P Quirke

University of Leeds, Leeds, England, United Kingdom

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Publications (226)1578.33 Total impact

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    ABSTRACT: Colorectal cancer (CRC) is a major cause of mortality and morbidity. The impact of inflammatory biomarkers (C-reactive protein etc.) on CRC is increasingly studied including systemic neutrophil-to-lymphocyte ratio (NLR) as they seem to predict outcome. All patients who underwent curative resection for CRC from 2000 to 2004 at Leeds Teaching Hospitals NHS Trust had pre-operative NLR calculated. Demographic, histopathological and survival data were collected. Tissue microarrays were created and stained to determine the mismatch repair (MMR) protein status of each tumour. Local lymphocytic response to the tumour was assessed and graded. About 358 patients were eligible. Of these 88 had an NLR ⩾5, which predicted lower overall survival and greater disease recurrence. A high NLR is associated with higher pT- and pN-stage and a greater incidence of extramural venous invasion. MMR protein status was not associated with NLR. A pronounced lymphocytic reaction at the invasive margin (IM) indicated a better prognosis and was associated with a lower NLR. Neutrophil-to-lymphocyte ratio predicts disease-free and overall survival and is associated with a more aggressive tumour phenotype. The lymphocytic response to tumour at the IM is associated with NLR however dMMR is not. Neutrophil-to-lymphocyte ratio is a cheap, easy-to-access test that predicts outcome in CRC.British Journal of Cancer advance online publication, 30 June 2015; doi:10.1038/bjc.2015.87 www.bjcancer.com.
    British Journal of Cancer 06/2015; 113(2). DOI:10.1038/bjc.2015.87 · 4.82 Impact Factor
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    ABSTRACT: Excellent anatomical knowledge of the rectum and surrounding structures is essential for total mesorectal excision (TME). Denonviliers' fascia (DVF) has been frequently studied, though the optimal anterior plane in TME is still disputed. The relationship of the lateral edges of DVF to the autonomic nerves and mesorectal fascia is unclear. We studied whole mout microscopic sections of en-bloc cadaveric pelvic exenteration and describe implications for TME.
    European Journal of Surgical Oncology 04/2015; 41(6). DOI:10.1016/j.ejso.2015.03.224 · 2.89 Impact Factor
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  • Zeitschrift für Gastroenterologie 08/2014; 52(08). DOI:10.1055/s-0034-1386011 · 1.67 Impact Factor
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    ABSTRACT: Background Complete mesocolic excision with central vascular ligation (CME) produces an optimal colonic cancer specimen. The ability of expert laparoscopic surgeons to produce equivalent specimens is unknown.Methods Fresh specimen photographs and clinicopathological data from patients undergoing laparoscopically assisted CME at St Mark's Hospital, Harrow, were submitted for independent pathological review. Surgery was performed by a mixture of consultant specialists and trainees under consultant specialist supervision, between February 2010 and July 2011. The planes of surgery were graded and tissue morphometry was performed using standard methods. The results were compared with published data from open CME and non-CME surgery.ResultsIn total, 69 patients were identified, and in 96 per cent resection was performed completely or partially by surgical trainees. Laparoscopic CME produced a similar specimen to open CME. The laparoscopic mesocolic plane resection rate was similar to that for open surgery (90 versus 88 per cent). The distance between the bowel wall and site of vascular division was similar for laparoscopic and open right-sided CME (92 versus 95 mm respectively). The corresponding values for left-sided CME were also similar (103 versus 107 mm). Compared with values from two non-CME series, laparoscopic CME had a higher mesocolic plane rate (90 versus 40 and 48 per cent), and resected more tissue between the bowel wall and the vascular division (right-sided: 92 versus 72 and 76 mm; left-sided: 103 versus 85 and 70 mm). The lymph node yield remained low following laparoscopic CME compared with open CME (median 18 versus 32; P < 0·001) and identical to that of non-CME surgery (median 18).Conclusion Laparoscopic CME can be performed to the same standard as open surgery by supervised trainees. However, this did not increase the lymph node yield.
    British Journal of Surgery 08/2014; 101(11). DOI:10.1002/bjs.9602 · 5.21 Impact Factor
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    ABSTRACT: Purpose: Laparoscopic resection and a multimodal approach known as an enhanced recovery program (ERP) have been major changes in colorectal perioperative care that have improved clinical outcomes for colorectal cancer resection. EnROL (Enhanced Recovery Open Versus Laparoscopic) is a multicenter randomized controlled trial examining whether the benefits of laparoscopy still exist when open surgery is optimized within an ERP. Patients and Methods: Adults with colorectal cancer suitable for elective resection were randomly assigned at a ratio of 1:1 to laparoscopic or open surgery within an ERP, stratified by center, cancer site (colon v rectum), and age group (< 66 v 66-75 v > 75 years) using minimization. The primary outcome was physical fatigue at 1 month postsurgery. Secondary outcomes included hospital stay, complications, other patient-reported outcomes (PROs), and physical function. Patients and outcome assessors were blinded until 7 days postsurgery or discharge if earlier. Central independent and blinded pathologic assessment of surgical quality was undertaken. Results: A total of 204 patients (laparoscopy, n = 103; open surgery, n = 101) were recruited from 12 UK centers from July 2008 to April 2012. One-month physical fatigue scores were similar in both groups (mean: laparoscopy, 12.28; 95% CI, 11.37 to 13.19 v open surgery, 12.05; 95% CI, 11.14 to 12.96; adjusted mean difference, -0.23; 95% CI, -1.52 to 1.07). Median total hospital stay was significantly shorter after laparoscopic surgery (median: laparoscopy, 5; interquartile range [IQR], 4 to 9 v open surgery, 7; IQR, 5 to 11 days; P = .033). There were no differences in other secondary outcomes or in specimen quality after central pathologic review. Conclusion: In patients treated by experienced surgeons within an ERP, physical fatigue and other PROs were similar in both groups, but laparoscopic surgery significantly reduced length of hospital stay.
    Journal of Clinical Oncology 06/2014; 32(17):1804-1811. DOI:10.1200/JCO.2013.54.3694 · 18.43 Impact Factor
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    ABSTRACT: Background: Molecular characteristics of cancer vary between individuals. In future, most trials will require assessment of biomarkers to allocate patients into enriched populations in which targeted therapies are more likely to be effective. The MRC FOCUS3 trial is a feasibility study to assess key elements in the planning of such studies. Patients and Methods: Patients with advanced colorectal cancer were registered from 24 centres between February 2010 and April 2011. With their consent, patients' tumour samples were analysed for KRAS/BRAF oncogene mutation status and topoisomerase 1 (topo-1) immunohistochemistry. Patients were then classified into one of four molecular strata; within each strata patients were randomised to one of two hypothesis-driven experimental therapies or a common control arm (FOLFIRI chemotherapy). A 4-stage suite of patient information sheets (PISs) was developed to avoid patient overload. Results: A total of 332 patients were registered, 244 randomised. Among randomised patients, biomarker results were provided within 10 working days (w.d.) in 71%, 15 w.d. in 91% and 20 w.d. in 99%. DNA mutation analysis was 100% concordant between two laboratories. Over 90% of participants reported excellent understanding of all aspects of the trial. In this randomised phase II setting, omission of irinotecan in the low topo-1 group was associated with increased response rate and addition of cetuximab in the KRAS, BRAF wild-type cohort was associated with longer progression-free survival. Conclusions: Patient samples can be collected and analysed within workable time frames and with reproducible mutation results. Complex multi-arm designs are acceptable to patients with good PIS. Randomisation within each cohort provides outcome data that can inform clinical practice.
    British Journal of Cancer 04/2014; 110(9). DOI:10.1038/bjc.2014.182 · 4.82 Impact Factor
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    ABSTRACT: In stage III colon cancer oxaliplatin/5FU-based adjuvant chemotherapy (FOLFOX) improves disease-free survival (DFS) and overall survival (OS). In rectal adenocarcinoma following neoadjuvant chemoradiation (CRT), we examined the benefit of postoperative adjuvant capecitabine and oxaliplatin (XELOX) chemotherapy. Eligible patients were randomly assigned following fluoropyrimidine-based CRT and curative resection to observation or 6 cycles of XELOX. The primary endpoint was DFS; secondary endpoints were acute toxicity and OS. 390 patients were required in each arm, to detect an improvement in 3-year DFS from 40% to 50.5%, with 85% power and two-sided 5% significance level. The study closed prematurely in 2008 because of poor accrual. Only 113 patients were randomly assigned to either observation (n=59) or XELOX (n=54). Compliance was poor, 93% allocated chemotherapy started and 48% completed 6 cycles. Protocolised dose reductions in XELOX were 39%, and levels of G3/G4 toxicity 40%. After a median follow-up of 44.8 months, 16 patients (27%) in the observation arm had relapsed or died compared with 12 patients (22%) in XELOX. The 3-year DFS rate was 78% with XELOX and 71% with observation (hazard ratio [HR] for DFS=0.80; 95% CI: 0.38-1.69; p=0.56). The 3-year OS for XELOX and observation were 89% and 88% respectively (HR for OS=1.18; 95% CI: 0.43-3.26; p=0.75). The observed improvement in DFS for adjuvant XELOX and similar OS were not statistically significant, as expected given the small number of patients and consequent low power. Our findings support the need for trials that test the role of neoadjuvant chemotherapy.
    Annals of Oncology 04/2014; 25(7). DOI:10.1093/annonc/mdu147 · 6.58 Impact Factor
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    ABSTRACT: It has been evident for a while that the result after resection for colon cancer may not have been optimal. Several years ago, this was showed by some leading surgeons in the USA but a concept of improving results was not consistently pursued. Later, surgeons in Europe and Japan have increasingly adopted the more radical principle of complete mesocolic excision (CME) as the optimal approach for colon cancer. The concept of CME is a similar philosophy to that of total mesorectal excision for rectal cancer and precise terminology and optimal surgery are key factors. There are three essential components to CME. The main component involves a dissection between the mesenteric plane and the parietal fascia and removal of the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains all lymph nodes draining the tumour area (Hohenberger et al., Colorectal Disease 11:354-365, 2009; West et al., J Clin Oncol 28:272-278, 2009). The second component is a central vascular tie to completely remove all lymph nodes in the central (vertical) direction. The third component is resection of an adequate length of bowel to remove involved pericolic lymph nodes in the longitudinal direction. The oncological rationale for CME and various technical aspects of the surgical management will be explored. The consensus conference agreed that there are sound oncological hypotheses for a more radical approach than has been common up to now. However, this may not necessarily apply in early stages of the tumour stage. Laparoscopic resection appears to be equally well suited for resection as open surgery.
    International Journal of Colorectal Disease 01/2014; 29(4). DOI:10.1007/s00384-013-1818-2 · 2.42 Impact Factor
  • P Quirke · N P West · I D Nagtegaal
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    ABSTRACT: Care for patients with colon and rectal cancer has improved in the last 20 years; however, a considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organizations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 01/2014; 464(2). DOI:10.1007/s00428-013-1534-x · 2.56 Impact Factor
  • P Quirke · G G A Hutchins · N P West
    Colorectal Disease 11/2013; 15(11):1358-60. DOI:10.1111/codi.12433 · 2.02 Impact Factor
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    EJC Supplements 09/2013; 11(2):60–71. DOI:10.1016/j.ejcsup.2013.07.033 · 9.39 Impact Factor
  • W. Fateen · S. Berri · H. Wood · J. Morgan · G. Taylor · P. Quirke
    Gut 06/2013; 62(Suppl 1):A191-A191. DOI:10.1136/gutjnl-2013-304907.435 · 13.32 Impact Factor
  • Journal of Hepatology 04/2013; 58:S427-S428. DOI:10.1016/S0168-8278(13)61042-9 · 10.40 Impact Factor
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    ABSTRACT: Large, high-resolution displays allow orders of magnitude more data to be visualized at a time than ordinary computer displays. Previous research is inconclusive about the circumstances under which large, high-resolution displays are beneficial and lacks behavioural data to explain inconsistencies in the findings. We conducted an experiment in which participants searched maps for densely or sparsely distributed targets, using 2-million-pixel (0.4 m × 0.3 m), 12-million-pixel (1.3 m × 0.7 m) and 54-million-pixel (3.0 m × 1.3 m) displays. Display resolution did not affect the speed at which dense targets were found, but participants found sparse targets in easily identifiable regions of interest 30% faster with the 54-million-pixel display than with the other displays. This was because of the speed advantage conferred by physical navigation and the fact that the whole dataset fitted onto the 54-million-pixel display. Contrary to expectations, participants found targets at a similar speed and interacted in a similar manner (mostly short panning movements) with the 2- and 12-million-pixel displays even though the latter provided more opportunity for physical navigation, though this may have been because panning used velocity-based control. We are applying these findings to the design of a virtual microscope for the diagnosis of diseases such as cancer.
    Information Visualization 03/2013; 14(2):137-147. DOI:10.1177/1473871613500978 · 0.77 Impact Factor
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    ABSTRACT: Background: Although family history is well established to be a risk factor for developing colorectal cancer (CRC), much less is known about its impact on patient survival. This study aimed to link CRC patient data from the National Study of Colorectal Cancer Genetics (NSCCG) to the National Cancer Data Repository (NCDR) to examine the relationship between family history and the characteristics and outcomes of CRC. Methods: All eligible NSCCG patients underwent a matching process to the NCDR using combinations of their personal identifiers. The characteristics and survival of CRC patients with and without a family history of CRC were compared. Results: Of the 10 937 NSCCG patients eligible to be matched into the NCDR, 10 782 (98.6%) could be fully linked. There were no significant differences between those with and without a family history of CRC (defined as having at least one affected first-degree relative) in terms of age, sex, tumour stage at diagnosis, presence of multiple cancers, mode of presentation to hospital and surgical management, although patients with familial CRC were more likely to have right-sided tumours (P<0.01). The survival of patients with familial CRC was significantly better than those with sporadic CRC (HR 0.89, 95%CI: 0.81–0.98, P=0.02). Conclusion: We have demonstrated that it is possible to robustly match patients recruited into the NSCCG into the NCDR and, by using this record linkage, enable genetic data to be related to CRC phenotype, clinical management and outcome. This study provides evidence that a family history of CRC is associated with better survival after a diagnosis of CRC.
    British Journal of Cancer 03/2013; DOI:10.1038/bjc.2013.91 · 4.82 Impact Factor
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    ABSTRACT: Background Clinical guidelines recommend that, where clinically appropriate, laparoscopic tumour resections should be available for patients with colorectal cancer. This study aimed to examine the introduction of laparoscopic surgery in the English National Health Service. Methods Data were extracted from the National Cancer Data Repository on all patients who underwent major resection for a primary colorectal cancer diagnosed between 2006 and 2008. Laparoscopic procedures were identified from codes in the Hospital Episode Statistics and National Bowel Cancer Audit Project data in the resource. Trends in the use of laparoscopic surgery and its influence on outcomes were examined. Results Of 58 135 resections undertaken over the study period, 10 955 (18·8 per cent) were attempted laparoscopically. This increased from 10·0 (95 per cent confidence interval (c.i.) 8·1 to 12·0) per cent in 2006 to 28·4 (25·4 to 31·4) per cent in 2008. Laparoscopic surgery was used less in patients with advanced disease (modified Dukes' stage ‘D’ versus A: odds ratio (OR) 0·45, 95 per cent c.i. 0·40 to 0·50), rectal tumours (OR 0·71, 0·67 to 0·75), those with more co-morbidity (Charlson score 3 or more versus 0: OR 0·69, 0·58 to 0·82) or presenting as an emergency (OR 0·15, 0·13 to 0·17). A total of 1652 laparoscopic procedures (15·1 per cent) were converted to open surgery. Conversion was more likely in advanced disease (modified Dukes' stage ‘D’ versus A: OR 1·56, 1·20 to 2·03), rectal tumours (OR 1·29, 1·14 to 1·46) and emergencies (OR 2·06, 1·54 to 2·76). Length of hospital stay (OR 0·65, 0·64 to 0·66), 30-day postoperative mortality (OR 0·55, 0·48 to 0·64) and risk of death within 1 year (hazard ratio 0·60, 0·55 to 0·65) were reduced in the laparoscopic group. Conclusion Laparoscopic surgery was used more frequently in low-risk patients. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
    British Journal of Surgery 03/2013; 100(4). DOI:10.1002/bjs.9023 · 5.21 Impact Factor
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    ABSTRACT: Background: The United Kingdom performs poorly in international comparisons of colorectal cancer survival with much of the deficit owing to high numbers of deaths close to the time of diagnosis. This retrospective cohort study investigates the patient, tumour and treatment characteristics of those who die in the first year after diagnosis of their disease. Methods: Patients diagnosed with colon (n=65 733) or rectal (n=26 123) cancer in England between 2006 and 2008 were identified in the National Cancer Data Repository. Multivariable logistic regression was used to investigate the odds of death within 1 month, 1–3 months and 3–12 months after diagnosis. Results: In all, 11.5% of colon and 5.4% of rectal cancer patients died within a month of diagnosis: this proportion decreased significantly over the study period. For both cancer sites, older age, stage at diagnosis, deprivation and emergency presentation were associated with early death. Individuals who died shortly after diagnosis were also more likely to have missing data about important prognostic factors such as disease stage and treatment. Conclusion: Using routinely collected data, at no inconvenience to patients, we have identified some important areas relating to early deaths from colorectal cancer, which merit further research.
    British Journal of Cancer 01/2013; 108(3). DOI:10.1038/bjc.2012.585 · 4.82 Impact Factor
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    ABSTRACT: BACKGROUND: Laparoscopic resection is used widely in the management of colorectal cancer; however, the data on long-term outcomes, particularly those related to rectal cancer, are limited. The results of long-term follow-up of the UK Medical Research Council trial of laparoscopically assisted versus open surgery for colorectal cancer are presented. METHODS: A total of 794 patients from 27 UK centres were randomized to laparoscopic or open surgery in a 2:1 ratio between 1996 and 2002. Long-term follow-up data were analysed to determine differences in survival outcomes and recurrences for intention-to-treat and actual treatment groups. RESULTS: Median follow-up of all patients was 62·9 (interquartile range 22·9 - 92·8) months. There were no statistically significant differences between open and laparoscopic groups in overall survival (78·3 (95 per cent confidence interval (c.i.) 65·8 to 106·6) versus 82·7 (69·1 to 94·8) months respectively; P = 0·780) and disease-free survival (DFS) (89·5 (67·1 to 121·7) versus 77·0 (63·3 to 94·0) months; P = 0·589). In colonic cancer intraoperative conversions to open surgery were associated with worse overall survival (hazard ratio (HR) 2·28, 95 per cent c.i. 1·47 to 3·53; P < 0·001) and DFS (HR 2·20, 1·31 to 3·67; P = 0·007). In terms of recurrence, no significant differences were observed by randomized procedure. However, at 10 years, right colonic cancers showed an increased propensity for local recurrence compared with left colonic cancers: 14·7 versus 5·2 per cent (difference 9·5 (95 per cent c.i. 2·3 to 16·6) per cent; P = 0·019). CONCLUSION: Long-term results continue to support the use of laparoscopic surgery for both colonic and rectal cancer. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
    British Journal of Surgery 01/2013; 100(1). DOI:10.1002/bjs.8945 · 5.21 Impact Factor
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    ABSTRACT: Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010. They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.
    Endoscopy 01/2013; 45(1). DOI:10.1055/s-0032-1325997 · 5.20 Impact Factor

Publication Stats

10k Citations
1,578.33 Total Impact Points


  • 1984–2015
    • University of Leeds
      • • Section of Pathology and Tumour Biology
      • • School of Medicine
      • • Leeds Institute of Molecular Medicine (LIMM)
      • • Division of Clinical Trials Research
      • • Section of Epidemiology and Biostatistics
      Leeds, England, United Kingdom
  • 2011–2013
    • Institute of Genetics and Molecular Medicine
      Edinburgh, Scotland, United Kingdom
  • 2005–2013
    • St. James University
      Сент-Джеймс, New York, United States
  • 2010
    • The Institute of Structural and Molecular Biology
      Londinium, England, United Kingdom
  • 2006
    • Saint James School Of Medicine
      Park Ridge, Illinois, United States
  • 1996
    • Centre for Digestive Diseases
      Newtown, New South Wales, Australia
    • Sapienza University of Rome
      • Laboratory of Experimental Medicine and Pathology Environmental
      Roma, Latium, Italy
  • 1995
    • King's College London
      Londinium, England, United Kingdom
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      Liverpool, England, United Kingdom
  • 1993
    • Bradford College
      Bradford, England, United Kingdom
  • 1992
    • Leeds Teaching Hospitals NHS Trust
      Leeds, England, United Kingdom
  • 1991
    • IRCCS Ospedale Casa Sollievo della Sofferenza
      • Department of Anatomical pathology
      Giovanni Rotondo, Apulia, Italy
  • 1988–1989
    • The University of Edinburgh
      • Division of Pathology
      Edinburgh, Scotland, United Kingdom
    • University of Leicester
      Leiscester, England, United Kingdom