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Baretton G, Lordick F, Gaiser T, Hofheinz R, Horst D, Lorenzen S, Möhler M, Röcken C, Schirmacher P, Stahl M, Thuss-Patience P, Tiemann K. [Standardized and quality-assured predictive PD-L1 testing in the upper gastrointestinal tract. German version]. Pathologie (Heidelb) 2024; 45:51-58. [PMID: 38170268 PMCID: PMC10827825 DOI: 10.1007/s00292-023-01215-3] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
As a result of the high approval dynamics and the growing number of immuno-oncological therapy concepts, the complexity of therapy decisions and control in the area of carcinomas of the esophagus, gastroesophageal junction and stomach is constantly increasing. Since the treatment indication for PD‑1 inhibitors that are currently approved in the European Union is often linked to the expression of PD-L1 (programmed cell death-ligand 1), the evaluation of tissue-based predictive markers by the pathologist is of crucial importance for treatment stratification. Even though the immunohistochemical analysis of the PD-L1 expression status is one of the best studied, therapy-relevant biomarkers for an immuno-oncological treatment, due to the high heterogeneity of carcinomas of the upper gastrointestinal tract, there are challenges in daily clinical diagnostic work with regard to implementation, standardization and interpretation of testing. An interdisciplinary group of experts from Germany has taken a position on relevant questions from daily pathological and clinical practice, which concern the starting material, quality-assured testing and the interpretation of pathological findings, and has developed recommendations for structured reporting.
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Affiliation(s)
- G Baretton
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - F Lordick
- Medizinische Klinik II (Onkologie, Gastroenterologie, Hepatologie und Pneumologie) und Universitäres Krebszentrum Leipzig, Universitätsmedizin Leipzig, Leipzig, Deutschland.
| | - T Gaiser
- PATHOLOGIE SPEYER Gemeinschaftspraxis GbR, Speyer, Deutschland
| | - R Hofheinz
- Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - D Horst
- Institut für Pathologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Lorenzen
- III. Medizinische Klinik, Klinikum rechts der Isar, München, Deutschland
| | - M Möhler
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität, Kiel, Deutschland
| | - P Schirmacher
- Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Stahl
- Klinik für Internistische Onkologie & Onkologische Palliativmedizin, KEM | Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Essen, Deutschland
| | - P Thuss-Patience
- Charité Centrum Tumormedizin CC14, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - K Tiemann
- Institut für Hämatopathologie, Hamburg, Deutschland
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2
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Purrucker JC, Röcken C, Reuss D. Iatrogenic cerebral amyloid angiopathy rather than sporadic CAA in younger adults with lobar intracerebral haemorrhage. Amyloid 2023; 30:434-436. [PMID: 37184951 DOI: 10.1080/13506129.2023.2212394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Affiliation(s)
- J C Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - D Reuss
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
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3
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Baretton GB, Lordick F, Gaiser T, Hofheinz R, Horst D, Lorenzen S, Moehler M, Röcken C, Schirmacher P, Stahl M, Thuss-Patience P, Tiemann K. Standardized and quality-assured predictive PD-L1 testing in the upper gastrointestinal tract. J Cancer Res Clin Oncol 2023; 149:16231-16238. [PMID: 37874352 PMCID: PMC10620316 DOI: 10.1007/s00432-023-05180-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 10/25/2023]
Abstract
As a result of the high approval dynamics and the growing number of immuno-oncological concepts, the complexity of treatment decisions and control in the area of cancers of the esophagus, gastroesophageal junction and stomach is constantly increasing. Since the treatment indication for PD-1 inhibitors that are currently approved in the European Union is often linked to the expression of PD-L1 (programmed cell death-ligand 1), the evaluation of tissue-based predictive markers by the pathologist is of crucial importance for treatment stratification. Even though the immunohistochemical analysis of the PD-L1 expression status is one of the best studied, therapy-relevant biomarkers for an immuno-oncological treatment, due to the high heterogeneity of carcinomas of the upper gastrointestinal tract, there are challenges in daily clinical diagnostic work with regard to implementation, standardization and interpretation of testing. An interdisciplinary group of experts from Germany has taken a position on relevant questions from daily pathological and clinical practice, which concern the starting material, quality-assured testing and the interpretation of pathological findings, and has developed recommendations for structured reporting.
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Affiliation(s)
- Gustavo B Baretton
- Institute for Pathology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Florian Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany.
| | - T Gaiser
- Institute of Applied Pathology, 67346, Speyer, Germany
| | - R Hofheinz
- University Medicine Mannheim, Mannheim, Germany
| | - D Horst
- Institute of Pathology of the Charité-University Medicine Berlin, Berlin, Germany
| | - S Lorenzen
- Department of Medicine III, Klinikum Rechts der Isar, Munich, Germany
| | - M Moehler
- Department of Medicine I, University Medicine Mainz, Mainz, Germany
| | - C Röcken
- Institute of Pathology, Christian-Albrechts University, Kiel, Germany
| | - P Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Stahl
- Department of Oncology and Palliative Care, Kliniken Essen Mitte, Evangelische Huyssens-Stiftung, Essen-Huttrop, Essen, Germany
| | - P Thuss-Patience
- Charité Center of Tumor Medicine CC14, Charité Campus Virchow-University Medicine Berlin, Berlin, Germany
| | - K Tiemann
- Institute of Hematopathology, Hamburg, Germany
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Abstract
Predictive biomarkers are the mainstay of precision medicine. This review summarizes the advancements in tissue-based diagnostic biomarkers for gastric cancer, which is considered the leading cause of cancer-related deaths worldwide. A disease seen in the elderly, it is often diagnosed at an advanced stage, thereby limiting therapeutic options. In Western countries, neoadjuvant/perioperative (radio-)chemotherapy is administered, and adjuvant chemotherapy is administered in the East. The morpho-molecular classification of gastric cancer has opened novel avenues identifying Epstein-Barr-Virus (EBV)-positive, microsatellite instable, genomically stable and chromosomal instable gastric cancers. In chromosomal instable tumors, receptor tyrosine kinases (RKTs) (e.g., EGFR, FGFR2, HER2, and MET) are frequently overexpressed. Gastric cancers such as microsatellite instable and EBV-positive types often express immune checkpoint molecules, such as PD-L1 and VISTA. Genomically stable tumors show alterations in claudin 18.2. Next-generation sequencing is increasingly being used to search for druggable targets in advanced palliative settings. However, most tissue-based biomarkers of gastric cancer carry the risk of a sampling error due to intratumoral heterogeneity, and adequate tissue sampling is of paramount importance.
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Affiliation(s)
- C. Röcken
- Department of Pathology, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 14, Haus U33, 24105 Kiel, Germany
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5
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Kiese D, Caliebe A, Haag J, Röcken C, Synowitz M, Ahmeti H. P11.13.B Long-term outcome of patients with WHO grade 3 glioma treated with radiotherapy and temozolomide or radiotherapy alone. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.202] [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: 11/13/2022] Open
Abstract
Abstract
Background
For a long time, for patients with WHO grade 3 glioma the gold-standard after surgical treatment has been radiotherapy (RT). Since the combined radio-chemotherapy became the standard as a postoperative therapy for patients with glioblastoma in 2005, the role of radio-chemotherapy with temozolomide (RT/TMZ) for patients with WHO grade 3 glioma has long been controversial. Evidence is growing that RT/TMZ provides advantages in progression-free survival (PFS) and overall survival (OS) in WHO grade 3 gliomas as well. The aim of this study was to compare RT/TMZ (after 2005) and RT alone (before or after 2005) for patients with WHO grade 3 glioma in the long term.
Material and Methods
167 adult patients with first diagnosis of a WHO grade 3 glioma between 1994 and 2019 and treatment with surgery and either RT/TMZ (after 2005) or RT (before or after 2005) were included. Clinical and sociodemographic parameters as well as IDH1/2-mutation-, MGMT-promotor methylation- and 1p/19q-codeletion-status of the patient’s FFPE-tumor-tissue have been retrospectively investigated. Primary outcome was PFS and OS depending on postoperative treatment with RT before 2005 (n = 75) vs. RT after 2005 (n = 33) vs. RT/TMZ after 2005 (n = 48). Therefore, Kaplan-Meier analysis has been performed.
Results
RT before 2005 showed a significant advantage over RT/TMZ after 2005 and RT after 2005 regarding the PFS (p < 0.05) and OS (p < 0.001). Median PFS was 3.34 years (95%-CI = 1.08 - 5.59) for RT before 2005 vs. 1.96 years (95%-CI = 0.89 - 3.02) for RT/TMZ after 2005 and 1.22 years (95%-CI = 0.00 - 2.50) for RT after 2005. RT/TMZ after 2005 showed a significant advantage over RT after 2005 regarding the OS (p < 0.05). Median OS was not reached for RT before 2005 vs. 4.90 years (95%-CI = 2.14 - 7.66) for RT/TMZ after 2005 and 1.60 years (95%CI = 0.43 - 2.78) for RT after 2005. To measure the variability of the therapy groups, a stratified risk analysis of risk factors including IDH1/2-mutation-, MGMT-promotor-methylation- and 1p/19q-codeletion-status, extent of resection, initial Karnofsky Performance Score, Ki67-score, age, gender, tumor entity and dose in gray has been performed by using the Kruskal-Wallis test and Fisher-Freeman-Halton test. There has been a significant difference in IDH1/2-mutation- and MGMT-promotor-methylation-status and dose in gray. Single risk analysis of that parameters resulted in superiority of the RT before 2005 over RT/TMZ after 2005 and RT after 2005 regarding the OS.
Conclusion
There have been several limitations in this study, for example the retrospective setting or the missing randomization of the patients. RT before 2005 resulted in the best long-term outcome, what has to be further investigated. However, RT/TMZ after 2005 showed a significant benefit for the OS in the long term vs. RT after 2005, supporting recent findings regarding the role of RT/TMZ in the therapy of WHO grade 3 gliomas.
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Affiliation(s)
- D Kiese
- Department of Neurosurgery, University Hospital Schleswig-Holstein , Kiel , Germany
| | - A Caliebe
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein , Kiel , Germany
| | - J Haag
- Department of Pathology, University Hospital Schleswig-Holstein , Kiel , Germany
| | - C Röcken
- Department of Pathology, University Hospital Schleswig-Holstein , Kiel , Germany
| | - M Synowitz
- Department of Neurosurgery, University Hospital Schleswig-Holstein , Kiel , Germany
| | - H Ahmeti
- Department of Neurosurgery, University Hospital Schleswig-Holstein , Kiel , Germany
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Jensen-Kondering U, Flüh C, Röcken C, Margraf NG. Probable cerebral amyloid angiopathy diagnosed on plain CT. Neurol Sci 2022; 43:7003-7005. [PMID: 35971045 PMCID: PMC9663360 DOI: 10.1007/s10072-022-06330-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/30/2022] [Indexed: 02/03/2023]
Affiliation(s)
- U. Jensen-Kondering
- grid.412468.d0000 0004 0646 2097Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105 Kiel, Germany ,grid.412468.d0000 0004 0646 2097Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus A, 23538 Lübeck, Germany
| | - C. Flüh
- grid.412468.d0000 0004 0646 2097Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105 Kiel, Germany
| | - C. Röcken
- grid.412468.d0000 0004 0646 2097Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus U33, 24105 Kiel, Germany
| | - N. G. Margraf
- grid.412468.d0000 0004 0646 2097Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105 Kiel, Germany
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von Stillfried S, Freeborn B, Windeck S, Boor P, Böcker J, Schmidt J, Tholen P, Röhrig R, Majeed R, Wienströer J, Bremer J, Weis J, Knüchel R, Breitbach A, Bülow RD, Cacchi C, Wucherpfennig S, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Spring O, Braun G, Römmele C, Kling E, Kröncke T, Wittmann M, Hirschbühl K, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Friemann J, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Esposito I, Crudele G, Seidl M, Mahlke N, Hartmann A, Haller F, Eichhorn P, Lange F, Amann KU, Coras R, Ingenwerth M, Rawitzer J, Schmid KW, Theegarten D, Gradhand E, Smith K, Wild P, Birngruber CG, Schilling O, Werner M, Acker T, Gattenlöhner S, Franz J, Metz I, Stadelmann C, Stork L, Thomas C, Zechel S, Ströbel P, Fathke C, Harder A, Wickenhauser C, Glatzel M, Matschke J, Krasemann S, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Ondruschka B, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Jonigk D, Werlein C, Domke LM, Hartmann L, Klein I, Schirmacher P, Schwab C, Röcken C, Langer D, Roth W, Strobl S, Rudelius M, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weichert W, Weirich G, Stock K, Barth P, Schnepper A, Wardelmann E, Evert K, Evert M, Büttner A, Manhart J, Nigbur S, Bösmüller H, Fend F, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Vogt N, Kurz F. [Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]. Pathologie (Heidelb) 2022; 43:101-105. [PMID: 36114379 PMCID: PMC9483541 DOI: 10.1007/s00292-022-01117-w] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autopsies are a valuable tool for understanding disease, including COVID-19. MATERIALS AND METHODS The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs. RESULTS The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy. CONCLUSIONS Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.
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Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Benita Freeborn
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Svenja Windeck
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Elektronenmikroskopische Einrichtung, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
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Krause C, Schawitzke A, Grunow R, Jacob D, Röcken C, Egberts JH. Seltene Differenzialdiagnose PET-positiver pulmonaler Raumforderungen. Chirurg 2019; 90:493-495. [DOI: 10.1007/s00104-019-0803-x] [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: 11/28/2022]
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Weimer J, Nusilati A, Tiemann K, Stope MB, Mustea A, Karow D, Hamann S, Hedemann N, Flörkemeier I, Röcken C, Bauerschlag D, Arnold N, Maass N. Array based Copy number variations (aCNV) are able to differ classes in endometrial carcinoma. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1675449] [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: 10/27/2022] Open
Affiliation(s)
- J Weimer
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - A Nusilati
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - K Tiemann
- Institute for Hematopathology Hamburg, Hamburg, Germany
| | - MB Stope
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Greifswald, Germany
| | - A Mustea
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Greifswald, Germany
| | - D Karow
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - S Hamann
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - N Hedemann
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - I Flörkemeier
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - C Röcken
- Deptment of Pathology, University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - D Bauerschlag
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - N Arnold
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - N Maass
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
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10
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Nusilati A, Weimer J, Tiemann K, Stope MB, Mustea A, Karow D, Hamann S, Hedemann N, Flörkemeier I, Röcken C, Bauerschlag D, Arnold N, Maass N. Imbalances and loss of heterozygosity (LOH) in endometrial carcinoma detected by array based Copy number variations (aCNV). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1675450] [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: 10/27/2022] Open
Affiliation(s)
- A Nusilati
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - J Weimer
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - K Tiemann
- Institute for Hematopathology Hamburg, Hamburg, Germany
| | - MB Stope
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Greifswald, Germany
| | - A Mustea
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Greifswald, Germany
| | - D Karow
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - S Hamann
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - N Hedemann
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - I Flörkemeier
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - C Röcken
- Department. of Pathology, University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - D Bauerschlag
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - N Arnold
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
| | - N Maass
- Clinic of Gynecology and Obstetrics, Oncology Laboratory; University Hospital of Schleswig-Holstein, Christian-Albrechts University Kiel; Germany
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11
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Röcken C. [Opening speech of the Congress President of the German Society for Pathology]. Pathologe 2018; 39:175-176. [PMID: 30302560 DOI: 10.1007/s00292-018-0513-z] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Röcken
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3/14, 24105, Kiel, Deutschland.
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12
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Böger C, Krüger S, Behrens HM, Bock S, Haag J, Kalthoff H, Röcken C. Epstein-Barr virus-associated gastric cancer reveals intratumoral heterogeneity of PIK3CA mutations. Ann Oncol 2018; 28:1005-1014. [PMID: 28453696 PMCID: PMC5406766 DOI: 10.1093/annonc/mdx047] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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] [Indexed: 02/07/2023] Open
Abstract
Background Recent whole-genome sequencing identified four molecular subtypes of gastric cancer (GC), of which the subgroup of Epstein–Barr virus-associated GC (EBVaGC) showed a significant enrichment of PIK3CA mutations. We here aimed to validate independently the enrichment of PIK3CA mutations in EBVaGC of a Central European GC cohort, to correlate EBV status with clinico-pathological patient characteristics and to test for a major issue of GC, intratumoral heterogeneity. Patients and methods In a first step, 484 GCs were screened for EBV and PIK3CA hot spot mutations of exon 9/20 using EBER in situ hybridization and pyrosequencing, respectively. Secondly, an extended sequencing of PIK3CA also utilizing next generation sequencing was carried out in all EBVaGCs and 96 corresponding lymph node metastases. Results Twenty-two GCs were EBER-positive, all being of latency type I. Intratumoral heterogeneity of EBER-positivity was found in 18% of EBVaGCs. Twenty-three GCs held PIK3CA mutations in hot spot regions of exon 9 or 20, being significantly more common in EBVaGCs (P < 0.001). Subsequent extended sequencing of PIK3CA of EBVaGCs showed that 14% harvested three to five different PIK3CA genotypes (including wildtype) in the same primary tumor, albeit in histologically and spatially distinct tumor areas, and that intratumoral heterogeneity of PIK3CA was also present in the corresponding lymph node metastases. Conclusions Our findings unravel issues of tumor heterogeneity and illustrate that the assessment of the EBV status in tissue biopsies might carry the risk of sampling errors, which may significantly hamper adequate molecular tumor classification in a more clinical setting. Moreover, this is the first report of intratumoral heterogeneity of PIK3CA mutations in GC, and our findings lead to the conclusion that PIK3CA mutant and -wildtype tumor subclones are skilled to metastasize independently to different regional lymph nodes.
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Affiliation(s)
- C Böger
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - S Krüger
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - H M Behrens
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - S Bock
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - J Haag
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - H Kalthoff
- Department of Experimental Cancer Research, Christian-Albrechts-University, Kiel, Germany
| | - C Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
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Karn T, Meissner T, Weber K, Sinn B, Denkert C, Budczies J, Nekljudova V, Fasching PA, Holtrich U, Schem C, Solbach C, Hartmann A, Röcken C, Untch M, Young BM, Willis S, Leyland-Jones B, von Minckwitz G, Loibl S. Abstract P2-09-02: Blinded molecular subtyping analysis from RNA-Seq of FFPE samples in the GeparQuinto trial reveals predictive value of VEGFA metagene for bevacizumab treatment. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-09-02] [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:
RNA-Seq from total RNA in FFPE tissue can be more challenging due to limited capture of partially degraded RNA. Exome-capture based RNA-Seq may circumvent such problems and allow reproducible complete molecular characterization of low-quality RNA from small clinical samples.
Methods:
HER2 negative patients within the GeparQuinto trial were treated with neoadjuvant anthracycline-taxane-based chemotherapy +/- bevacizumab. Patients with bevacizumab therapy had a significantly higher pCR rate, especially within the triple negative subgroup. We performed exome-capture RNA-Seq on 5µm FFPE sections from pre-therapeutic cores of 400 HER2 negative samples from this trial. In a prospectively planned, blinded study we correlated molecular subtypes and metagenes for proliferation, stroma, MHC2, and VEGFA with clinical and histopathological data. Molecular subtypes were defined using the AIMS methods. Metagenes were calculated as mean values corresponding to previously described gene clusters after platform transfer (Rody et al. 2011 PMID 21978456, Hu et al. 2009 PMID 19291283) and then z-transformed.
Results:
296 samples with RNA-Seq data were classified as either of high (n=226) or of limited quality (n=70). For 22 samples RNA yield was insufficient and 82 did not pass initial QC. 121 (41%), 63 (21%), 34 (11.5%), 46 (15.5%), and 32 (11%) samples were defined as basal-like, HER2-enriched, luminal A, luminal B, and normal-like, respectively. Subtyping was robust with regard to gene filtering, normalization, and sample quality. ER and PR status from local IHC strongly correlated with gene expression (overall correctness 84% and 80% for ER, and 85% and 74% for PR, in samples with high and limited quality, respectively) and luminal subtypes (95% ER positive). Proliferation metagene correlated with histological grade (median -0.73, -0.39, and 0.53 in G1, G2, and G3, respectively; P<0.001) and MHC2 metagene correlated strongly with TIL counts (Rho=0.53, P<0.001). Among the high quality samples response rates (49.3% pCR overall) differed significantly by subtype, with higher pCR rates in basal-like (68.9%) and HER2-enriched (45.5%) than in luminal B (35.7%), luminal A (17.9%), and normal-like (20.0%). MHC2- (OR 1.60, 95%CI 1.21-2.12, P=0.001), proliferation- (OR 2.88, 95%CI 2.00-4.16, P<0.001), and VEGFA-metagenes (OR 1.92, 95%CI 1.41-2.60, P<0.001) were significant predictors for pCR. In a multivariate logistic regression (adjusted for bevacizumab treatment and hormone receptor status) both VEGFA metagene (OR 2.59, 95%CI 1.40-4.77, P=0.002) and the interaction between the VEGFA-metagene and bevacizumab treatment arm (P=0.023) significantly predicted pCR.
Conclusions:
Exome-capture RNA-Seq allows robust genomic characterization of clinical samples with limited FFPE material from core biopsies, and molecular subtypes and immune metagenes are predictive for pCR. The VEGFA metagene is a specific predictor for response to neoadjuvant bevacizumab treatment.
Citation Format: Karn T, Meissner T, Weber K, Sinn B, Denkert C, Budczies J, Nekljudova V, Fasching PA, Holtrich U, Schem C, Solbach C, Hartmann A, Röcken C, Untch M, Young BM, Willis S, Leyland-Jones B, von Minckwitz G, Loibl S. Blinded molecular subtyping analysis from RNA-Seq of FFPE samples in the GeparQuinto trial reveals predictive value of VEGFA metagene for bevacizumab treatment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-02.
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Affiliation(s)
- T Karn
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - T Meissner
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - K Weber
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - B Sinn
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - C Denkert
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - J Budczies
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - V Nekljudova
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - PA Fasching
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - U Holtrich
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - C Schem
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - C Solbach
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - A Hartmann
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - C Röcken
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - M Untch
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - BM Young
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - S Willis
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - B Leyland-Jones
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - G von Minckwitz
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
| | - S Loibl
- Goethe University, Frankfurt; Avera Cancer Institute; German Breast Group; Charite University; University Hospital Erlangen; University Hospital Schleswig-Holstein Kiel; Helios Kliniken Berlin-Buch
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14
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Röcken C. [Industry 4.0 in pathology : Process optimization by lean management]. Pathologe 2017; 38:489. [PMID: 29051977 DOI: 10.1007/s00292-017-0390-x] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Röcken
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3/14, 24105, Kiel, Deutschland.
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15
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Siepen FAD, Bauer R, Voss A, Hein S, Aurich M, Riffel J, Mereles D, Röcken C, Buss SJ, Katus HA, Kristen AV. Predictors of survival stratification in patients with wild-type cardiac amyloidosis. Clin Res Cardiol 2017; 107:158-169. [DOI: 10.1007/s00392-017-1167-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
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16
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Diehl K, Dinges LA, Helm O, Ammar N, Plundrich D, Arlt A, Röcken C, Sebens S, Schäfer H. Nuclear factor E2-related factor-2 has a differential impact on MCT1 and MCT4 lactate carrier expression in colonic epithelial cells: a condition favoring metabolic symbiosis between colorectal cancer and stromal cells. Oncogene 2017; 37:39-51. [DOI: 10.1038/onc.2017.299] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 12/28/2022]
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17
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Röcken C, Baretton GB, Kreipe HH, Kirchner T. [University Pathology in Germany]. Pathologe 2017; 38:324-330. [PMID: 28432389 DOI: 10.1007/s00292-017-0285-x] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - G B Baretton
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - H H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - T Kirchner
- Pathologisches Institut, Ludwig-Maximilians-Universität, München, Deutschland
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18
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Abstract
Gastric cancer is the fifth (men) and sixth (women) most common cause of cancer-related death in Germany. Despite a declining incidence of distal gastric cancer, the prognosis remains dismal: the 5‑year survival rate ranges between 35% for women and 31% for men. The majority are adenocarcinomas, which occur sporadically, familial or hereditary. Adenomas and intraepithelial neoplasms are considered as precursor lesions. Recently, whole genome sequencing and comprehensive molecular profiling described four molecular subtypes of gastric cancer: Epstein-Barr virus (EBV) positive, microsatellite unstable, chromosomal unstable and genomically stable gastric cancer. Currently, only the TNM classification has stood the test of time for the assessment of patient prognosis. Neuroendocrine tumor types 1-3 and soft tissue tumors occur significantly less often in the stomach. Gastrointestinal stromal tumors and inflammatory fibroid polyps are among the more common soft tissue tumors of the stomach and show distinct phenotypes. This review gives an overview of the current World Health Organization (WHO) classification of gastric tumors.
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität Kiel, Arnold-Heller-Straße 3/14, 24105, Kiel, Deutschland.
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19
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Lordick F, Al-Batran SE, Hofheinz RD, Lorenzen S, Thuss-Patience P, Baretton GB, Dietel M, Gaiser T, Kirchner T, Kreipe HH, Quaas A, Röcken C, Rüschoff J, Tannapfel A. [HER2 testing in gastric cancer - results of a German expert meeting]. Z Gastroenterol 2016; 54:791-6. [PMID: 27529529 DOI: 10.1055/s-0042-110794] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Valid HER2 testing is essential for optimal therapy of patients with HER2 positive gastric cancer and the correct use of first-line treatment. While each breast cancer is routinely being tested for the HER2 status, HER2 testing in gastric cancer has still not become part of the routine and is often only done upon request by the therapist. An interdisciplinary German expert group took the challenges of HER2 testing in gastric cancer as an opportunity to address essential aspects and questions for the practical use of HER2 testing in this indication from the perspective of pathologists and therapists. The recommendations made in this manuscript reflect the consensus of all participants and correspond to their opinions and long-term experience.
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Affiliation(s)
- F Lordick
- Universitätsklinikum Leipzig, Universitäres Krebszentrum (UCCL), Leipzig, Germany
| | | | | | - S Lorenzen
- III. Medizinischen Klinik des Klinikums rechts der Isar, München, Germany
| | - P Thuss-Patience
- Charité - Universitätsmedizin Berlin, CVK: Campus Virchow-Klinikum Charité Centrum Tumormedizin CC14, Berlin, Germany
| | - G B Baretton
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - M Dietel
- Institut für Pathologie, Charité Universitätsmedizin Berlin Campus Mitte, Berlin, Germany
| | - T Gaiser
- Pathologisches Institut Mannheim, Mannheim, Germany
| | - T Kirchner
- Pathologisches Institut der Ludwig-Maximilians-Universität München, München, Germany
| | - H H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - A Quaas
- Uniklinik Köln, Institut für Pathologie, Köln, Germany
| | - C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität, Kiel, Germany
| | - J Rüschoff
- Institut für Pathologie Nordhessen u. Targos GmbH, Kassel, Germany
| | - A Tannapfel
- Georgius Agricola Stiftung Ruhr, Institut für Pathologie der Ruhr-Universität Bochum am Berufsgenossenschaftlichen Universitätsklinikum, Bergmannsheil, Bochum, Germany
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20
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Baretton G, Dietel M, Gaiser T, Kirchner T, Kreipe HH, Quaas A, Röcken C, Rüschoff J, Tannapfel A, Lordick F, Al-Batran S, Hofheinz R, Lorenzen S, Moehler M, Thuss-Patience P. HER2-Testung beim Magenkarzinom. Pathologe 2016; 37:361-6. [DOI: 10.1007/s00292-016-0179-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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21
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Morgenthal S, Bayer R, Schneider E, Zachäus M, Röcken C, Dreßler J, Ondruschka B. Nodular pulmonary amyloidosis with spontaneous fatal blood aspiration. Forensic Sci Int 2016; 262:e1-4. [DOI: 10.1016/j.forsciint.2016.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/22/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
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22
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Abstract
Urachal carcinoma is a rare form of cancer. It often is diagnosed incidentally, like in our case report, because its cardinal symptom also occurs in a number of other urological diseases. We report the case of a 26-year-old man with a mucinous adenocarcinoma of the urachus. The carcinoma was removed via partial cystectomy with umbilical tumour excision.
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Affiliation(s)
- W. Köhler
- Klinik für Urologie und Kinderurologie Universitätsklinikum Schleswig-Holstein Campus Kiel
| | - C. Naumann
- Klinik für Urologie und Kinderurologie Universitätsklinikum Schleswig-Holstein Campus Kiel
| | - M. Hamann
- Klinik für Urologie und Kinderurologie Universitätsklinikum Schleswig-Holstein Campus Kiel
| | - K. Bothe
- Klinik für Urologie und Kinderurologie Universitätsklinikum Schleswig-Holstein Campus Kiel
| | - C. Röcken
- Institut für Pathologie Universitätsklinikum Schleswig-Holstein Campus Kiel
| | - K. Jünemann
- Klinik für Urologie und Kinderurologie Universitätsklinikum Schleswig-Holstein Campus Kiel
| | - D. Osmonov
- Klinik für Urologie und Kinderurologie Universitätsklinikum Schleswig-Holstein Campus Kiel
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23
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität Kiel, Arnold-Heller-Straße 3/14, 24105, Kiel, Deutschland,
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24
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Röcken C, Behrens HM. Validating the prognostic and discriminating value of the TNM-classification for gastric cancer - a critical appraisal. Eur J Cancer 2015; 51:577-86. [PMID: 25682192 DOI: 10.1016/j.ejca.2015.01.055] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 05/29/2014] [Revised: 01/10/2015] [Accepted: 01/18/2015] [Indexed: 02/07/2023]
Abstract
AIM We investigated the effect of the new tumour-, node-, metastasis- (TNM) classification on predicting and discriminating gastric cancer patient prognosis using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. PATIENTS AND METHODS From the SEER-database we retrieved gastric cancer patients with a primary adenocarcinoma, of Caucasian or Asian ethnicity and without distant metastases (M0). The pTNM-stage was determined according to the 7th edition of the union internationale contre le cancer (UICC) guidelines. RESULTS Spanning the period 2004-2010, 6136 patients fulfilled all inclusion criteria including 3424 (55.8%) men, 2712 (44.2%) women, 4629 (75.4%) Caucasian and 1507 (24.6%) Asian patients. 1524 (24.8%) patients underwent total gastrectomy and 4612 (75.2%) non-total gastrectomy. Only in 41.2% of the patients were >15 lymph nodes resected. 1857 (31.0%) patients received radiotherapy. Patient survival depended on ethnicity, type of surgery and radiotherapy. The discriminating value of the UICC-stage grouping could not be validated for Caucasian patients with >15 lymph nodes resected and who had not received radiotherapy: stage groups IIB, IIIA, IIIB and IIIC showed substantial overlap in survival ranges. In addition, the tumour specific survival of the different T-/N-combinations was significantly different in stage groups IIIB and IIIC, respectively. CONCLUSIONS Our retrospective analysis of the SEER-database does not validate the discriminating value of stage grouping of the 7th edition of the UICC-stage grouping. A revision should be considered and more reliable prognostic biomarkers are urgently needed.
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Affiliation(s)
- C Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany.
| | - H-M Behrens
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
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25
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Ingold Heppner B, Behrens HM, Balschun K, Haag J, Krüger S, Becker T, Röcken C. HER2/neu testing in primary colorectal carcinoma. Br J Cancer 2014; 111:1977-84. [PMID: 25211663 PMCID: PMC4229629 DOI: 10.1038/bjc.2014.483] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/04/2014] [Accepted: 08/07/2014] [Indexed: 02/06/2023] Open
Abstract
Background: Anti-HER2/neu therapy is well-established in breast and gastric carcinoma. The increased understanding of this pathway led to the identification of new promising drugs in addition to trastuzumab, offering further perspectives. The role of HER2/neu in colorectal carcinoma is controversially discussed, as discrepant data has been reported. Methods: Here, we retrospectively assessed the prevalence of HER2/neu positivity in a large series of colorectal carcinoma, testing HER2/neu status according to current recommendations. We correlated the results to clinico-pathological data and patient survival. Results: Overall, in 1645 primary colorectal carcinoma cases, 1.6% of the cases were HER2/neu positive. HER2/neu positivity significantly correlated with higher UICC stages (P=0.017) and lymph node metastases (P=0.029). In the subgroup of sigmoideal and rectal carcinomas, positive HER2/neu status was associated with T-category (P=0.041) and higher UICC stages (P=0.022). Although statistically not significant, HER2/neu-positive colorectal carcinomas displayed a tendency to poorer overall survival. Conclusions: These results illustrate the importance of testing HER2/neu by approved diagnostic techniques and scoring systems. We assume that although the prevalence of HER2/neu positivity in colorectal carcinoma is low, HER2/neu testing in advanced, nodal-positive colorectal carcinoma is reasonable, offering a potential target in high risk colorectal carcinoma.
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Affiliation(s)
- B Ingold Heppner
- Department of Pathology, Campus Mitte, Charité University Hospital, 10117 Berlin, Germany
| | - H-M Behrens
- Department of Pathology, Christian-Albrechts-University, 24105 Kiel, Germany
| | - K Balschun
- Department of Pathology, Christian-Albrechts-University, 24105 Kiel, Germany
| | - J Haag
- Department of Pathology, Christian-Albrechts-University, 24105 Kiel, Germany
| | - S Krüger
- Department of Pathology, Christian-Albrechts-University, 24105 Kiel, Germany
| | - T Becker
- Department of General Surgery and Thoracic Surgery, Christian-Albrechts-University, 24105 Kiel, Germany
| | - C Röcken
- Department of Pathology, Christian-Albrechts-University, 24105 Kiel, Germany
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26
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Schwarz MVP, Schmidt T, Hilpert F, Heilmann T, Weisser B, Röcken C, Dürkop J, Jonat W, Mundhenke C. Auswirkungen körperlicher Aktivität auf physiologische, psychische und kognitive Parameter sowie auf den Insulin- und Glukosestoffwechsel bei Brustkrebspatientinnen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388414] [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: 10/24/2022] Open
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Abstract
Gastric cancer is the fourth most common tumor and the second most common cause of cancer-related deaths in the world. Approximately 70 % of the patients already have lymph node metastases at the time of the diagnosis leading to a median overall survival time of 16.7 months. Complete resection of the primary tumor with D2 lymphadenectomy offers the only chance of cure in the early stages of the disease. Survival of more locally advanced gastric cancer was improved by the introduction of perioperative, adjuvant and palliative chemotherapy of gastric cancer; however, the identification of novel predictive and diagnostic targets is urgently needed. Our own studies on gastric cancer biology identified several putative tumor biologically relevant G-protein-coupled receptors (e.g. AT1R, AT2R, CXCR4, FZD7, LGR4, LGR5, LGR6). Some of these receptors are also putative stem cell markers and may serve as future targets of an individualized therapy of gastric cancer.
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität Kiel, Arnold-Heller-Strasse 3/14, Kiel, Germany.
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28
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Renker T, Haneke E, Röcken C, Borradori L. Systemic Light-Chain Amyloidosis Revealed by Progressive Nail Involvement, Diffuse Alopecia and Sicca Syndrome: Report of an Unusual Case with a Review of the Literature. Dermatology 2014; 228:97-102. [DOI: 10.1159/000354262] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 07/06/2013] [Indexed: 11/19/2022] Open
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Egberts F, Bergner I, Krüger S, Haag J, Behrens H, Hauschild A, Röcken C. Metastatic melanoma of unknown primary resembles the genotype of cutaneous melanomas. Ann Oncol 2014; 25:246-50. [DOI: 10.1093/annonc/mdt411] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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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Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, Fietkau R, Follmann M, Friess H, Galle P, Geissler M, Glanemann M, Gress T, Heinemann V, Hohenberger W, Hopt U, Izbicki J, Klar E, Kleeff J, Kopp I, Kullmann F, Langer T, Langrehr J, Lerch M, Löhr M, Lüttges J, Lutz M, Mayerle J, Michl P, Möller P, Molls M, Münter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Röcken C, Roeb E, Saeger H, Schmid R, Schmiegel W, Schoenberg M, Siveke J, Stuschke M, Tannapfel A, Uhl W, Unverzagt S, van Oorschot B, Vashist Y, Werner J, Yekebas E. [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 2013; 51:1395-440. [PMID: 24338757 DOI: 10.1055/s-0033-1356220] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- T Seufferlein
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - M Porzner
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - T Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Kiel
| | - V Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin
| | - G Ceyhan
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Esposito
- Institut für Allgemeine Pathologie, Klinikum rechts der Isar, TU München
| | - R Fietkau
- Strahlenklinik, Universitätsklinikum Erlangen
| | - M Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - H Friess
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - P Galle
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
| | - M Geissler
- Klinik für Allgemeine Innere Medizin, Onkologie/Hämatologie, Gastroenterologie und Infektiologie, Klinikum Esslingen
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes Homburg/Saar
| | - T Gress
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - V Heinemann
- Medizinischen Klinik und Poliklinik III, Klinikum der Universität München LMU
| | | | - U Hopt
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg
| | - J Izbicki
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - E Klar
- Klinik für Allgemeine Chirurgie, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock
| | - J Kleeff
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg
| | | | - T Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - J Langrehr
- Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus Berlin
| | - M Lerch
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - M Löhr
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - J Lüttges
- Institut für Pathologie, Marienkrankenhaus Hamburg
| | - M Lutz
- Medizinische Klinik - Schwerpunkt Gastroenterologie, Endokrinologie, Infektiologie, Caritasklinikum Saarbrücken
| | - J Mayerle
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - P Michl
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm
| | - M Molls
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, TU München
| | - M Münter
- Klinik für Strahlentherapie und Radioonkologie, Klinikum Stuttgart
| | - M Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Berlin
| | - H Oettle
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim
| | - A Reinacher-Schick
- Abt. für Hämatologie und Onkologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - C Röcken
- Institut für Pathologie, Universitätsklinikum Kiel
| | - E Roeb
- Medizinische Klinik II, SP Gastroenterologie, Universitätsklinikum Gießen und Marburg
| | - H Saeger
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Dresden
| | - R Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - W Schmiegel
- Medizinische Klinik, Klinikum der Ruhr-Universität Bochum
| | | | - J Siveke
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - M Stuschke
- Klinik für Strahlentherapie, Universitätsklinikum Essen
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum
| | - W Uhl
- Chirurgische Klinik, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - S Unverzagt
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - B van Oorschot
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg
| | - Y Vashist
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - J Werner
- Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg
| | - E Yekebas
- Klinik für Allgemein-, Thorax- und Viszeralchirurgie, Klinikum Darmstadt
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Denkert C, Erbersdobler A, Kellner U, Kristiansen G, Lage H, Petersen I, Röcken C, Stenzinger A, Turzynski A, Weichert W. [Congratulations on your birthday, dear Mr. Dietel!]. Pathologe 2013; 34:389-90. [PMID: 23934409 DOI: 10.1007/s00292-013-1780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Röcken C, Höfler H, Hummel M, Meyermann R, Zietz C, Schirmacher P. Beteiligung und Unterstützung klinischer Studien und anderer wissenschaftlicher Untersuchungen. Pathologe 2013; 34:466-75. [DOI: 10.1007/s00292-013-1793-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Röcken C, Rüdiger T. [Certified further education in Der Pathologe]. Pathologe 2013; 34:292. [PMID: 23835840 DOI: 10.1007/s00292-013-1779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schreml S, Weber BH, Schröder J, Siegmund H, Schaller J, Vogt T, Landthaler M, Schönbuchner I, Röcken C, Babilas P. Familial primary localized cutaneous amyloidosis with an oncostatin M receptor-β mutation, Pro694Leu. Clin Exp Dermatol 2013; 38:932-5. [DOI: 10.1111/ced.12160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S. Schreml
- Department of Dermatology; University Medical Center Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - B. H. Weber
- Institute of Human Genetics; University Medical Center Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - J. Schröder
- Institute of Pathology; University Medical Center Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - H. Siegmund
- Institute of Pathology; University Medical Center Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - J. Schaller
- Laboratory for Dermatohistology; Duisburg Germany
| | - T. Vogt
- Department of Dermatology; Saarland University Hospital; Homburg/Saar Germany
| | - M. Landthaler
- Department of Dermatology; University Medical Center Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - I. Schönbuchner
- Institute of Human Genetics; University Medical Center Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
| | - C. Röcken
- Institute of Pathology; University Medical Center Kiel; Kiel Germany
| | - P. Babilas
- Department of Dermatology; University Medical Center Regensburg; Franz-Josef-Strauss-Allee 11 93053 Regensburg Germany
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35
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Röcken C. [Clinical studies in oncology--a challenge for clinical and academic pathology]. Dtsch Med Wochenschr 2013; 138:1073-6. [PMID: 23670265 DOI: 10.1055/s-0033-1343111] [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]
Affiliation(s)
- C Röcken
- Institut für Pathologie der Universität Kiel.
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36
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Lordick F, Röcken C. The identification of predictive factors for perioperative chemotherapy in esophago-gastric cancer. Ann Oncol 2013; 24:1135-8. [DOI: 10.1093/annonc/mdt111] [Citation(s) in RCA: 4] [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: 12/21/2022] Open
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Warneke VS, Behrens HM, Böger C, Becker T, Lordick F, Ebert MPA, Röcken C. Her2/neu testing in gastric cancer: evaluating the risk of sampling errors. Ann Oncol 2012; 24:725-33. [PMID: 23139264 PMCID: PMC3574551 DOI: 10.1093/annonc/mds528] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We evaluated the risk of sampling errors in specimens of biopsy size, which may be caused by heterogeneous overexpression of Her2/neu in gastric cancer (GC). PATIENTS AND METHODS The study cohort comprised 454 gastrectomy patients with adenocarcinoma of the stomach or esophago-gastric junction. Tissue micro-arrays (TMAs) served as 'biopsy procedure' and were generated from formalin-fixed and paraffin-embedded tissue: five tissue cylinders were collected randomly from each tumor, rendering 2230 core cylinders. These were compared with 454 whole tissue sections obtained from the same paraffin blocks. Her2/neu expression and gene amplification were analyzed by immunohistochemistry and in situ hybridization. The Her2/neu status was determined according to GC scoring system by two independent observers. RESULTS In whole tissue sections, 37 (8.1%; observer 1) and 38 (8.4%; observer 2) of the GCs, and in the corresponding TMAs, 28 (6.3%; observer 1) and 28 (6.3%; observer 2) of the GCs were classified as Her2/neu-positive (kappa value 98.5% and 96.2%; P < 0001). Comparison of whole tissue sections with corresponding TMAs showed a false-negative rate of 24% and a false-positive rate of 3% for TMAs. CONCLUSION Assessment of the Her2/neu status in tissue biopsies carries a significant risk of sampling errors, thereby rendering patients unsuitable for treatment with trastuzumab.
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Affiliation(s)
- V S Warneke
- Department of Pathology, Christian-Albrechts University, D-24105 Kiel, Germany
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Affiliation(s)
- L. Hagmeyer
- Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen
| | - S. Stieglitz
- Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen
| | - C. Röcken
- Institut für Pathologie, Christian-Albrechts-Universität, Kiel
| | - W. Randerath
- Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen
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Ehling R, Helbok R, Beer R, Lackner P, Broessner G, Pfausler B, Röcken C, Aguzzi A, Chemelli A, Schmutzhard E. Recurrent intracerebral haemorrhage after coitus: a case report of sporadic cerebral amyloid angiopathy in a younger patient. Eur J Neurol 2012; 19:e29-31. [PMID: 22329859 DOI: 10.1111/j.1468-1331.2011.03624.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Harder J, Ihorst G, Heinemann V, Hofheinz R, Moehler M, Buechler P, Kloeppel G, Röcken C, Bitzer M, Boeck S, Endlicher E, Reinacher-Schick A, Schmoor C, Geissler M. Multicentre phase II trial of trastuzumab and capecitabine in patients with HER2 overexpressing metastatic pancreatic cancer. Br J Cancer 2012; 106:1033-8. [PMID: 22374460 PMCID: PMC3304403 DOI: 10.1038/bjc.2012.18] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: New therapeutic options for metastatic pancreatic cancer are urgently needed. In pancreatic cancer, overexpression of the epidermal growth factor receptor 2 (HER2) has been reported in up to 45%. This multicentre phase II study investigated the efficacy and toxicity of the HER2 antibody trastuzumab combined with capecitabine in the patients with pancreatic cancer and HER2 overexpression. Methods: Primary endpoint was progression-free survival (PFS) after 12 weeks. A total of 212 patients were screened for HER2 expression. Results: Immunohistochemical (IHC) HER2 expression was: 83 (40%) grade 0, 71 (34%) grade 1, 31 (15%) grade 2, 22 (11%) grade 3. A total of 17 patients with IHC +3 HER2 expression or gene amplification could be assessed for the treatment response. Grade 3/4 treatment toxicities were: each 7% leucopenia, diarrhoea, nausea and hand-foot syndrome. Progression-free survival after 12 weeks was 23.5%, median overall survival (OS) 6.9 months. Conclusion: This study demonstrates +3 HER2 expression or gene amplification in 11% of patients. Contrary to breast and gastric cancer, only 7 out of 11 (64%) patients with IHC +3 HER2 expression showed gene amplification. Although the therapy was well tolerated, PFS and OS did not perform favourably compared with standard chemotherapy. Together, we do not recommend further evaluation of anti-HER2 treatment in patients with metastatic pancreatic cancer.
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Affiliation(s)
- J Harder
- Medizinische Klinik II, Hegau- Bodensee Klinikum, Virchowstraße 10, D-78224 Singen, Germany.
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Abstract
Amyloidosis is a heterogeneous group of diseases characterized by the pathological deposition of autologous proteins in an antiparallel β-sheet confirmation forming non-branching linear fibrils of indefinite length and an approximate diameter of 10-12 nm. Cardiac amyloidosis is caused by deposits in the heart and may lead to cardiac arrhythmia and low output failure. Following the diagnosis, classification of the amyloid protein and evaluation of further organ involvement is mandatory. Treatment approaches are based on reduction of the production of amyloid precursor proteins. Standard heart failure treatment is usually not well tolerated and the underlying disease remains unaffected. Cardiac amyloidosis, especially of the light chain type, is associated with a poor outcome. The clinical picture is uncharacteristic, therefore correct diagnosis of cardiac amyloidosis is often delayed in many patients. Combination of clinical symptoms of different organ systems should alert the physician to the diagnosis of amyloidosis.
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Affiliation(s)
- A V Kristen
- Abteilung für Innere Medizin III (Kardiologie, Angiologie, Pneumologie), Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
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Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Böhle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Höcht S, Hofheinz RD, Höfler H, Höhler T, Hölscher AH, Horneber M, Hübner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Körber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Mönig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Röcken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schütte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 2011; 49:461-531. [PMID: 21476183 DOI: 10.1055/s-0031-1273201] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M Moehler
- Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 Mainz.
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Stecker K, Vieth M, Koschel A, Wiedenmann B, Röcken C, Anders M. Impact of the coxsackievirus and adenovirus receptor on the adenoma-carcinoma sequence of colon cancer. Br J Cancer 2011; 104:1426-33. [PMID: 21468049 PMCID: PMC3101933 DOI: 10.1038/bjc.2011.116] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Coxsackie and adenovirus receptor (CAR) has been suggested to function as a tumour suppressor. Its impact on the adenoma–carcinoma sequence of the colon, however, is unclear. Methods: Coxsackie and adenovirus receptor was analysed in non-cancerous and neoplastic colon samples using immunohistochemistry and quantitative RT–PCR. The function of CAR in colon cancer cell lines was determined following application of CAR siRNA or ectopic expression of a human full-length CAR cDNA. Results: Compared with healthy mucosa, increased CAR-mRNA expression was found in adenomas, whereas primary cancers and metastases displayed a marked decline. At the plasma membrane, CAR was present in normal mucosa samples (93%), adenomas, and metastases (100% ea.), whereas in colon cancers, it was found less frequently (49%, P<0.0001). Cytoplasmic CAR immunopositivity increased from normal mucosa (22%), to adenomas (73%, P=0.0006), primary cancers (83%, P<0.0001), and metastases (67%, P=0.0019). In cancer cell lines, CAR inhibition resulted in increased proliferation, whereas enforced ectopic CAR expression led to opposite results. Blocking the extracellular portion of CAR increased cell invasion in vitro. In mice, xenotransplants of colon cancer cells with enforced CAR expression formed significantly smaller tumours, whereas CAR inhibition increased the formation of liver metastases. Conclusion: We conclude that CAR facilitates complex effects during colon carcinogenesis, potentially mediated by its stage-dependent subcellular distribution; high CAR expression potentially prevents apoptosis in adenomas, loss of CAR at the plasma membrane promotes growth, and dissemination of primary cancers, and high membranous CAR presence may support the establishment of distant metastases.
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Affiliation(s)
- K Stecker
- Department of Internal Medicine, Divisions of Gastroenterology and Hepatology, Charité Medical School, Campus Virchow, Augustenburgerplatz 1, Berlin 13353, Germany
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Abstract
In the last ten years, almost 60 departments of surgical pathology were accredited in Germany according to DIN EN ISO/IEC 17020. Accreditation in pathology was accompanied by the adoption of a highly dynamic process, which requires staff to be more aware of quality and to introduce a quality-oriented system. The accreditation body in turn needed to consider all the duties, responsibilities and processes in surgical pathology and was supported in this regard by the Sector Committee of Pathology and Neuropathology of the DGA German Association for Accreditation. In this review we illustrate the various problems associated with accreditation in surgical pathology by answering eight questions that have arisen over many years of activity. These include the registration and appropriate presentation of the scope of accreditation, the terminology, as well as the extent and depth of documentation. A department of pathology applying for accreditation is required to document the entire step-wise process leading to a surgical pathological diagnosis.
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
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Lordick F, Grenacher L, Röcken C, Ebert M, Moehler M, Schumacher G. [Diagnosis and treatment of gastric cancer]. Dtsch Med Wochenschr 2010; 135:1671-82; quiz 1683-6. [PMID: 20721843 DOI: 10.1055/s-0030-1262460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
From a global perspective, gastric cancer including cancer of the esophago-gastric junction is the fourth most common malignant tumor and the second-most common cause of cancer-related death. Due to the lack of screening programs in Western countries, most gastric cancers are diagnosed in advanced stages. A sophisticated staging should include high-resolution computed tomography of the thorax, abdomen and pelvis and video-documented endoscopy and endoscopic ultrasound. In mucosal gastric cancer, endoscopic resection can replace surgical resection if specific criteria are present. In the stages II and III perioperative chemotherapy has been established as a standard of care and should be applied. In the metastatic setting, treatment goals are palliative. Chemotherapy can prolong survival, improve symptoms and can help to maintain a better quality of life. Combination chemotherapy including a platinum compound and a fluoropyrimidine regarded as standard. About 20 % of gastric cancers exhibit overexpression of the growth factor receptor family member Her2. Trastuzumab is a monoclonal antibody directed against Her2 and has shown to prolong survival when combined with cisplatin and 5-fluorouracil or capecitabine.
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Affiliation(s)
- F Lordick
- Medizinische Klinik III (Hämatologie und Onkologie), Klinikum Braunschweig und Medizinische Hochschule Hannover
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Schlolaut B, Griff S, Schönfeld N, Mairinger T, Kaiser D, Röcken C, Förster G. Eine neue Differenzialdiagnose des PET-positiven Rundherds: die solitäre primär pulmonale Amyloidose. Pneumologie 2010. [DOI: 10.1055/s-0030-1251225] [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: 10/19/2022]
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Babilas P, Fiebig B, Aslanidis C, Hansen J, Röcken C, Schroeder J, Schmitz G, Weber B, Landthaler M, Vogt T. Identification of an oncostatin M receptor mutation associated with familial primary cutaneous amyloidosis. Br J Dermatol 2009; 161:944-7. [DOI: 10.1111/j.1365-2133.2009.09237.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION We reassessed the histopathology and origin of amyloid in liver biopsies. MATERIALS AND METHODS All liver biopsies were retrieved from a series of 588 cases with histologically confirmed amyloidosis submitted between February 2006 and January 2009 to the Amyloid Registry of the Charité University Hospital. Liver biopsies had been fixed in formalin and embedded in paraffin. 3-5 microm thick paraffin sections were stained with hematoxylin and eosin and Congo red. Amyloid was classified immunohistochemically, using antibodies directed against amyloid P-component, AA amyloid, apolipoprotein AI, fibrinogen, lysozyme, lambda- and kappa-light chain, and transthyretin. RESULTS Amyloid was found in 46 liver biopsies (29 men, 17 women; mean age 60 years, range 34-87 years). Immunohistochemical classification succeeded in 42 cases. AL amyloidosis was present in 40 (87%) cases and was further categorized into AL amyloid of lambda-light chain origin in 26 (57%) cases, and kappa-light chain origin in 14 (30%) cases. ATTR and AA amyloidosis were found in a single patient each (2%). In 4 (9%) cases, amyloid remained unclassified. CONCLUSIONS Hepatic amyloidosis is most commonly AL amyloid of lambda- and kappa-light chain origin and is often associated with marked parenchymal atrophy.
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Affiliation(s)
- Z Gioeva
- Institut für Pathologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Abstract
Amyloid is a pathologic fibrillar aggregation of polypeptides in a cross-beta-sheet conformation. Amyloidoses are caused by the deposition of amyloid and may occur as cerebral and extracerebral disease. More than 29 different amyloid proteins have been identified. Analysis of a Congo red-stained tissue section by polarization microscopy is the gold standard for diagnosing amyloid. Subsequent classification of the amyloid is mandatory and is increasingly supported by molecular biological analyses. In Germany, this recently led to the discovery of several hereditary amyloid diseases. The correct classification of amyloid is of paramount importance. This helps to asses the prognosis and plan patient treatment.
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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50
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Abstract
Mutations in the gene encoding dysferlin (DYSF) cause limb-girdle muscular dystrophy 2B (LGMD2B) and Miyoshi myopathy (MM). We were able to examine eight patients suspected of LGMD2B clinically, histochemically. The genotype was determined in every case. We found sarcolemmal and interstitial amyloid deposits in four muscle sections. All of the mutations associated with amyloid were located in the N-terminal region of dysferlin, and dysferlin clearly proved to be a component of the amyloid deposits. Dysferlin-deficient muscular dystrophy is the first muscular dystrophy in which amyloidosis is involved. This fact must be considered in the process of developing therapeutic strategies. The influence of the amyloid deposits on the pathogenesis of the disease and the possible involvement of other organs in the progressive course are as yet unclear.
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Affiliation(s)
- M Carl
- Abteilung für Myologie, Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin und Max-Delbrück-Centrum Berlin, Lindenberger Weg 80, 13125, Berlin, Deutschland.
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