Surgery News - August 2008 - (Page 9) AUGUST 2008 • SURGERY NEWS NEWS FROM THE COLLEGE Diagnostic Tests Benefit Cancer Research B Y D A V I D O TA , M . D . , FA C S , A N D H E I D I N E L S O N , M . D. , FA C S S urgeons who perform cancer surgery work closely with their pathologists to obtain accurate assessment of tissue diagnosis; final histopathological diagnosis, tumor grading, margin assessment, and clinicopathological staging; and assessment of expression of specific biomarkers in the resected primary tumor. Breast surgeons are familiar with receptor expression in breast cancer; urologists follow prostate-specific antigen tests; and gastrointestinal surgeons order carcinoembryonic antigen tests for their colorectal cancer patients. Advances in laboratory pathology technologies and newly targeted agents have increased the requests for diagnostic tests. For primary breast cancer, there are gene-expression profiling (Oncotype Dx, Mammoprint) for prognosis (Bull. Am. Coll. Surg. 2007;92:43-44), immunohistochemical detection of micrometastases in sentinel lymph nodes, and now GeneSearch intraoperative reverse transcriptase-polymerase chain reaction (PCR) detection of micrometastases in sentinel lymph nodes (Am. J. Surg. 2007;194:426-32). Laboratory investigations in clinical trials are studying novel expression profiles that will predict the response of estrogen receptor–positive breast cancer to antihormonal therapy (Bull. Am. Coll. Surg. 2007;92:47-48). Mutations of a specific gene in the primary tumor are also an important diagnostic test in a resected tumor. Gastrointestinal stromal tumors (GIST) are known to overexpress ckit; and a specific agent, ima- tinib (Gleevec), inhibits the tyrosine kinase of c-kit, resulting in tumor regression. Ron Matteo, M.D., FACS, presented the results of the American College of Surgeons Oncology Group (ACOSOG) Z9001 trial in 2007. This phase III, doubleblinded, randomized adjuvant trial of 1-year placebo versus imatinib in patients with R0/R1 >3 cm resected GIST showed that imatinib taken for 1 year after complete resection of GIST significantly increased recurrence-free survival (RFS). ACOSOG conducted Z9000, a phase II trial of adjuvant imatinib, for 1 year in 106 patients who had a complete resection of >10 cm resected GIST. It turns out that the ckit gene in GIST can have different mutations that are detected by PCR analysis and are found in exon 11, exon 9, platelet-derived growth factor receptor, or wild type. Dr. De- Matteo correlated these mutations with recurrence-free survival in the 106 patients of Z9000 and reported that while imatinib suppressed tumor recurrence during the 1 year of adjuvant therapy, those patients whose GIST had the exon 9 mutation had a much higher recurrence rate compared with the other mutational types. ACOSOG Z9000 showed that mutations of the target (ckit) may affect response to an agent such as imatinib. This finding is also being observed in other tumor types such as colorectal cancer. Inhibitors of epidermal growth factor receptor (EGFR) are available. Mutational analysis of k-RAS gene has shown that tumors with a k-RAS mutation have a lower response to EGFR inhibitors compared with wild type ( J. Clin. Oncol. 2008;26:1626-34). These mutation findings are being incorporated into postoperative adjuvant chemotherapy trials for colorectal cancer. Thus, surgeons now have a multitude of biomarkers to request when resected specimens are sent to pathology. Tumor diagnostics will continue to expand as more targeted anti-cancer therapies make their way through the clinical trials pipeline. Surgeons will likely become more involved in ordering such tests in diagnostic biopsy tissue or resected specimens. Future ACOSOG trials will incorporate diagnostic tests into a trial design. Your participation in these trials will bring you and your patients closer to novel molecular diagnostics and therapeutics. ■ DR. OTA, of Durham, NC, and DR. NELSON, of Rochester, Minn. are ACOSOG co-chairs. SDIF Second Quarter 2008 Performance Report Issued S econd quarter 2008 performance information for the Surgeons Diversified Investment Fund (SDIF) is now available (see chart). The information can also be accessed online at www.surgeonsfund.com. To learn more about SDIF or to receive a hard copy of the performance sheet, contact Savi Pai at 312-202-5056 or spai@facs.org, or Tom Kiley at 312202-5019 or tkiley@facs.org. You may also contact the Fund directly at 800208-6070. An investor should consider the investment objectives, risks, and charges and expenses of SDIF carefully before investing. SDIF’s prospectus contains this and other information about SDIF and should be read before investing. SDIF’s prospectus may be downloaded from SDIF’s Web site at www.surgeonsfund.com or requested by calling 800.208.6070. Course Teaches Interpretation of Outcomes Data he Surgical Research Committee of the ACS will hold the third biennial Outcomes Research Course Nov. 14-16, 2008, at ACS headquarters in Chicago. Intended primarily for surgeon researchers, the course has a flexible curriculum and interactive format. Novices will learn how to work with and interpret data; surgeons with previous experience in outcomes research will receive feedback and practical advice. Day 1 provides a broad overview of the field. On Day 2, participants may choose from among several skills labs. On Day 3, select course faculty will present their own “Research in Progress” in interactive sessions. The course advances surgeons’ skills in clinical epidemiology and statistical analysis through modules covering health-related quality-of-life assessment, decision analysis, meta-analysis, and other aspects specific to surgical outcomes researchers. Visit www.facs.org/cqi/src/ outcomesres.html to obtain a preliminary course schedule, course fee information, or a registration form. Questions? Call 312-202-5319 or email mfitzgerald@facs.org. Participation is limited, and priority is given to ACS members. Register by Aug. 29, 2008, to receive the early sign-up discount. ■ Laparoscopic Images Shown On Web Portal mage of the Month is an innovative feature on e-FACS.org, the ACS members-only Web portal, that provides visitors to the portal’s Minimally Invasive Surgery community with full-color, finely detailed illustrations of laparoscopic procedures. Each month, an image from Cine-Med’s Atlas of Minimally Invasive Surgery is presented with a brief description of the procedure. These images are an excellent resource for surgeons who are looking to enhance their laparoscopic practice. When visiting the Minimally Invasive Surgery community, be sure to read “An Easy Way to Control Liver Bed Hemorrhages During Laparoscopic Cholecystectomies.” This article, featured recently in the Journal of the American College of Surgeons, proposes a technique for controlling persistent hemorrhages of the liver bed. The community can be accessed at http://efacs.org/portal/page/ portal/ACS_Content/ ACSCOMMUNITIESSPECIALTIES/GenSurg_SPA/MinInvCmty. It is managed by community editor Daniel B. Jones, M.D., FACS, and offers videos of laparoscopic procedures as well as links to other resources. ■ Performance numbers have been positively impacted by fee waivers and/or expense reimbursements, without which performance numbers would have been lower. Returns for SDIF are before taxes and are net of all expenses and advisory fees. All index returns listed herein also include the reinvestment of dividends, distributions, and interest (total return). The returns shown do not reflect the deduction of taxes a shareholder may pay on the redemption of SDIF shares or SDIF distributions. The S&P 500 Index/Lehman Brothers U.S. Aggregate Index is composed of 70% S&P 500 Index and 30% of Lehman Brothers U.S. Aggregate Index. SDIF is distributed by Ultimus Fund Distributors, LLC, 225 Pictoria Dr., Suite 450, Cincinnati, OH 45246; 513587-3400. ■ T I Average Annual Total Returns¹ for Periods Ended 6/30/08 ELSEVIER GLOBAL MEDICAL NEWS SDIF S&P 500 Index/Lehmann Brothers U.S. Aggregate Index Quarter –0.29% –2.11% YTD² –5.72% –8.02% 1 Year –5.26% –7.25% Since Inception³ 3.74% 2.03% ¹Average annual total return figures include changes in principal value, reinvested dividends, and capital gain distributions. ²YTD return is not annualized and represents an aggregate total return. ³SDIF commenced operation Sept. 22, 2006. http://www.surgeonsfund.com http://www.surgeonsfund.com http://www.facs.org/cqi/src/outcomesres.html http://efacs.org/portal/page/portal/ACS_Content/ACSCOMMUNITIESSPECIALTIES/GenSurg_SPA/MinInvCmty http://www.facs.org/cqi/src/outcomesres.html http://efacs.org/portal/page/portal/ACS_Content/ACSCOMMUNITIESSPECIALTIES/GenSurg_SPA/MinInvCmty http://efacs.org/portal/page/portal/ACS_Content/ACSCOMMUNITIESSPECIALTIES/GenSurg_SPA/MinInvCmty http://efacs.org/portal/page/portal/ACS_Content/ACSCOMMUNITIESSPECIALTIES/GenSurg_SPA/MinInvCmty
Table of Contents Feed for the Digital Edition of Surgery News - August 2008 Surgery News - August 2008 Contents The 20/20 Vision: Making Amends News From the College: Dedicated Effort Opinion: NOTESworthy? Pediatric Surgery: Burn Remedy Surgery News - August 2008 Surgery News - August 2008 - Contents (Page 1) Surgery News - August 2008 - Contents (Page 2) Surgery News - August 2008 - Contents (Page 3) Surgery News - August 2008 - Contents (Page 4) Surgery News - August 2008 - Contents (Page 5) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 6) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 7) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 8) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 9) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 10) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 11) Surgery News - August 2008 - Opinion: NOTESworthy? (Page 12) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 13) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 14) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 15) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 16)
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