patient sera as compared to mainly di-antennary N-glycans in sera from controls. Furthermore, glycan alterations showed strong associations with cancer stage and survival: The five-year survival rate largely varied between patients with an altered serum N-glycome (46%) and an N-glycome similar to controls (87%). Importantly, the total serum N-glycome showed prognostic value beyond age and stage. This clinical glycomics study provides novel serum biomarker candidates and shows the potential of total serum N-glycans as a prognostic panel. Moreover, serum N-glycome changes reverted to a control-like profile after successful treatment as was demonstrated from pre- and post-operative samples.
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Affiliation(s)
- Stefan W de Vroome
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Mar Rodriguez Girondo
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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38
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Zunder SM, van Pelt GW, Gelderblom HJ, Mancao C, Putter H, Tollenaar RA, Mesker WE. Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer. Br J Cancer 2018; 119:164-169. [PMID: 29755119 PMCID: PMC6048031 DOI: 10.1038/s41416-018-0083-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 12/13/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022] Open
Abstract
Background The tumour–stroma ratio (TSR) has proven to be an independent prognostic factor in colon cancer. methods Haematoxylin eosin tissue slides of patients from the AVANT trial were microscopically scored for TSR and categorised as stroma -low or stroma -high. Scores were correlated to the primary and secondary endpoint disease-free survival (DFS) and overall survival (OS). Results Patients with stroma-high tumours (N = 339, 28%) had a significantly shorter DFS (p < 0.001) compared to stroma-low tumours (N = 824, 68%). In the bevacizumab-FOLFOX-4 arm, DFS was significantly shorter compared to FOLFOX-4 in stroma-low tumours, with a hazard ratio (HR) of 1.94 (95% CI 1.24–3.04; p = 0.004). In stroma-high tumours a trend for better DFS was seen in bevacizumab-FOLFOX-4 vs. FOLFOX-4 (HR 0.61 (95% CI 0.35–1.07; p = 0.08)). For bevacizumab-XELOX vs. FOLFOX-4, this was not seen (stroma-low HR 1.07 (95% CI 0.64–1.77; p = 0.80); stroma-high HR 0.78 (95% CI 0.47–1.30; p = 0.35)). OS showed the same pattern for bevacizumab-FOLFOX-4 vs. FOLFOX-4 with a HR of 2.53 (95% CI 1.36–4.71; p = 0.003) for stroma-low and HR 0.50 (95% CI 0.22–1.14; p = 0.10) for stroma-high tumours. For bevacizumab-XELOX vs. FOLFOX-4, HR 1.13 (95% CI 0.55–2.31; p = 0.74) for stroma-low tumours and HR 0.74 (95% CI 0.37–1.51; p = 0.41) for stroma-high tumours. Conclusions This exploratory analysis suggests a significantly shorter DFS and OS in stroma-low tumours with addition of bevacizumab to intravenous oxaliplatin-based chemotherapy, contrary to stroma-high tumours, where a beneficial trend is observed.
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Affiliation(s)
- Stéphanie M Zunder
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands.,Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Hans J Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Christoph Mancao
- Oncology Biomarker Development, Genentech Inc., CH-4070, Basel, Switzerland
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
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39
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Huijbers A, van Pelt GW, Kerr RS, Johnstone EC, Tollenaar RAEM, Kerr DJ, Mesker WE. The value of additional bevacizumab in patients with high-risk stroma-high colon cancer. A study within the QUASAR2 trial, an open-label randomized phase 3 trial. J Surg Oncol 2018; 117:1043-1048. [PMID: 29448309 DOI: 10.1002/jso.24998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/29/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Patients with a high stroma percentage within the primary tumor have a poor prognosis. In this study, we investigate whether anti-angiogenic therapy might improve survival of patients with a stroma-high profile with potentially increased angiogenesis. MATERIALS AND METHODS Tissue samples of the primary tumor of 965 colon cancer patients participating in the QUASAR2 trial were analyzed for tumor-stroma ratio (TSR). Stroma-high (>50%) and stroma-low (≤50%) groups were evaluated with respect to survival. RESULTS Disease free survival (DFS) was significantly lower in the stroma-high group (HR 1.53, 95%CI 1.19-1.95, P = 0.001). No difference in DFS was seen with respect to treatment with capecitabine alone (CAP) or capecitabine with bevacizumab (CAPBEV) (Stroma-high HR 1.00, 95%CI 0.69-1.46, P = 0.996; stroma-low HR 1.02, 95%CI 0.75-1.41, P = 0.883). A significant difference in survival was seen comparing groups with or without vascular invasion (DFS P < 0.001). A correlation between vascular invasion and stroma-high was seen (χ2 -test P = 0.043). DISCUSSION AND CONCLUSIONS The TSR confirmed to be a strong prognosticator for disease-free survival in a selected high-risk patient population. No benefit was found in response to treatment with bevacizumab when stratified for TSR. TSR showed to have an additional prognostic value in patients with vascular invasion present in the primary tumor.
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Affiliation(s)
- Anouck Huijbers
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
| | - Rachel S Kerr
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | | | - Rob A E M Tollenaar
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
| | - David J Kerr
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, United Kingdom
| | - Wilma E Mesker
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
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40
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Vangangelt KMH, van Pelt GW, Engels CC, Putter H, Liefers GJ, Smit VTHBM, Tollenaar RAEM, Kuppen PJK, Mesker WE. Prognostic value of tumor-stroma ratio combined with the immune status of tumors in invasive breast carcinoma. Breast Cancer Res Treat 2018; 168:601-612. [PMID: 29273955 PMCID: PMC5842256 DOI: 10.1007/s10549-017-4617-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/07/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE Complex interactions occur between cancer cells and cells in the tumor microenvironment. In this study, the prognostic value of the interplay between tumor-stroma ratio (TSR) and the immune status of tumors in breast cancer patients was evaluated. METHODS A cohort of 574 breast cancer patients was analyzed. The percentage of tumor stroma was visually estimated on Hematoxylin and Eosin (H&E) stained histological tumor tissue sections. Immunohistochemical staining was performed for classical human leukocyte antigen (HLA) class I, HLA-E, HLA-G, markers for regulatory T (Treg) cells, natural killer (NK) cells and cytotoxic T-lymphocytes (CTLs). RESULTS TSR (P < .001) and immune status of tumors (P < .001) were both statistically significant for recurrence free period (RFP) and both independent prognosticators (P < .001) in which tumors with a high stromal content behave more aggressively as well as tumors with a low immune status. Ten years RFP for patients with a stroma-low tumor and high immune status profile was 87% compared to 17% of patients with a stroma-high tumor combined with low immune status profile (P < .001). Classical HLA class I is the most prominent immune marker in the immune status profiles. CONCLUSIONS Determination of TSR is a simple, fast and cheap method. The effect on RFP of TSR when combined with immune status of tumors or expression of classical HLA class I is even stronger. Both are promising for further prediction and achievement of tailored treatment for breast cancer patients.
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Affiliation(s)
- K M H Vangangelt
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - G W van Pelt
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - C C Engels
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - P J K Kuppen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - W E Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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41
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van Pelt GW, Sandberg TP, Morreau H, Gelderblom H, van Krieken JHJM, Tollenaar RAEM, Mesker WE. The tumour-stroma ratio in colon cancer: the biological role and its prognostic impact. Histopathology 2018; 73:197-206. [PMID: 29457843 DOI: 10.1111/his.13489] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The tumour microenvironment consists of a complex mixture of non-neoplastic cells, including fibroblasts, immune cells and endothelial cells embedded in the proteins of the extracellular matrix. The tumour microenvironment plays an active role in tumour behaviour. By interacting with cancer cells, it influences disease progression and the metastatic capacity of the tumour. Tumours with a high amount of stroma correspond to poor patient prognosis. The tumour-stroma ratio (TSR) is a strong independent prognostic tool in colon cancer and provides additional value to the current clinically used tumour-node-metastasis classification. The TSR is assessed on conventional haematoxylin and eosin-stained paraffin sections at the invasive front of the tumour. Here we review studies demonstrating the prognostic significance of the TSR in solid epithelial tumours with a focus on colon cancer. Moreover, the biological role of the tumour microenvironment during tumour progression and invasion will be discussed, as well as the attempts to target the tumour stroma for therapeutic purposes. We suggest that the TSR can be implemented with little effort and without additional costs in current routine pathology diagnostics owing to its simplicity and reliability.
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Affiliation(s)
- Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tessa P Sandberg
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Han J M van Krieken
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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42
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van Pelt GW, Huijbers A, Tollenaar RAEM, Mesker WE. In reply to Hynes et al.: 'Back to the future: routine morphological assessment of the tumour microenvironment is prognostic in stages II/III colon cancer in a large population-based study'. Histopathology 2017; 72:531-532. [PMID: 28898449 DOI: 10.1111/his.13396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anouck Huijbers
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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43
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Roeke T, Sobral-Leite M, Dekker TJA, Wesseling J, Smit VTHBM, Tollenaar RAEM, Schmidt MK, Mesker WE. The prognostic value of the tumour-stroma ratio in primary operable invasive cancer of the breast: a validation study. Breast Cancer Res Treat 2017; 166:435-445. [PMID: 28795248 DOI: 10.1007/s10549-017-4445-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/05/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE The primary aim of the current study is to validate the prognostic relevance of the relative amount of tumour-associated stroma, the tumour-stroma ratio, in a large cohort of primary operable breast cancer patients. METHODS A retrospective cohort study was performed on women diagnosed and treated for primarily operable invasive breast cancer in the period from 1 January 1990 till 31 December 1999. Tumour-stroma ratio was estimated by microscopic evaluation of haematoxylin and eosin tumour slides. Two independent observers (k = 0.68) performed tumour-stroma ratio evaluation in a significant part of the cohort. The prognostic potential with respect to overall, recurrence-free and distant metastasis-free survival was evaluated. RESULTS A total of n = 737 women were evaluated. Median follow-up time was 11.5 years. High stromal content was an independent prognosticator for worse overall (hazard ratio 1.56, p = 0.002, 95% confidence interval 1.18-2.05), distant metastasis-free (hazard ratio 1.52, p = 0.008, 95% confidence interval 1.12-2.06) and recurrence-free survival (hazard ratio 1.35, p = 0.046, 95% confidence interval 1.01-1.81). In subgroups of hormone receptor-positive and lymph node-negative cases, high stromal content was also an independent prognosticator for worse outcome. CONCLUSION Tumour-stroma ratio is an independent risk factor for worse overall, distant metastasis-free and recurrence-free survival in primarily operable breast cancer. However, detailed prospective studies with respect to tumour-stroma ratio are necessary to gain more insight in its prognostic potential in clinical practice.
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Affiliation(s)
- Toni Roeke
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Marcelo Sobral-Leite
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Tim J A Dekker
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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44
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Holst S, van Pelt GW, Mesker WE, Tollenaar RA, Belo AI, van Die I, Rombouts Y, Wuhrer M. High-Throughput and High-Sensitivity Mass Spectrometry-Based N-Glycomics of Mammalian Cells. Methods Mol Biol 2017; 1503:185-196. [PMID: 27743367 DOI: 10.1007/978-1-4939-6493-2_14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 06/06/2023]
Abstract
The current protocols for glycomic analysis of cells often require a large quantity of material (5-20 million cells). In order to analyze the N-glycosylation from small amounts of cells (≤1 million) as obtained from, for example, primary cell lines or cell sorting, and in a higher throughput approach, we set up a robust 96-well format PVDF-membrane based N-glycan release protocol followed by linkage-specific sialic acid stabilization, cleanup, and MALDI-TOF-MS analysis. We further evaluated the influence of PNGase F incubation time on the N-glycan profile.
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Affiliation(s)
- Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Postzone S3, Postbus 9600, 2300, RC, Leiden, The Netherlands.
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Ana I Belo
- Department of Molecular Cell Biology and Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Irma van Die
- Department of Molecular Cell Biology and Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Yoann Rombouts
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Postzone S3, Postbus 9600, 2300, RC, Leiden, The Netherlands
- University Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59 000, Lille, France
| | - Manfred Wuhrer
- Division of BioAnalytical Chemistry, VU University Amsterdam, De Boelelaan 1083, Amsterdam, 1081, HV, The Netherlands
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
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45
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Heijs B, Holst S, Briaire-de Bruijn IH, van Pelt GW, de Ru AH, van Veelen PA, Drake RR, Mehta AS, Mesker WE, Tollenaar RA, Bovée JVMG, Wuhrer M, McDonnell LA. Multimodal Mass Spectrometry Imaging of N-Glycans and Proteins from the Same Tissue Section. Anal Chem 2016; 88:7745-53. [PMID: 27373711 DOI: 10.1021/acs.analchem.6b01739] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
On-tissue digestion matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) can be used to record spatially correlated molecular information from formalin-fixed, paraffin-embedded (FFPE) tissue sections. In this work, we present the in situ multimodal analysis of N-linked glycans and proteins from the same FFPE tissue section. The robustness and applicability of the method are demonstrated for several tumors, including epithelial and mesenchymal tumor types. Major analytical aspects, such as lateral diffusion of the analyte molecules and differences in measurement sensitivity due to the additional sample preparation methods, have been investigated for both N-glycans and proteolytic peptides. By combining the MSI approach with extract analysis, we were also able to assess which mass spectral peaks generated by MALDI-MSI could be assigned to unique N-glycan and peptide identities.
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Affiliation(s)
- Bram Heijs
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Arnoud H de Ru
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Peter A van Veelen
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Anand S Mehta
- Department of Microbiology and Immunology, College of Medicine, Drexel University , Philadelphia, Pennsylvania 19129, United States
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center , Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands.,Department of Pathology, Leiden University Medical Center , Leiden, The Netherlands.,Fondazione Pisana per la Scienza ONLUS , Pisa, Italy
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46
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Potjer TP, Mertens BJ, Nicolardi S, van der Burgt YEM, Bonsing BA, Mesker WE, Tollenaar RAEM, Vasen HFA. Application of a Serum Protein Signature for Pancreatic Cancer to Separate Cases from Controls in a Pancreatic Surveillance Cohort. Transl Oncol 2016; 9:242-7. [PMID: 27267843 PMCID: PMC4907893 DOI: 10.1016/j.tranon.2016.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 12/18/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pancreatic cancer (PC) surveillance is currently offered to individuals with a genetic predisposition to PC, but routinely used radiological screening modalities are not entirely reliable in detecting early-stage PC or its precursor lesions. We recently identified a discriminating PC biomarker signature in a sporadic patient cohort. In this study, we investigated if protein profiling can accurately distinguish PC from non-PC in a pancreatic surveillance cohort of genetically predisposed individuals. METHODS Serum samples of 66 individuals with a CDKN2A germline mutation who participated in the pancreatic surveillance program (5 cases, 61 controls) were obtained following a standardized protocol. After sample clean-up, peptide and protein profiles were obtained on an ultrahigh-resolution matrix-assisted laser desorption/ionization-Fourier transform ion cyclotron resonance mass spectrometry platform. A discriminant score for each sample was calculated with a previously designed prediction rule, and the median discriminant scores of cases and controls were compared. Individuals with precursor lesions of PC (n = 4) and individuals with a recent diagnosis of melanoma (n = 4) were also separately considered. RESULTS Cases had a higher median discriminant score than controls (0.26 vs 0.016; P = .001). The only individual with pathologically confirmed precursor lesions of PC could also be clearly distinguished from controls, and having a (recent) medical history of melanoma did not influence the protein signatures. CONCLUSIONS Peptide and protein signatures are able to accurately distinguish PC cases from controls in a pancreatic surveillance setting. Mass spectrometry-based protein profiling therefore seems to be a promising candidate for implementation in the pancreatic surveillance program as an additional screening modality.
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Affiliation(s)
- Thomas P Potjer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Bart J Mertens
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Simone Nicolardi
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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47
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Holst S, Heijs B, de Haan N, van Zeijl RJM, Briaire-de Bruijn IH, van Pelt GW, Mehta AS, Angel PM, Mesker WE, Tollenaar RA, Drake RR, Bovée JVMG, McDonnell LA, Wuhrer M. Linkage-Specific in Situ Sialic Acid Derivatization for N-Glycan Mass Spectrometry Imaging of Formalin-Fixed Paraffin-Embedded Tissues. Anal Chem 2016; 88:5904-13. [PMID: 27145236 DOI: 10.1021/acs.analchem.6b00819] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging is a rapidly evolving field in which mass spectrometry techniques are applied directly on tissues to characterize the spatial distribution of various molecules such as lipids, protein/peptides, and recently also N-glycans. Glycans are involved in many biological processes and several glycan changes have been associated with different kinds of cancer, making them an interesting target group to study. An important analytical challenge for the study of glycans by MALDI mass spectrometry is the labile character of sialic acid groups which are prone to in-source/postsource decay, thereby biasing the recorded glycan profile. We therefore developed a linkage-specific sialic acid derivatization by dimethylamidation and subsequent amidation and transferred this onto formalin-fixed paraffin-embedded (FFPE) tissues for MALDI imaging of N-glycans. Our results show (i) the successful stabilization of sialic acids in a linkage specific manner, thereby not only increasing the detection range, but also adding biological meaning, (ii) that no noticeable lateral diffusion is induced during to sample preparation, (iii) the potential of mass spectrometry imaging to spatially characterize the N-glycan expression within heterogeneous tissues.
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Affiliation(s)
- Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Bram Heijs
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Noortje de Haan
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - René J M van Zeijl
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Anand S Mehta
- Department of Microbiology and Immunology, Drexel University College of Medicine , 245 N. 15th Street, Philadelphia, Pennsylvania 19102, United States
| | - Peggy M Angel
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands.,Department of Pathology, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands.,Fondazione Pisana per la Scienza ONLUS, c/o Croce Rossa Italiana , via Panfilo Castaldi 2, 56121, Ospedaletto, Pisa, Italy
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
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48
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Kjaer-Frifeldt S, Pelt GWV, Christensen RD, Mesker WE, Jakobsen AKM, Smit VT, Tollenaar RA, Soerensen FB. Contribution of tumor stroma ratio to a better selection of stage II colon cancer patients into high and low risk groups: A population based study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3582] [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: 11/20/2022] Open
Affiliation(s)
- Sanne Kjaer-Frifeldt
- Department of Pathology, Odense University Hospital, and Danish Colorectal Cancer Group South, Odense, Denmark
| | | | - Rene dePont Christensen
- Research Unit of General Practice Odense, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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49
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Li Y, Jin K, van Pelt GW, van Dam H, Yu X, Mesker WE, Ten Dijke P, Zhou F, Zhang L. c-Myb Enhances Breast Cancer Invasion and Metastasis through the Wnt/β-Catenin/Axin2 Pathway. Cancer Res 2016; 76:3364-75. [PMID: 27197202 DOI: 10.1158/0008-5472.can-15-2302] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/30/2016] [Indexed: 11/16/2022]
Abstract
The molecular underpinnings of aggressive breast cancers remain mainly obscure. Here we demonstrate that activation of the transcription factor c-Myb is required for the prometastatic character of basal breast cancers. An analysis of breast cancer patients led us to identify c-Myb as an activator of Wnt/β-catenin signaling. c-Myb interacted with the intracellular Wnt effector β-catenin and coactivated the Wnt/β-catenin target genes Cyclin D1 and Axin2 Moreover, c-Myb controlled metastasis in an Axin2-dependent manner. Expression microarray analyses revealed a positive association between Axin2 and c-Myb, a target of the proinflammatory cytokine IL1β that was found to be required for IL1β-induced breast cancer cell invasion. Overall, our results identified c-Myb as a promoter of breast cancer invasion and metastasis through its ability to activate Wnt/β-catenin/Axin2 signaling. Cancer Res; 76(11); 3364-75. ©2016 AACR.
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Affiliation(s)
- Yihao Li
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China. Department of Molecular Cell Biology, Cancer Genomics Centre Netherlands, Leiden University Medical Center, Leiden, the Netherlands
| | - Ke Jin
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans van Dam
- Department of Molecular Cell Biology, Cancer Genomics Centre Netherlands, Leiden University Medical Center, Leiden, the Netherlands. Ludwig Institute for Cancer Research, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Xiao Yu
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter Ten Dijke
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China. Department of Molecular Cell Biology, Cancer Genomics Centre Netherlands, Leiden University Medical Center, Leiden, the Netherlands. Ludwig Institute for Cancer Research, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Fangfang Zhou
- Institutes of Biology and Medical Science, Soochow University, Suzhou, P.R. China.
| | - Long Zhang
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China.
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50
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van Pelt GW, Hansen TF, Bastiaannet E, Frifeldt SK, van Krieken JHJM, AEM Tollenaar R, Sorensen FB, Mesker WE. Stroma-High Lymph Node Involvement Predicts Poor Survival More Accurately for Patients with Stage III Colon Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2472-4971.1000116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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