Ernst Bertner: A Surgeon with Prescient Vision for the Largest Medical Center in the World.

More than 75 years ago, surgeon Ernst Bertner envisioned the Texas Medical Center (TMC) as "breathtaking in the scope and breadth of its conception," that would be "one of the largest in the world"; a gigantic medical enterprise that would "attract the greatest scientists of the world" and would combine patient care, research, and education, on a scale that was "second to none." During the next 3 years, Bertner accomplished important pieces of the Herculean task to bring onto the campus 11 major buildings, including the University of Texas MD Anderson Hospital for Cancer Research, for which he was the interim director. This was an extraordinary accomplishment because at the outset he had only a strategic plan, the deed to 134 acres of forest, and financial support from the MD Anderson Foundation! Bertner further forecasted world-class clinical and educational programs in the TMC, stating: "We envision the time when the Medical Center will become a great magnet, drawing leaders in education, medicine, and dental professions. It will provide the physical facilities and the environment in which research will flourish and bring forth for all of us new discoveries in the field of medicine." So how did his bold vision and passionate leadership culminate in the TMC today? By any criteria of scale and program excellence, the TMC today can be regarded as the largest medical center in the world. Occupying a contiguous campus of 1345 acres (2.1 square miles), it comprises 162 buildings, 60+ member institutions, 21 hospitals (> 9200 beds), 21 academic institutions, 4 medical schools, 7 nursing schools, 3 public health schools, 2 pharmacy schools, and a dental school. More than 106,000 patients and visitors come daily to the TMC, which has more than 120,000 employees, including 5000 physicians, 5700 researchers, and 11,000 registered nurses. Ernst Bertner is credited for transforming the original vision of the TMC into a workable program, and whose dynamic devotion to the idea captured the devotion of others to accomplish this extraordinary feat. Thus, during this short interval from 1946 to 1950, Bertner transitioned the leadership of the MD Anderson Cancer Hospital to Dr. R. Lee Clark, conducted a busy general surgery and gynecologic practice, facilitated the monumental transfer of the Baylor Medical School from Dallas to Houston, helped to recruit Dr. Michael DeBakey from New Orleans, and fought a heroic battle against rhabdomyosarcoma, a very rare and aggressive cancer.

Detection of Residual Peritoneal Metastases Following Cytoreductive Surgery Using Pegsitacianine, a pH-Sensitive Imaging Agent: Final Results from a Phase II Study.

BACKGROUND: For patients with peritoneal carcinomatosis, extent of disease and completeness of cytoreductive surgery (CRS) are major prognostic factors for long-term survival. Assessment of these factors could be improved using imaging agents. Pegsitacianine is a pH-sensitive polymeric micelle conjugated to the fluorophore indocyanine green. The micelle disassembles in acidic microenvironments, such as tumors, resulting in localized fluorescence unmasking. We assessed the utility of pegsitacianine in detecting residual disease following CRS. PATIENTS AND METHODS: NCT04950166 was a phase II, non-randomized, open-label, multicenter US study. Patients eligible for CRS were administered an intravenous dose of pegsitacianine at 1 mg/kg 24-72 h before surgery. Following CRS, the peritoneal cavity was reexamined under near-infrared (NIR) illumination to evaluate for fluorescent tissue. Fluorescent tissue identified was excised and evaluated by histopathology. The primary outcome was the rate of clinically significant events (CSE), defined as detection of histologically confirmed residual disease excised with pegsitacianine or a revision in the assessment of completeness of CRS. Secondary outcomes included acceptable safety and pegsitacianine performance. RESULTS: A total of 53 patients were screened, 50 enrolled, and 40 were evaluable for CSE across six primary tumor types. Residual disease was detected with pegsitacianine in 20 of 40 (50%) patients. Pegsitacianine showed high sensitivity and was well tolerated with no serious adverse events (SAEs). Transient treatment-related, non-anaphylactic infusion reactions occurred in 28% of patients. CONCLUSIONS: Pegsitacianine was well tolerated and facilitated the recognition of occult residual disease following CRS. The high rate of residual disease detected suggests that the use of pegsitacianine augmented surgeon assessment and performance during CRS.

Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual.

Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors "microscopic" and "macroscopic" for regional node metastasis are redefined as "clinically occult" and "clinically apparent"; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA-IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472-492. © 2017 American Cancer Society.

Prediction of nonsentinel lymph node metastasis in acral melanoma with positive sentinel lymph nodes.

BACKGROUND: Metastasis in a nonsentinel lymph node (non-SLN) is an unfavorable independent prognostic factor in cutaneous melanoma (CM). Recent data did suggest potential value of completion lymph node dissection (CLND) in CM patients with non-SLN metastasis. Prediction of non-SLN metastasis assists clinicians in deciding on adjuvant therapy without CLND. We analyzed risk factors and developed a prediction model for non-SLN status in acral melanoma (AM). METHODS: This retrospective study enrolled 656 cases of melanoma who underwent sentinel lymph node biopsy at Fudan University Shanghai Cancer Center from 2009 to 2017. We identified 81 SLN + AM patients who underwent CLND. Clinicopathologic data, including SLN tumor burden and non-SLN status were examined with Cox and Logistics regression models. RESULTS: Ulceration, Clark level, number of deposits in the SLN (NumDep) and maximum size of deposits (MaxSize) are independent risk factors associated with non-SLN metastases. We developed a scoring system that combines ulceration, the cutoff values of Clark level V, MaxSize of 2 mm, and NumDep of 5 to predict non-SLN metastasis with an efficiency of 85.2% and 100% positive predictive value in the high-rank group (scores of 17-24). CONCLUSIONS: A scoring system that included ulceration, Clark level, MaxSize, and NumDep is reliable and effective for predicting non-SLN metastasis in SLN-positive AM.

Distinct clinical and somatic mutational features of breast tumors with high-, low-, or non-expressing human epidermal growth factor receptor 2 status.

BACKGROUND: HER2-low breast cancers were reported to have distinct clinicopathological characteristics from HER2-zero; however, the difference in their genetic features remains unclear. This study investigated the clinical and molecular features of breast tumors according to HER2 status. METHODS: We analyzed the clinicopathological and genomic data of 523 Chinese women with breast cancer. Genomic data was generated by targeted next-generation sequencing (NGS) of breast tumor samples using a commercial 520 gene panel. The cohort was stratified according to HER2 status as HER2-zero (n = 90), HER2-low (n = 231), and HER2-positive (n = 202) according to their immunohistochemistry and fluorescence in situ hybridization results. RESULTS: HER2-low breast tumors were enriched with hormone receptor-positive tumors, and who had lower Ki67 expression levels. Genes were differentially mutated across HER2 subgroups. HER2-low tumors had significantly more mutations involved in PI3K-Akt signaling than HER2-positive (p < 0.001) and HER2-zero breast tumors (p < 0.01). HER2-zero tumors had more mutations in checkpoint factors (p < 0.01), Fanconi anemia (p < 0.05), and p53 signaling and cell cycle pathway (p < 0.05) compared to HER2-low breast tumors. Compared with HER2-zero tumors, HER2-low tumors had significantly lower pathological complete response rates after neoadjuvant therapy (15.9% vs. 37.5%, p = 0.042) and proportion of relapsed/progressed patients across follow-up time points (p = 0.031), but had comparable disease-free survival (p = 0.271). CONCLUSION: Our results demonstrate the distinct clinical and molecular features and clinical outcomes of HER2-low breast tumors.

The Politics of Recruiting Dr. R. Lee Clark Jr as the First Permanent Director of the University of Texas MD Anderson Hospital for Cancer Research : Part I: Creating the Texas Cancer Hospital and Events that Might Have Changed the Course of History (1941-1945).

The MD Anderson Cancer Center is one of the world's largest programs in cancer patient care, research, and education; yet, there were many historical twists and turns that almost led the cancer hospital to be located in a different place, under a different authority, and under different leadership. Although it was finally located in Houston, Texas, historical events could possibly have resulted in the cancer hospital being located in Dallas, Galveston, or Austin, Texas. Although Dr. R. Lee Clark Jr eventually became the first permanent Director, five other physicians were offered the position before him. After the war ended, Dr. Bertner, as acting director, urged the university Regents to press their search for a permanent director, but the selection process was snafued and prolonged because Regent D. Frank Strickland filibustered for his own candidate for the permanent job. And it was not Dr. R. Lee Clark Jr, who was favored by the other eight Regents.

The Politics of Recruiting Dr. R Lee Clark Jr. as the First Permanent Director of The University of Texas MD Anderson Hospital for Cancer Research : Part II: The Process and Politics of Recruiting Lt. Colonel R. Lee Clark Jr. to The University of Texas MD Anderson Hospital.

Dr. R. Lee Clark Jr. was a man of bold and extraordinary vision. He was truly a surgical oncology leader of the twentieth century. His leadership had a significant impact on the cancer community nationally and internationally. Historically, it is intriguing that Dr. Clark almost did not become President of the UT MD Anderson Cancer Center, since five other candidates were first offered the position and turned it down, and then Clark himself almost withdrew during the search process because of the political stalemate among the UT Regents to select a candidate. The saga began in 1945, when the Acting Director of MD Anderson Hospital for Cancer Research, Dr. Ernst Bertner, pressed the UT Regents to recruit a permanent Director, since he had just been appointed as the first President of the Texas Medical Center. Bertner was a major figure in recruiting Dr. R. Lee Clark, who was then a Lt. Colonel in the Army Air Force. Dr. Clark's vision for this unique cancer facility was first drafted on Randolph Army Airfield stationary in February 1946. An interesting twist to the story is that Dr. Clark almost did not get the job because of an alternative candidate, and because of the political vicissitudes among the University of Texas Board of Regents. Many of these political barriers were eventually overcome, and Dr. Clark was unanimously approved as the first permanent Director on 13 July 1946, and his leadership over the next 32 years changed the course of history.

The Pivotal Leadership of Doctors R. Lee Clark and Murray M. Copeland in Transforming the Commission on Cancer (1955-1965).

In September 1959, Dr. Clark was appointed as Chair and Dr. Murray M Copeland as Vice Chair of the Committee on Cancer. With their typical leadership style to improve the functions and value of organizations, they reorganized and revitalized the Committee on Cancer during the next 6 years. Thus, Drs. Clark and Copeland and the Committee members developed more uniform standards of cancer registries, implemented the American Joint Committee on Cancer Staging and End Results Reporting (with Dr. Copeland as Chair), published a revised Manual for Cancer Programs (which defined minimum standards requisite for approval of a cancer service), established a new regionalization program (with liaison surgeons from each state), and planned all the cancer educational programs for the College's annual Clinical Congress and Sectional Meetings. Importantly, Clark and Copeland led a 10-year strategic plan (called the "Program of the Sixties") to expand and revitalize the scale and scope of the Committee's activities and to reorganize the Committee structure by including liaison members from other physician, oncologic, and hospital organizations. As Dr. Clark completed his 5-year tenure as Committee Chair in October 1964, he formally recommended a reorganization of the Committee on Cancer to assume an even greater role in the cancer community as the Commission on Cancer. As the new Committee Chair, Dr. Copeland shepherded this recommendation to the ACS Board of Regents, which was approved and implemented in July 1965. The Regents emphasized that the functions and activities of the Committee on Cancer had become so complex and far reaching (under Clark's and Copeland's leadership) that its many subcommittees had already assumed duties of committee stature. Dr. Copeland thus became the first Chair of the Commission on Cancer until October 1965, when Dr. John Cline became Chair. For his contributions to the cancer field and to the College of Surgeons, Dr. Clark received their Distinguished Service Award in October 1969 "for his life-long devotion to the treatment of patients and to research in cancer, for notable service to this College, particularly as Chairman of the Cancer Commission from 1960 to 1964."

An Evidence-Based Staging System for Mucosal Melanoma: A Proposal.

BACKGROUND: There is no widely employed staging system for mucosal melanoma (MuM) that incorporates all anatomic sites. We hypothesized that MuM patients arising from different anatomical sites could be staged using a common approach. METHODS: A prospective database contained 1814 MuM patients with a median follow-up of 5.14 years was employed. Overall survival (OS) was calculated from the time of pathological diagnosis to the date of death from any cause. Multivariate analyses of prognostic variables and OS were performed using the Cox proportional hazard model. RESULTS: For localized MuM, the most significant median OS differences were primary tumors invading submucosa (i.e., T1) versus deeper (i.e., T2/T3/T4): 4.3 versus 3.4, 3.1, and 2.9 years, respectively (p < 0.001). For patients only with regional node metastasis at presentation, the most significant were: 1 versus ≥ 2 regional nodes (N1 vs. N2, 2.5 vs. 2.1 years, p < 0.001). For patients with distant metastasis at presentation, the median OS was 1.5, 1.2, 0.8, and 0.6 years respectively for skin/subcutaneous tissue/distant lymph nodes (M1a), lung metastasis (M1b), all other visceral sites except brain (M1c), and brain (M1d) (p < 0.001). Based on these results, the staging system for MuM is proposed: (1) Stage I: T1N0M0 (median OS, 4.3 years); (2) Stage II: T2-4N0M0 (3.1 years); (3) Stage IIIA: T1-4N1M0 (2.5 years), Stage IIIB: T1-4N2M0 (2.1 years); (4) Stage IV: TanyNanyM1 (0.9 years) (p < 0.001). CONCLUSIONS: A single, unified, staging system for mucosal melanoma inclusive of all anatomical primary tumor sites can harmonize staging of MuM and the design of clinical trials.

Prognostic impact of Breslow thickness in acral melanoma: A retrospective analysis.

BACKGROUND: Evidence for the prognostic importance of tumor thickness in acral melanoma (AM) patients is limited. OBJECTIVE: The objective of the study was to determine the prognostic impact of Breslow thickness in AM. METHODS: This multicenter study enrolled patients diagnosed with localized AM between January 1, 2000 and December 31, 2017. Melanoma-specific survival (MSS) in different tumor thickness strata (T1-T4: ≤1, >1-2, >2-4, >4 mm, respectively) was estimated by the Kaplan-Meier method. Comparisons were performed by the log-rank test and multivariable Cox regression. RESULTS: A total of 853 patients with clinical N0 (cN0) AM were included in the analysis. The median follow-up time was 60.1 months. The median MSS in patients with T1-T4 disease was not reached, 111.0, 92.8, and 67.1 months, respectively. MSS differed significantly among cN0 patients with T1-T3 AM (log-rank P = .004, .012, <0.001 for T1 vs T2, T2 vs T3, and T1 vs T3, respectively); however, there was no significant difference between T3 and T4 AM (hazard ratio = 0.82, 95% CI, 0.62-1.09). Six-subgroup analyses confirmed that survival outcomes were similar between different subgroups with tumor thickness >2 mm. LIMITATIONS: The limitations were retrospective design and some missing variables. CONCLUSIONS: There was no association between tumor thickness and survival in AM patients with a Breslow thickness >2 mm.

The first BGICC consensus and recommendations for breast cancer awareness, early detection and risk reduction in low- and middle-income countries and the MENA region.

In low-middle income countries (LMICs) and the Middle East and North Africa (MENA) region, there is an unmet need to establish and improve breast cancer (BC) awareness, early diagnosis and risk reduction programs. During the 12th Breast, Gynecological & Immuno-oncology International Cancer Conference - Egypt 2020, 26 experts from 7 countries worldwide voted to establish the first consensus for BC awareness, early detection and risk reduction in LMICs/MENA region. The panel advised that there is an extreme necessity for a well-developed BC data registries and prospective clinical studies that address alternative modalities/modified BC screening programs in areas of limited resources. The most important recommendations of the panel were: (a) BC awareness campaigns should be promoted to public and all adult age groups; (b) early detection programs should combine geographically distributed mammographic facilities with clinical breast examination (CBE); (c) breast awareness should be encouraged; and (d) intensive surveillance and chemoprevention strategies should be fostered for high-risk women. The panel defined some areas for future clinical research, which included the role of CBE and breast self-examination as an alternative to radiological screening in areas of limited resources, the interval and methodology of BC surveillance in women with increased risk of BC and the use of low dose tamoxifen in BC risk reduction. In LMICs/MENA region, BC awareness and early detection campaigns should take into consideration the specific disease criteria and the socioeconomic status of the target population. The statements with no consensus reached should serve as potential catalyst for future clinical research.

The Surgical Legacy of Randolph Lee Clark Jr, MD: First Surgeon-in-Chief and Director of University of Texas MD Anderson Cancer Center I. Training and Surgical Practice Before Recruitment to University of Texas MD Anderson Hospital.

Dr R. Lee Clark Jr was the first Surgeon-in-Chief and permanent Director of the University of Texas MD Anderson Cancer Hospital, leading the institution from 1946 to 1978. He is known for his visionary leadership as President, but much less about his prodigious activity as a general surgeon and for his academic contributions as a clinical researcher and surgical educator. His general surgery training at the Mayo Clinic from 1935 to 1939 was extensive, having been involved in over 2000 operations. Dr Clark then began a prodigious surgery practice for 2 years in Jackson, MS. He described his clinical practice: "I have done more than 600 major operations a year, of all types-from the brain to the colon". He was commissioned into the Army Air Force in 1942, as Chief of Surgical Services, with 30 surgeons at a 1000-bed hospital in North Carolina. In 1944, he transferred to Wright Patterson Field in Dayton, OH, as Chief of the Experimental Surgical Unit. He published numerous articles about surgical problems in aviation medicine and edited the journal Air Surgeon's Bulletin. His final assignment in 1945 was Chairman of the Department of Surgery at Randolph Field in San Antonio, TX. On 12 July 1946, after a rather turbulent and vacillating recruitment process, Dr Clark received a unanimous vote by the University of Texas Board of Regents to become the first permanent Director and Surgeon-in-Chief, and so, Randolph Lee Clark Jr began the most productive and impactful phase of his career.

The MD Anderson Cancer Hospital That R. Lee Clark Built.

The MD Anderson Hospital for Cancer Research (as it was named in 1946) incorporated pioneering changes that set new standards in hospital design, construction, and function. It is remarkable that surgeon R. Lee Clark, the new Director of the MD Anderson Hospital, and with no previous experience in hospital construction, personally led the design and supervision of a world class medical care and research facility. This is the untold story of his leadership and his diligence visiting hospitals and cancer facilities in America and Europe, his clever hiring, his supervision of the architectural firms (through 23 versions of architectural plans), his adaptability to the market when building costs were skyrocketing, and his extraordinary ability in raising enormous funds from private, state, and federal sources. He was such a creative genius in his inaugural building project that the new MD Anderson "cancer station" was described by national magazines as totally unique in its design that set new standards in cancer care delivery. With his typical determination, enthusiasm, and creative approach to problem-solving, Clark embarked on this building project in 1946 with a budget of $1,750,000, expecting to complete this project in 2 to 3 years. In fact, the entire project took 8 years and cost five times more than the original estimate, at almost $9,000,000! The process took 2 years for Dr. Clark to visit more than 30 cancer facilities and many academic hospitals in America and in Europe, 2 years of architectural planning, and 4 years of construction. When MD Anderson opened its doors in 1954, it was described by national magazines as "one of the most modern hospitals in the nation."

The Surgical Legacy of Randolph Lee Clark, Jr, MD: First Director and Surgeon-in-Chief of University of Texas MD Anderson Cancer Center II. Surgical Practice and Leadership at University of Texas MD Anderson Cancer Center (1946-1978).

Dr. R. Lee Clark Jr brought a broad-based cancer surgery experience to MD Anderson Hospital for Cancer Research when he became its first Surgeon-in-Chief and full-time salaried physician in 1946. He performed major surgery until 1971 including major head and neck operations, thyroidectomy, mastectomy, radical melanoma and sarcoma surgery, gastric and abdominal-perineal resection, and even hemipelvectomy. He initiated major programs in radiation therapy and mammography breast screening, and organized teams of specialists in a group practice providing multidisciplinary cancer care. Dr. Clark was elected into membership by the James Ewing Society (currently the Society of Surgical Oncology), the Southern Surgical Association, and the American Surgical Association, and was a founding member of the Society of Head and Neck Surgery. The Society of Surgical Oncology honored him with the Lucy Wortham James Award in 1965 and the James Ewing Lecture Award in 1977. Dr. Clark also provided invaluable leadership in the American College of Surgeons, leading a fledgling Committee on Cancer into a robust organization that became the Commission on Cancer. The College of Surgeons honored him with their Distinguished Service Award in 1969. Dr. Clark recruited major surgical leaders and personally designed the new hospital that opened in 1954, described in Time magazine as "the most modern, most ingeniously designed hospital in the U.S." R. Lee Clark, Jr. was an accomplished and busy clinical surgeon, a visionary and charismatic leader, and an organizational genius. Indeed, he was one of the first pioneers in the specialty of surgical oncology.

Academic Advancement in Global Surgery: Appointment, Promotion, and Tenure: Recommendations From the American Surgical Association Working Group on Global Surgery.

: There is growing interest in global surgery among US academic surgical departments. As academic global surgery is a relatively new field, departments may have minimal experience in evaluation of faculty contributions and how they integrate into the existing academic paradigm for promotion and tenure. The American Surgical Association Working Group on Global Surgery has developed recommendations for promotion and tenure in global surgery, highlighting criteria that: (1) would be similar to usual promotion and tenure criteria (eg, publications); (2) would likely be undervalued in current criteria (eg, training, administrative roles, or other activities that are conducted at low- and middle-income partner institutions and promote the partnerships upon which other global surgery activities depend); and (3) should not be considered (eg, mission trips or other clinical work, if not otherwise linked to funding, training, research, or building partnerships).

Academic Partnerships in Global Surgery: An Overview American Surgical Association Working Group on Academic Global Surgery.

: Most surgeons from high-income countries who work in global surgery will do so through partnerships between their institutions and institutions in low- and middle-income countries (LMICs). In this article, the American Surgical Association Working Group for Global Surgery lays out recommendations for criteria that contribute to equitable, sustainable, and effective partnerships. These include ethically engaging with the LMIC partner institution by putting its interests first and by proactively seeking to be aware of cultural issues. Formally structuring the partnership with a memorandum of understanding and clearly designating leaders at both institutions are important criteria for assuring long-term sustainability. Needs assessments can be done using existing methods, such as those established for development of national surgical, obstetric, and anesthesia plans. Such assessments help to identify opportunities for partnerships to be most effective in addressing the biggest surgical needs in the LMIC. Examples of successful high-income countries-LMIC partnerships are provided.

Genetic mutation profile of Chinese HER2-positive breast cancers and genetic predictors of responses to Neoadjuvant anti-HER2 therapy.

PURPOSE: Despite the therapeutic success of existing HER2-targeted therapies, tumors respond quite differently to them. This study aimed at figuring out genetic mutation profile of Chinese HER2-positive patients and investigating predictive factors of neoadjuvant anti-HER2 responses. METHODS: We employed two cohorts. The first cohort was comprised of 181 HER2-positive patients treated at Guangdong Provincial People's Hospital from 2012 to 2018. The second cohort included 40 patients from the first cohort who underwent HER2-targeted neoadjuvant chemotherapy. Genetic mutations were characterized using next-generation sequencing. We employed the most commonly used definition of pathological complete response (pCR)-eradication of tumor from both breast and lymph nodes (ypT0/is ypN0). RESULTS: In Chinese HER2-positive breast cancer patients, TP53 (74.6%), CDK12 (64.6%) and PIK3CA (46.4%) have the highest mutation frequencies. In cohort 2, significant differences were found between pCR and non-pCR groups in terms of the initial Ki67 status, TP53 missense mutations, TP53 LOF mutations, PIK3CA mutations and ROS1 mutations (p = 0.028, 0.019, 0.005, 0.013, 0.049, respectively). Furthermore, TP53 LOF mutations and initial Ki67 status (OR 7.086, 95% CI 1.366-36.749, p = 0.020 and OR 6.007, 95% CI 1.120-32.210, p = 0.036, respectively) were found to be predictive of pCR status. CONCLUSION: TP53 LOF mutations and initial Ki67 status in HER2-positive breast cancer are predictive of pCR status after HER2-targeted NACT.

Special Article Celebrating SSO 80th Anniversary: William Stewart MacComb-The Father of the Society of Surgical Oncology (SSO) and a Pioneering Surgical Oncologist.

The year 2020 marks the 80th anniversary of the Society of Surgical Oncology (SSO), so it is appropriate to celebrate the vision and leadership of Dr. William MacComb, who led the formation of the James Ewing Society as an alumni organization of the Memorial Hospital in New York City. The Ewing Society was later renamed and reorganized as the SSO in 1975. Dr. MacComb was elected as the first and second President of the James Ewing Society from 1940 to 1942. He was elected onto the Executive Council when it first formed in 1947 as the Secretary/Treasurer from 1947 to 1948, as Vice-President from 1948 to 1949, and then continued as a member of the Executive Council for 3 years until 1952. He was elected again as Vice President from 1958 to 1959, as President-elect from 1959 to 1960, as President for a third time from 1960 to 1961, and then as Chair of the Executive Committee from 1961 to 1962. No other person in the history of the SSO was President for multiple terms and also was one of the founding leaders. For these reasons, it would be a fitting accolade to refer to Dr. William MacComb as "the Father of the Society of Surgical Oncology" (founded as the James Ewing Society). Dr. MacComb also served as President of both the American Radium Society (1950) and the Society of Head and Neck Surgery (1969). He one of the first surgical oncologist trained in head and neck surgery, and, uniquely, one of the first physicians to be Board Certified in Radiology because of his training and publications in therapeutic radiology. Dr. MacComb made important contributions in the field of Head and Neck surgery, as a pioneer in the development of radiation therapy and radiation physics, and for advancing the use of combined surgery and radiation therapy for head and neck cancers.

Surgical Oncologists and the COVID-19 Pandemic: Guiding Cancer Patients Effectively through Turbulence and Change.

BACKGROUND: The COVID-19 pandemic has posed extraordinary demands from patients, providers, and health care systems. Despite this, surgical oncologists must maintain focus on providing high-quality, empathetic care for the almost 2 million patients nationally who will be diagnosed with operable cancer this year. The focus of hospitals is transitioning from initial COVID-19 preparedness activities to a more sustained approach to cancer care. METHODS: Editorial Board members provided observations of the implications of the pandemic on providing care to surgical oncology patients. RESULTS: Strategies are presented that have allowed institutions to successfully prepare for cancer care during COVID-19, as well as other strategies that will help hospitals and surgical oncologists manage anticipated challenges in the near term. Perspectives are provided on: (1) maintaining a safe environment for surgical oncology care; (2) redirecting the multidisciplinary model to guide surgical decisions; (3) harnessing telemedicine to accommodate requisite physical distancing; (4) understanding interactions between SARS CoV-2 and cancer therapy; (5) considering the ethical impact of professional guidelines for surgery prioritization; and (6) advocating for our patients who require oncologic surgery in the midst of the COVID-19 pandemic. CONCLUSIONS: Until an effective vaccine becomes available for widespread use, it is imperative that surgical oncologists remain focused on providing optimal care for our cancer patients while managing the demands that the COVID-19 pandemic will continue to impose on all of us.

The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma.

BACKGROUND: The clinicopathological and survival profiles across primary sites in acral melanoma (AM) are still controversial and unclear. METHODS: This is a multi-center retrospective study. Clinicopathological data of AM patients diagnosed between 1 January 2000 and 31 December 2017 from 6 large tertiary hospitals in China were extracted. Chi square tests were used to compare basic characteristics between primary sites of sole, palm and nail bed. Melanoma-specific survival (MSS) differences based on primary sites were compared by log-rank tests and multivariate Cox regressions were used to identify prognostic factors for MSS. RESULTS: In total, 1157 AM patients were included. The sole group had a more advanced initial stage, deeper Breslow thickness, higher recurrence rate and distant metastases risk (all P < 0.05). The proportion of age < 65 years and ulceration were statistically lower in nail bed and palm groups, respectively. A total of 294 patients underwent sentinel lymph node biopsy and rates of positive SLN status had no statistical difference across primary sites. Among 701 patients with genetic profiles, the mutational frequency of BRAF, C-KIT, and PDGFRA were similar except for NRAS (higher in sole group, P = 0.0102). The median MSS of sole, nail bed and palm patients were 65.0 months, 112.0 months, and not reached, respectively (log-rank P = 0.0053). In multivariate analyses, primary site, initial stage, ulceration and recurrence were the prognostic factors for MSS in overall population, but the statistical significance varied over primary sites. CONCLUSIONS: Substantial clinicopathological and survival heterogeneities exist across different primary sites in the AM population. Sole melanoma has worse prognosis compared with palm and nail bed subtypes.