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Gluz O, Nitz UA, Christgen M, Kuemmel S, Holtschmidt J, Schumacher J, Hartkopf A, Potenberg J, Lüedtke-Heckenkamp K, Just M, Schem C, von Schumann R, Kolberg-Liedtke C, Eulenburg CZ, Schinköthe T, Graeser M, Wuerstlein R, Kates RE, Kreipe HH, Harbeck N. Efficacy of Endocrine Therapy Plus Trastuzumab and Pertuzumab vs De-escalated Chemotherapy in Patients with Hormone Receptor-Positive/ERBB2-Positive Early Breast Cancer: The Neoadjuvant WSG-TP-II Randomized Clinical Trial. JAMA Oncol 2023:2804892. [PMID: 37166817 PMCID: PMC10176180 DOI: 10.1001/jamaoncol.2023.0646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Importance Combination of chemotherapy with (dual) ERBB2 blockade is considered standard in hormone receptor (HR)-positive/ERBB2-positive early breast cancer (EBC). Despite some promising data on endocrine therapy (ET) combination with dual ERBB2 blockade in HR-positive/ERBB2-positive BC, to our knowledge, no prospective comparison of neoadjuvant chemotherapy vs ET plus ERBB2 blockade in particular with focus on molecular markers has yet been performed. Objective To determine whether neoadjuvant de-escalated chemotherapy is superior to endocrine therapy, both in combination with pertuzumab and trastuzumab, in a highly heterogeneous HR-positive/ERBB2-positive EBC. Design, Setting, and Participants This prospective, multicenter, neoadjuvant randomized clinical trial allocated 207 patients with centrally confirmed estrogen receptor-positive and/or progesterone receptor-positive (>1%) HR-positive/ERBB2-positive EBC to 12 weeks of standard ET (n = 100) vs paclitaxel (n = 107) plus trastuzumab and pertuzumab. A total of 186 patients were required to detect a statistically significant difference in pathological complete response (pCR) (assumptions: 19% absolute difference in pCR; power, ≥80%; 1-sided Fisher exact test, 2.5% significance level). Interventions Standard ET (aromatase inhibitor or tamoxifen) or paclitaxel, 80 mg/m2, weekly plus trastuzumab and pertuzumab every 21 days. Main Outcomes and Measures The primary end point was pCR (ypT0/is, ypN0). Secondary end points included safety, translational research, and health-related quality of life. Omission of further chemotherapy was allowed in patients with pCR. PAM50 analysis was performed on baseline tumor biopsies. Results Of the 207 patients included (median [range] age, 53 [25-83] years), 121 (58%) had cT2 to cT4 tumors, and 58 (28%) had clinically node-positive EBC. The pCR rate in the ET plus trastuzumab and pertuzumab arm was 23.7% (95% CI, 15.7%-33.4%) vs 56.4% (95% CI, 46.2%-66.3%) in the paclitaxel plus trastuzumab and pertuzumab arm (odds ratio, 0.24; 95% CI, 0.12-0.46; P < .001). Both immunohistochemical ERBB2 score of 3 or higher and ERBB2-enriched subtype were independent predictors for pCR in both arms. Paclitaxel was superior to ET only in the first through third quartiles but not in the highest ERBB2 quartile by messenger RNA. In contrast with the paclitaxel plus trastuzumab and pertuzumab arm, no decrease in health-related quality of life after 12 weeks was observed in the ET plus trastuzumab and pertuzumab arm. Conclusions and Relevance The WSG-TP-II randomized clinical trial is, to our knowledge, the first prospective trial comparing 2 neoadjuvant de-escalation treatments in HR-positive/ERBB2-positive EBC and demonstrated an excellent pCR rate after 12 weeks of paclitaxel plus trastuzumab and pertuzumab that was clearly superior to the pCR rate after ET plus trastuzumab and pertuzumab. Trial Registration ClinicalTrials.gov Identifier: NCT03272477.
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Affiliation(s)
- Oleg Gluz
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
- University Clinics Cologne, Cologne, Germany
| | - Ulrike A Nitz
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Mönchengladbach, Germany
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Holtschmidt
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Breast Center, St Elisabeth-Krankenhaus Köln-Hohenlind, Cologne, Germany
| | | | - Andreas Hartkopf
- Department of Gynecology and Obstetrics, Tüebingen University Hospital, Tüebingen, Germany
| | | | | | | | | | | | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Women's Clinic, University Clinics Essen, Essen, Germany
| | - Christine Zu Eulenburg
- West German Study Group, Mönchengladbach, Germany
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Timo Schinköthe
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
- CANKADO Service GmbH, Kirchheim bei München, Germany
| | - Monika Graeser
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
- Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- West German Study Group, Mönchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
| | | | | | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
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2
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Harbeck N, Nitz UA, Christgen M, Kümmel S, Braun M, Schumacher C, Potenberg J, Tio J, Aktas B, Forstbauer H, Grischke EM, Scheffen I, Malter W, von Schumann R, Just M, Zu Eulenburg C, Biehl C, Kolberg-Liedtke C, Deurloo R, de Haas S, Jóźwiak K, Hauptmann M, Kates R, Graeser M, Wuerstlein R, Kreipe HH, Gluz O. De-Escalated Neoadjuvant Trastuzumab-Emtansine With or Without Endocrine Therapy Versus Trastuzumab With Endocrine Therapy in HR+/HER2+ Early Breast Cancer: 5-Year Survival in the WSG-ADAPT-TP Trial. J Clin Oncol 2023:JCO2201816. [PMID: 36809046 DOI: 10.1200/jco.22.01816] [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: 02/23/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy is standard of care in human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC), irrespective of the hormone receptor status. Trastuzumab-emtansine (T-DM1), antibody-drug conjugate, is highly effective in HER2+ EBC; however, no survival data are available for de-escalated antibody-drug conjugate-based neoadjuvant therapy without conventional chemotherapy. PATIENTS AND METHODS In the WSG-ADAPT-TP (ClinicalTrials.gov identifier: NCT01779206) phase II trial, 375 centrally reviewed patients with hormone receptor-positive (HR+)/HER2+ EBC (clinical stage I-III) were randomly assigned to 12 weeks of T-DM1 with or without endocrine therapy (ET) or trastuzumab + ET once every 3 weeks (ratio 1:1:1). Adjuvant chemotherapy (ACT) omission was allowed in patients with pathologic complete response (pCR). In this study, we report the secondary survival end points and biomarker analysis. Patients who received at least one dose of study treatment were analyzed. Survival was analyzed using the Kaplan-Meier method, two-sided log-rank statistics, and Cox regression models stratified for nodal and menopausal status. P values < .05 were considered statistically significant. RESULTS T-DM1, T-DM1 + ET, and trastuzumab + ET induced similar 5-year invasive disease-free survival (iDFS; 88.9%, 85.3%, 84.6%; Plog-rank = .608) and overall survival rates (97.2%, 96.4%, 96.3%; Plog-rank = .534). Patients with pCR versus non-pCR had improved 5-year iDFS rates (92.7% v 82.7%; hazard ratio, 0.40; 95% CI, 0.18 to 0.85). Among the 117 patients with pCR, 41 did not receive ACT; 5-year iDFS rates were similar in those with (93.0%; 95% CI, 84.0 to 97.0) and without ACT (92.1%; 95% CI, 77.5 to 97.4; Plog-rank = .848). Translational research revealed that tumors with PIK3CA wild type, high immune marker expression, and luminal-A tumors (by PAM50) had an excellent prognosis with de-escalated anti-HER2 therapy. CONCLUSION The WSG-ADAPT-TP trial demonstrated that pCR after 12 weeks of chemotherapy-free de-escalated neoadjuvant therapy was associated with excellent survival in HR+/HER2+ EBC without further ACT. Despite higher pCR rates for T-DM1 ± ET versus trastuzumab + ET, all trial arms had similar outcomes because of mandatory standard chemotherapy after non-pCR. WSG-ADAPT-TP demonstrated that such de-escalation trials in HER2+ EBC are feasible and safe for patients. Patient selection on the basis of biomarkers or molecular subtypes may increase the efficacy of systemic chemotherapy-free HER2-targeted approaches.
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Affiliation(s)
- Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Ulrike A Nitz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | | | - Sherko Kümmel
- West German Study Group, Moenchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | | | | | - Joke Tio
- Department of Gynecology, University Hospital Münster, Münster, Germany
| | - Bahriye Aktas
- Women's Clinic, University Clinics Essen, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | - Iris Scheffen
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Breast Center, University Hospital, Cologne, Germany
| | | | | | - Christine Zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Claudia Biehl
- Westphalian Brest Center Dortmund, Dortmund, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Women's Clinic, University Clinics Essen, Essen, Germany
| | | | | | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
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3
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Gluz O, Nitz U, Kolberg-Liedtke C, Prat A, Christgen M, Kuemmel S, Mohammadian MP, Gebauer D, Kates R, Paré L, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Wuerstlein R, Graeser M, Pelz E, Jóźwiak K, Zu Eulenburg C, Kreipe HH, Harbeck N. De-escalated Neoadjuvant Chemotherapy in Early Triple-Negative Breast Cancer (TNBC): Impact of Molecular Markers and Final Survival Analysis of the WSG-ADAPT-TN Trial. Clin Cancer Res 2022; 28:4995-5003. [PMID: 35797219 DOI: 10.1158/1078-0432.ccr-22-0482] [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] [Received: 02/13/2022] [Revised: 04/13/2022] [Accepted: 07/05/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Although optimal treatment in early triple-negative breast cancer (TNBC) remains unclear, de-escalated chemotherapy appears to be an option in selected patients within this aggressive subtype. Previous studies have identified several pro-immune factors as prognostic markers in TNBC, but their predictive impact regarding different chemotherapy strategies is still controversial. EXPERIMENTAL DESIGN ADAPT-TN is a randomized neoadjuvant multicenter phase II trial in early patients with TNBC (n = 336) who were randomized to 12 weeks of nab-paclitaxel 125 mg/m2 + gemcitabine or carboplatin d 1,8 q3w. Omission of further (neo-) adjuvant chemotherapy was allowed only in patients with pathological complete response [pCR, primary endpoint (ypT0/is, ypN0)]. Secondary invasive/distant disease-free and overall survival (i/dDFS, OS) and translational research objectives included quantification of a predictive impact of markers regarding selection for chemotherapy de-escalation, measured by gene expression of 119 genes (including PAM50 subtype) by nCounter platform and stromal tumor-infiltrating lymphocytes (sTIL). RESULTS After 60 months of median follow-up, 12-week-pCR was favorably associated (HR, 0.24; P = 0.001) with 5y-iDFS of 90.6% versus 62.8%. No survival advantage of carboplatin use was observed, despite a higher pCR rate [HR, 1.04; 95% confidence interval (CI), 0.68-1.59]. Additional anthracycline-containing chemotherapy was not associated with a significant iDFS advantage in pCR patients (HR, 1.29; 95% CI, 0.41-4.02). Beyond pCR rate, nodal status and high sTILs were independently associated with better iDFS, dDFS, and OS by multivariable analysis. CONCLUSIONS Short de-escalated neoadjuvant taxane/platinum-based combination therapy appears to be a promising strategy in early TNBC for using pCR rate as an early decision point for further therapy (de-) escalation together with node-negative status and high sTILs. See related commentary by Sharma, p. 4840.
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Affiliation(s)
- Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany
| | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Mohammad Parsa Mohammadian
- Institute of Biostatistics and Registry Research, Brandenburg Medical School "Theodor Finane," Neuruppin, Germany
| | | | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Laia Paré
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Michael Braun
- Rotkreuz Clinics Munich, Breast Center, Munich, Germany
| | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department Obstetrics and Gynecology, Breast Center, LMU University Hospital and CCC Munich, Munich, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Moenchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Enrico Pelz
- Institute of Pathology Viersen, Viersen, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School "Theodor Finane," Neuruppin, Germany
| | - Christine Zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department Obstetrics and Gynecology, Breast Center, LMU University Hospital and CCC Munich, Munich, Germany
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4
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Grote I, Bartels S, Kandt L, Bollmann L, Christgen H, Gronewold M, Raap M, Lehmann U, Gluz O, Nitz U, Kuemmel S, Zu Eulenburg C, Braun M, Aktas B, Grischke EM, Schumacher C, Luedtke-Heckenkamp K, Kates R, Wuerstlein R, Graeser M, Harbeck N, Christgen M, Kreipe H. TP53 mutations are associated with primary endocrine resistance in luminal early breast cancer. Cancer Med 2021; 10:8581-8594. [PMID: 34779146 PMCID: PMC8633262 DOI: 10.1002/cam4.4376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/26/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background Whereas the genomic landscape of endocrine‐resistant breast cancer has been intensely characterized in previously treated cases with local or distant recurrence, comparably little is known about genomic alterations conveying primary non‐responsiveness to endocrine treatment in luminal early breast cancer. Methods In this study, 622 estrogen receptor‐expressing breast cancer cases treated with short‐term preoperative endocrine therapy (pET) from the WSG‐ADAPT trial (NCT01779206) were analyzed for genetic alterations associated with impaired endocrine proliferative response (EPR) to 3‐week pET with tamoxifen or aromatase inhibitors. EPR was categorized as optimal (post‐pET Ki67 <10%) versus slightly, moderately, and severely impaired (post‐pET Ki67 10%–19%, 20%–34%, and ≥35%, respectively). Recently described gene mutations frequently found in previously treated advanced breast cancer were analyzed (ARID1A, BRAF, ERBB2, ESR1, GATA3, HRAS, KRAS, NRAS, PIK3CA, and TP53) by next‐generation sequencing. Amplifications of CCND1, FGFR1, ERBB2, and PAK1 were determined by digital PCR or fluorescence in situ hybridization. Results ERBB2 amplification (p = 0.0015) and mutations of TP53 (p < 0.0001) were significantly associated with impaired EPR. Impaired EPR in TP53‐mutated breast cancer cases was independent from the Oncotype DX Recurrence Score group and was seen both with tamoxifen‐ and aromatase inhibitor‐based pET (p = 0.0005 each). Conclusion We conclude that impaired EPR to pET is suitable to identify cases with primary endocrine resistance in early luminal breast cancer and that TP53‐mutated luminal cancers might not be sufficiently treated by endocrine therapy alone.
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Affiliation(s)
- Isabel Grote
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Stephan Bartels
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Leonie Kandt
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Laura Bollmann
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | | | - Malte Gronewold
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Mieke Raap
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Ulrich Lehmann
- Hannover Medical School, Institute of Pathology, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Moenchengladbach, Germany.,University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Moenchengladbach, Germany
| | - Sherko Kuemmel
- West German Study Group, Moenchengladbach, Germany.,Clinics Essen-Mitte, Breast Unit, Essen, Germany.,Charité, Women's Clinic, Berlin, Germany
| | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | | | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Rachel Wuerstlein
- Department OB&GYN and CCC Munich, LMU University Hospital, Breast Center, Munich, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Ev. Bethesda Hospital, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department OB&GYN and CCC Munich, LMU University Hospital, Breast Center, Munich, Germany
| | | | - Hans Kreipe
- Hannover Medical School, Institute of Pathology, Hannover, Germany
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5
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Woelber L, Bommert M, Harter P, Prieske K, Zu Eulenburg C, Jueckstock J, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann K, Beckmann M, Mustea A, Meier W, Mahner S, Jaeger A. Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study. Ann Surg Oncol 2021; 28:6696-6704. [PMID: 33723714 PMCID: PMC8460538 DOI: 10.1245/s10434-021-09744-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 11/06/2020] [Accepted: 02/04/2021] [Indexed: 12/23/2022]
Abstract
Background As the population at risk for pelvic nodal involvement remains poorly described, the role of pelvic lymphadenectomy (LAE) in vulvar squamous cell cancer (VSCC) has been a matter of discussion for decades. Methods In the AGO-CaRE-1 study, 1618 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or higher primary VSCC treated at 29 centers in Germany between 1998 and 2008 were documented. In this analysis, only patients with pelvic LAE (n = 70) were analyzed with regard to prognosis and correlation between inguinal and pelvic lymph node involvement. Results The majority of patients had T1b/T2 tumors (n = 47; 67.1%), with a median diameter of 40 mm (2–240 mm); 54/70 patients (77.1%) who received pelvic LAE had positive groin nodes. For 42 of these 54 patients, the number of affected groin nodes had been documented as a median of 3; 14/42 (33.3%) of these patients had histologically confirmed pelvic nodal metastases (median number of affected pelvic nodes 3 [1–12]). In these 14 patients, the median number of affected groin nodes was 7 (1–30), with a groin metastases median maximum diameter of 42.5 mm (12–50). Receiver operating characteristic analysis showed an area under the curve of 0.85, with 83.3% sensitivity and 92.6% specificity for the prediction of pelvic involvement in cases of six or more positive groin nodes. No cases of pelvic nodal involvement without groin metastases were observed. Prognosis in cases of pelvic metastasis was poor, with a median progression-free survival of only 12.5 months. Conclusion For the majority of node-positive patients with VSCC, pelvic nodal staging appears unnecessary since a relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, LMU - University of Munich, Munich, Germany
| | - Felix Hilpert
- Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Nikolaus de Gregorio
- Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany
| | - Severine Iborra
- Department of Gynecology and Gynecologic Oncology, University Hospital Aachen, RWTH Aachen, Aachen, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Sophie Fuerst
- Department of Obstetrics and Gynecology, University Hospital, LMU - University of Munich, Munich, Germany
| | | | - Klaus Baumann
- Department of Gynecology, Medical Center Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, Bonn, Germany
| | - Werner Meier
- Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU - University of Munich, Munich, Germany
| | - Anna Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Seiffert K, Thoene K, Eulenburg CZ, Behrens S, Schmalfeldt B, Becher H, Chang-Claude J, Witzel I. The effect of family history on screening procedures and prognosis in breast cancer patients - Results of a large population-based case-control study. Breast 2020; 55:98-104. [PMID: 33395600 PMCID: PMC7782318 DOI: 10.1016/j.breast.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/14/2020] [Revised: 12/06/2020] [Accepted: 12/18/2020] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND The potential benefit of additional breast cancer screening examinations in moderate risk patients (patients with a history of breast cancer in one or two family members) remains unclear. METHODS A large population-based case-control study on breast cancer in postmenopausal women in Germany recruited 2002-2005 (3813 cases and 7341 age-matched controls) was used to assess the association of family history with breast cancer risk. Analysis of family history, participation in screening procedures, and tumor size regarding prognosis in patients was based on follow-up data until 2015. RESULTS A first degree family history of breast cancer was associated with higher breast cancer risk (OR 1.39, p < 0.001). Patients with a first degree family history of breast cancer were more likely to have had >10 mammograms (MG) (42.7% vs. 24.9%, p < 0.001) and showed a higher rate of imaging-detected tumors (MG or ultrasound) (45.8% vs. 31.9%, p < 0.001). A smaller tumor size at initial diagnosis (below 2 cm) was more likely in patients with a positive family history (OR 1.45, p < 0.001) and a higher number of MG (≥10 MG: OR 2.29). After accounting for tumor characteristics, mammogram regularity (HR 0.72, p < 0.001) and imaging-assisted tumor detection (HR 0.66, p < 0.001) were associated with better overall survival but not with a positive family history. DISCUSSION Patients with a positive family history had a higher rate of imaging detected tumors with smaller size at initial diagnosis compared to patients without affected family members. Screening was associated with improved survival after a breast cancer diagnosis, irrespective of a positive family history.
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Affiliation(s)
- Katharina Seiffert
- University Medical Center Hamburg-Eppendorf, Department of Gynecology, Martinistraße 52, 20246, Hamburg, Germany.
| | - Kathrin Thoene
- Department of Cancer Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christine Zu Eulenburg
- University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Martinistraße 52, 20246, Hamburg, Germany; University of Groningen, University Medical Center Groningen, Epidemiology, Groningen, the Netherlands
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Schmalfeldt
- University Medical Center Hamburg-Eppendorf, Department of Gynecology, Martinistraße 52, 20246, Hamburg, Germany
| | - Heiko Becher
- Department of Cancer Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jenny Chang-Claude
- Department of Cancer Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany; Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabell Witzel
- University Medical Center Hamburg-Eppendorf, Department of Gynecology, Martinistraße 52, 20246, Hamburg, Germany
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7
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Dashorst P, Huntjens RJC, Mooren TM, Kleber RJ, Zu Eulenburg C, de Jong PJ. Intrusions related to indirectly experienced events in clinical offspring of World War Two survivors. J Anxiety Disord 2020; 71:102209. [PMID: 32193000 DOI: 10.1016/j.janxdis.2020.102209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/23/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022]
Abstract
Negative events may not only linger on in the form of intrusive memories in the minds of those directly exposed but also in those who are only indirectly confronted with these events. The aim of the present study was to investigate if intrusions referring to indirectly experienced traumatic events do indeed occur, and to compare their frequency and characteristics to intrusions about directly experienced negative events. Participants (N = 98) were adult postwar offspring of World War Two survivors currently in treatment in one of two clinics specialized in the treatment of war victims. We examined the frequency and characteristics of intrusions about indirectly experienced (i.e., parent war-related) events and two types of directly (self-) experienced events: Self-experienced traumatic events and negative events related to participants' upbringing. Intrusions referring to indirectly experienced traumatic events did indeed occur. The frequency as well as other characteristics of these intrusions did not differ from those of both types of intrusions about directly experienced events. The similarities between intrusions related to different types of events emphasize the (re)constructive nature of memory. Our findings indicate that traumatic events not only affect those directly involved but may also continue to plague the next generation.
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Affiliation(s)
| | - Rafaele J C Huntjens
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Trudy M Mooren
- ARQ Centrum'45, Diemen/Oegstgeest, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Rolf J Kleber
- ARQ Centrum'45, Diemen/Oegstgeest, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Christine Zu Eulenburg
- Department for Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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8
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Bouwstra R, He Y, de Boer J, Kooistra H, Cendrowicz E, Fehrmann RSN, Ammatuna E, Zu Eulenburg C, Nijland M, Huls G, Bremer E, van Meerten T. CD47 Expression Defines Efficacy of Rituximab with CHOP in Non-Germinal Center B-cell (Non-GCB) Diffuse Large B-cell Lymphoma Patients (DLBCL), but Not in GCB DLBCL. Cancer Immunol Res 2019; 7:1663-1671. [PMID: 31409608 DOI: 10.1158/2326-6066.cir-18-0781] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/27/2019] [Accepted: 08/09/2019] [Indexed: 11/16/2022]
Abstract
Addition of rituximab (R) to "CHOP" (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy improved outcome for diffuse large B-cell lymphoma (DLBCL) patients. Approximately 40% of patients who receive R-CHOP still succumb to disease due to intrinsic resistance or relapse. A potential negative regulator of DLBCL treatment outcome is the CD47 "don't eat me" immune checkpoint. To delineate the impact of CD47, we used a clinically and molecularly well-annotated cohort of 939 DLBCL patients, comprising both germinal center B-cell (GCB) and non-GCB DLBCL subtypes, treated with either CHOP or R-CHOP. High (above median) CD47 mRNA expression correlated with a detrimental effect on overall survival (OS) when DLBCL patients received R-CHOP therapy (P = 0.001), but not CHOP therapy (P = 0.645). Accordingly, patients with low CD47 expression benefited most from the addition of rituximab to CHOP [HR, 0.32; confidence interval (CI), 0.21-0.50; P < 0.001]. This negative impact of high CD47 expression on OS after R-CHOP treatment was only evident in cancers of non-GCB origin (HR, 2.09; CI, 1.26-3.47; P = 0.004) and not in the GCB subtype (HR, 1.16; CI, 0.68-1.99; P = 0.58). This differential impact of CD47 in non-GCB and GCB was confirmed in vitro, as macrophage-mediated phagocytosis stimulated by rituximab was augmented by CD47-blocking antibody only in non-GCB cell lines. Thus, high expression of CD47 mRNA limited the benefit of addition of rituximab to CHOP in non-GCB patients, and CD47-blockade only augmented rituximab-mediated phagocytosis in non-GCB cell lines. Patients with non-GCB DLBCL may benefit from CD47-targeted therapy in addition to rituximab.
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Affiliation(s)
- Renée Bouwstra
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Yuan He
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Janneke de Boer
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Hilde Kooistra
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Ewa Cendrowicz
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Rudolf S N Fehrmann
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - Emanuele Ammatuna
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Christine Zu Eulenburg
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Marcel Nijland
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Gerwin Huls
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands
| | - Edwin Bremer
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands.
| | - Tom van Meerten
- University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, the Netherlands.
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9
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Dekker AD, Sacco S, Carfi A, Benejam B, Vermeiren Y, Beugelsdijk G, Schippers M, Hassefras L, Eleveld J, Grefelman S, Fopma R, Bomer-Veenboer M, Boti M, Oosterling GDE, Scholten E, Tollenaere M, Checkley L, Strydom A, Van Goethem G, Onder G, Blesa R, Zu Eulenburg C, Coppus AMW, Rebillat AS, Fortea J, De Deyn PP. The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale: Comprehensive Assessment of Psychopathology in Down Syndrome. J Alzheimers Dis 2019; 63:797-819. [PMID: 29689719 PMCID: PMC5929348 DOI: 10.3233/jad-170920] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 12/31/2022]
Abstract
People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving.
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Affiliation(s)
- Alain D Dekker
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | | | - Angelo Carfi
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Bessy Benejam
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | - Yannick Vermeiren
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Gonny Beugelsdijk
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Mieke Schippers
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Lyanne Hassefras
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - José Eleveld
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Sharina Grefelman
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Roelie Fopma
- Talant, Center for Intellectual Disabilities, Heerenveen, The Netherlands
| | | | - Mariángeles Boti
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | | | - Esther Scholten
- Elver, Center for Intellectual Disabilities, Nieuw-Wehl, The Netherlands
| | - Marleen Tollenaere
- Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Laura Checkley
- Division of Psychiatry, University College London, London, UK
| | - André Strydom
- Division of Psychiatry, University College London, London, UK
| | - Gert Van Goethem
- Het GielsBos, Center for Intellectual Disabilities, Gierle, Belgium.,Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Graziano Onder
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Rafael Blesa
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christine Zu Eulenburg
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonia M W Coppus
- Dichterbij, Center for Intellectual Disabilities, Gennep, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Juan Fortea
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain.,Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
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10
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Janning M, Müller V, Vettorazzi E, Cubas-Cordova M, Gensch V, Ben-Batalla I, Zu Eulenburg C, Schem C, Fasching PA, Schnappauf B, Karn T, Fehm T, Just M, Kühn T, Holms F, Overkamp F, Krabisch P, Rack B, Denkert C, Untch M, Tesch H, Rezai M, Kittel K, Pantel K, Bokemeyer C, Loibl S, von Minckwitz G, Loges S. Evaluation of soluble carbonic anhydrase IX as predictive marker for efficacy of bevacizumab: A biomarker analysis from the geparquinto phase III neoadjuvant breast cancer trial. Int J Cancer 2019; 145:857-868. [PMID: 30694523 DOI: 10.1002/ijc.32163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/19/2018] [Revised: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022]
Abstract
We analyzed the predictive potential of pretreatment soluble carbonic anhydrase IX levels (sCAIX) for the efficacy of bevacizumab in the phase III neoadjuvant GeparQuinto trial. sCAIX was determined by enzyme-linked immunosorbent assay (ELISA). Correlations between sCAIX and pathological complete response (pCR), disease-free and overall survival (DFS, OS) were assessed with logistic and Cox proportional hazard regression models using bootstrapping for robust estimates and internal validation. 1,160 HER2-negative patient sera were analyzed, of whom 577 received bevacizumab. Patients with low pretreatment sCAIX had decreased pCR rates (12.1 vs. 20.1%, p = 0.012) and poorer DFS (adjusted 5-year DFS 71.4 vs. 80.5 months, p = 0.010) compared to patients with high sCAIX when treated with neoadjuvant chemotherapy (NCT). For patients with low sCAIX, pCR rates significantly improved upon addition of bevacizumab to NCT (12.1 vs. 20.4%; p = 0.017), which was not the case in patients with high sCAIX (20.1% for NCT vs. 17.0% for NCT-B, p = 0.913). When analyzing DFS we found that bevacizumab improved 5-year DFS for patients with low sCAIX numerically but not significantly (71.4 vs. 78.5 months; log rank 0.234). In contrast, addition of bevacizumab worsened 5-year DFS for patients with high sCAIX (81 vs. 73.6 months, log-rank 0.025). By assessing sCAIX levels we identified a patient cohort in breast cancer that is potentially undertreated with NCT alone. Bevacizumab improved pCR rates in this group, suggesting sCAIX is a predictive biomarker for bevacizumab with regards to treatment response. Our data also show that bevacizumab is not beneficial in patients with high sCAIX.
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Affiliation(s)
- Melanie Janning
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Clinic and Policlinic for Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miguel Cubas-Cordova
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria Gensch
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Ben-Batalla
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Zu Eulenburg
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Schem
- Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Benjamin Schnappauf
- Department of Obstetrics and Gynecology, School of Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Thomas Karn
- Department of Obstetrics and Gynecology, School of Medicine, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Düsseldorf, Germany
| | - Marianne Just
- Onkologische Schwerpunktpraxis Bielefeld, Bielefeld, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Frank Holms
- Department of Gynecology and Obstetrics, St. Barbara Kliniken Heessen, Hamm, Germany
| | | | - Petra Krabisch
- Department of Gynecology and Obstetrics, Klinikum Chemnitz, Germany
| | - Brigitte Rack
- Department of Obstetrics and Gynecology, Campus Innenstadt, University Hospital Munich, Germany
| | - Carsten Denkert
- Department of Pathology, Charité Berlin Campus Mitte and German Cancer Consortium (DKTK), Berlin, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Hans Tesch
- Centre for Hematology and Oncology, Frankfurt, Germany
| | - Mahdi Rezai
- Centre for Breast Cancer, Luisenkrankenhaus Düsseldorf, Germany
| | | | - Klaus Pantel
- Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Sonja Loges
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tumor Biology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Lauseker M, Zu Eulenburg C. Analysis of cause of death: Competing risks or progressive illness-death model? Biom J 2019; 61:264-274. [PMID: 30680772 DOI: 10.1002/bimj.201700238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/10/2017] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022]
Abstract
The analysis of cause of death is increasingly becoming a topic in oncology. It is usually distinguished between disease-related and disease-unrelated death. A frequently used approach is to define death as disease-related when a progression to advanced phases has occurred before, otherwise as disease-unrelated. The data are often analyzed as competing risks, while a progressive illness-death model might in fact describe the situation more precisely. In this study, we investigated under which circumstances this misspecification leads to biased estimations of the state occupation probabilities. We simulated data according to the progressive illness-death model in various settings, analyzed them with a competing risks model and with a progressive illness-death model and compared them to the true state occupation probabilities. Censoring was either added independently of the status or based on the patients' status. The simulations showed that the censoring mechanism was decisive for the bias while neither the progression hazard nor the Markov property was important. Further, we found a slightly increased standard deviation for the competing risk estimator when censoring was independent of the patients' status. For illustration, both methods were applied to two practical examples of chronic myeloid leukemia (CML): one randomized controlled trial and one registry data set. While in the first case both estimators yielded almost identical results, in the latter case, visible differences were found between both methods.
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Affiliation(s)
- Michael Lauseker
- Ludwig-Maximilians-Universität München, Institute for Medical Information Processing, Biometry and Epidemiology, München, Bavaria, Germany
| | - Christine Zu Eulenburg
- Department of Epidemiology, Medical Statistics and Decision Making, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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12
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Dekker AD, Vermeiren Y, Beugelsdijk G, Schippers M, Hassefras L, Eleveld J, Grefelman S, Fopma R, Bomer-Veenboer M, Oosterling GDE, Scholten E, Tollenaere M, Van Goethem G, Zu Eulenburg C, Coppus AMW, De Deyn PP. [The behavioral and psychological symptoms of dementia in down syndrome (BPSD-DS) scale: comprehensive assessment of psychopathology in down syndrome]. Tijdschr Gerontol Geriatr 2018; 49:187-205. [PMID: 30238286 DOI: 10.1007/s12439-018-0262-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/06/2018] [Indexed: 11/26/2022]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) have not been comprehensively studied in people with Down syndrome, despite their high risk on dementia. A novel evaluation scale was developed to identify the nature, frequency and severity of behavioral changes (83 behavioral items in 12 clinically defined sections). Central aim was to identify items that change in relation to the dementia status. Structured interviews were conducted with informants of people with Down syndrome without dementia (DS, N = 149), with questionable dementia (DS + TD, N = 65) and with diagnosed dementia (DS + AD, N = 67). Group comparisons showed a pronounced increase in frequency and severity of items about anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and, eating/drinking behavior. The proportion of individuals presenting an increase was highest in the DS + AD group and lowest in the DS group. Interestingly, among DS + TD individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy and depressive symptoms, suggesting that these changes may be early alarm signals of dementia. The scale may contribute to a better understanding of the changes, adapting daily care/support, and providing suitable therapies to people with Down syndrome. The scale needs to be optimized based on the results and experiences. The applicability, reliability and validity require further study.
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Affiliation(s)
- Alain D Dekker
- Afdeling Neurologie en Alzheimer Onderzoekscentrum, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, postbus 30.001, 9700 RB, Groningen, Nederland
- Instituut Born-Bunge, Universiteit Antwerpen, Wilrijk, België
| | - Yannick Vermeiren
- Afdeling Neurologie en Alzheimer Onderzoekscentrum, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, postbus 30.001, 9700 RB, Groningen, Nederland
- Instituut Born-Bunge, Universiteit Antwerpen, Wilrijk, België
| | | | | | | | | | | | | | | | | | | | - Marleen Tollenaere
- Instituut Born-Bunge, Universiteit Antwerpen, Wilrijk, België
- Afdeling Neurologie, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim en Hoge Beuken, Antwerpen, België
| | - Gert Van Goethem
- Het GielsBos, Gierle, België
- Afdeling Neurologie, Universitair Ziekenhuis Antwerpen, Edegem, België
| | - Christine Zu Eulenburg
- Afdeling Epidemiologie, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, Groningen, Nederland
| | - Antonia M W Coppus
- Dichterbij, Gennep, Nederland
- Afdeling Eerstelijnsgeneeskunde, Radboud Universitair Medisch Centrum, Nijmegen, Nederland
| | - Peter P De Deyn
- Afdeling Neurologie en Alzheimer Onderzoekscentrum, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen, postbus 30.001, 9700 RB, Groningen, Nederland.
- Instituut Born-Bunge, Universiteit Antwerpen, Wilrijk, België.
- Afdeling Neurologie, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim en Hoge Beuken, Antwerpen, België.
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13
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Friedrich RE, Lehmann JM, Rother J, Christ G, Zu Eulenburg C, Scheuer HT, Scheuer HA. A lateral cephalometry study of patients with neurofibromatosis type 1. J Craniomaxillofac Surg 2017; 45:809-820. [PMID: 28365079 DOI: 10.1016/j.jcms.2017.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 10/14/2016] [Revised: 01/16/2017] [Accepted: 02/13/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Neurofibromatosis type 1 (NF1) is an autosomal dominant transmitted tumour suppressor syndrome and also a bone disease. Osseous dysplasia affecting the craniofacial region is characteristic of NF1. The aim of this study was to analyse the lateral cephalograms of NF1 patients in comparison to individuals who were not affected by this condition in order to describe the skeletal phenotype of NF1 in more detail. MATERIALS AND METHODS The study comprises the lateral cephalograms of 172 patients with established NF1 diagnoses (female = 85, male = 87). NF1 patients were distinguished by radiological and/or histological findings of the facial region suggestive of plexiform neurofibroma (PNF) or disseminated cutaneous NF (DNF). The analysed radiographs of a collection of 29 healthy volunteers with ideal occlusion served as controls. The focus of this analysis was cephalometrically defined angles. RESULTS Cephalometric analyses of patients with DNF did not differ from those of controls for the vast majority of parameters. However, the measurement results of patients with PNF differed significantly from those of healthy volunteers and patients with DNF. The number of trigeminal nerve branches affected in PNF patients had an effect on the measurement results. CONCLUSION Lateral cephalograms revealed no significant alteration of the facial skeleton in NF1 patients as compared to controls. Indeed, the stigma of a so-called 'NF1 facies' cannot be derived from the cephalometric findings presented. Notably, a wide range of deviating readings were recorded for individuals with facial PNF. Clinicians who treat patients with NF1 should be aware of deviations from cephalometric standards on lateral cephalograms in NF1 patients, especially when craniofacial surgical procedures are planned. Some of these findings, particularly asymmetries of the facial skeleton, could be indicators of an associated PNF.
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Affiliation(s)
- Reinhard E Friedrich
- Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany; Neurofibromatosis Laboratory, Hamburg-Lokstedt, Hamburg, Germany.
| | - Jan-Marten Lehmann
- Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany; Neurofibromatosis Laboratory, Hamburg-Lokstedt, Hamburg, Germany
| | - Jonathan Rother
- Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany; Neurofibromatosis Laboratory, Hamburg-Lokstedt, Hamburg, Germany
| | - Georg Christ
- Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany; Neurofibromatosis Laboratory, Hamburg-Lokstedt, Hamburg, Germany
| | - Christine Zu Eulenburg
- Institute of Epidemiology and Biometry, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Hannah T Scheuer
- Neurofibromatosis Laboratory, Hamburg-Lokstedt, Hamburg, Germany
| | - Hanna A Scheuer
- Orthodontics, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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14
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Steib S, Zahn P, Zu Eulenburg C, Pfeifer K, Zech A. Time-dependent postural control adaptations following a neuromuscular warm-up in female handball players: a randomized controlled trial. BMC Sports Sci Med Rehabil 2016; 8:33. [PMID: 27757240 PMCID: PMC5064777 DOI: 10.1186/s13102-016-0058-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 09/01/2016] [Accepted: 10/08/2016] [Indexed: 11/25/2022]
Abstract
Background Female handball athletes are at a particular risk of sustaining lower extremity injuries. The study examines time-dependent adaptations of static and dynamic balance as potential injury risk factors to a specific warm-up program focusing on neuromuscular control. Methods Fourty one (24.0 ± 5.9 years) female handball athletes were randomized to an intervention or control group. The intervention group implemented a 15-min specific neuromuscular warm-up program, three times per week for eleven weeks, whereas the control group continued with their regular warm-up. Balance was assessed at five time points. Measures included the star excursion balance test (SEBT), and center of pressure (COP) sway velocity during single-leg standing. Results No baseline differences existed between groups in demographic data. Adherence to neuromuscular warm-up was 88.7 %. Mean COP sway velocity decreased significantly over time in the intervention group (−14.4 %; p < .001), but not in the control group (−6.2 %; p = 0.056). However, these effects did not differ significantly between groups (p = .098). Mean changes over time in the SEBT score were significantly greater (p = .014) in the intervention group (+5.48) compared to the control group (+3.45). Paired t-tests revealed that the first significant balance improvements were observed after 6 weeks of training. Conclusions A neuromuscular warm-up positively influences balance variables associated with an increased risk of lower extremity injuries in female handball athletes. The course of adaptations suggests that a training volume of 15 min, three times weekly over at least six weeks produces measurable changes. Trial registration Retrospectively registered on 4th October 2016. Registry: clinicaltrials.gov. Trial number: NCT02925377. Electronic supplementary material The online version of this article (doi:10.1186/s13102-016-0058-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon Steib
- Institute of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Zahn
- Institute of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christine Zu Eulenburg
- University Medical Center Groningen, Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Klaus Pfeifer
- Institute of Sport Science and Sport, Division of Exercise and Health, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Astrid Zech
- Department of Sport Science, Friedrich Schiller University Jena, Jena, Germany
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15
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Mathey S, Graeser MK, Zu Eulenburg C, Woelber L, Trillsch F, Jaenicke F, Müller V, Milde-Langosch K, Mahner S. Platelet-derived growth factor receptor beta serum concentrations during first-line therapy in ovarian cancer. Oncology 2013; 85:69-77. [PMID: 23860180 DOI: 10.1159/000351032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Angiogenesis plays an important role in ovarian cancer. The interaction of platelet-derived growth factor receptor-beta (PDGFR-β) with vascular endothelial growth factor (VEGF) in the process of angiogenesis may represent an essential feature in the progression of the disease. METHODS Patients with epithelial ovarian cancer, who underwent primary surgery and platinum-based first-line chemotherapy, were included. A total of 133 serum samples from 39 patients were analyzed. Samples were prospectively collected at 4 time points: (1) before surgery, (2) after surgery and before chemotherapy, (3) during chemotherapy and (4) after chemotherapy. Serum PDGFR-β was quantified by ELISA. We analyzed the correlation of serum levels to chemotherapy response, progression-free and overall survival (PFS and OS) and the serum markers CA-125 and VEGF-165. RESULTS Serum concentration of PDGFR-β ranged between 4 and 72 ng/ml and increased significantly during first-line chemotherapy (p = 0.019). PDGFR-β serum concentrations showed an inverse correlation with CA-125 and VEGF-165 after chemotherapy (r = -0.495, p = 0.003 and r = -0.345, p = 0.04, respectively). Increased PDGFR-β serum levels after chemotherapy were significantly correlated with better PFS (p = 0.026) and OS (p = 0.013) in a univariate analysis. CONCLUSION PDGFR-β might be a useful biomarker in terms of prognosis and could be important as antiangiogenic agents become a component of standard treatment in ovarian cancer.
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Affiliation(s)
- Sabrina Mathey
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Wellge BE, Sterneck M, Teufel A, Rust C, Franke A, Schreiber S, Berg T, Günther R, Kreisel W, Zu Eulenburg C, Braun F, Beuers U, Galle PR, Lohse AW, Schramm C. Pregnancy in primary sclerosing cholangitis. Gut 2011; 60:1117-21. [PMID: 21339205 DOI: 10.1136/gut.2010.228924] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a paucity of data on fertility or pregnancy in patients with primary sclerosing cholangitis (PSC). OBJECTIVE To assess fertility in PSC by comparing the number of children in a large cohort of PSC patients to healthy controls and to investigate the outcome of pregnancy, as well as the influence of pregnancy on the disease course. DESIGN Case series. SETTING Germany. PARTICIPANTS 229 PSC patients and 569 healthy controls were evaluated for the number of children. 17 patients with PSC and at least one pregnancy, or who received a diagnosis of PSC within 6 months after delivery, were included in the more detailed analysis. MAIN OUTCOME MEASURES Number of children per patient and control; disease activity during pregnancy and after delivery including maternal complications; long-term development of live births, fetal loss rate and the influence of medication on fetal and maternal outcome. RESULTS Fertility did not seem to be reduced in PSC since the number of children did not differ between PSC patients and healthy controls. 25 pregnancies in 17 female PSC patients (median age at conception 31 years) were investigated in detail. An increase in liver enzymes was documented during five pregnancies (20%) and eight times (32%) post-partum. There were no serious maternal complications. All 21 live births presented with a normal perinatal and postnatal development over a median observation time of 50 months. Two pregnancies were delivered pre-term and four fetal losses occurred early in pregnancy (<12 wk). Continuation of treatment with ursodeoxycholic acid (15/21) or azathioprine (2/21) had no negative effects on pregnancy outcome. CONCLUSIONS Fertility does not seem to be reduced in patients with PSC, who are able to deliver healthy children without an apparent increase in risk for mother or child.
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Affiliation(s)
- Björn E Wellge
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr, Hamburg 20246, Germany
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17
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Effenberger KE, Borgen E, Eulenburg CZ, Bartkowiak K, Grosser A, Synnestvedt M, Kaaresen R, Brandt B, Nesland JM, Pantel K, Naume B. Detection and clinical relevance of early disseminated breast cancer cells depend on their cytokeratin expression pattern. Breast Cancer Res Treat 2010; 125:729-38. [PMID: 20449649 DOI: 10.1007/s10549-010-0911-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
The factors determining the clinical relevance of disseminated tumor cells (DTC) in breast cancer patients are largely unknown. Here we compared the specificity and clinical performance of two antibodies frequently used for DTC detection. Reactivities of antibodies A45-B/B3 (A45) and AE1/AE3 (AE) for selected cytokeratins (CK) were assessed by 2-DE Western Blot analysis. Using these antibodies bone marrow aspirates from 391 breast cancer patients (M(0), pT1-3, pN0-3) were screened for the presence of DTC. To obtain prognostic information, patients were followed up over a median of 83 months for time to relapse and 99 months for time to death. Among the analyzed CK, AE detected CK5, CK7, CK8, and CK19, whereas A45 recognized CK7 and CK18. In total, 24 of 391 patients (6.1%) were DTC-positive for A45, and 41 (10.5%) for AE. Although concordance between the two antibodies was 84.4%, overlap among positive cases was only 3.2%. DTC-positivity with AE and A45 was more frequent in patients of higher nodal status (P=0.019 and P=0.036, respectively). Nearly all patients with A45-positive DTC had hormone receptor-positive tumors (23/24), while detection of AE-positive DTC was more frequent among hormone receptor negative patients (P=0.006). Survival analyses of all patients revealed shorter distant disease-free survival (P=0.039) for patients with A45-positive DTC, whereas the prognostic relevance of AE-positive DTC was restricted to node-positive patients. The clinical utility of immunocytochemical (ICC) DTC detection depends on the anti-CK antibody used, which may reflect the complex CK composition of DTC.
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Affiliation(s)
- Katharina E Effenberger
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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18
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Witzel ID, Milde-Langosch K, Wirtz RM, Roth C, Ihnen M, Mahner S, Zu Eulenburg C, Jänicke F, Müller V. Comparison of microarray-based RNA expression with ELISA-based protein determination of HER2, uPA and PAI-1 in tumour tissue of patients with breast cancer and relation to outcome. J Cancer Res Clin Oncol 2010; 136:1709-18. [PMID: 20204407 DOI: 10.1007/s00432-010-0829-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Prognostic and predictive markers in breast cancer are currently determined by single analysis of protein amounts. If RNA-based multi-gene analyses enter clinical practice, simultaneous determination of currently established markers like human epidermal growth factor receptor 2 (HER2), urokinase plasminogen activator (uPA) and its inhibitor (PAI-1) would represent an elegant simplification. To investigate the correlation between RNA and protein levels, we assessed HER2, uPA and PAI-1 in patients with breast cancer. In addition, we evaluated the influence of these factors on patient outcome. METHODS We collected tumour samples from 133 patients with primary breast cancer. Protein and mRNA levels were measured for HER2, uPA and PAI-1. Protein concentration was measured by ELISA, mRNA expression was analysed by Affymetrix A133U Gene Chip and validated by quantitative PCR. RESULTS We were able to demonstrate a statistically significant correlation between mRNA and protein expression for HER2 (r = 0.67, P < 0.001) and uPA (r = 0.7, P < 0.001) but not for PAI-1 (r = 0.27). We observed a prognostic information for PAI-1 mRNA and protein values. Patients with high PAI-1 mRNA expression had a reduced 10-year disease-free survival (DFS) rate (60 vs. 70%, P = 0.071) and 10-year overall survival (OS) rate (68 vs. 79%, P = 0.034). Patients with PAI-1 protein levels above 14 ng/mg protein had a reduced disease-free (10-year DFS rate 54 vs. 71%, P = 0.006) and overall survival rate (10-year OS-rate 63 vs. 83%, P = 0.018). In the patient cohort with no chemotherapy, PAI-1 mRNA levels were the strongest prognostic factor for OS in univariate and multivariate analysis. CONCLUSIONS Results of RNA-based multi-gene analyses of the prognostic and predictive markers HER2 and uPA correlate with the corresponding protein levels. This is not the case for PAI-1. However, PAI-1 mRNA expression might reveal new clinically relevant information in addition to PAI protein levels.
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Affiliation(s)
- Isabell D Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Mahner S, Woelber L, Jung S, Eulenburg CZ, Ihnen M, Schwarz J, Sehouli J, Jaenicke F. Prognostic significance of CA-125 in the management of patients with recurrent epithelial ovarian carcinoma selected for secondary cytoreduction. Anticancer Res 2009; 29:2817-2821. [PMID: 19596967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Despite radical surgical and chemotherapeutic treatment of ovarian cancer, the majority of patients develop recurrence and die due to progressive disease. Routine measurement of the tumor marker CA-125 is often used in the follow-up management. However, the role of preoperative CA-125 as a prognostic factor before secondary cytoreduction of relapsed ovarian cancer has not been determined. PATIENTS AND METHODS CA-125 serum concentration and relevant clinico-pathological variables were analyzed regarding their potential prognostic impact in patients selected for secondary cytoreduction of recurrent epithelial ovarian cancer. RESULTS In total, 48 patients underwent secondary cytoreduction at the University Medical Center Hamburg-Eppendorf between 1996 and 2004 and 36 patients were evaluable for serum CA-125 concentration. Median age was 60 years (range 30-78 years) and median relapse-free survival before secondary cytoreduction was 18 months. The median time to progression after secondary surgery was 22 months (range 1-100 months), and median overall survival was 26 months (range 1-100 months). Serum CA-125 at the time of secondary cytoreduction was elevated (>35 kU/L) in 30 of 36 patients (81%) with a median of 212 kU/L (range 6-3866 kU/L). Multivariate analysis did not reveal a prognostic significance for preoperative CA-125. The only independent prognostic factors of improved survival were progression-free interval before secondary cytoreduction (p=0.047) and minimal residual disease after secondary cytoreduction (p=0.024). CONCLUSION Although most patients had elevated serum CA-125 at the time of secondary cytoreductive surgery, CA-125 had no prognostic relevance.
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Affiliation(s)
- Sven Mahner
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Woelber L, Mahner S, Voelker K, Eulenburg CZ, Gieseking F, Choschzick M, Jaenicke F, Schwarz J. Clinicopathological prognostic factors and patterns of recurrence in vulvar cancer. Anticancer Res 2009; 29:545-552. [PMID: 19331201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Vulvar cancer is a rare disease and knowledge on prognostic factors is therefore limited and inconsistent. The aim of this study was to determine prognostic variables for recurrence and survival and to identify patterns of recurrence in patients with vulvar cancer. PATIENTS AND METHODS All patients (n = 103) with primary vulvar cancer treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2003 were retrospectively analysed regarding the prognostic relevance of different clinicopathological variables. Recurrences were evaluated with regard to their characteristics and localisation. RESULTS Age, lymph node metastasis, tumor size, depth of invasion and involvement of resection margins predicted poor disease-free and overall survival in univariate analysis. In multivariate analysis, lymph node status was the most important independent prognostic factor (p = 0.002). No correlation was observed between lymph node metastasis and localization of recurrent disease. Regardless of initial nodal involvement, recurrences occurred primarily in the vulvar region. CONCLUSION Inguinofemoral lymph node status at initial diagnosis is of critical prognostic importance for patients with vulvar cancer. Further tumour biological characteristics need to be identified to stratify patients with nodal involvement for adjuvant radiotherapy of the vulva to prevent local recurrences.
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Affiliation(s)
- Linn Woelber
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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