Professor John Primrose is Professor of Surgery within Medicine at the University of Southampton.
Professor John Primrose is Professor of Surgery at the University of Southampton, a post he has held since 1994. He is one of the few surgeons to be the UK Academy of Medical Sciences and is an NIHR Senior Investigator. He trained in Glasgow and Leeds where he was Lecturer and then Senior Lecturer in Surgery. His clinical interest is in cancer, particularly hepatobiliary (HPB) cancer and Southampton is a large tertiary referral centre for HPB disease. It is the largest laparoscopic HPB centre in the UK.
His research interest is gastrointestinal cancer, clinical and translational, principally liver and colorectal. He is Chief Investigator of several major national and international clinical trials and has changed global practice in 3 critical areas. He is highly published with an “H” factor of 50.
He currently Chairs Deutche Krebshilfe (German Cancer Aid) Translational Funding Committee and serves on the MRC Clinical Training Board and the UKRI Future Leaders Panel. Previously he was a member of numerous CRUK Committees and was Chair of the NCRI Upper GI Clinical Studies Group.
From 2007 to 2017 he was Director of the NIHR Hampshire and Isle of Wight Comprehensive Local Research Network promoting a research led NHS. He was elected Vice President and then President of the Association of Surgeons of Great Britain and Ireland, the principle membership organisation for surgeons in the British Isles. He is (joint) Editor in Chief of the Oxford Textbook of General Surgery. He holds Honorary Chairs at the University of Glasgow (his alma mater) and Emory University, Atlanta.
- Professor Primrose’s research is in gastrointestinal cancer, clinical and translational and Health Services Research. The focus is on improving outcomes for patients undergoing surgical treatment for cancer. This is being achieved through devising and undertaking large scale national and international trials. All the studies are associated with tissue collections with a view to the development of biomarkers which will have prognostic value and may also predict response to therapy.
The FACS trial is the definitive randomised trial examining means of patients with colorectal liver metastases and has changed practice globally. This Health Technology Assessment Programme funded trial has run since 2003 and a final survival review is currently planned. The trial studied various interventions used in the follow up of patients with colorectal cancer following surgery. The analysis published in JAMA shows that more intensive follow up results in more patients having intervention for recurrence but with no effect on mortality over less intensive observations. Translational analysis of collected tissue should add prognostic information which may determine whether a patient requires surveillance.
The EPOC trial, supported by CRUK and reported in the Lancet, showed that the addition of chemotherapy to surgery for colorectal liver metastases improves the progression free survival. The follow-on trial, New EPOC, also funded by CRUK examined whether the addition of cetuximab, an anti EGF receptor antibody, to chemotherapy improves the outcome still further. Surprisingly this showed cetuximab resulted in a 2 year reduction in overall survival (Lancet Oncology), a phenomenon unexplained by any trial related factors. Death was due to rapidly progressive multi-site metastasis (Br J Cancer). This detriment occurs principally in the patients with what may be considered to have the best outlook. It has been shown that the detriment can be predicted by the expression of microRNA Mir21 (Oncotarget). A full multiomics analysis of primary tumour and liver metastases is currently underway via the MRC/CRUK funded S:CORT collaborative to fully clarify the biological basis of the findings.
Other work has attempted to clarify the role of minimally invasive surgery in liver and pancreatic malignancy (Annals of Surgery and others)
Biliary tract cancer
The BILCAP trial is examining whether adjuvant chemotherapy may improve the outcome of biliary tract cancer (cholangiocarcinoma and gallbladder cancer). This is funded by CRUK as are the associated translational studies. We have demonstrated a 16-month improvement in survival in the chemotherapy treated patients and this has been adopted as global standard of care. He is now in receipt of a large industrial grant to sequence the tumours from the tissue blocks to gain insights into the mutational and expression characteristics of bile duct cancer, correlations with treatments and the discovery of the frequency of actionable mutations.
Current PhD Students
Professor Primrose lectures widely nationally and internationally on gastrointestinal cancer, surgical and oncological treatment and translational science. He is dedicated to the training of the next generation of clinical academic surgeons and surgeons with a specialty experience surgery of the liver and pancreas.