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2016 ; 5
(ä): 385
Nephropedia Template TP
gab.com Text
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A divide-and-conquer strategy in tumor sampling enhances detection of intratumor
heterogeneity in routine pathology: A modeling approach in clear cell renal cell
carcinoma
#MMPMID27127618
Lopez JI
; Cortes JM
F1000Res
2016[]; 5
(ä): 385
PMID27127618
show ga
Intratumor heterogeneity (ITH) is an inherent process in cancer development which
follows for most of the cases a branched pattern of evolution, with different
cell clones evolving independently in space and time across different areas of
the same tumor. The determination of ITH (in both spatial and temporal domains)
is nowadays critical to enhance patient treatment and prognosis. Clear cell renal
cell carcinoma (CCRCC) provides a good example of ITH. Sometimes the tumor is too
big to be totally analyzed for ITH detection and pathologists decide which parts
must be sampled for the analysis. For such a purpose, pathologists follow
internationally accepted protocols. In light of the latest findings, however,
current sampling protocols seem to be insufficient for detecting ITH with
significant reliability. The arrival of new targeted therapies, some of them
providing promising alternatives to improve patient survival, pushes the
pathologist to obtain a truly representative sampling of tumor diversity in
routine practice. How large this sampling must be and how this must be performed
are unanswered questions so far. Here we present a very simple method for tumor
sampling that enhances ITH detection without increasing costs. This method
follows a divide-and-conquer (DAC) strategy, that is, rather than sampling a
small number of large-size tumor-pieces as the routine protocol (RP) advises, we
suggest sampling many small-size pieces along the tumor. We performed a
computational modeling approach to show that the usefulness of the DAC strategy
is twofold: first, we show that DAC outperforms RP with similar laboratory costs,
and second, DAC is capable of performing similar to total tumor sampling (TTS)
but, very remarkably, at a much lower cost. We thus provide new light to push
forward a shift in the paradigm about how pathologists should sample tumors for
achieving efficient ITH detection.