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Ray-Coquard I, Leary A, Pignata S, Cropet C, González-Martin A, Marth C, Nagao S, Vergote I, Colombo N, Mäenpää J, Selle F, Sehouli J, Lorusso D, Alia EMG, Bogner G, Yoshida H, Lefeuvre-Plesse C, Buderath P, Mosconi AM, Lortholary A, Burges A, Medioni J, El-Balat A, Rodrigues M, Park-Simon TW, Dubot C, Denschlag D, You B, Pujade-Lauraine E, Harter P. Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial. Ann Oncol 2023:S0923-7534(23)00686-5. [PMID: 37211045 DOI: 10.1016/j.annonc.2023.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND In the PAOLA-1/ENGOT-ov25 primary analysis, maintenance olaparib plus bevacizumab demonstrated a significant progression-free survival (PFS) benefit in newly diagnosed advanced ovarian cancer patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab, irrespective of surgical status. Prespecified, exploratory analyses by molecular biomarker status showed substantial benefit in patients with a BRCA1/BRCA2 mutation (BRCAm) or homologous recombination deficiency (HRD; BRCAm and/or genomic instability). We report the prespecified final overall survival (OS) analysis, including analyses by HRD status. PATIENTS AND METHODS Patients were randomized 2:1 to olaparib (300 mg bid; up to 24 months) plus bevacizumab (15 mg/kg q3w; 15 months total) or placebo plus bevacizumab. Analysis of OS, a key secondary endpoint in hierarchical testing, was planned for ∼60% maturity or 3 years after the primary analysis. RESULTS After median follow-up of 61.7 and 61.9 months in the olaparib and placebo arms, respectively, median OS was 56.5 versus 51.6 months in the ITT (hazard ratio [HR]=0.92, 95% CI 0.76-1.12; P=0.4118). Subsequent poly(ADP-ribose) polymerase (PARP) inhibitor therapy was received by 105 (19.6%) olaparib patients versus 123 (45.7%) placebo patients. In the HRD-positive population, OS was longer with olaparib plus bevacizumab (HR=0.62, 95% CI 0.45-0.85; 5-year OS rate, 65.5% versus 48.4%); at 5 years, updated PFS also showed a higher proportion of olaparib plus bevacizumab patients without relapse (HR=0.41, 95% CI 0.32-0.54; 5-year PFS rate, 46.1% versus 19.2%). Myelodysplastic syndrome, acute myeloid leukemia, aplastic anemia, and new primary malignancy incidence remained low and balanced between arms. CONCLUSIONS Olaparib plus bevacizumab provided clinically meaningful OS improvement for first-line patients with HRD-positive ovarian cancer. These prespecified exploratory analyses demonstrated improvement despite a high proportion of patients in the placebo arm receiving PARP inhibitors post-progression, confirming the combination as one of the standards of care in this setting with the potential to enhance cure.
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Affiliation(s)
- I Ray-Coquard
- Department of Medical Oncology, Centre Léon BERARD, Lyon, and GINECO, France;.
| | - A Leary
- Gynecological Cancer Unit, Department of Medicine, Institut Gustave Roussy, Villejuif, and GINECO, France
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, and MITO, Italy
| | - C Cropet
- Department of Biostatistics Centre Léon BERARD, Lyon, and GINECO, France
| | - A González-Martin
- Department of Medical Oncology, Clínica Universidad de Navarra, Program in Solid Tumors (CIMA), Pamplona, and GEICO, Spain
| | - C Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, and AGO Austria, Austria
| | - S Nagao
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, and GOTIC, Japan
| | - I Vergote
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven Cancer Institute, Leuven, and BGOG, Belgium, European Union
| | - N Colombo
- University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS Milan, and MANGO, Italy
| | - J Mäenpää
- Department of Obstetrics and Gynecology and Cancer Center, Tampere University and University Hospital, Tampere, and NSGO, Finland
| | - F Selle
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, and GINECO, France
| | - J Sehouli
- Charité - Department of Gynecology with Center of Oncological Surgery, Universitätsmedizin Berlin, Berlin, and AGO, Germany
| | - D Lorusso
- (3)Gynecologic Oncology Unit, Catholic University of Sacred Heart and Fondazione Policlinico Gemelli IRCCS, Rome, and MITO, Italy
| | - E M Guerra Alia
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, and GEICO, Spain
| | - G Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, and AGO Austria, Austria
| | - H Yoshida
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, and GOTIC, Japan
| | - C Lefeuvre-Plesse
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, and GINECO, France
| | - P Buderath
- Universitätsklinikum Essen, University Hospital Essen, West German Cancer Center, Department of Gynecology and Obstetrics, Essen and AGO, Germany
| | - A M Mosconi
- S.C. di Oncologia Medica Osp. S. Maria della Misericordia - AO di Perugia, and MITO, Italy
| | - A Lortholary
- Centre Catherine de Sienne Hopital privé du Confluent, Nantes, and GINECO, France
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, and AGO, Germany
| | - J Medioni
- Hôpital Européen Georges Pompidou, Universite de Paris Cite, Paris, and GINECO, France
| | - A El-Balat
- Spital Uster, Frauenklinik, Uster, Switzerland, and Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, and AGO, Germany
| | - M Rodrigues
- Department of Medical Oncology, Institut Curie, Hopital Claudius Régaud, PSL Research University, Paris, France, and GINECO, France
| | - T-W Park-Simon
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, and AGO, Germany
| | - C Dubot
- Oncologie Médicale, Institut Curie, Hôpital René Huguenin, Saint Cloud, Paris, and GINECO, France
| | - D Denschlag
- Hochtaunuskliniken, Bad Homburg, and AGO, Germany
| | - B You
- HCL - Hospices Civils de Lyon IC-HCL, CITOHL, Université Claude Bernard Lyon 1, CICLY,Lyon, and GINECO, France
| | | | - P Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, and AGO, Germany
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Youssef A, Brunelli E, Fiorentini M, Lenzi J, Pilu G, El-Balat A. Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal. Ultrasound Obstet Gynecol 2021; 58:609-615. [PMID: 33847431 DOI: 10.1002/uog.23649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA). METHODS Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra- and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using Bland-Altman analysis. Student's t-test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements. RESULTS Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80-0.93) and 0.83 (95% CI, 0.71-0.90), respectively. The mean difference between measurements was 0.4° (95% CI, -1.4 to 2.2°) for intraobserver repeatability and -0.4° (95% CI, -2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9-15.1°) and 13.6° (95% CI, 9.9-17.3°) for intra- and interobserver repeatability, respectively. The lower limits of agreement were -11.2° (95% CI, -14.3 to -8.1°) and -14.4° (95% CI, -18.2 to -10.7°) for intra- and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra- or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- or interobserver reliability. CONCLUSIONS BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Fiorentini
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - A El-Balat
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
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3
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Hanker LC, El-Balat A, Drosos Z, Kommoss S, Karn T, Holtrich U, Gitas G, Graeser-Mayer M, Anglesio M, Huntsman D, Rody A, Gevensleben H, Hoellen F. Sphingosine-kinase-1 expression is associated with improved overall survival in high-grade serous ovarian cancer. J Cancer Res Clin Oncol 2021; 147:1421-1430. [PMID: 33660008 PMCID: PMC8021516 DOI: 10.1007/s00432-021-03558-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022]
Abstract
Purpose Sphingosine-kinase-1 (SPHK1) is a key enzyme of sphingolipid metabolism which is involved in ovarian cancer pathogenesis, progression and mechanisms of drug resistance. It is overexpressed in a variety of cancer subtypes. We investigated SPHK1 expression as a prognostic factor in epithelial ovarian cancer patients. Methods Expression analysis of SPHK1 was performed on formalin-fixed paraffin-embedded tissue from 1005 ovarian cancer patients with different histological subtypes using immunohistochemistry. Staining intensity of positive tumor cells was assessed semi-quantitatively, and results were correlated with clinicopathological characteristics and survival. Results In our ovarian cancer collective, high levels of SPHK1 expression correlated significantly with complete surgical tumor resection (p = 0.002) and lower FIGO stage (p = 0.04). Progression-free and overall survival were further significantly longer in patients with high-grade serous ovarian cancer and overexpression of SPHK1 (p = 0.002 and p = 0.006, respectively). Conclusion Our data identify high levels of SPHK1 expression as a potential favorable prognostic marker in ovarian cancer patients. Supplementary Information The online version of this article (10.1007/s00432-021-03558-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L C Hanker
- Department of Gynecology and Obstetrics, University Hospital Luebeck, Luebeck, Germany.
| | - A El-Balat
- Department of Obstetrics and Gynecology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Z Drosos
- Department of Gynecology and Obstetrics, University Hospital Luebeck, Luebeck, Germany
| | - S Kommoss
- Department of Woman's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - T Karn
- Department of Obstetrics and Gynecology, Goethe-University Frankfurt, Frankfurt, Germany
| | - U Holtrich
- Department of Obstetrics and Gynecology, Goethe-University Frankfurt, Frankfurt, Germany
| | - G Gitas
- Department of Gynecology and Obstetrics, University Hospital Luebeck, Luebeck, Germany
| | - M Graeser-Mayer
- Evangelical Hospital Bethesda, Lower Rhine Breast Center, Moenchengladbach, Germany
| | - M Anglesio
- Department of Molecular Oncology, BCCA Cancer Research Centre, Vancouver, Canada
| | - D Huntsman
- Department of Molecular Oncology, BCCA Cancer Research Centre, Vancouver, Canada
| | - A Rody
- Department of Gynecology and Obstetrics, University Hospital Luebeck, Luebeck, Germany
| | - H Gevensleben
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - F Hoellen
- Department of Gynecology and Obstetrics, University Hospital Luebeck, Luebeck, Germany
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Schnelzer A, Harter P, Sehouli J, Canzler U, Marmé F, De Gregorio N, Buderath P, Lück HJ, Gropp-Meier M, Runnebaum I, Belau A, Renner S, Schmalfeldt B, El-Balat A, Burges A, Hillemanns P, Denschlag D, Bauerschlag D, Hanker L, Ray-Coquard I. Phase III PAOLA-1/ENGOT-ov25 trial: Olaparib plus bevacizumab (bev) as maintenance therapy in patients (pts) with newly diagnosed, advanced ovarian cancer (OC) treated with platinum-based chemotherapy (PCh) plus bev. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Schnelzer
- Universitätsfrauenklinik TU München Klinikum rechts der Isar
- RoMed Klinikum Rosenheim, Gynäkologie und Geburtshilfe
| | | | | | - U Canzler
- Universitätsfrauenklinik, Technische Universität Dresden
| | - F Marmé
- Universitätsfrauenklinik Heidelberg
- Universitätsfrauenklinik Mannheim
| | | | | | | | | | | | - A Belau
- Universitätsfrauenklinik Greifswald
- Gynäkologische Praxis
| | - S Renner
- Universitätsfrauenklinik Erlangen
| | | | | | - A Burges
- Universitätsfrauenklinik München Großhadern
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Wimberger P, Sehouli J, Schmalfeldt B, Rau J, Thiel F, Hanker L, Marmé F, El-Balat A, De Gregorio N, Baumann K, Mahner S, Park-Simon TW, Meier W, Kommoss S, Bauerschlag D, Lück HJ, Kimmig R, Burges A, Schröder W, Jackisch C, Gropp-Meier M, Harter P, Pfisterer J. Carboplatin/PLD/Bevacizumab als neue Standardtherapieoption beim Ovarialkarzinomspätrezidiv – aktuelle Ergebnisse der AGO OVAR 2.21 Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- P Wimberger
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe der Technischen Universität Dresden
| | - J. Sehouli
- Charite Berlin, Klinik für Gynäkologie und Gynäkologische Onkologie – CVK
| | - B Schmalfeldt
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - J. Rau
- Philipps Universität Marburg, KKS
| | - F Thiel
- Universitätsklinikum Erlangen, Frauenklinik
| | - L Hanker
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Frauenklinik
| | - F Marmé
- Universitätsklinikum Mannheim, Frauenklinik
- Universitätsklinikum Heidelberg, NCT/Frauenklinik
| | - A El-Balat
- Universitätsklinikum Frankfurt, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | | | - K Baumann
- Klinikum der Stadt Ludwigshafen am Rhein gemeinnützige GmbH, Frauenklinik
| | - S Mahner
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
- LMU München Großhadern, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - TW Park-Simon
- Medizinische Hochschule Hannover, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - W Meier
- Universitätsklinikum Düsseldorf, Frauenklinik
- EVK Düsseldorf, Düsseldorf
| | - S Kommoss
- Universitätsklinikum Tübingen, Frauenklinik
| | - D Bauerschlag
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - HJ Lück
- Gynäkologisch Onkologische Praxis Hannover
| | - R Kimmig
- Universitätsklinikum Essen, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - A Burges
- LMU München Großhadern, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | | | | | | | - P Harter
- Kliniken Essen-Mitte, Klinik für Gynäkologie und Gynäkologische Onkologie
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El-Balat A, Marmé F, Sehouli J, Welslau M, Grabowski J, Hartkopf A, Glowik R, Hilpert F. Olaparib routine clinical practice in Germany – Quality of life interim results of the non-interventional C-PATROL study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A El-Balat
- Universitätsklinikum Frankfurt, Klinik für Frauenheilkunde und Geburtshilfe
| | - F Marmé
- University Medical Centre Mannheim, Medical Faculty Mannheim, Department of Gynecology
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Medical University, Berlin, Germany
| | - M Welslau
- Medical office for hemato-oncology, Aschaffenburg
| | - J.P Grabowski
- Department of Gynecology and Center for Oncological Surgery, Charité Medical University, Berlin, Germany
| | - A Hartkopf
- University Hospital of Tuebingen, Center for Women’s Health
| | | | - F Hilpert
- Oncology Centre at Jerusalem Hospital Hamburg
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Colombo N, Gantzer J, Ataseven B, Cropet C, Scambia G, Herrero A, Sevelda P, Kobayashi H, Vuylsteke P, Mirza M, Priou F, Buderath P, Pisano C, Lainez N, Guillemet C, Burges A, Sverdlin R, El-Balat A, Raban N, Ray-Coquard I. 812MO Maintenance olaparib + bevacizumab (bev) in patients (pts) with newly diagnosed advanced high-grade ovarian cancer (HGOC): RECIST and/or CA-125 objective response rate (ORR) in the phase III PAOLA-1 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sehouli J, Hilpert F, Welslau M, Grabowski J, Seitz J, El-Balat A, Hartkopf A, Glowik R, Marmé F. Results of the 3rd interim analysis of C-Patrol: A non-interventional study on olaparib in German routine clinical practice. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Gregorio N, Park-Simon TW, Meier W, Kommoss S, Hilpert F, Lück HJ, Baumann K, Harter P, Sehouli J, Canzler U, Schmalfeldt B, Hein A, Hanker L, Marmé F, El-Balat A, Mahner S, Kimmig R, Burges A, Schröder W, Jackisch C, Gropp-Meier M, Fehm T, Hasenburg A, Denschlag D, Belau A, Pfisterer J. Carboplatin/Caelyx/Bevacizumab vs. Carboplatin/Gemcitabine/Bevacizumab beim platinsensiblen Ovarialkarzinomrezidiv: Ergebnisse der prospektiv-randomisierten Phase III AGO-OVAR 2.21 Studie. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - W Meier
- Evangelisches Krankenhaus Düsseldorf
| | | | - F Hilpert
- Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - HJ Lück
- Gynäkologisch-Onkologische Praxis Hannover
| | | | | | | | - U Canzler
- Universitätsklinikum an der TU Dresden
| | | | - A Hein
- Universitäts-Frauenklinik Erlangen
| | | | - F Marmé
- Universitätsklinikum Heidelberg
| | | | | | | | | | | | | | | | - T Fehm
- Universitätsklinikum Düsseldorf
| | - A Hasenburg
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz
| | | | - A Belau
- Universitätsmedizin Greifswald
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Marmé F, Hilpert F, Welslau M, Grabowski J, Seitz J, El-Balat A, Hartkopf A, Glowik R, Sehouli J. Results of the second interim analysis of C-PATROL: A non-interventional study on olaparib within German routine clinical practice. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Karn T, Denkert C, Weber K, Jank P, El-Balat A, Rody A, Untch M, Loibl S, Pusztai L, Holtrich U. Para-necrotic expression of VEGFA metagene signature identified by single-cell profiling. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karn T, Denkert C, Sinn BV, Weber K, Nekljudova V, Rody A, Meissner T, Hatzis C, El-Balat A, Becker S, Solbach C, Untch M, Schneeweiss A, von Minckwitz G, Loibl S, Pusztai L, Holtrich U. Abstract P3-10-01: Single-cell profiling identifies hypoxic carcinoma cells as source of an immunosuppressive VEGFA metagene. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-10-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
We have previously shown that expression of the IL8/VEGFA-metagene eliminates the good prognostic effect of TILs in TNBC (PMID 21978456, 28750120). We also showed that the VEGFA metagene predicted response to neoadjuvant bevacizumab in the GeparQuinto trial (Karn 2017 SABCS #851166). The main cellular sources of the transcripts that comprise the VEGFA metagene are unknown since mRNA profiling of bulk biopsies contains signals from different cell types.
Methods:
Individual genes that comprise the VEGFA metagene were measured in bulk tissue- and single cell-RNA-Seq from breast cancer subtypes and normal cells on different platforms (Affymetrix n=4915, Agilent n=597, Illumina n=2433, RNA-Seq n=1215, Exome Capture RNA-Seq n=226, HTG-Seq n=243, sc-RNA-Seq n=24710). For blinded, orthogonal validation we performed immunohistochemistry. Effect of neoadjuvant chemotherapy with or without bevacizumab was studied by RNA-Seq and IHC on samples from GeparQuinto trial. SWOG S0800 (GSE114403), PROMIX (GSE87455), and GeparSixto trials were used for validation. TCGA was mined for mutations and somatic CNA. RNA-Seq from GeparNuevo was used for correlation with checkpoint inhibitor treatment.
Results:
We identified a stable core of six genes (VEGFA, ANGPTL4, ADM, NDRG1, DDIT4, CSTB) in different cohorts. Strong expression of this signature was mainly restricted to TNBC subtype and associated with poor prognosis within this subgroup. Single cell RNA-Seq of breast epithelial cells from 4 reduction mammoplasties and 4 TNBC revealed that these genes are coexpressed in individual epithelial cells and not associated with endothelial cells. In line with their presumed functions in cellular stress and hypoxia, immunohistochemistry revealed strong para-necrotic expression in TNBC. Moreover, high gene expression in TNBC was associated with mutations in DNA damage control pathways, somatic copy number alterations, and lower TILs. While chemotherapy led to downregulation, bevacizumab increased expression. In multivariate analysis, high pretreatment values predict pCR to both bevacizumab and chemotherapy (OR 2.40, P=0.006), which may be explained by sensitivity of tumors which are already under cellular stress. On the other hand, expression of the VEGFA metagene seems to create an immunosuppressive environment that counteracts the positive prognostic effect of TILs. In pre-treatment biopsies from the GeparNuevo checkpoint inhibitor trial we found a negative correlation of VEGFA metagene expression with the amount of the recently identified tissue-resident memory T cell subset (CD8TRM, PMID 29942092; P=0.002), while the subsequent increase of CD8TRM during treatment was larger in tumors with high VEGFA (P=0.019).
Conclusions:
Perinecrotic carcinoma cells under stress from hypoxia and or chromosomal instability are the source of the VEGFA metagene signature. Its predictive value in TNBC suggests estimating and reporting the amount of necrosis in the pathology report may be helpful in predicting response to preoperative chemotherapy, and could be used as stratification factor in clinical trials. The signature indicates an immunosuppressive environment and should be further studied in the context of immune therapies in combinations with anti-angiogenic treatment.
Citation Format: Karn T, Denkert C, Sinn BV, Weber K, Nekljudova V, Rody A, Meissner T, Hatzis C, El-Balat A, Becker S, Solbach C, Untch M, Schneeweiss A, von Minckwitz G, Loibl S, Pusztai L, Holtrich U. Single-cell profiling identifies hypoxic carcinoma cells as source of an immunosuppressive VEGFA metagene [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-01.
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Affiliation(s)
- T Karn
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - C Denkert
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - BV Sinn
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - K Weber
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - V Nekljudova
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - A Rody
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - T Meissner
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - C Hatzis
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - A El-Balat
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - S Becker
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - C Solbach
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - M Untch
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - A Schneeweiss
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - G von Minckwitz
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - S Loibl
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - L Pusztai
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - U Holtrich
- Goethe University, Frankfurt, Germany; Charite University, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Avera Cancer Institute, Sioux Falls, SD; Yale Cancer Center, New Haven, CT; Helios Kliniken, Berlin-Buch, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
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Hanker LC, Drosos Z, Kommoss S, Karn T, Holtrich U, Graeser-Mayer M, Anglesio M, El-Balat A, Rody A, Gevensleben H. Expression of Sphingosine-Kinase 1 (SPHK1) as a prognostic factor in ovarian cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- LC Hanker
- University Luebeck, Department of Gynecology and Obstetrics, Luebeck, Deutschland
| | - Z Drosos
- University Luebeck, Department of Gynecology and Obstetrics, Luebeck, Deutschland
| | - S Kommoss
- Tuebingen University Hospital, Department of Woman's Health, Tuebingen, Deutschland
| | - T Karn
- Goethe University Frankfurt, Department of Obstetrics and Gynecology, Frankfurt, Deutschland
| | - U Holtrich
- Goethe University Frankfurt, Department of Obstetrics and Gynecology, Frankfurt, Deutschland
| | - M Graeser-Mayer
- Bethesda Hospital, Department of Gynecology, Moenchengladbach, Deutschland
| | - M Anglesio
- BCCA Cancer Research Centre, Department of Molecular Oncology, Vancouver, Kanada
| | - A El-Balat
- Goethe University Frankfurt, Department of Obstetrics and Gynecology, Frankfurt, Deutschland
| | - A Rody
- University Luebeck, Department of Gynecology and Obstetrics, Luebeck, Deutschland
| | - H Gevensleben
- University Hospital Bonn, Institute of Pathology, Bonn, Deutschland
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Pfisterer J, Dean A, Baumann K, Rau J, Harter P, Joly F, Sehouli J, Canzler U, Schmalfeldt B, Shannon C, Hein A, Reimer D, Hanker L, Petit T, Marmé F, El-Balat A, Glasspool R, de Gregorio N, Mahner S, Kurtz JE. Carboplatin/pegylated liposomal doxorubicin/bevacizumab (CD-BEV) vs. carboplatin/gemcitabine/bevacizumab (CG-BEV) in patients with recurrent ovarian cancer: A prospective randomized phase III ENGOT/GCIG-Intergroup study (AGO study group, AGO-Austria, ANZGOG, GINECO, SGCTG). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.142] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Grabowski JP, Sehouli J, Hilpert F, Welslau M, Schinköthe T, Seitz J, El-Balat A, Grischke EM, Glowik R, Marmé F. Olaparib in German routine clinical practice – Updated interim results of the non-interventional study C-PATROL. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- JP Grabowski
- Charité Medical University Berlin, Department of Gynecology and Center for Oncological Surgery and European Competence Center for Ovarian Cancer, Berlin, Deutschland
| | - J Sehouli
- Charité Medical University Berlin, Department of Gynecology and Center for Oncological Surgery and European Competence Center for Ovarian Cancer, Berlin, Deutschland
| | - F Hilpert
- Oncology Centre at Jerusalem Hospital Hamburg, Hamburg, Deutschland
| | - M Welslau
- Medical office for hemato-oncology, Aschaffenburg, Deutschland
| | | | - J Seitz
- University Hospital Heidelberg, Department of Obstetrics & Gynecology, Heidelberg, Deutschland
| | - A El-Balat
- Goethe University Frankfurt, Department of Obstetrics and Gynecology, Frankfurt, Deutschland
| | - EM Grischke
- University Hospital of Tübingen, Center for Women's Health, Tübingen, Deutschland
| | | | - F Marmé
- University Hospital Heidelberg, Department of Obstetrics & Gynecology, Heidelberg, Deutschland
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El-Balat A, Abbasova A, Schmeil I, Bogdanyova S, Becker S. Minimally Invasive Radical Hysterectomy for Cervical Cancer Compared with Laparotomy: Single-Institution Experience. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Karn T, Jiang T, Hatzis C, Sänger N, El-Balat A, Rody A, Holtrich U, Becker S, Bianchini G, Pusztai L. Immune pruning of genomic heterogeneity in TNBC. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx140.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karn T, Jiang T, Hatzis C, Sänger N, El-Balat A, Holtrich U, Becker S, Bianchini G, Pusztai L. Abstract S1-07: Immune sculpting of the triple negative breast cancer genome. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s1-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumors with infiltrating lymphocytes (TIL) demonstrate a better prognosis particularly in TNBC and HER2 positive breast cancer. Two competing hypothesis predict contrasting relationships of TILs and genomic heterogeneity. On one hand, a strong immune response may lead to “pruning” of intratumor heterogeneity by eliminating immunogenic clones resulting in a near equilibrium, hence better prognosis, while cancers that escape the surveillance may evolve towards greater clonal heterogeneity and genomic complexity. In some cancers, the predicted neoantigens are less frequent than expected by chance also suggesting immune mediated elimination of neoplastic clones (Rooney et al. 2015). Studies also showed an inverse association between immune cell infiltration and intratumor clonal heterogeneity (Morris et al. 2016). On the other hand, cancers with greater genomic instability and mutational burden will have larger clonal heterogeneity and therefore more neoantigens and greater immune infiltration. Indeed, a positive correlation between overall mutation load and immune activity in the tumor microenvironment was observed in pooled data across a broad range of cancer types (Brown et al. 2014, Rooney et al. 2015, Schumacher and Schreiber 2015).
Methods: We assessed these two competing hypothesis and examined the relationship between genomic complexity and immune gene expression in different breast cancer subtypes. We used previously described immune metagene expression (DNA microarray n=655) as measures of immune infiltration in the TCGA data set (RNA-Seq n=1215). We compared somatic mutations, mutation count, neoantigen load, clonal heterogeneity metrics and the distribution of mutations in 119 canonical cancer genes and 12 cancer pathways between good and poor prognosis TNBC (n=208) corresponding to high and low immune infiltration.
Results:A positive but weak correlation between mutation count and immune metagene expression was observed when all breast cancer subtypes were analyzed together (P=0.08). This was driven by the generally higher mutation count and immune infiltration in TNBC. When TNBC was analyzed separately, good prognosis TNBC with high immune infiltration had lower total mutation count (P=0.021) and predicted neo-antigen count (P=0.035). Clonal heterogeneity was also lower in good prognosis TNBC (P=0.001). There was a strong inverse relationship of dispersion in mutation variant allele frequencies and immune metagene expression. CASP8 was the top enriched mutation in TNBC with high immune infiltration (P=0.007 with no adjustment for multiple testing).
Conclusions:High immune infiltration is associated with reduced intratumor heterogeneity in TNBC suggesting immune sculpting of the tumor and a near equilibrium between the cancer and immune surveillance. Surgical resection of the primary tumor may tilt the balance towards the immune system resulting in the better prognosis of high-TIL TNBC. TNBC with low immune infiltration has greater clonal heterogeneity and mutation load and may represent the consequence of escape from immune surveillance. Mutation of CASP8 may be one way to evade tumor cell killing in high-TIL TNBC as previously noted.
Citation Format: Karn T, Jiang T, Hatzis C, Sänger N, El-Balat A, Holtrich U, Becker S, Bianchini G, Pusztai L. Immune sculpting of the triple negative breast cancer genome [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S1-07.
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Affiliation(s)
- T Karn
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - T Jiang
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - C Hatzis
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - N Sänger
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - A El-Balat
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - U Holtrich
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - S Becker
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - G Bianchini
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
| | - L Pusztai
- Goethe University, Frankfurt, Germany; Yale Cancer Center, New Haven, CT; San Raffaele Scientific Institute, Milan, Italy
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Reinisch A, El-Balat A, Becker S, Bechstein WO, Habbe N. Is it safe to perform rectal anastomosis in gynaecological debulking surgery without a diverting stoma? Colorectal Dis 2016; 18:1142-1146. [PMID: 27136599 DOI: 10.1111/codi.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/18/2016] [Indexed: 02/08/2023]
Abstract
AIM Colorectal resection is frequently performed during cytoreductive surgery for gynaecological malignancy. The aim of this study was to assess the safety of colorectal anastomosis, and especially low rectal anastomosis, in the absence of a protective stoma in patients with gynaecological cancer and peritoneal metastasis. METHOD Patient data were retrospectively collected from a database for gynaecological cancer procedures carried out between January 2013 and July 2015. All patients who underwent a colorectal resection during cytoreduction were included in the study. The primary outcome was anastomotic leakage in the presence or absence of a diverting stoma. Secondary outcome parameters were complications and reoperations. RESULTS In the period of study, 43 major colorectal procedures were performed on 37 women. The most common colorectal procedure was low rectal resection (n = 22; 59%) followed by anterior rectal resection (n = 7; 19%) and sigmoid resection (n = 4; 11%). Five (14%) patients underwent Hartmann's procedure. In three (8%) patients, a diverting loop ileostomy was created. CONCLUSION Low rectal resection during debulking procedures for gynaecological cancers with peritoneal carcinomatosis can safely be performed by an experienced surgeon without a diverting stoma.
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Affiliation(s)
- A Reinisch
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - A El-Balat
- Department of Gynecology and Gynecological Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - S Becker
- Department of Gynecology and Gynecological Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - N Habbe
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
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Hoellen F, Rody A, Kostara A, Karn T, Holtrich U, El-Balat A, Otto M, Hanker L. Expression and impact of TFF3 in epithelial ovarian cancer. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kommoss S, Harter P, Hauke J, Heitz F, Reuss A, Marmé F, Heimbach A, Prieske K, Richters L, Burges A, Neidhardt G, de Gregorio N, El-Balat A, Hilpert F, Meier W, Heubner M, Kast K, Braicu I, Hahnen E, Schmutzler R. Incidence of germline mutations in risk genes including BRCA1/2 in consecutive ovarian cancer (OC) patients (AGO TR-1). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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