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UCSF Surgical Oncologists Present Clinical Findings at International Conference

2023 SSO Annual Meeting Focuses on New Treatment Options

The latest advances in surgical cancer care and research were showcased at the Society of Surgical Oncology’s (SSO) Annual Meeting, the International Conference on Surgical Cancer Care. The meeting was held in Boston, from March 22 – 25, 2023. 

This year’s program featured presentations and updates on new data and diagnostic developments by the UCSF Health Division of Surgical Oncology.

Some highlights included:

Colorectal Parallel Session: Thursday, March 23, 10:56 am – 11:06 am EDT

25: Combination Immunotherapy with Oncolytic Virus Induces Immunogenic Cell Death and T-cell Proliferation in Colon Cancer: UCSF medical student Paul Wong, BS, presented this study in which viral-delivered immunotherapy was used induce cell death and tumor regression of colorectal liver metastases. The study discovered that oncolytic virus treatment of colon cancer cells induced immunogenic cell death, and that viral-delivery of TNFSF14 (LIGHT) into tumor cells induced impressive T-cell proliferation. The study demonstrates that a tumor-selective, replication competent oncolytic virus can deliver new immunotherapies into the tumor microenvironment while simultaneously inducing cell death that may augment the antitumor immune response. Wong is a graduate student researcher in the lab of Ajay V. Maker, MD, FACS, FSSO, senior author and Chief of the UCSF Division of Surgical Oncology.


The Use of ctDNA in the Management of Breast Malignancies: Current Use and Future Directions: Thursday, March 23, 2:48 pm – 3:04 pm EDT

Mark Jesus M. Magbanua, PhD, UCSF senior scientist discussed his research into circulating tumor DNA (ctDNA). His research has aimed at developing machine learning strategies for combining ctDNA and magnetic resonance imaging (MRI) data to create accurate prediction models of response and outcome in neoadjuvant-treated early-stage breast cancer. His research is also focused on elucidating the biology of ctDNA shedding using machine learning and systems biology approaches.

Plenary Session 1: Friday, March 24, 2:01 pm – 2:13 pm EDT

3: Changes in axillary surgical management over 10 years – report on > 1400 breast cancer patients treated with neoadjuvant chemotherapy on I-SPY2: Laura Esserman, MD and Rita Mukhtar, MD are among the authors of this multicenter study looking at advances in breast care surgery after neoadjuvant chemotherapy (NAC) for 1400 breast cancer patients treated on I-SPY2 trial.The researchers sought to understand the evolution of surgical management of the axilla in patients diagnosed with clinically node negative breast cancer treated with NAC. Of patients at high risk of distant disease treated with NAC, axillary lymph node dissection has significantly decreased over the last decade. Laura Esserman, MD, MBA, is Director of UCSF Breast Care Center and Co-leader of the UCSF Breast Oncology Program. Rita Mukhtar, MD, is a breast oncologic surgeon-scientist and UCSF associate professor of Clinical Surgery.


Breast Parallel Session 1: Friday, March 24, 4:31 pm – 4:41 pm EDT

4: Germline Genetic Mutations in a Prospective Multi-Center Cohort of 241 Phyllodes Tumors; Time to Expand Testing Criteria: Jasmine Wong, MD, UCSF associate professor of Surgery and Barry S. Tong, MS, MPH, UCSF genetic counselor, are among the authors of this study looking atthe role of germline mutations in breast phylloides tumors. Germline genetic mutations in women with phyllodes tumors (PT) are understudied, although a few have described associations with TP53, BRCA1, and RB1 mutations. The researchers sought to determine the prevalence of pathogenic/likely pathogenic (P/LP) variants in women with PT in a contemporary cohort.


PSM Poster Presentations 2: Friday, March 24, 6:16 pm – 6:21 pm EDT

P56: A Data Driven Approach for Individualized Risk Prediction of Serious Complications After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: UCSF associate professor of Surgery, Mohamed Adam, MD, is first author and presenter for this study looking at risk prediction of complications after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). The combination of cytoreductive surgery with HIPEC has been shown to provide benefit in select patients with carcinomatosis but there has been lack of decision tools for preoperative selection for CRS-HIPEC. The researchers sought to leverage state-of-the-art machine learning and traditional algorithms to develop a validated calculator to predict severity of 90-day complications after CRS-HIPEC.


PSM Parallel Session: Saturday, March 25, 8:01 am – 8:11 am EDT

67: Molecular mechanism of colorectal peritoneal metastasis: an interesting TWIST: Mohamed Adam, MD, is also an author for this study aboutmolecular mechanisms of colorectal peritoneal metastases.Colorectal cancer (CRC) carries a high propensity for peritoneal metastasis (PM). The diagnosis of CRC PM results in median overall survival of 16.3 months in treated patients with nearly 0% surviving at 5 years. A process known as the epithelial-mesenchymal transition (EMT) is thought to be the biologic programing responsible for cancer metastasis and is activated by transcription factors (TF). This study sought to examine the expression profile of canonical EMT-TFs and investigate its role in CRC PM.

E161 (Poster) Resected Tumor Outcome and Recurrence (RESTORE) Index Predicts Risk of Hepatocellular Carcinoma Recurrence After Resection: Daniel B. Hoffman, MD, UCSF General Surgery Resident (Presenter and Author); Ryan Gill, MD, PhD, UCSF Professor of Pathology (Author); Mohamed Adam, MD, UCSF Assistant Professor of Surgery (Author); Ajay V. Maker, MD, Professor of Surgery (Author); Shareef Syed, MBChB, MRCS, UCSF Assistant Professor of Surgery (Author); Neil Mehta, MD, UCSF Associate Professor of Medicine (Author). Numerous factors have been associated with an increased risk of recurrence after hepatocellular carcinoma (HCC) resection. Quantifying this risk has remained challenging. The authors aimed to develop an accurate and simple to use score to predict recurrence after HCC resection with curative intent. They conducted a single center retrospective analysis at a tertiary care referral hospital. All patients who underwent resection with curative intent for HCC between January 2005 and May 2019 with complete pathology and follow-up were included. Univariate and multivariate Cox regression analysis was used to identify patient and tumor factors associated with HCC recurrence. A multivariable Cox-proportional hazard regression model with listwise deletion was used to create a risk score. The authors were able to create a simple-to-implement and novel prognostic score that may help identify patients who would benefit most from intensive surveillance strategies or adjuvant therapies after undergoing resection for HCC.


E41 (Poster) Neoadjuvant Chemotherapy and Completion Mastectomies in Invasive Lobular Breast Cancer: Kirithiga Ramalingam, MD, UCSF post-doctoral scholar (Presenter and Author); Rita Mukhtar, MD, UCSF associate professor of Surgery and breast oncologic surgeon-scientist. Women with invasive lobular carcinoma (ILC) have higher rates of positive margins and completion mastectomies compared to those with invasive ductal carcinoma. Reports suggest less response to chemotherapy. The authors retrospectively analyzed a prospectively maintained institutional ILC database and evaluated factors associated with receiving neoadjuvant chemotherapy, and associations with completion mastectomy rates in women with stage I-III hormone receptor positive, HER2 negative ILC, stratified by menopausal status. Neoadjuvant chemotherapy was more common in pre-menopausal women compared to post-menopausal women and was associated with significantly higher rate of completion mastectomy among post-menopausal women. These data suggest the need for further investigation to identify systemic therapies that may reduce mastectomy rates for women with ILC.


E105 (Poster) Mechanical Preparation Plus Oral Antibiotics is Associated With Improved Outcomes After Non-Emergent Obstructed Colon Cancer Surgery: Lyonell B. Kone, MD, MHS, Surgery Resident - University of Illinois at Chicago (Presenter and Author); Mika Varma, MD, UCSF Chief of Colorectal Surgery (Author); Ajay V. Maker, MD, UCSF Professor of Medicine (Author). Mechanical bowel preparation (MBP) and oral antibiotics (OAB) are used as standard procedure in colorectal surgery with the aim to decrease surgical site infection (SSI) and morbidity. There is little data for the use of MBP in obstructed colon cancer. While the increased bacterial load and proximal stool burden in obstructed colon cancer are a good rationale to administer MBP and OAB, the potential for complications related to obstructive physiology, are indications to avoid MBP and thus, are currently used less frequently. In this retrospective study, the authors found that MBP with OAB for patients with non-emergent obstructed colon cancer is associated with decreased surgical site infection, ileus, and 30-day morbidity. They suggest further evaluation is warranted to establish parameters for safe MBP in this patient population.


E124 (Poster) Prophylactic Ureteral Stent at the Time of High-Risk Oncologic Colorectal Surgery is Not Associated With Decreased Injury Rates: Lyonell B. Kone, MD, MHS, Surgery Resident - University of Illinois at Chicago (Presenter and Author); Mika Varma, MD, UCSF Chief of Colorectal Surgery (Author); Ajay V. Maker, MD, UCSF Professor of Surgery (Author). Prophylactic ureteral stents (PUS) are often employed to aid in ureteral identification during colorectal surgery. Numerous studies have not demonstrated a clear advantage for the use of PUS on ureteral injury in these cases. It remains unclear whether PUS has an advantage specifically in the high-risk cohort of oncologic colorectal surgery where margins, lymph node retrieval, radiation therapy, and loss of embryologic tissue planes may render the identification of the ureters more challenging. In their study, the authors found that while patient selection bias for stent placement is difficult to control for in a retrospective analysis, after PSM and high-risk model creation using a large national database, there was no difference in ureteral injury rates during high-risk oncologic colorectal surgery associated with PUS.


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