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  1. Article ; Online: Dissecting intratumor heterogeneity in HCC: new research strategies and clinical implications.

    Behrens, Shay / Wang, Xin Wei

    Carcinogenesis

    2022  Volume 43, Issue 12, Page(s) 1103–1109

    Abstract: Hepatocellular carcinoma (HCC) accounts for the majority of liver cancers and is driven by a multitude of viral, metabolic, and lifestyle factors initiating liver injury that subsequently progresses to cancer. Despite significant medical advancements, ... ...

    Abstract Hepatocellular carcinoma (HCC) accounts for the majority of liver cancers and is driven by a multitude of viral, metabolic, and lifestyle factors initiating liver injury that subsequently progresses to cancer. Despite significant medical advancements, current treatment options are limited in their efficacy and overall survival remains poor. Recent studies have suggested that intratumor heterogeneity may play a significant role in treatment response, resistance, and overall prognosis. In this review, we will outline new techniques that utilize both human samples and non-human models to evaluate intratumor heterogeneity. Additionally, we will provide an overview of the clinical implications of intratumor heterogeneity on patients with HCC.
    MeSH term(s) Humans ; Carcinoma, Hepatocellular/pathology ; Liver Neoplasms/pathology ; Research Design ; Prognosis
    Language English
    Publishing date 2022-12-13
    Publishing country England
    Document type Review ; Journal Article ; Research Support, N.I.H., Intramural
    ZDB-ID 603134-1
    ISSN 1460-2180 ; 0143-3334
    ISSN (online) 1460-2180
    ISSN 0143-3334
    DOI 10.1093/carcin/bgac099
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  2. Article ; Online: ASO Author Reflections: Surgical Oncology Fellowship Training: Is Training Hitting the Mark?

    Dineen, Sean P / Behrens, Shay / Grubbs, Elizabeth G / Davis, Jeremy L / Farma, Jeffrey M

    Annals of surgical oncology

    2023  Volume 31, Issue 3, Page(s) 1785–1786

    MeSH term(s) Humans ; Surgical Oncology/education ; Fellowships and Scholarships
    Language English
    Publishing date 2023-12-07
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-023-14717-4
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  3. Article ; Online: Delayed adjuvant endocrine therapy is associated with decreased recurrence-free survival following neoadjuvant chemotherapy for breast cancer.

    Sutton, Thomas L / Patel, Ranish / Behrens, Shay / Schwantes, Issac / Fewel, Connor / Gardiner, Stuart K / Johnson, Nathalie / Garreau, Jennifer R

    American journal of surgery

    2023  Volume 225, Issue 5, Page(s) 861–865

    Abstract: Background: In hormone receptor-positive breast cancer (HRPBC), endocrine therapy is often initiated after adjuvant radiotherapy given concerns of radiation fibrosis. No studies have investigated how this may impact outcomes in high-risk patients ... ...

    Abstract Background: In hormone receptor-positive breast cancer (HRPBC), endocrine therapy is often initiated after adjuvant radiotherapy given concerns of radiation fibrosis. No studies have investigated how this may impact outcomes in high-risk patients undergoing neoadjuvant chemotherapy (NAC).
    Methods: Females with nonmetastatic HRPBC receiving NAC from 2011 to 2017 were identified from our multi-institutional database. Interval from surgery to endocrine therapy (ISET) was calculated in weeks. Recurrence-free survival (RFS) and overall survival (OS) were evaluated with Kaplan-Meier and Cox proportional hazards modeling.
    Results: Of 280 patients, 179 (64%) received adjuvant radiotherapy; all deaths (n = 25) and 90% (n = 27) of recurrences occurred in this group, which was the focus of subsequent analysis. Median follow-up was 49 months. Recurrences were predominantly distant metastases (n = 21, 81%). Median ISET was 12 weeks (range 0-55 weeks). On multivariable analysis, ISET >14 weeks was independently associated with worse RFS (HR 3.20, 95% C.I. 1.22-8.40, P = 0.02) but not OS (HR 2.15, 95% C.I. 0.75-6.15, P = 0.15).
    Conclusion: In patients with HRPBC treated with NAC and adjuvant radiation, increasing ISET is associated with adverse oncologic outcomes.
    MeSH term(s) Female ; Humans ; Breast Neoplasms/drug therapy ; Breast Neoplasms/pathology ; Neoadjuvant Therapy/adverse effects ; Disease-Free Survival ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Retrospective Studies
    Language English
    Publishing date 2023-02-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.02.020
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  4. Article ; Online: High-volume centers are associated with higher receipt of combined therapy in stage III pancreatic cancer.

    Behrens, Shay / Potter, Kristin / Patel, Ranish K / Schwantes, Issac R / Sutton, Thomas L / Johnson, Alicia J / Pommier, Rodney F / Sheppard, Brett C

    American journal of surgery

    2023  Volume 225, Issue 5, Page(s) 887–890

    Abstract: Background: Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at a locally advanced stage with vascular involvement which was previously viewed as a contraindication to resection. However, high-volume centers are increasingly capable of ... ...

    Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at a locally advanced stage with vascular involvement which was previously viewed as a contraindication to resection. However, high-volume centers are increasingly capable of resecting complex tumors. We aimed to explore patterns of treatment that are uncharacterized on a population level.
    Methods: A statewide registry was queried from 2003 to 2018 for stage III PDAC. Stepwise logistic regression and Kaplan-Meier were used for statistical analysis.
    Results: We identified 424 eligible patients. 348 (82%) received chemotherapy, 17 (4.0%) received resection, and 59 (13.9%) received both; median survival was 10.7, 8.7, and 22.7 months, respectively (P < 0.001). High-volume centers (≥20 cases per year; OR 5.40 [95% CI: 2.76, 10.58], P < 0.001) and later year of diagnosis (OR 1.12/year [95% CI: 1.04, 1.20], P = 0.004) were associated with higher odds of receiving combined therapy.
    Conclusion: PDAC patients with vascular involvement who receive both systemic chemotherapy and surgical resection have improved overall survival. High-volume centers are independently associated with higher odds of receiving combined systemic therapy and surgical resection.
    MeSH term(s) Humans ; Pancreatic Neoplasms/pathology ; Carcinoma, Pancreatic Ductal/pathology ; Retrospective Studies ; Pancreatic Neoplasms
    Language English
    Publishing date 2023-02-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.02.012
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  5. Article ; Online: Care at high-volume centers is associated with improved outcomes for patients with pancreatic neuroendocrine tumors: A population-level analysis.

    Patel, Ranish K / Sutton, Thomas L / Schwantes, Issac R / Behrens, Shay / Pommier, Rodney F / Rocha, Flavio G / Sheppard, Brett C

    Journal of surgical oncology

    2023  Volume 127, Issue 6, Page(s) 956–965

    Abstract: Background and objectives: Primary resection and debulking of liver metastases have been associated with improved survival in pancreatic neuroendocrine tumors (PNETs). The treatment patterns and outcomes differences between low-volume (LV) institutions ... ...

    Abstract Background and objectives: Primary resection and debulking of liver metastases have been associated with improved survival in pancreatic neuroendocrine tumors (PNETs). The treatment patterns and outcomes differences between low-volume (LV) institutions and high-volume (HV) institutions remains unstudied.
    Methods: A statewide cancer registry was queried for patients with nonfunctional PNET from 1997 to 2018. LV institutions were defined as treating <5 newly diagnosed patients with PNET per year, while HV institutions treated ≥5.
    Results: We identified 647 patients: 393 with locoregional (n = 236 HV care, n = 157 LV care) and 254 with metastatic disease (n = 116 HV care, n = 138 LV care). Patients with HV care had improved disease-specific survival (DSS) compared to patients with LV care for both locoregional (median 63 vs. 32 months, p < 0.001) and metastatic disease (median 25 vs. 12 months, p < 0.001). In patients with metastatic disease, primary resection (hazard ratio [HR]: 0.55, p = 0.003) and HV institution (HR: 0.63, p = 0.002) were independently associated with improved DSS. Furthermore, diagnosis at a HV center was independently associated with higher odds of receiving primary site surgery (odds ratio [OR]: 2.59, p = 0.01) and metastasectomy (OR: 2.51, p = 0.03).
    Conclusions: Care at HV centers is associated with improved DSS in PNET. We recommend referral of all patients with PNETs to HV centers.
    MeSH term(s) Humans ; Neuroendocrine Tumors ; Proportional Hazards Models ; Registries ; Pancreatic Neoplasms/surgery ; Neuroectodermal Tumors, Primitive ; Retrospective Studies
    Language English
    Publishing date 2023-03-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 82063-5
    ISSN 1096-9098 ; 0022-4790
    ISSN (online) 1096-9098
    ISSN 0022-4790
    DOI 10.1002/jso.27225
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    Zs.A 706: Show issues Location:
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  6. Article ; Online: Referral and treatment patterns in pancreatic acinar cell carcinoma: A regional population-level analysis.

    Patel, Ranish K / Parappilly, Michael / Sutton, Thomas L / Behrens, Shay / Schwantes, Issac R / Johnson, Alicia J / Pommier, Rodney F / Sheppard, Brett C

    American journal of surgery

    2023  Volume 231, Page(s) 55–59

    Abstract: Background: Pancreatic acinar cell carcinoma (PACC) is a rare exocrine tumor of the pancreas. We evaluated the effect disease stage, surgical intervention, and institutional volume status plays in survival.: Methods: We queried the Oregon State ... ...

    Abstract Background: Pancreatic acinar cell carcinoma (PACC) is a rare exocrine tumor of the pancreas. We evaluated the effect disease stage, surgical intervention, and institutional volume status plays in survival.
    Methods: We queried the Oregon State Cancer Registry for patients with PACC from 1997 to 2018. Treatment and referral patterns were analyzed, and overall survival (OS) was evaluated with Kaplan-Meier and Cox-proportional hazard analysis.
    Results: 43 patients were identified. Median OS was 33.1 and 7.1 months in those with locoregional and metastatic disease respectively (p ​= ​0.008). Surgical intervention was associated with improved OS (hazard ratio 0.28, p ​< ​0.0001). High volume center (HVC) care trended towards improving OS. While the majority of cases were diagnosed at low volume centers (74%), referral to HVCs was rare (n ​= ​4) and limited to advanced (stage III/IV) disease.
    Conclusion: Stage and surgical resection influence survival outcomes in PACC, more data is needed to delineate the impact of institutional volume status.
    MeSH term(s) Humans ; Carcinoma, Acinar Cell/surgery ; Pancreatic Neoplasms/surgery ; Registries ; Referral and Consultation ; Oregon/epidemiology ; Retrospective Studies
    Language English
    Publishing date 2023-04-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.04.010
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  7. Article ; Online: Metastasectomy for metastatic melanoma in the era of effective systemic therapy.

    Schwantes, Issac R / Sutton, Thomas / Behrens, Shay / Fowler, Graham / Han, Gang / Vetto, John T / Han, Dale

    American journal of surgery

    2023  Volume 231, Page(s) 65–69

    Abstract: Introduction: Effective systemic therapy (EST) in patients with metachronous metastatic melanoma (MMM) improves survival and alters surgical decision-making. Surgical metastasectomy is another treatment option, however, it is unclear if metastasectomy ... ...

    Abstract Introduction: Effective systemic therapy (EST) in patients with metachronous metastatic melanoma (MMM) improves survival and alters surgical decision-making. Surgical metastasectomy is another treatment option, however, it is unclear if metastasectomy confers survival benefit. This study seeks to identify any survival benefit associated with surgical management of MMM.
    Methods: Patients with MMM from 2009 to 2021 were grouped by receipt of metastasectomy and treatment era (pre-versus post-EST). Overall survival (OS) was calculated from date of metastasis and evaluated with Kaplan-Meier analysis.
    Results: Our dataset identified 226 patients with MMM; 32% were diagnosed pre-EST. On Kaplan-Meier analysis, OS was improved for patients undergoing treatment post-versus pre-EST (p < 0.001). In the post-EST era, metastasectomy was associated with an increase in OS compared to no resection (p = 0.022).
    Conclusions: In the post-EST group, EST paired with metastasectomy was associated with improved OS compared to the pre-EST group, suggesting persistent evidence of a survival benefit from metastasectomy.
    MeSH term(s) Humans ; Melanoma/pathology ; Metastasectomy ; Kaplan-Meier Estimate ; Retrospective Studies ; Survival Rate ; Prognosis
    Language English
    Publishing date 2023-05-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.04.020
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  8. Article ; Online: Lineage and ecology define liver tumor evolution in response to treatment.

    Revsine, Mahler / Wang, Limin / Forgues, Marshonna / Behrens, Shay / Craig, Amanda J / Liu, Meng / Tran, Bao / Kelly, Michael / Budhu, Anuradha / Monge, Cecilia / Xie, Changqing / Hernandez, Jonathan M / Greten, Tim F / Wang, Xin Wei / Ma, Lichun

    Cell reports. Medicine

    2024  Volume 5, Issue 2, Page(s) 101394

    Abstract: A tumor ecosystem constantly evolves over time in the face of immune predation or therapeutic intervention, resulting in treatment failure and tumor progression. Here, we present a single-cell transcriptome-based strategy to determine the evolution of ... ...

    Abstract A tumor ecosystem constantly evolves over time in the face of immune predation or therapeutic intervention, resulting in treatment failure and tumor progression. Here, we present a single-cell transcriptome-based strategy to determine the evolution of longitudinal tumor biopsies from liver cancer patients by measuring cellular lineage and ecology. We construct a lineage and ecological score as joint dynamics of tumor cells and their microenvironments. Tumors may be classified into four main states in the lineage-ecological space, which are associated with clinical outcomes. Analysis of longitudinal samples reveals the evolutionary trajectory of tumors in response to treatment. We validate the lineage-ecology-based scoring system in predicting clinical outcomes using bulk transcriptomic data of additional cohorts of 716 liver cancer patients. Our study provides a framework for monitoring tumor evolution in response to therapeutic intervention.
    MeSH term(s) Humans ; Cell Lineage/genetics ; Gene Expression Profiling ; Liver Neoplasms/genetics ; Liver Neoplasms/therapy ; Liver Neoplasms/pathology ; Transcriptome/genetics ; Tumor Microenvironment/genetics
    Language English
    Publishing date 2024-01-26
    Publishing country United States
    Document type Journal Article
    ISSN 2666-3791
    ISSN (online) 2666-3791
    DOI 10.1016/j.xcrm.2024.101394
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  9. Article ; Online: Gastric Intussusception Secondary to Fundic Gland Polyposis.

    Behrens, Shay / Obando, Jorge / Blazer, Dan G

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

    2018  Volume 23, Issue 5, Page(s) 1073–1074

    Language English
    Publishing date 2018-10-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2012365-6
    ISSN 1873-4626 ; 1934-3213 ; 1091-255X
    ISSN (online) 1873-4626 ; 1934-3213
    ISSN 1091-255X
    DOI 10.1007/s11605-018-3975-7
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    Zs.A 5207: Show issues Location:
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  10. Article ; Online: Nutrition Support During Prone Positioning: An Old Technique Reawakened by COVID-19.

    Behrens, Shay / Kozeniecki, Michelle / Knapp, Nathan / Martindale, Robert G

    Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition

    2020  Volume 36, Issue 1, Page(s) 105–109

    Abstract: Acute respiratory distress syndrome (ARDS) is a complex disease characterized by inflammation, resulting in diffuse alveolar damage, proliferation, and fibrosis, and carries a high mortality rate. Recently, the novel coronavirus, severe acute respiratory ...

    Abstract Acute respiratory distress syndrome (ARDS) is a complex disease characterized by inflammation, resulting in diffuse alveolar damage, proliferation, and fibrosis, and carries a high mortality rate. Recently, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has overwhelmed healthcare systems worldwide, as many patients have required hospitalization for the management of respiratory failure similar in nature to ARDS. In addition to lung-protective ventilation strategies aimed to maintain an oxygen saturation >90%, a ratio of partial pressure of oxygen to fraction of inspired oxygen >200, a pH of 7.25-7.40, and a plateau pressure <35 cm H
    MeSH term(s) COVID-19/drug therapy ; COVID-19/physiopathology ; COVID-19/therapy ; COVID-19/virology ; Humans ; Nutrition Therapy/methods ; Prone Position ; Respiration, Artificial/methods ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-10-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 645074-x
    ISSN 1941-2452 ; 0884-5336
    ISSN (online) 1941-2452
    ISSN 0884-5336
    DOI 10.1002/ncp.10592
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