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Feizollahi P, Payandeh M, Samimi Z, Shahrokhvand SZ, Rezaei M, Mahdizadeh B, Taghadosi M. The association between killer cell immunoglobulin-like receptor-ligand (KIR-L) and breast cancer risk among the Kermanshahi women. Meta Gene 2022. [DOI: 10.1016/j.mgene.2021.101005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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2
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Awareness of breast cancer incidence and risk factors among healthy women in Germany: an update after 10 years. Eur J Cancer Prev 2020; 28:515-521. [PMID: 30681416 DOI: 10.1097/cej.0000000000000500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early breast cancer detection programs depend for effectiveness on the participation rate, which is affected by risk factor awareness. This study investigated changes in women's risk factor awareness between 2004 and 2016. Results from a 2004 survey of 2107 healthy women were compared with new data obtained using the same questionnaire in 2016, with 866 participants indicating their knowledge and perceptions regarding breast cancer incidence, risk factors, risk perceptions, and levels of concern. Logistic regression models assessed the influence of time point (2004 vs. 2016) on correct recognition of risk factors such as age at first childbirth, childlessness, lack of breastfeeding, hormone replacement therapy (HRT), and family history. Regression models were adjusted for common sociodemographic characteristics. Reproductive risk factors were regarded as influencing breast cancer risk less often. In 2004, age at first birth, childlessness, and lack of breastfeeding were regarded as risk factors by 24, 32, and 37%, respectively, in comparison with only 15, 18, and 23% in 2016. All changes were statistically significant. Awareness of HRT as a risk factor increased significantly (36-57%), and family history was recognized as a risk by 75 and 73% in 2004 and 2016, respectively. Most women recognized family history as a breast cancer risk factor. This did not change, reflecting the topic's media prominence. Awareness of HRT as a risk factor increased, probably owing to public information after the large HRT studies. It is unclear why reproductive risk factors are less frequently recognized; educational programs should address this information deficit.
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Wunderle M, Häberle L, Hein A, Jud SM, Lux MP, Hack CC, Emons J, Heindl F, Nabieva N, Loehberg CR, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA, Gass P. Influence of Family History of Breast or Ovarian Cancer on Pathological Complete Response and Long-Term Prognosis in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Breast Care (Basel) 2020; 16:254-262. [PMID: 34248466 DOI: 10.1159/000507475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/24/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose In breast cancer, a pathological complete response (pCR) has been described as generally resulting in a favorable prognosis. However, there are subgroups, such as patients with a mutation in BRCA1 or BRCA2, in which the effect of pCR on the prognosis is suspected to be weaker. Patients with a family history of breast and/or ovarian cancer may therefore react differently in relation to pCR and prognosis, and this is investigated in this study. Patients and Methods Breast cancer patients were identified from a clinical breast cancer registry. The study subjects had been treated with neoadjuvant chemotherapy from 2001 to 2018 and their pathological and clinical information as well as medical family history were available. They were considered to have a positive family history if they had at least 1 first-degree relative with breast and/or ovarian cancer. Multivariate logistic regression analyses were performed to study the association between family history, pCR (ypT0; ypN0), and disease-free survival (DFS). Results Of 1,480 patients, 228 (15.4%) had a positive family history. The pCR rates were 24.9% in all patients, and 24.4% and 27.6% in those without/with a family history, respectively. Family history was not associated with a higher pCR rate (adjusted odds ratio [OR] 1.23; 95% confidence interval [CI] 0.85-1.76; p = 0.27) or a different disease-free survival (DFS; adjusted hazard ratio [HR] 1.15; 95% CI 0.88-1.52; p = 0.30). pCR did not affect the prognosis differently in relation to family history. Conclusions In this retrospective analysis, family history was not associated with pCR and DFS. pCR improved survival, independently of family history.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise Paderborn, Women's Hospital St. Josefs-Krankenhaus Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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4
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Schrauder MG, Brunel-Geuder L, Häberle L, Wunderle M, Hoyer J, Csorba R, Reis A, Schulz-Wendtland R, Beckmann MW, Lux MP. Cost effectiveness of bilateral risk-reducing mastectomy and salpingo-oophorectomy. Eur J Med Res 2019; 24:32. [PMID: 31521205 PMCID: PMC6744699 DOI: 10.1186/s40001-019-0391-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Growing demand for risk-reducing surgery in individuals with inherited susceptibility to cancer leads to the question whether these procedures are cost effective for the executing hospitals. This study compared the clinical costs for bilateral risk-reducing mastectomy (BRRM) with and without different types of reconstruction, risk-reducing salpingo-oophorectomy (RRSO), and their combinations with corresponding reimbursements in the statutory health-care system in Germany. Patients and methods Real total costs of care for BRRM with and without reconstruction, RRSO, and their combinations were calculated as the sum of all personnel and technical costs. These costs calculated in a German University hospital were compared with the sum of all reimbursements in the German DRG-based health-care system. Results While sole RRSO, BRRM without reconstruction, and BRRM with secondary DIEP (deep inferior epigastric perforator)—reconstruction still result in a small benefit, we even found shortfalls for the hospital with all other prophylactic operations under consideration. The calculated deficits were especially high for BRRM with implant-based breast reconstruction and for combined operations when the risk reduction is achieved with a minimum of separate operations. Conclusions Risk-reducing surgery in BRCA-mutation carriers is frequently not cost-covering for the executing hospitals in the German health-care system. Thus, appropriate concepts are required to ensure a nationwide care.
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Affiliation(s)
- Michael G Schrauder
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054, Erlangen, Germany. .,Department of Obstetrics and Gynecology, Hospital of Aschaffenburg-Alzenau, Aschaffenburg, Germany.
| | - Lisa Brunel-Geuder
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Juliane Hoyer
- Institute of Human Genetics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Roland Csorba
- Department of Obstetrics and Gynecology, Hospital of Aschaffenburg-Alzenau, Aschaffenburg, Germany.,Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - André Reis
- Institute of Human Genetics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Radiology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054, Erlangen, Germany
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5
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Translational highlights in breast cancer research and treatment: recent developments with clinical impact. Curr Opin Obstet Gynecol 2019; 31:67-75. [DOI: 10.1097/gco.0000000000000510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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6
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Association between breast cancer risk factors and molecular type in postmenopausal patients with hormone receptor-positive early breast cancer. Breast Cancer Res Treat 2019; 174:453-461. [PMID: 30603996 DOI: 10.1007/s10549-018-05115-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Evidence shows that genetic and non-genetic risk factors for breast cancer (BC) differ relative to the molecular subtype. This analysis aimed to investigate associations between epidemiological risk factors and immunohistochemical subtypes in a cohort of postmenopausal, hormone receptor-positive BC patients. METHODS The prospective, single-arm, multicenter phase IV PreFace study (Evaluation of Predictive Factors Regarding the Effectivity of Aromatase Inhibitor Therapy) included 3529 postmenopausal patients with hormone receptor-positive early BC. Data on their epidemiological risk factors were obtained from patients' diaries and their medical histories. Data on estrogen receptor, progesterone receptor, and HER2 receptor status were obtained from pathology reports. Patients with incomplete information were excluded. Data were analyzed using conditional inference regression analysis, analysis of variance, and the chi-squared test. RESULTS In a cohort of 3392 patients, the strongest association with the molecular subtypes of BC was found for hormone replacement therapy (HRT) before diagnosis of early BC. The analysis showed that patients who took HRT at diagnosis had luminal A-like BC more often (83.7%) than those who had never taken HRT or had stopped taking it (75.5%). Luminal B-like BC and HER2-positive BC were diagnosed more often in women who had never taken HRT or had stopped taking it (13.3% and 11.2%, respectively) than in women who were taking HRT at diagnosis of BC (8.3% and 8.0%, respectively). CONCLUSIONS This analysis shows an association between HRT and the distribution of molecular subtypes of BC. However, no associations between other factors (e.g., age at diagnosis, body mass index, smoking status, age at menopause, number of deliveries, age at first delivery, breastfeeding history, or family history) were noted.
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7
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Wöckel A, Lux MP, Janni W, Hartkopf AD, Nabieva N, Taran FA, Overkamp F, Hadji P, Tesch H, Ettl J, Lüftner D, Müller V, Welslau M, Belleville E, Brucker SY, Schütz F, Fasching PA, Fehm TN, Schneeweiss A, Kolberg HC. Update Breast Cancer 2018 (Part 3) - Genomics, Individualized Medicine and Immune Therapies - in the Middle of a New Era: Prevention and Treatment Strategies for Early Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:1110-1118. [PMID: 30498278 PMCID: PMC6255743 DOI: 10.1055/a-0715-2821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/23/2018] [Indexed: 02/08/2023] Open
Abstract
In primary early breast cancer, the aim of treatment planning is to obtain an increasingly better understanding of the disease. The identification of patients with an excellent prognosis could help this group avoid unnecessary treatments. Furthermore, the planning of treatment is becoming increasingly patient-focussed. There is a growing understanding of those patients who benefit particularly from chemotherapy, as well as of those who could benefit from immunotherapy. Studies conducted on immunotherapies will be published shortly. Smaller individual studies offer an initial insight into the efficacy of checkpoint inhibitors (anti-PD1/PDL1 therapies). Not least, one of the largest breast cancer studies of all times has recently come to an end. The use of a multigene test has shown that it is sufficient to identify patients with such a good prognosis that chemotherapy is unnecessary. This review article is intended to summarise the current studies and give an outlook on current developments.
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Affiliation(s)
- Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Germany
| | - Michael P Lux
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Naiba Nabieva
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | - Peyman Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Manfred Welslau
- Onkologie Aschaffenburg, Hämatolo-Onkologische Schwerpunktpraxis am Klinikum Aschaffenburg, Aschaffenburg, Germany
| | | | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Florian Schütz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andreas Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany
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8
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Prediction of pathological complete response and prognosis in patients with neoadjuvant treatment for triple-negative breast cancer. BMC Cancer 2018; 18:1051. [PMID: 30373556 PMCID: PMC6206705 DOI: 10.1186/s12885-018-4925-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background It has been reported that pathological complete response is an important surrogate marker for disease-free survival and overall survival in patients with triple-negative breast cancer. This study investigates predictors of the response to neoadjuvant platinum-based or anthracycline-based treatment, and of the prognosis, in patients with triple-negative breast cancer. Methods A total of 121 patients with triple-negative breast cancer received neoadjuvant treatment with either platinum or anthracycline between 2008 and 2013. Pathological complete response was assessed relative to different treatments using logistic regression models with age, clinical tumor stage, grading, and Ki-67 as predictors and interaction terms, to obtain adjusted and subgroup-specific results. The impact of the pathological complete response rate on disease-free survival and overall survival was also analyzed. Results The pathological complete response rate was higher after platinum/taxane treatment compared with anthracycline/taxane (50.0% vs. 41.8%), but this was not significant in the adjusted analysis (OR 1.44; 95% CI, 0.68 to 3.09). A high histological grade (G3) was a predictor for higher pathological complete response in platinum-based therapy (OR 2.27; 95% CI, 1.00 to 5.30). The effect of neoadjuvant chemotherapy on pathological complete response was significantly different for G1–2 vs. G3 (Pinteraction = 0.013), and additional subgroup-specific differences were noted. Pathological complete response was a predictor for improved disease-free survival and overall survival in both treatment groups, with and without platinum chemotherapy. Conclusions This retrospective study of patients with triple-negative breast cancer adds to the evidence that the treatment effect of platinum may be greatest particularly in G3 tumors. In addition, the effect of pathological complete response on the prognosis does not depend on the treatment used.
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9
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Mansoori Y, Tabei MB, Askari A, Izadi P, Daraei A, Bastami M, Naghizadeh MM, Nariman-Saleh-Fam Z, Mansoori B, Tavakkoly-Bazzaz J. Expression levels of breast cancer-related GAS5 and LSINCT5 lncRNAs in cancer-free breast tissue: Molecular associations with age at menarche and obesity. Breast J 2018; 24:876-882. [PMID: 29785740 DOI: 10.1111/tbj.13067] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/23/2017] [Accepted: 10/02/2017] [Indexed: 12/22/2022]
Abstract
Long noncoding RNAs (lncRNAs) constitute a major class of the human transcriptome which play crucial roles in the key biological processes of both normal and malignant breast cells. Although the aberrant expression of lncRNAs has been well-documented in breast cancer (BC), little is currently known about the association between their expression levels in the breast tissue of healthy women and BC risk factors, especially the reproductive or demographic characteristics that are among the most well-known BC risk modifiers. This study was an attempt to investigate the correlation between the expression levels of 2 breast cancer-related lncRNAs, including GAS5 and LSINCT5, and reproductive and demographic characteristics in 145 normal breast tissues that were obtained from women without breast cancer undergoing cosmetic surgery. Total RNA was extracted from fresh normal breast tissues, and the expression level of target lncRNAs was quantified using real-time qPCR. Differences in the mean normalized gene expression among the subgroups of different variables were analyzed. The expression levels of both genes was lower in the overweight-obese (BMI ≥ 25) subgroup than that in the normal BMI (BMI < 25) subgroup (GAS5 P = .019, LSINCT5 P = .036). Moreover, the expression level of GAS5 was negatively correlated with BMI (r: -.170, P: .041). The expression level of GAS5 was higher in women with late menarche (>13 years) than that with early menarche (≤13 years; P = .017). These findings may assist to obtain insights into the molecular mechanisms through which the reproductive or obesity-related estrogen changes contribute to the breast carcinogenesis. In conclusion, this study presents the first evidence for the presence of a link between the lncRNA expression and the reproductive or obesity related factors in the breast tissue of healthy women.
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Affiliation(s)
- Yaser Mansoori
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad Bagher Tabei
- Department of Medical Genetics, School of Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Askari
- Department of Orthopedy, Shiraz University of Medical Sciences, Shiraz, Iran.,Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pantea Izadi
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Daraei
- Department of Genetics, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Milad Bastami
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Ziba Nariman-Saleh-Fam
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnam Mansoori
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Javad Tavakkoly-Bazzaz
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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10
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Poehls UG, Hack CC, Ekici AB, Beckmann MW, Fasching PA, Ruebner M, Huebner H. Saliva samples as a source of DNA for high throughput genotyping: an acceptable and sufficient means in improvement of risk estimation throughout mammographic diagnostics. Eur J Med Res 2018; 23:20. [PMID: 29703267 PMCID: PMC5921411 DOI: 10.1186/s40001-018-0318-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/10/2018] [Indexed: 01/04/2023] Open
Abstract
Background Breast cancer screening programs seem to be an insufficient tool for women at high genetic risk for breast cancer. These women are not adequately monitored yet. Genetic testing may improve clearly the quality of breast cancer prevention programs. At present, blood samples are favored for obtaining high-quality DNA; however, DNA can also be obtained by collecting saliva. The aim of this study was, on the one hand, to determine whether saliva sampling is a practicable means to obtain sufficient quantity and quality of DNA and, on the other hand, whether it is accepted by patients throughout mammographic diagnostics. Methods 67 consecutive women with diagnostic need for mammography with or without a family history for breast cancer were asked for their basic willingness to undergo a genetic testing by saliva sample in addition to standard diagnostics. Saliva samples were analyzed in terms of DNA quantity and quality. Results 64 (95.6%) women agreed to provide a saliva sample; 3 of them denied participation. And even 63 out of 64 (98.4%) were interested in their specific results. 45 out of 64 samples contained a DNA concentration above 50 ng/µl, 12 samples were between 25 and 50 ng/µl and only 7 of them were under 25 ng/µl with the standard extraction procedure. Conclusion A high number of patients seem to accept salvia samples as a risk assessment tool in breast diagnostics and are interested in their specific risk situation. At the same time, it could be demonstrated that it is an effective way to provide high-quality DNA for breast cancer gene analysis. However, it remains to be shown whether it would be possible to integrate it with the same acceptance in a nationwide breast cancer screening program. Electronic supplementary material The online version of this article (10.1186/s40001-018-0318-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- U G Poehls
- Women's Health Center Wuerzburg, Kaiserstrasse 26, 97070, Würzburg, Germany.,Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - C C Hack
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - A B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 10, 91054, Erlangen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - M Ruebner
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - H Huebner
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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11
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Schneeweiss A, Lux MP, Janni W, Hartkopf AD, Nabieva N, Taran FA, Overkamp F, Kolberg HC, Hadji P, Tesch H, Wöckel A, Ettl J, Lüftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Wallwiener D, Brucker SY, Schütz F, Fasching PA, Fehm TN. Update Breast Cancer 2018 (Part 2) - Advanced Breast Cancer, Quality of Life and Prevention. Geburtshilfe Frauenheilkd 2018; 78:246-259. [PMID: 29576630 PMCID: PMC5862553 DOI: 10.1055/s-0044-101614] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 11/18/2022] Open
Abstract
The treatment of metastatic breast cancer has become more complicated due to increasing numbers of new therapies which need to be tested. Therapies are now being developed to treat special clinical or molecular subgroups. Even though intrinsic molecular subtypes play a major role, more and more new therapies for subgroups and histological subtypes are being developed, such as the use of PARP inhibitors to treat patients with BRCA mutations (breast and ovarian cancer). Supportive therapies are also evolving, allowing problems such as alopecia or nausea and vomiting to be treated more effectively. Treatment-related side effects have a direct impact on the prognosis of patients with metastatic breast cancer, and supportive therapy can improve compliance. Digital tools could be useful to establish better patient management systems. This overview provides an insight into recent trials and how the findings could affect routine treatment. Current aspects of breast cancer prevention are also presented.
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Affiliation(s)
- Andreas Schneeweiss
- National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Michael P. Lux
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Andreas D. Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Naiba Nabieva
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | - Peyman Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Matthias W. Beckmann
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y. Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Florian Schütz
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
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12
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Hack CC, Emons J, Jud SM, Heusinger K, Adler W, Gass P, Haeberle L, Heindl F, Hein A, Schulz-Wendtland R, Uder M, Hartmann A, Beckmann MW, Fasching PA, Pöhls UG. Association between mammographic density and pregnancies relative to age and BMI: a breast cancer case-only analysis. Breast Cancer Res Treat 2017; 166:701-708. [PMID: 28828694 DOI: 10.1007/s10549-017-4446-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/05/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Percentage mammographic density (PMD) is a major risk factor for breast cancer (BC). It is strongly associated with body mass index (BMI) and age, which are themselves risk factors for breast cancer. This analysis investigated the association between the number of full-term pregnancies and PMD in different subgroups relative to age and BMI. METHODS Patients were identified in the breast cancer database of the University Breast Center for Franconia. A total of 2410 patients were identified, for whom information on parity, age, and BMI, and a mammogram from the time of first diagnosis were available for assessing PMD. Linear regression analyses were conducted to investigate the influence on PMD of the number of full-term pregnancies (FTPs), age, BMI, and interaction terms between them. RESULTS As in previous studies, age, number of FTPs, and BMI were found to be associated with PMD in the expected direction. However, including the respective interaction terms improved the prediction of PMD even further. Specifically, the association between PMD and the number of FTPs differed in young patients under the age of 45 (mean decrease of 0.37 PMD units per pregnancy) from the association in older age groups (mean decrease between 2.29 and 2.39 PMD units). BMI did not alter the association between PMD and the number of FTPs. CONCLUSIONS The effect of pregnancies on mammographic density does not appear to become apparent before the age of menopause. The mechanism that drives the effect of pregnancies on mammographic density appears to be counter-regulated by other influences on mammographic density in younger patients.
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Affiliation(s)
- Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Michael Uder
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Uwe G Pöhls
- Practice of Dr. Pöhls, Women's Health Center of Würzburg, Würzburg, Germany
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13
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Häberle L, Hein A, Rübner M, Schneider M, Ekici AB, Gass P, Hartmann A, Schulz-Wendtland R, Beckmann MW, Lo WY, Schroth W, Brauch H, Fasching PA, Wunderle M. Predicting Triple-Negative Breast Cancer Subtype Using Multiple Single Nucleotide Polymorphisms for Breast Cancer Risk and Several Variable Selection Methods. Geburtshilfe Frauenheilkd 2017; 77:667-678. [PMID: 28757654 DOI: 10.1055/s-0043-111602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Studies of triple-negative breast cancer have recently been extending the inclusion criteria and incorporating additional molecular markers into the selection criteria, opening up scope for targeted therapies. The screening phases required for studies of this type are often prolonged, since the process of determining the molecular subtype and carrying out additional biomarker assessment is time-consuming. Parameters such as germline genotypes capable of predicting the molecular subtype before it becomes available from pathology might be helpful for treatment planning and optimizing the timing and cost of screening phases. This appears to be feasible, as rapid and low-cost genotyping methods are becoming increasingly available. The aim of this study was to identify single nucleotide polymorphisms (SNPs) for breast cancer risk capable of predicting triple negativity, in addition to clinical predictors, in breast cancer patients. METHODS This cross-sectional observational study included 1271 women with invasive breast cancer who were treated at a university hospital. A total of 76 validated breast cancer risk SNPs were successfully genotyped. Univariate associations between each SNP and triple negativity were explored using logistic regression analyses. Several variable selection and regression techniques were applied to identify a set of SNPs that together improve the prediction of triple negativity in addition to the clinical predictors of age at diagnosis and body mass index (BMI). The most accurate prediction method was determined by cross-validation. RESULTS The SNP rs10069690 (TERT, CLPTM1L) was the only significant SNP (corrected p = 0.02) after correction of p values for multiple testing in the univariate analyses. This SNP and three additional SNPs from the genes RAD51B, CCND1, and FGFR2 were selected for prediction of triple negativity. The addition of these SNPs to clinical predictors increased the cross-validated area under the curve (AUC) from 0.618 to 0.625. Age at diagnosis was the strongest predictor, stronger than any genetic characteristics. CONCLUSION Prediction of triple-negative breast cancer can be improved if SNPs associated with breast cancer risk are added to a prediction rule based on age at diagnosis and BMI. This finding could be used for prescreening purposes in complex molecular therapy studies for triple-negative breast cancer.
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Affiliation(s)
- Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Rübner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Schneider
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Wing-Yee Lo
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tübingen, Tübingen, Germany
| | - Werner Schroth
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tübingen, Tübingen, Germany
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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14
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Hack CC, Stoll MJ, Jud SM, Heusinger K, Adler W, Haeberle L, Ganslandt T, Heindl F, Schulz-Wendtland R, Cavallaro A, Uder M, Beckmann MW, Fasching PA, Bayer CM. Correlation of mammographic density and serum calcium levels in patients with primary breast cancer. Cancer Med 2017; 6:1473-1481. [PMID: 28464481 PMCID: PMC5463083 DOI: 10.1002/cam4.1066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 03/04/2017] [Accepted: 03/07/2017] [Indexed: 11/25/2022] Open
Abstract
Percentage mammographic breast density (PMD) is one of the most important risk factors for breast cancer (BC). Calcium, vitamin D, bisphosphonates, and denosumab have been considered and partly confirmed as factors potentially influencing the risk of BC. This retrospective observational study investigated the association between serum calcium level and PMD. A total of 982 BC patients identified in the research database at the University Breast Center for Franconia with unilateral BC, calcium and albumin values, and mammogram at the time of first diagnosis were included. PMD was assessed, using a semiautomated method by two readers. Linear regression analyses were conducted to investigate the impact on PMD of the parameters of serum calcium level adjusted for albumin level, and well‐known clinical predictors such as age, body mass index (BMI), menopausal status and confounder for serum calcium like season in which the BC was diagnosed. Increased calcium levels were associated with reduced PMD (P = 0.024). Furthermore, PMD was inversely associated with BMI (P < 0.001) and age (P < 0.001). There was also an association between PMD and menopausal status (P < 0.001). The goodness‐of‐fit of the regression model was moderate. This is the first study assessing the association between serum calcium level and PMD. An inverse association with adjusted serum calcium levels was observed. These findings add to previously published data relating to vitamin D, bisphosphonates, denosumab, and the RANK/RANKL signaling pathway in breast cancer risk and prevention.
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Affiliation(s)
- Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Martin J Stoll
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Werner Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Thomas Ganslandt
- Medical Center for Information and Communication Technology, Erlangen University Hospital, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | | | - Alexander Cavallaro
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Germany
| | - Michael Uder
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany.,Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Christian M Bayer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
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15
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Alomar SY, Alkhuriji A, Trayhyrn P, Alhetheel A, Al-Jurayyan A, Mansour L. Association of the genetic diversity of killer cell immunoglobulin-like receptor genes and HLA-C ligand in Saudi women with breast cancer. Immunogenetics 2016; 69:69-76. [PMID: 27631728 DOI: 10.1007/s00251-016-0950-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/31/2016] [Indexed: 01/12/2023]
Abstract
Breast cancer (BC) progression and metastases have been linked to antitumor immunity inefficiency and particularly to natural killer (NK) cells. Killer cell immunoglobulin-like receptors (KIRs) are the most polymorphic receptors of NK cells. Through their interactions with human leukocyte antigen (HLA)-C ligands, they modulate NK and T cell actions against target cells. Therefore, we studied the combinatorial effect of KIR genes and their HLA-C ligands on the susceptibility to development of BC in Saudi women. The presence of KIR genes and HLA-C1 and HLA-C2 groups was typed in 50 Saudi patients living in Riyadh and 65 healthy controls using polymerase chain reaction with sequence-specific primers. Our results indicated a protective effect by the KIR2DS2, 2DS3, and 2DL5A genes against BC (OR = 0.25, 0.21, and 0.27, respectively, and p < 0.01). The synergistic action of the three genes was observed when they occurred together, and the absence of the three genes increased BC occurrence by 6.5-fold. Distribution of the HLA-C1/C2 ligand between patients and controls showed an increase in the risk of BC occurrence for the heterozygote C1/C2 (OR = 2.33; 95 % CI = 1.08-5.02; p = 0.037) and a protective effect of the homozygote C2C2 (OR = 0.03; 95 % CI = 0.009-0.098; p < 0.001). Combinatory analyses of KIR genes and their HLA-C ligands showed protective effects of KIR2DL2 and 2DL3 in the absence of their HLA-C1 ligand. These results suggested that KIR-gene content combined with their ligand could influence the risk of BC development in women in Saudi Arabia.
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Affiliation(s)
- Suliman Y Alomar
- Zoology Department, College of Sciences, King Saud University, Post Office Box 2455, Riyadh, 11451, Saudi Arabia
| | - Afrah Alkhuriji
- Zoology Department, College of Sciences, King Saud University, Post Office Box 2455, Riyadh, 11451, Saudi Arabia
| | - Paul Trayhyrn
- Zoology Department, College of Sciences, King Saud University, Post Office Box 2455, Riyadh, 11451, Saudi Arabia
- Clore Laboratory, Buckingham Institute for Translational Medicine, University of Buckingham, Buckingham, UK
| | - Abdulkarim Alhetheel
- Department of Microbiology/Pathology, King Khalid University Hospital, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Al-Jurayyan
- Immunology and HLA section, Pathology and Clinical Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Lamjed Mansour
- Zoology Department, College of Sciences, King Saud University, Post Office Box 2455, Riyadh, 11451, Saudi Arabia.
- Faculty of Sciences of Gabès, University of Gabès, Erriadh City, 6072, Zrig Gabès, Tunisia.
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16
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Hein A, Gass P, Walter CB, Taran FA, Hartkopf A, Overkamp F, Kolberg HC, Hadji P, Tesch H, Ettl J, Wuerstlein R, Lounsbury D, Lux MP, Lüftner D, Wallwiener M, Müller V, Belleville E, Janni W, Fehm TN, Wallwiener D, Ganslandt T, Ruebner M, Beckmann MW, Schneeweiss A, Fasching PA, Brucker SY. Computerized patient identification for the EMBRACA clinical trial using real-time data from the PRAEGNANT network for metastatic breast cancer patients. Breast Cancer Res Treat 2016; 158:59-65. [PMID: 27283834 DOI: 10.1007/s10549-016-3850-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
As breast cancer is a diverse disease, clinical trials are becoming increasingly diversified and are consequently being conducted in very small subgroups of patients, making study recruitment increasingly difficult. The aim of this study was to assess the use of data from a remote data entry system that serves a large national registry for metastatic breast cancer. The PRAEGNANT network is a real-time registry with an integrated biomaterials bank that was designed as a scientific study and as a means of identifying patients who are eligible for clinical trials, based on clinical and molecular information. Here, we report on the automated use of the clinical data documented to identify patients for a clinical trial (EMBRACA) for patients with metastatic breast cancer. The patients' charts were assessed by two independent physicians involved in the clinical trial and also by a computer program that tested patients for eligibility using a structured query language script. In all, 326 patients from two study sites in the PRAEGNANT network were included in the analysis. Using expert assessment, 120 of the 326 patients (37 %) appeared to be eligible for inclusion in the EMBRACA study; with the computer algorithm assessment, a total of 129 appeared to be eligible. The sensitivity of the computer algorithm was 0.87 and its specificity was 0.88. Using computer-based identification of patients for clinical trials appears feasible. With the instrument's high specificity, its application in a large cohort of patients appears to be feasible, and the workload for reassessing the patients is limited.
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Affiliation(s)
- Alexander Hein
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander, Erlangen University Hospital University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander, Erlangen University Hospital University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Andreas Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Friedrich Overkamp
- Outpatient Department of Hematology and Oncology, Recklinghausen, Germany
| | | | | | | | - Johannes Ettl
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany
| | | | - Michael P Lux
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander, Erlangen University Hospital University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumour ImmunologyCharité, University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Thomas Ganslandt
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander, Erlangen University Hospital University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.,Institut Fuer Frauengesundheit GmbH, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander, Erlangen University Hospital University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases and Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander, Erlangen University Hospital University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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17
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Burghaus S, Häberle L, Schrauder MG, Heusinger K, Thiel FC, Hein A, Wachter D, Strehl J, Hartmann A, Ekici AB, Renner SP, Beckmann MW, Fasching PA. Endometriosis as a risk factor for ovarian or endometrial cancer - results of a hospital-based case-control study. BMC Cancer 2015; 15:751. [PMID: 26487094 PMCID: PMC4618513 DOI: 10.1186/s12885-015-1821-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 10/16/2015] [Indexed: 01/11/2023] Open
Abstract
Background No screening programs are available for ovarian or endometrial cancer. One reason for this is the low incidence of the conditions, resulting in low positive predictive values for tests, which are not very specific. One way of addressing this problem might be to use risk factors to define subpopulations with a higher incidence. The aim of this study was to investigate the extent to which a medical history of endometriosis can serve as a risk factor for ovarian or endometrial cancer. Methods In a hospital-based case–control analysis, the cases represented patients with endometrial or ovarian cancer who were participating in studies aimed at assessing the risk for these diseases. The controls were women between the age of 40 and 85 who were invited to take part via a newspaper advertisement. A total of 289 cases and 1016 controls were included. Using logistic regression models, it was tested whether self-reported endometriosis is a predictor of case–control status in addition to age, body mass index (BMI), number of pregnancies and previous oral contraceptive (OC) use. Results Endometriosis was reported in 2.1 % of the controls (n = 21) and 4.8 % of the cases (n = 14). Endometriosis was a relevant predictor for case–control status in addition to other predictive factors (OR 2.63; 95 % CI, 1.28 to 5.41). Conclusion This case–control study found that self-reported endometriosis may be a risk factor for endometrial or ovarian cancer in women between 40 and 85 years. There have been very few studies addressing this issue, and incorporating it into a clinical prediction model would require a more precise characterization of the risk factor of endometriosis.
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Affiliation(s)
- Stefanie Burghaus
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany. .,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Michael G Schrauder
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany. .,Current address: ALB FILS KLINKEN GmbH, Goeppingen, Germany.
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - David Wachter
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Johanna Strehl
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Arif B Ekici
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Stefan P Renner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany. .,Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
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18
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Grischke EM, Röhm C, Hahn M, Helms G, Brucker S, Wallwiener D. ICG Fluorescence Technique for the Detection of Sentinel Lymph Nodes in Breast Cancer: Results of a Prospective Open-label Clinical Trial. Geburtshilfe Frauenheilkd 2015; 75:935-940. [PMID: 26500370 PMCID: PMC4596694 DOI: 10.1055/s-0035-1557905] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction: Detection of sentinel lymph nodes (SLN) is the standard procedure to evaluate axillary lymph node status in breast cancer. In addition to known and established procedures such as the blue dye method and scintigraphy, this study investigated the efficacy of a method based on use of the fluorescent dye indocyanine green (ICG). Patients and Method: A total of 126 women with breast cancer histologically verified by punch biopsy were studied during surgical removal of SLN. In addition to SLN marking with technetium and scintigraphy, intra-individual comparison was done using indocyanine green (ICG) for marking instead of the standard blue dye. Results: Scintigraphy had a detection rate of 96 %; the detection rate with ICG was just under 89 %. A body mass index (BMI) > 40 was found to be a limiting factor for the fluorescent method. Investigation into potential toxicities associated with the use of the fluorescent dye ICG revealed no systemic or even local side effects. The fluorescent method was found to be significantly less expensive than the scintigraphy method. Conclusion: The ICG fluorescence technique for the detection of SLN was found to be a valid and feasible method in clinical practice when compared directly with the blue dye method and scintigraphy.
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Affiliation(s)
| | - C. Röhm
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - M. Hahn
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - G. Helms
- Universitäts-Frauenklinik Tübingen, Tübingen
| | - S. Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen
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19
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Lux MP, Hildebrandt T, Knetzger SM, Schrauder MG, Jud SM, Hein A, Rauh C, Fasching PA, Beckmann MW, Thiel FC. Knowledge and attitudes regarding medical research studies among patients with breast cancer and gynecological diseases. BMC Cancer 2015; 15:587. [PMID: 26272451 PMCID: PMC4535277 DOI: 10.1186/s12885-015-1584-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Medical research studies are becoming increasingly important for optimizing the prevention, diagnosis and treatment of illnesses. Participation in research studies can have many benefits for patients. In randomized and controlled clinical studies, they can receive the best possible medical care currently available. However, only a small proportion of patients nowadays are treated within the framework of medical research. The primary endpoint of this study was to discover what level of knowledge patients have about clinical studies and how they currently perceive them, in order to identify ways of optimizing the information provided about studies from the patients’ point of view. Methods The study included 2546 patients (breast cancer 21.6 %, gynecological cancer 8.3 %, obstetrics 32.7 %, endometriosis 7.8 %, fertility treatment 3.2 %, other benign gynecological illnesses 19.2 %, no information for 7.2 %) in the outpatient clinic (45.2 %) and in the in-patient sector (54.8 %) at the Department of Gynecology at Erlangen University Hospital and associated centers. In the single-center study, conducted between January 2011 and January 2012, the patients were asked about their level of knowledge regarding the background to medical research studies and the ways in which they are carried out and used. The patients were also asked how they perceived medical studies and how they thought study conditions might be optimized. The three-page questionnaire was included in the feedback sheet received by patients as part of the hospital’s quality management system. Results As a whole, the group only had moderate knowledge about clinical studies. A majority of the respondents considered that studies were valuable (91.6 %), but only a few were also willing to take part in them (58.4 %). Knowledge and willingness to participate strongly depended on age (P < 0.001), educational level (P < 0.001) and patient group (P < 0.001). Most patients would prefer to decide about participating in studies through a discussion with their outpatient physicians. Conclusions The information that patients have about clinical studies affects whether they participate in them. It is therefore extremely important for patients to be well informed, for their anxieties about participation to be relieved, and for the benefits of participation to be explained to them.
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Affiliation(s)
- Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Sandra-Maria Knetzger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Michael G Schrauder
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
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20
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Kern P, Zarth F, Kimmig R, Rezai M. Impact of Age, Obesity and Smoking on Patient Satisfaction with Breast Implant Surgery - A Unicentric Analysis of 318 Implant Reconstructions after Mastectomy. Geburtshilfe Frauenheilkd 2015; 75:597-604. [PMID: 26166841 DOI: 10.1055/s-0035-1546171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 12/11/2022] Open
Abstract
Aim: Breast reconstruction has become increasingly important for the body image of women with breast cancer. We conducted a study to investigate how patient characteristics correlate with surgical outcome after breast reconstruction with implant after mastectomy and to identify risk factors which could facilitate patient selection for reconstruction. Patients and Methods: For this case cohort analysis (n = 257 patients with 318 heterologous reconstructions), we analyzed BMI, smoking, pre-existing disease, chemotherapy and radiotherapy, one-stage/two-stage reconstruction, immediate/delayed reconstruction, antibiotic therapy and complications, partner interaction and adherence to the decision for reconstruction using a customized questionnaire. Results: 257 patients with 318 implant reconstructions (196 unilateral, 61 bilateral) were eligible for inclusion in the study. Median follow-up time was 3.1 years (range: 1 month to 10 years). Response rate to the questionnaire was 71.8 %. Median age was 49 years (range 24-79 years), median BMI was 22.44 (range 16.33-40.09). A BMI > 30 was inversely correlated with positive self-image (p = 0.004), and implant loss/rotation was more frequent in this group (p < 0.05). Smoking > 10 cigarettes/day had a negative impact on surgical outcome. A positive self-image had a positive impact on partner interaction (p < 0.001) and was correlated with a lower perception of pain. Aesthetic results did not vary with age (p = 0.054). Titanized polypropylene meshes were used to protect against implant rotation (p = 0.034). Rates of capsular fibrosis were low in our cohort (< 10 %), and implant loss rate was less than 2 %. Conclusions: This study offers a differentiated approach for the pre-surgical counselling of patients and shows that patients up to 80 years of age are highly satisfied with implant reconstruction. A high BMI and smoking > 10 cigarettes/day are unfavorable preconditions for implant reconstruction. The use of prophylactic antibiotics was confirmed as beneficial for surgical outcome. A positive self-image after reconstruction strongly influences partner interaction.
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Affiliation(s)
- P Kern
- Department of Gynecology and Obstetrics; University Hospital Essen, Essen ; Breast Center Düsseldorf, Luisenkrankenhaus, Düsseldorf
| | - F Zarth
- Department of Gynecology and Obstetrics; University Hospital Essen, Essen
| | - R Kimmig
- Department of Gynecology and Obstetrics; University Hospital Essen, Essen
| | - M Rezai
- Breast Center Düsseldorf, Luisenkrankenhaus, Düsseldorf
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21
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Rauh C, Schuetz F, Rack B, Stickeler E, Klar M, Orlowska-Volk M, Windfuhr-Blum M, Heil J, Rom J, Sohn C, Andergassen U, Jueckstock J, Fehm T, Loehberg CR, Hein A, Schulz-Wendtland R, Hartmann A, Beckmann MW, Janni W, Fasching PA, Häberle L. Hormone Therapy and its Effect on the Prognosis in Breast Cancer Patients. Geburtshilfe Frauenheilkd 2015; 75:588-596. [PMID: 26166840 DOI: 10.1055/s-0035-1546149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/02/2015] [Accepted: 05/19/2015] [Indexed: 12/23/2022] Open
Abstract
Introduction: Use of hormone therapy (HT) has declined dramatically in recent years. Some studies have reported that HT use before a diagnosis of breast cancer (BC) may be a prognostic factor in postmenopausal patients. This study aimed to examine the prognostic relevance of HT use before BC diagnosis. Methods: Four BC cohort studies in Germany were pooled, and 4492 postmenopausal patients with HT use data were identified. Patient data and tumor characteristics were compared between users and nonusers, along with overall survival (OS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS). Cox proportional hazards models were stratified by study center and adjusted for age at diagnosis, tumor stage, grading, nodal status, and hormone receptors. Results: Women with HT use before the diagnosis of BC were more likely to have a lower tumor stage, to be estrogen receptor-negative, and to have a lower grading. With regard to prognosis there were effects seen for OS, DMFS and LRFS, specifically in the subgroup of women with a positive hormone receptor. In these subgroups, BC patients had a better prognosis with previous HT use. Conclusions: HT use before a diagnosis of BC is associated with a more favorable prognosis in women with a positive hormone receptor status. It may be recommended that the prognostic factor HT should be documented and analyzed as a confounder for prognosis in studies of postmenopausal hormone-responsive breast cancers.
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Affiliation(s)
- C Rauh
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - F Schuetz
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - B Rack
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - E Stickeler
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg
| | - M Klar
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg
| | - M Orlowska-Volk
- Institute of Pathology, Freiburg University Medical Center, Freiburg
| | - M Windfuhr-Blum
- Department of Radiology, Freiburg University Medical Center, Freiburg
| | - J Heil
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - J Rom
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - C Sohn
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - U Andergassen
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - J Jueckstock
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - T Fehm
- Department of Gynecology and Obstetrics, Duesseldorf University Hospital, Düsseldorf
| | - C R Loehberg
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - A Hein
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - R Schulz-Wendtland
- Institute of Diagnostic Radiology, University Breast Center, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - A Hartmann
- Institute of Pathology, University Breast Center, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - M W Beckmann
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - W Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm
| | - P A Fasching
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen ; Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, USA
| | - L Häberle
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen ; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
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22
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Schulz-Wendtland R, Dankerl P, Dilbat G, Bani M, Fasching PA, Heusinger K, Lux MP, Loehberg CR, Jud SM, Rauh C, Bayer CM, Beckmann MW, Wachter DL, Uder M, Meier-Meitinger M, Brehm B. Comparison of Sonography versus Digital Breast Tomosynthesis to Locate Intramammary Marker Clips. Geburtshilfe Frauenheilkd 2015; 75:72-76. [PMID: 25684789 DOI: 10.1055/s-0034-1396164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/08/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve the accuracy when locating intramammary marker clips compared to sonography and could, in future, be used to complement or even completely replace sonography.
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Affiliation(s)
- R Schulz-Wendtland
- Gynäkologische Radiologie, Radiologisches Institut + Universitätsklinikum Erlangen, Erlangen
| | - P Dankerl
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - G Dilbat
- Radiologie, Radiologie Roth, Roth
| | - M Bani
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - P A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - K Heusinger
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M P Lux
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C R Loehberg
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - S M Jud
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C Rauh
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C M Bayer
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - D L Wachter
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - M Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - M Meier-Meitinger
- Gynäkologische Radiologie, Radiologisches Institut + Universitätsklinikum Erlangen, Erlangen
| | - B Brehm
- Gynäkologische Radiologie, Radiologisches Institut + Universitätsklinikum Erlangen, Erlangen
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23
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Fasching PA, Brucker SY, Fehm TN, Overkamp F, Janni W, Wallwiener M, Hadji P, Belleville E, Häberle L, Taran FA, Lüftner D, Lux MP, Ettl J, Müller V, Tesch H, Wallwiener D, Schneeweiss A. Biomarkers in Patients with Metastatic Breast Cancer and the PRAEGNANT Study Network. Geburtshilfe Frauenheilkd 2015; 75:41-50. [PMID: 25684786 DOI: 10.1055/s-0034-1396215] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 12/17/2022] Open
Abstract
Progress has been made in the treatment of metastatic breast cancer in recent decades, but very few therapies use patient or tumor-specific characteristics to tailor individualized treatment. More than ten years after the publication of the reference human genome sequence, analysis methods have improved enormously, fostering the hope that biomarkers can be used to individualize therapies and offer precise treatment based on tumor and patient characteristics. Biomarkers at every level of the system (genetics, epigenetics, gene expression, micro-RNA, proteomics and others) can be used for this. This has led to changes in clinical study designs, with drug developments often only focusing on small or very small subgroups of patients and tumors. The screening and registration of patients and their molecular tumor data has therefore become very important for the successful completion of clinical studies. This new form of medicine presents particular challenges for patients and physicians. Even in this new age of genome-wide analysis, the focus should still be on the patients' quality of life. This review summarizes recent developments and describes how the PRAEGNANT study network manages the aforementioned medical challenges and changes to create a professional infrastructure for patients and physicians.
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Affiliation(s)
- P A Fasching
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen ; Wissenschaftliche Leitung PRAEGNANT-Studiennetzwerk
| | - S Y Brucker
- Forschungsinstitut für Frauengesundheit, Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen ; Wissenschaftliche Leitung PRAEGNANT-Studiennetzwerk
| | - T N Fehm
- Universitäts-Frauenklinik Düsseldorf, Heinrich-Heine Universität Düsseldorf, Düsseldorf
| | - F Overkamp
- Oncologianova GmbH Recklinghausen, Recklinghausen
| | - W Janni
- Universitätsfrauenklinik Ulm, Ulm
| | - M Wallwiener
- Universitätsfrauenklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Heidelberg
| | - P Hadji
- Krankenhaus Nordwest, Klinik für Gynäkologie und Geburtshilfe, Frankfurt am Main
| | | | - L Häberle
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen ; Unit of Biostatistics, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen
| | - F-A Taran
- Universitäts-Frauenklinik, Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen
| | - D Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie; Charité Campus Benjamin Franklin Berlin, Berlin
| | - M P Lux
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - J Ettl
- Abteilung Gynäkologie und Geburtshilfe, Klinikum rechts der Isar, Technische Universität München, Munich
| | - V Müller
- Klinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H Tesch
- Onkologie Bethanien, Frankfurt am Main ; Studienleitung PRAEGNANT-Studie
| | - D Wallwiener
- Universitäts-Frauenklinik, Department für Frauengesundheit, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Tübingen ; Studienleitung PRAEGNANT-Studie
| | - A Schneeweiss
- Universitätsfrauenklinik Ulm, Ulm ; Nationales Centrum für Tumorerkrankungen, Heidelberg
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24
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Maass N, Schütz F, Fasching PA, Fehm T, Janni W, Kümmel S, Kolberg HC, Lüftner D, Wallwiener M, Lux MP. Breast Cancer Update 2014 - Focus on the Patient and the Tumour. Geburtshilfe Frauenheilkd 2015; 75:170-182. [PMID: 25797960 PMCID: PMC4361168 DOI: 10.1055/s-0035-1545704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 02/06/2023] Open
Abstract
The therapy for patients with breast cancer has developed markedly in the past ten years. Our understanding of the molecular biology of tumours and the characteristics of the patients has shaped the recent advances. In this review we present the latest knowledge about the therapy for breast cancer. There are new tests and options not only in the field of anti-HER2 therapy but also in the management of triple negative and hormone receptor-positive patients. Comprehension of prognosis and therapeutic response to chemotherapies is little by little helping to define patient groups who will not respond to chemotherapy or who do not need treatment because their prognosis is extremely good. In the field of anti-HER2 therapy, work is continuing on the development of drugs suitable for and able to overcome trastuzumab resistance. For hormone receptor-positive cancers, we now have a better understanding of which therapy groups will benefit from which anti-endocrine drugs, and which will be able to overcome a possible resistance (treatment of the PI3K pathways, inhibition of the cell cycle). Molecular tests are still being evaluated with regard to the clinical situations in which they may have the greatest relevance for therapeutic decision-making; however, evidence is also increasing as to the fields in which good predictions for the prognosis can be obtained. On the whole, more work is needed to promote our understanding of the new developments in diagnostics and therapy and to involve both physicians and patients equally in the procedures.
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Affiliation(s)
- N. Maass
- Department of Gynecology and Obstetrics, University Hospital Aachen, Aachen
| | - F. Schütz
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - P. A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - T. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf
| | - W. Janni
- Frauenklinik, Klinikum der Universität Ulm, Ulm
| | - S. Kümmel
- Brustzentrum, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - H.-C. Kolberg
- Klinik für Gynäkologie und Geburtshilfe, Marienhospital Bottrop, Bottrop
| | - D. Lüftner
- Medizinische Klinik und Poliklinik II, Campus Charité Mitte, Berlin
| | - M. Wallwiener
- Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - M. P. Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
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Liang Z, Sun XY, Xu LC, Fu RZ. Abnormal expression of serum soluble E-cadherin is correlated with clinicopathological features and prognosis of breast cancer. Med Sci Monit 2014; 20:2776-82. [PMID: 25553984 PMCID: PMC4280058 DOI: 10.12659/msm.892049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Increased amounts of soluble E-cadherin (E-cad) have been found in the serum in various cancers, but the role of serum soluble E-cad in the prognosis of breast cancer patients has not been explored in Asian populations. MATERIAL/METHOD Blood samples from 111 consecutive patients diagnosed with breast cancer and 55 healthy controls were investigated.Serum soluble E-cad expression levels were measured by enzyme-linked immunosorbent assay(ELISA) with an immunoassay kit according to the manufacturer's directions. Kaplan-Meier analyses were used to evaluate the association between serum soluble E-cad expression level and survival. All statistical tests were 2-sided. RESULTS The serum levels of soluble E-cad in breast cancer patients were significantly higher than those of the control group (2218.9±319.6 ng/ml vs. 742.8±91.7 ng/ml, p<0.001). Serum levels of soluble E-cad correlated significantly with TNM stage (P=0.007), tumor grade (P=0.03), and lymph node metastasis (P<0.001). Kaplan-Meier analysis with the log-rank test indicated that high serum levels of soluble E-cad had a significant impact on overall survival (55.4% vs. 81.4%; P=0.032) and disease-free survival (36.8% vs. 67.8%; P=0.002) in breast cancer. Multivariate analysis revealed that serum levels of soluble E-cad were independently associated with overall survival and disease-free survival in breast cancer patients. CONCLUSIONS Serum soluble E-cad level is an independent prognostic factor in Asian breast cancer patients.
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Affiliation(s)
- Zhi Liang
- Shandong University, Jinan, China (mainland)
| | - Xue-Yan Sun
- Reproductive Medical Center, Yantaishan Hospital, Yantai, China (mainland)
| | - Li-Cheng Xu
- Department of Breast Surgery, Yantaishan Hospital, Yantai, China (mainland)
| | - Rong-Zhan Fu
- Department of Breast and Thyroid Surgery, Qianfoshan Hospital, Jinan, China (mainland)
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Sänger N, Engels K, Graf A, Ruckhäberle E, Effenberger KE, Fehm T, Holtrich U, Becker S, Karn T. Molecular Markers as Prognostic Factors in DCIS and Small Invasive Breast Cancers. Geburtshilfe Frauenheilkd 2014; 74:1016-1022. [PMID: 25484376 DOI: 10.1055/s-0034-1383033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 12/12/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) accounts for up to half of screen-detected breast cancers and thus constitutes a major public health problem. Despite effective current treatment many patients with DCIS are either over- or undertreated because of the paucity of precise models to predict recurrence or progression. The combination of clinical and molecular factors as already applied for invasive disease may help to build such models also for DCIS. We compared 53 DCIS (36.6 %) and 92 (63.4 %) invasive breast cancer cases and found no significant differences in age, receptor status of ER, PR, and HER2, and the use of radiotherapy. Interestingly, the proportion of disseminated tumor cells (DTC) did also not significantly differ between DCIS and invasive cases (p = 0.57). A negative PR status was associated with the detection of DTCs (p = 0.026). We then compared relationships of clinical parameters and biomarkers with patients' prognosis in 43 DCIS and 40 small invasive tumors ≤ 5 mm (T1a). ER negativity was associated with shorter relapse free survival in the complete cohort (p = 0.004) and showed a trend in both subgroups (p = 0.053 for DCIS and p = 0.046 for T1a, respectively). In conclusion, we found markedly similar properties of both DCIS and small invasive breast cancers with respect to the distribution of several parameters as well as to the prognostic value of biomarkers. DCIS with a luminal phenotype seem to be characterized by a favourable prognosis.
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Affiliation(s)
- N Sänger
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie, Neuss
| | - A Graf
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - E Ruckhäberle
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf
| | | | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf
| | - U Holtrich
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - S Becker
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
| | - T Karn
- Dept. of Gynecology and Obstetrics, Goethe University Frankfurt, Frankfurt
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Hartkopf AD, Brendel MH, Wallwiener M, Taran FA, Brucker S, Grischke EM. Trastuzumab Administration in Patients with Metastatic Breast Cancer - Experience of a Large University Breast Center. Geburtshilfe Frauenheilkd 2014; 74:563-568. [PMID: 24976638 DOI: 10.1055/s-0034-1368244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/16/2014] [Accepted: 01/30/2014] [Indexed: 01/06/2023] Open
Abstract
Background: Administered either alone or in combination with various cytostatic, endocrine or targeted therapies, trastuzumab significantly improves the prognosis of patients with HER2-positive breast cancer. As trastuzumab is effective across multiple lines of therapy in the metastatic setting (treatment beyond progression: TBP), it is often administered over a long period of time. The aim of this study was to evaluate the tolerability and clinical practice of long-term trastuzumab administration (> 1 year) in metastatic breast cancer patients treated in a large university breast center. Methods: Metastatic breast cancer patients who received at least 18 cycles of trastuzumab administered every three weeks at the University Gynecological Hospital of Tuebingen between 1999 and 2012 were included in this retrospective study. Typical combination drugs, side effects, and the impact of administration on left ventricular ejection fraction (LVEF) were investigated. Results: 72 patients were eligible for inclusion in the study. The mean number of administrations was 50.14 (SD: 27.51). In 53 patients the principle of TBP was followed across an average of 2.4 therapy lines. Classic cardiac risk factors were present at the beginning of trastuzumab treatment in 34 patients (47 %). Seven patients (10 %) experienced a decrease in LVEF during treatment, 9 patients (13 %) had hypersensitivity reactions. Treatment was discontinued in two patients due to side effects (1 × progressive LVEF decrease, 1 × intolerance). Summary: The administration of trastuzumab across multiple lines of therapy was generally tolerated well. Cardiac risk factors were not a limiting factor. If regular cardiac monitoring is done, trastuzumab appears not only to improve survival but also helps preserve the quality of life of patients with HER2-positive metastatic breast cancer.
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Affiliation(s)
- A D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - M H Brendel
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - M Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg
| | - F-A Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - S Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - E-M Grischke
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
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HER2 and TOP2A amplification in a hospital-based cohort of breast cancer patients: associations with patient and tumor characteristics. Breast Cancer Res Treat 2014; 145:193-203. [PMID: 24682655 DOI: 10.1007/s10549-014-2922-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 12/31/2022]
Abstract
Gene amplification is an important factor for altered gene expression in breast cancers. TOP2A-amplification often occurs concomitantly with HER2 amplification, and it has been suggested to be predictive for the response to anthracycline chemotherapy. This study assessed the correlation between HER2 status and TOP2A co-amplification, the possible association of TOP2A single-nucleotide polymorphisms with the frequency of this co-amplification as well as confirmation of association with outcome. HER2 and TOP2A amplification were analyzed in a tissue microarray from a clinical cohort study. Additionally, a common genetic variant (rs13695) in the TOP2A gene was genotyped in germline DNA. HER2 gene amplification was compared with HER2-IHC findings assessed during clinical routine work, and the association between all the biomarkers analyzed and the clinical outcome was determined. As an exploratory aim, rs13695 genotypes were compared with TOP2A amplification status. HER2 amplification was seen in 101 of 628 (16.1 %) and TOP2A amplification in 32 (5.1 %) cancers. No TOP2A amplification occurred without HER2 co-amplification. HER2 amplification was found in 8, 13.6, and 55.1 % of patients with HER2-IHC 0/1+, 2+, and 3+ tumors, respectively. HER2-IHC was not associated with an effect on the prognosis, but HER2-FISH was. There was an association between the rs13695 genotype and TOP2A amplification status (P = 0.03). Although there was a significant correlation between HER2 status determined by IHC and HER2 by FISH, only HER2 gene amplification status by FISH was correlated with outcome indicating greater utility for FISH in routine clinical settings.
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Polymorphisms in the RANK/RANKL genes and their effect on bone specific prognosis in breast cancer patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:842452. [PMID: 24729980 PMCID: PMC3963378 DOI: 10.1155/2014/842452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/30/2014] [Indexed: 01/06/2023]
Abstract
The receptor activator of NF-κB (RANK) pathway is involved in bone health as well as breast cancer (BC) pathogenesis and progression. Whereas the therapeutic implication of this pathway is established for the treatment of osteoporosis and bone metastases, the application in adjuvant BC is currently investigated. As genetic variants in this pathway have been described to influence bone health, aim of this study was the prognostic relevance of genetic variants in RANK and RANKL. Single nucleotide polymorphisms in RANK(L) (rs1054016/rs1805034/rs35211496) were genotyped and analyzed with regard to bone metastasis-free survival (BMFS), disease-free survival, and overall survival for a retrospective cohort of 1251 patients. Cox proportional hazard models were built to examine the prognostic influence in addition to commonly established prognostic factors. The SNP rs1054016 seems to influence BMFS. Patients with two minor alleles had a more favorable prognosis than patients with at least one common allele (HR 0.37 (95% CI: 0.17, 0.84)), whereas other outcome parameters remained unaffected. rs1805034 and rs35211496 had no prognostic relevance. The effect of rs1054016(RANKL) adds to the evidence that the RANK pathway plays a role in BC pathogenesis and progression with respect to BMFS, emphasizing the connection between BC and bone health.
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