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Kramer C, Lanjouw L, Ruano D, Ter Elst A, Santandrea G, Solleveld-Westerink N, Werner N, van der Hout AH, de Kroon CD, van Wezel T, Berger L, Jalving M, Wesseling J, Smit V, de Bock GH, van Asperen CJ, Mourits M, Vreeswijk M, Bart J, Bosse T. Causality and functional relevance of BRCA1 and BRCA2 pathogenic variants in non-high-grade serous ovarian carcinomas. J Pathol 2024; 262:137-146. [PMID: 37850614 DOI: 10.1002/path.6218] [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: 05/26/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
The identification of causal BRCA1/2 pathogenic variants (PVs) in epithelial ovarian carcinoma (EOC) aids the selection of patients for genetic counselling and treatment decision-making. Current recommendations therefore stress sequencing of all EOCs, regardless of histotype. Although it is recognised that BRCA1/2 PVs cluster in high-grade serous ovarian carcinomas (HGSOC), this view is largely unsubstantiated by detailed analysis. Here, we aimed to analyse the results of BRCA1/2 tumour sequencing in a centrally revised, consecutive, prospective series including all EOC histotypes. Sequencing of n = 946 EOCs revealed BRCA1/2 PVs in 125 samples (13%), only eight of which were found in non-HGSOC histotypes. Specifically, BRCA1/2 PVs were identified in high-grade endometrioid (3/20; 15%), low-grade endometrioid (1/40; 2.5%), low-grade serous (3/67; 4.5%), and clear cell (1/64; 1.6%) EOCs. No PVs were identified in any mucinous ovarian carcinomas tested. By re-evaluation and using loss of heterozygosity and homologous recombination deficiency analyses, we then assessed: (1) whether the eight 'anomalous' cases were potentially histologically misclassified and (2) whether the identified variants were likely causal in carcinogenesis. The first 'anomalous' non-HGSOC with a BRCA1/2 PV proved to be a misdiagnosed HGSOC. Next, germline BRCA2 variants, found in two p53-abnormal high-grade endometrioid tumours, showed substantial evidence supporting causality. One additional, likely causal variant, found in a p53-wildtype low-grade serous ovarian carcinoma, was of somatic origin. The remaining cases showed retention of the BRCA1/2 wildtype allele, suggestive of non-causal secondary passenger variants. We conclude that likely causal BRCA1/2 variants are present in high-grade endometrioid tumours but are absent from the other EOC histotypes tested. Although the findings require validation, these results seem to justify a transition from universal to histotype-directed sequencing. Furthermore, in-depth functional analysis of tumours harbouring BRCA1/2 variants combined with detailed revision of cancer histotypes can serve as a model in other BRCA1/2-related cancers. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Cjh Kramer
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - L Lanjouw
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D Ruano
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Ter Elst
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - N Solleveld-Westerink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Werner
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A H van der Hout
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - T van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lpv Berger
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Wesseling
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vthbm Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mje Mourits
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mpg Vreeswijk
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - J Bart
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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Pouwer AW, Te Grootenhuis NC, Hinten F, de Bock GH, van der Zee AGJ, Melchers WJG, Oonk MHM, de Hullu JA, Hollema H, Bulten J. Prognostic value of HPV-PCR, p16 and p53 immunohistochemical status on local recurrence rate and survival in patients with vulvar squamous cell carcinoma. Virchows Arch 2023:10.1007/s00428-023-03690-8. [PMID: 37938322 DOI: 10.1007/s00428-023-03690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
The primary aim of this study was to assess the association between human papilloma virus (HPV) and p53 expression and local recurrence (LR), disease specific survival (DSS), and overall survival (OS) in patients with vulvar squamous cell carcinoma (VSCC). Secondary, the accuracy of p16 immunohistochemistry for HPV status was assessed. The tumor tissue of 255 patients, surgically treated for primary unifocal VSCC between 2000 and 2010, was analyzed. HPV-PCR and P16 and p53 immunohistochemical stainings were performed. All histologic slides were independently reviewed by two expert gyneco-pathologists. Time to first LR, DSS, and OS for the variables p16, p53, and HPV-PCR were compared using univariable and multivariable Cox-regression analyses. In 211/255 (83.5%) patients, HPV-PCR was negative. The local recurrence rate was significantly lower in patients positive with HPV-PCR (10-year LR rate 24.6%) versus negative tumors (47.5%), p = 0.004. After multivariable analyses, this difference remained significant (HR 0.23 (95% CI 0.08-0.62) p = 0.004). There was no difference in LR rate correlated to the p53 expression. DSS and OS did not significantly differ after multivariable analyses for all different subgroups. Sensitivity and specificity of p16 staining for presence of HPV detected by HPV-PCR were 86.4% and 93.8%, respectively. In conclusion, patients with HPV-negative VSCCs have significantly more LR compared to patients with HPV-positive VSCCs, and p16 immunohistochemistry is a reliable surrogate marker for HPV status. No relevant subgroup for LR or survival based on HPV/p53 status could be identified. We advise to perform an HPV-PCR or p16 IHC staining in all patients with VSCC.
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Affiliation(s)
- A W Pouwer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N C Te Grootenhuis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - F Hinten
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A G J van der Zee
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M H M Oonk
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Hollema
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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de Waard J, Bhattacharya A, de Boer MT, van Hemel BM, Esajas MD, Vermeulen KM, de Bock GH, Schuuring E, Wisman GBA. Identification of a methylation panel as an alternative triage to detect CIN3+ in hrHPV-positive self-samples from the population-based cervical cancer screening programme. Clin Epigenetics 2023; 15:103. [PMID: 37322534 PMCID: PMC10273737 DOI: 10.1186/s13148-023-01517-6] [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: 04/12/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The Dutch population-based cervical cancer screening programme (PBS) consists of primary high-risk human papilloma virus (hrHPV) testing with cytology as triage test. In addition to cervical scraping by a general practitioner (GP), women are offered self-sampling to increase participation. Because cytological examination on self-sampled material is not feasible, collection of cervical samples from hrHPV-positive women by a GP is required. This study aims to design a methylation marker panel to detect CIN3 or worse (CIN3+) in hrHPV-positive self-samples from the Dutch PBS as an alternative triage test for cytology. METHODS Fifteen individual host DNA methylation markers with high sensitivity and specificity for CIN3+ were selected from literature and analysed using quantitative methylation-specific PCR (QMSP) on DNA from hrHPV-positive self-samples from 208 women with CIN2 or less (< CIN2) and 96 women with CIN3+. Diagnostic performance was determined by area under the curve (AUC) of receiver operating characteristic (ROC) analysis. Self-samples were divided into a train and test set. Hierarchical clustering analysis to identify input methylation markers, followed by model-based recursive partitioning and robustness analysis to construct a predictive model, was applied to design the best marker panel. RESULTS QMSP analysis of the 15 individual methylation markers showed discriminative DNA methylation levels between < CIN2 and CIN3+ for all markers (p < 0.05). The diagnostic performance analysis for CIN3+ showed an AUC of ≥ 0.7 (p < 0.001) for nine markers. Hierarchical clustering analysis resulted in seven clusters with methylation markers with similar methylation patterns (Spearman correlation> 0.5). Decision tree modeling revealed the best and most robust panel to contain ANKRD18CP, LHX8 and EPB41L3 with an AUC of 0.83 in the training set and 0.84 in the test set. Sensitivity to detect CIN3+ was 82% in the training set and 84% in the test set, with a specificity of 74% and 71%, respectively. Furthermore, all cancer cases (n = 5) were identified. CONCLUSION The combination of ANKRD18CP, LHX8 and EPB41L3 revealed good diagnostic performance in real-life self-sampled material. This panel shows clinical applicability to replace cytology in women using self-sampling in the Dutch PBS programme and avoids the extra GP visit after a hrHPV-positive self-sampling test.
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Affiliation(s)
- J de Waard
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, PO-Box 30001, 9700 RB, Groningen, The Netherlands
| | - A Bhattacharya
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M T de Boer
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, PO-Box 30001, 9700 RB, Groningen, The Netherlands
| | - B M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M D Esajas
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Schuuring
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G B A Wisman
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, PO-Box 30001, 9700 RB, Groningen, The Netherlands.
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Spoor DS, van den Bogaard VAB, Sijtsema NM, Van der Meer P, de Bock GH, Langendijk JA, Maduro JH, Crijns APG. A comparison of cardiovascular and pulmonary morbidities and risk factors in breast cancer survivors compared to an age-matched female control group in the Lifelines prospective population cohort. Breast 2023; 70:49-55. [PMID: 37331094 DOI: 10.1016/j.breast.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/21/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE To provide more insight into late treatment-related toxicities among breast cancer (BC) survivors by comparing morbidities and risk factors between BC survivors and age-matched controls. MATERIALS AND METHODS All female participants diagnosed with BC before inclusion in Lifelines, a population-based cohort in the Netherlands, were selected and matched 1:4 to female controls without any oncological history on birth year. Baseline was defined as the age at BC diagnosis. Outcomes were obtained from questionnaires and functional analyses performed at entry to Lifelines (follow-up 1; FU1) and several years later (FU2). Cardiovascular and pulmonary events were defined as morbidities that were absent at baseline but present at FU1 or FU2. RESULTS The study consisted of 1,325 BC survivors and 5,300 controls. The median period from baseline (i.e., BC treatment) to FU1 and FU2 was 7 and 10 years, respectively. Among BC survivors more events of heart failure (OR: 1.72 [1.10-2.68]) and less events of hypertension (OR: 0.79 [0.66-0.94]) were observed. At FU2, more electrocardiographic abnormalities were found among BC survivors compared to controls (4.1% vs. 2.7%, respectively; p = 0.027) and Framingham scores for the 10-year risk of coronary heart disease were lower (difference: 0.37%; 95% CI [-0.70 to -0.03%]). At FU2, BC survivors had more frequently a forced vital capacity below the lower limit of normal than controls (5.4% vs. 2.9%, respectively; p = 0.040). CONCLUSION BC survivors are at risk of late treatment-related toxicities despite a more favourable cardiovascular risk profile compared to age-matched female controls.
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Affiliation(s)
- D S Spoor
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - V A B van den Bogaard
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - N M Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - P Van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A P G Crijns
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Lancaster HL, Heuvelmans MA, de Bock GH, Du Y, Mohamed Hoesein FAA, Nackaerts K, Walter JE, Vliegenthart R, Oudkerk M. Influenza season influence on outcome of new nodules in the NELSON study. Sci Rep 2023; 13:6589. [PMID: 37085595 PMCID: PMC10121576 DOI: 10.1038/s41598-023-33672-4] [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: 06/30/2022] [Accepted: 04/17/2023] [Indexed: 04/23/2023] Open
Abstract
We evaluated the impact of the influenza season on outcome of new lung nodules in a LDCT lung cancer screening trial population. NELSON-trial participants with ≥ 1 new nodule detected in screening rounds two and three were included. Outcome (resolution or persistence) of new nodules detected per season was calculated and compared. Winter (influenza season) was defined as 1st October to 31st March, and compared to the summer (hay-fever season), 1st April to 30th September. Overall, 820 new nodules were reported in 529 participants. Of the total new nodules, 482 (59%) were reported during winter. When considering the outcome of all new nodules, there was no statistically significant association between summer and resolving nodules (OR 1.07 [CI 1.00-1.15], p = 0.066), also when looking at the largest nodule per participant (OR 1.37 [CI 0.95-1.98], p = 0.094). Similarly, there was no statistically significant association between season and screen detected cancers (OR 0.47 [CI 0.18-1.23], p = 0.123). To conclude, in this lung cancer screening population, there was no statistically significant association between influenza season and outcome of new lung nodules. Hence, we recommend new nodule management strategy is not influenced by the season in which the nodule is detected.
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Affiliation(s)
- H L Lancaster
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A Heuvelmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Y Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F A A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Nackaerts
- Department of Pneumology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - J E Walter
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - R Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Oudkerk
- Faculty of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
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Suazo-Zepeda E, Vinke PC, Heuvelmans MA, Sidorenkov G, Hiltermann TJN, de Bock GH. Quality of life after treatment with immune checkpoint inhibitors for lung cancer; the impact of age. Lung Cancer 2023; 176:89-97. [PMID: 36628904 DOI: 10.1016/j.lungcan.2022.12.017] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have revolutionized lung cancer treatment. However, it remains unclear as to whether changes in Health-Related Quality-of-Life (HRQoL) are associated with the age of lung cancer patients treated using ICIs. This study aimed to evaluate this possible association and to compare ICI-treated patients' HRQoL scores with normative data of an age-matched non-cancer general population. METHODS Lung cancer patients from the OncoLifeS data-biobank were included if they were treated with ICIs, irrespective of other treatments, at the University Medical Center Groningen between 2015 and 2021 and had completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTCQLQ-C30), both at the start of ICI treatment and after six months. Association of age as a continuous variable (per 10 years) and changes in HRQoL scores between baseline and 6 months was assessed using multivariable regression analyses. Clinical relevance of differences in HRQoL scores between OncoLifeS and the general population was classified into trivial, small, medium, and large, for three age groups (<60, 60-69 and ≥ 70 years). RESULTS 151 patients were included with a mean age of 65.8 years. An increase in age per 10 years was associated with a larger decrease in the summary HRQoL score(β = -3.28,CI95%-6.42;-0.14), physical(β = -4.8, CI95% -8.71;-0.88), cognitive(β = -4.51,CI95%-8.24;-0.78), role functioning(β = -5.41,CI95%-10.78;-0.05), symptom burden(β = -3.66,CI95%-6.6;-0.73), and smaller negative changes in financial difficulties(β = 6.5 95 % CI 3.16; 9.85). OncoLifeS HRQoL scores were lower than those of the general population and differences were most often classified as large and medium. CONCLUSION Older lung cancer patients experience larger deteriorations in most HRQoL domains after 6 months of ICI treatment. Also, these patients showed significantly lower HRQoL scores compared to the general population.
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Affiliation(s)
- E Suazo-Zepeda
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - P C Vinke
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - G Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - T J N Hiltermann
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Leimkühler M, Bourgonje AR, van Goor H, Campmans-Kuijpers MJE, de Bock GH, van Leeuwen BL. ASO Visual Abstract: Oxidative Stress Predicts Post-surgery Complications in Gastrointestinal Cancer Patients. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11685-z] [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: 11/18/2022]
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Leimkühler M, Bourgonje AR, van Goor H, Campmans-Kuijpers MJE, de Bock GH, van Leeuwen BL. ASO Author Reflections: Oxidative Stress as a Predictor of Short-Term Outcome After Oncological Surgery for Gastrointestinal Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11453-z. [PMID: 35226218 PMCID: PMC8883749 DOI: 10.1245/s10434-022-11453-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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
Affiliation(s)
- M Leimkühler
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - A R Bourgonje
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H van Goor
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M J E Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Leimkühler M, Bourgonje AR, van Goor H, Campmans-Kuijpers MJE, de Bock GH, van Leeuwen BL. Oxidative Stress Predicts Post-Surgery Complications in Gastrointestinal Cancer Patients. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11412-8. [PMID: 35175456 PMCID: PMC9174134 DOI: 10.1245/s10434-022-11412-8] [Citation(s) in RCA: 1] [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: 09/01/2021] [Accepted: 01/18/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION An excessive perioperative inflammatory reaction can lead to more postoperative complications in patients treated for gastrointestinal cancers. It has been suggested that this inflammatory reaction leads to oxidative stress. The most important nonenzymatic antioxidants are serum free thiols. The purpose of this study was to evaluate whether high preoperative serum free thiol levels are associated with short-term clinical outcomes. METHODS Blood samples were drawn before, at the end of, and 1 and 2 days after surgery of a consecutive series of patients with gastrointestinal cancer. Serum free thiols were detected using a colorimetric detection method using Ellman's reagent. Short-term clinical outcomes were defined as 30-day complications (Clavien-Dindo ≥2) and length of hospital stay. Logistic regression was applied to examine the association between serum free thiol levels and short-term patient outcomes. RESULTS Eighty-one patients surgically treated for gastrointestinal cancer were included in the study. Median age was 68 (range 26-87) years, and 28% were female. Patients in the lowest tertile of preoperative serum free thiols had a threefold higher risk to develop postoperative complications (odds ratio [OR]: 3.4; 95% confidence interval [CI]:1.1-10.7) and a fourfold higher risk to have an increased length of stay in the hospital (OR 4.0; 95% CI 1.3-12.9) compared with patients in the highest tertile. CONCLUSIONS Patients with lower preoperative serum free thiol levels, indicating a decrease in extracellular antioxidant capacity and therefore an increase in systemic oxidative stress, are more likely to develop postoperative complications and show a longer in hospital stay than patients with higher serum free thiol levels.
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Affiliation(s)
- M Leimkühler
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A R Bourgonje
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H van Goor
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M J E Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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10
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van den Oever LB, van Veldhuizen WA, Cornelissen LJ, Spoor DS, Willems TP, Kramer G, Stigter T, Rook M, Crijns APG, Oudkerk M, Veldhuis RNJ, de Bock GH, van Ooijen PMA. Qualitative Evaluation of Common Quantitative Metrics for Clinical Acceptance of Automatic Segmentation: a Case Study on Heart Contouring from CT Images by Deep Learning Algorithms. J Digit Imaging 2022; 35:240-247. [PMID: 35083620 PMCID: PMC8921356 DOI: 10.1007/s10278-021-00573-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/29/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022] Open
Abstract
Organs-at-risk contouring is time consuming and labour intensive. Automation by deep learning algorithms would decrease the workload of radiotherapists and technicians considerably. However, the variety of metrics used for the evaluation of deep learning algorithms make the results of many papers difficult to interpret and compare. In this paper, a qualitative evaluation is done on five established metrics to assess whether their values correlate with clinical usability. A total of 377 CT volumes with heart delineations were randomly selected for training and evaluation. A deep learning algorithm was used to predict the contours of the heart. A total of 101 CT slices from the validation set with the predicted contours were shown to three experienced radiologists. They examined each slice independently whether they would accept or adjust the prediction and if there were (small) mistakes. For each slice, the scores of this qualitative evaluation were then compared with the Sørensen-Dice coefficient (DC), the Hausdorff distance (HD), pixel-wise accuracy, sensitivity and precision. The statistical analysis of the qualitative evaluation and metrics showed a significant correlation. Of the slices with a DC over 0.96 (N = 20) or a 95% HD under 5 voxels (N = 25), no slices were rejected by the readers. Contours with lower DC or higher HD were seen in both rejected and accepted contours. Qualitative evaluation shows that it is difficult to use common quantification metrics as indicator for use in clinic. We might need to change the reporting of quantitative metrics to better reflect clinical acceptance.
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Affiliation(s)
- L B van den Oever
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - W A van Veldhuizen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - L J Cornelissen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - D S Spoor
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - T P Willems
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - G Kramer
- Department of Radiology, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - T Stigter
- Department of Radiology, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - M Rook
- Department of Radiology, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - A P G Crijns
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - M Oudkerk
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - R N J Veldhuis
- Department of Electrical Engineering, Computer Science and Mathematics, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - P M A van Ooijen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
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11
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Suazo-Zepeda E, Bokern M, Vinke PC, Hiltermann TJN, de Bock GH, Sidorenkov G. Risk factors for adverse events induced by immune checkpoint inhibitors in patients with non-small-cell lung cancer: a systematic review and meta-analysis. Cancer Immunol Immunother 2021; 70:3069-3080. [PMID: 34195862 PMCID: PMC8505368 DOI: 10.1007/s00262-021-02996-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/19/2021] [Indexed: 12/24/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) can cause serious immune-related adverse events (irAEs). This study aimed to identify risk factors for all types of irAEs induced by ICIs in patients with non-small-cell lung cancer (NSCLC), by systematic review and meta-analyses. Methods A systematic search was performed in Pubmed, Embase and Web of Science by two independent reviewers. Studies were selected that included patients with NSCLC and evaluated characteristics of patients with and without irAEs induced by ICIs. Quality and risk of bias of the selected studies were assessed. Random effects meta-analyses were conducted to estimate pooled odds ratios (ORs) for risk factors of developing all type of irAEs, and separately for pneumonitis, interstitial lung disease and severe irAEs. With the objective of exploring sources of heterogeneity, stratified analyses were performed by quality and region. Results 25 studies met the inclusion criteria. In total, the data of 6696 patients were pooled. 33 different risk factors for irAEs were reported. irAEs of interest were reported for 1653 (25%) of the patients. Risk factors related to the development of irAEs were: C-reactive protein, neutrophil lymphocyte ratio (NLR), use of PD-1 inhibitor, high PD-L1 expression, an active or former smoking status, ground glass attenuation, and a better treatment response. Conclusion The identified risk factors for the development of these irAEs are mostly related to the alteration of the immune system, proinflammatory states and loss of immunological self-tolerance. Patients identified as having a higher risk for irAEs should be monitored more closely. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-02996-3.
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Affiliation(s)
- E Suazo-Zepeda
- Department of Epidemiology, Graduate School of Medical Sciences, University of Groningen, Zusterhuis, Hanzeplein 1, Groningen, The Netherlands
| | - M Bokern
- Department of Epidemiology, Graduate School of Medical Sciences, University of Groningen, Zusterhuis, Hanzeplein 1, Groningen, The Netherlands
| | - P C Vinke
- Department of Epidemiology, Graduate School of Medical Sciences, University of Groningen, Zusterhuis, Hanzeplein 1, Groningen, The Netherlands
| | - T J N Hiltermann
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - G H de Bock
- Department of Epidemiology, Graduate School of Medical Sciences, University of Groningen, Zusterhuis, Hanzeplein 1, Groningen, The Netherlands
| | - G Sidorenkov
- Department of Epidemiology, Graduate School of Medical Sciences, University of Groningen, Zusterhuis, Hanzeplein 1, Groningen, The Netherlands.
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12
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Wisselink HJ, Pelgrim GJ, Rook M, Imkamp K, van Ooijen PMA, van den Berge M, de Bock GH, Vliegenthart R. Ultra-low-dose CT combined with noise reduction techniques for quantification of emphysema in COPD patients: An intra-individual comparison study with standard-dose CT. Eur J Radiol 2021; 138:109646. [PMID: 33721769 DOI: 10.1016/j.ejrad.2021.109646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/09/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Phantom studies in CT emphysema quantification show that iterative reconstruction and deep learning-based noise reduction (DLNR) allow lower radiation dose. We compared emphysema quantification on ultra-low-dose CT (ULDCT) with and without noise reduction, to standard-dose CT (SDCT) in chronic obstructive pulmonary disease (COPD). METHOD Forty-nine COPD patients underwent ULDCT (third generation dual-source CT; 70ref-mAs, Sn-filter 100kVp; median CTDIvol 0.38 mGy) and SDCT (64-multidetector CT; 40mAs, 120kVp; CTDIvol 3.04 mGy). Scans were reconstructed with filtered backprojection (FBP) and soft kernel. For ULDCT, we also applied advanced modelled iterative reconstruction (ADMIRE), levels 1/3/5, and DLNR, levels 1/3/5/9. Emphysema was quantified as Low Attenuation Value percentage (LAV%, ≤-950HU). ULDCT measures were compared to SDCT as reference standard. RESULTS For ULDCT, the median radiation dose was 84 % lower than for SDCT. Median extent of emphysema was 18.6 % for ULD-FBP and 15.4 % for SDCT (inter-quartile range: 11.8-28.4 % and 9.2 %-28.7 %, p = 0.002). Compared to SDCT, the range in limits of agreement of emphysema quantification as measure of variability was 14.4 for ULD-FBP, 11.0-13.1 for ULD-ADMIRE levels and 10.1-13.9 for ULD-DLNR levels. Optimal settings were ADMIRE 3 and DLNR 3, reducing variability of emphysema quantification by 24 % and 27 %, at slight underestimation of emphysema extent (-1.5 % and -2.9 %, respectively). CONCLUSIONS Ultra-low-dose CT in COPD patients allows dose reduction by 84 %. State-of-the-art noise reduction methods in ULDCT resulted in slight underestimation of emphysema compared to SDCT. Noise reduction methods (especially ADMIRE 3 and DLNR 3) reduced variability of emphysema quantification in ULDCT by up to 27 % compared to FBP.
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Affiliation(s)
- H J Wisselink
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - G J Pelgrim
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - M Rook
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands; Martini Hospital Groningen, Department of Radiology, Groningen, the Netherlands
| | - K Imkamp
- University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, the Netherlands
| | - P M A van Ooijen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - M van den Berge
- University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, the Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - R Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands.
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13
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Ding L, Jidkova S, Greuter MJW, Van Herck K, Goossens M, Martens P, de Bock GH, Van Hal G. Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade. Int J Equity Health 2020; 19:212. [PMID: 33246477 PMCID: PMC7694412 DOI: 10.1186/s12939-020-01323-z] [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: 04/13/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer (BC) is the most common cancer in women in the developed world. In order to find developing cancers in an early stage, BC screening is commonly used. In Flanders, screening is performed in and outside an organized breast cancer screening program (BCSP). However, the determinants of BC screening coverage for both screening strategies are yet unknown. Objective To assess the determinants of BC screening coverage in Flanders. Methods Reimbursement data were used to attribute a screening status to each woman in the target population for the years 2008–2016. Yearly coverage data were categorized as screening inside or outside BCSP or no screening. Data were clustered by municipality level. A generalized linear equation model was used to assess the determinants of screening type. Results Over all years and municipalities, the median screening coverage rate inside and outside BCSP was 48.40% (IQR: 41.50–54.40%) and 14.10% (IQR: 9.80–19.80%) respectively. A higher coverage rate outside BSCP was statistically significantly (P < 0.001) associated with more crowded households (OR: 3.797, 95% CI: 3.199–4.508), younger age, higher population densities (OR: 2.528, 95% CI: 2.455–2.606), a lower proportion of unemployed job seekers (OR: 0.641, 95% CI: 0.624–0.658) and lower use of dental care (OR: 0.969, 95% CI: 0.967–0.972). Conclusion Coverage rate of BC screening is not optimal in Flanders. Women with low SES that are characterized by younger age, living in a high population density area, living in crowded households, or having low dental care are less likely to be screened for BC in Flanders. If screened, they are more likely to be screened outside the BCSP.
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Affiliation(s)
- L Ding
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - S Jidkova
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - M J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - K Van Herck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - M Goossens
- Center for Cancer Detection, Flanders, Belgium
| | - P Martens
- Center for Cancer Detection, Flanders, Belgium
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - G Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium.,Center for Cancer Detection, Flanders, Belgium
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14
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Maass SWMC, Boerman LM, Brandenbarg D, Verhaak PFM, Maduro JH, de Bock GH, Berendsen AJ. Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care. Breast 2020; 54:133-138. [PMID: 33035934 PMCID: PMC7554212 DOI: 10.1016/j.breast.2020.09.013] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/20/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Various long-term symptoms can manifest after breast cancer treatment, but we wanted to clarify whether these are more frequent among long-term breast cancer survivors than matched controls and if they are associated with certain diagnoses. Methods This was a cross-sectional, population-based study of 350 breast cancer survivors treated with chemo- and/or radiotherapy ≥5 years (median 10) after diagnosis and 350 women without cancer matched by age and primary care physician. All women completed a questionnaire enquiring about symptoms, underwent echocardiography to assess the left ventricle ejection fraction, and completed the Hospital Anxiety and Depression Scale. Cardiovascular diseases were diagnosed from primary care records. In a multivariable logistic regression analysis, symptoms were adjusted for the long-term effects and compared between cohorts and within the survivor group. Results Concentration difficulties, forgetfulness, dizziness, and nocturia were more frequent among breast cancer survivors compared with controls, but differences could not be explained by cardiac dysfunction, cardiovascular diseases, depression, or anxiety. Intermittent claudication and appetite loss were more frequent among breast cancer survivors than controls and associated with cardiac dysfunction, depression, and anxiety. Breast cancer survivors treated with chemotherapy with/without radiotherapy were at significantly higher odds of forgetfulness and nocturia, but significantly lower odds of dizziness, compared with breast cancer survivors treated with radiotherapy alone. Conclusions Intermittent claudication and appetite loss are common among breast cancer survivors and are associated with cardiac dysfunction and mood disorders. Other symptoms varied by whether the patient underwent chemotherapy with/without radiotherapy (forgetfulness and nocturia) radiotherapy alone (dizziness). Even 10 years after diagnosis, breast cancer survivors experience various long-term symptoms. Some symptoms are more common among breast cancer survivors than among controls without cancer. Not all symptoms are associated with known cardiovascular or psychological diagnoses. A symptom-specific approach may be appropriate. This study does not evaluate a causal relation.
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Affiliation(s)
- S W M C Maass
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands.
| | - L M Boerman
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands
| | - D Brandenbarg
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands
| | - P F M Verhaak
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands; NIVEL, Netherlands Institute of Health Services Research, Postbus 1568, 3500 BN, Utrecht, the Netherlands
| | - J H Maduro
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - A J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, PO Box 196, 9700 AD, Groningen, the Netherlands
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15
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van den Oever LB, Vonder M, van Assen M, van Ooijen PMA, de Bock GH, Xie XQ, Vliegenthart R. Application of artificial intelligence in cardiac CT: From basics to clinical practice. Eur J Radiol 2020; 128:108969. [PMID: 32361380 DOI: 10.1016/j.ejrad.2020.108969] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/07/2019] [Revised: 01/30/2020] [Accepted: 03/11/2020] [Indexed: 12/18/2022]
Abstract
Research into the possibilities of AI in cardiac CT has been growing rapidly in the last decade. With the rise of publicly available databases and AI algorithms, many researchers and clinicians have started investigations into the use of AI in the clinical workflow. This review is a comprehensive overview on the types of tasks and applications in which AI can aid the clinician in cardiac CT, and can be used as a primer for medical researchers starting in the field of AI. The applications of AI algorithms are explained and recent examples in cardiac CT of these algorithms are further elaborated on. The critical factors for implementation in the future are discussed.
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Affiliation(s)
- L B van den Oever
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, the Netherlands
| | - M Vonder
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, the Netherlands
| | - M van Assen
- University of Groningen, University Medical Center Groningen, Faculty of Medicine, Groningen, the Netherlands; Divisions of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - P M A van Ooijen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, the Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, the Netherlands
| | - X Q Xie
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Department of Radiology, Shanghai, The People's Republic of China
| | - R Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, the Netherlands.
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16
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Eltahir Y, Bosma E, Teixeira N, Werker PMN, de Bock GH. Satisfaction with cosmetic outcomes of breast reconstruction: Investigations into the correlation between the patients' Breast-Q outcome and the judgment of panels. JPRAS Open 2020; 24:60-70. [PMID: 32420440 PMCID: PMC7215106 DOI: 10.1016/j.jpra.2020.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives We aimed to determine the relation between breast reconstruction method, patient satisfaction, and surgeon reported cosmetic outcome among women who underwent breast reconstruction after mastectomy. Study Design A cross-sectional study of patients treated between 2006 and 2010. Main Outcome Women's satisfaction with cosmetic outcomes after breast reconstruction. Measures Cosmetic outcomes were evaluated by (1) women using the Breast-Q to rate satisfaction with breasts outcomes, and (2) an independent panel using the Strasser score. The relationships between the Breast-Q rating, Strasser scores, and breast reconstruction methods, including laterality and timing, were evaluated by Mann–Whitney U tests, Spearman's rank correlations, and Wilcoxon signed-rank tests. Results Ninety-four women were included. Patients were more satisfied with their breasts if they had undergone autologous, unilateral, or secondary breast reconstruction compared with those who underwent alloplastic, bilateral, or primary breast reconstruction (p-values 0.008, 0.011, and 0.001, respectively). The Strasser system did not reveal significant cosmetic differences, with all breast reconstructions graded as mediocre or poor. Conclusions Patient satisfaction with breast outcomes, as measured by the Breast-Q, was described as mediocre or poorly reflected by the Strasser score. If doctors are to support patients to make informed decisions on the optimal method of breast reconstruction, we need a more sensitive, comprehensive tool reflecting patients’ cosmetic outcomes.
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Affiliation(s)
- Y Eltahir
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, BB81, 9700 RB Groningen, the Netherlands
| | - E Bosma
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, BB81, 9700 RB Groningen, the Netherlands
| | - N Teixeira
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, BB81, 9700 RB Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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17
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Gruppen EG, Kunutsor SK, Kieneker LM, van der Vegt B, Connelly MA, de Bock GH, Gansevoort RT, Bakker SJL, Dullaart RPF. GlycA, a novel pro-inflammatory glycoprotein biomarker is associated with mortality: results from the PREVEND study and meta-analysis. J Intern Med 2019; 286:596-609. [PMID: 31260573 PMCID: PMC6851697 DOI: 10.1111/joim.12953] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic diseases are associated with an inflammatory response. We determined the association of two inflammatory markers, GlycA and high-sensitivity C-reactive protein (hsCRP), with overall and cause-specific mortality in a cohort of men and women. METHODS Cox regression analyses were used to examine associations of GlycA and hsCRP with all-cause, cancer and cardiovascular mortality in 5526 subjects (PREVEND cohort; average follow-up 12.6 years). RESULTS GlycA was associated with all-cause mortality (n = 838), independent of clinical risk factors and hsCRP (hazard ratio 1.43 [95% confidence interval (CI): 1.09-1.87] for top versus bottom quartiles). For hsCRP, the association with all-cause mortality was nonsignificant after adjustment for GlycA. GlycA and hsCRP were associated with cancer mortality in men (n = 248), but not in women (n = 132). Neither GlycA nor hsCRP was independently associated with cardiovascular mortality (n = 201). In a meta-analysis of seven population-based studies, including 8153 deaths, the pooled multivariable-adjusted relative risk of GlycA for all-cause mortality was 1.74 (95% CI: 1.40-2.17) for top versus bottom quartiles. The association of GlycA with all-cause mortality was somewhat stronger than that of hsCRP. GlycA and hsCRP were not independently associated with cardiovascular mortality. The associations of GlycA and hsCRP with cancer mortality were present in men, but not in women. CONCLUSIONS GlycA is significantly associated with all-cause mortality. GlycA and hsCRP were each not independently associated with cardiovascular mortality. The association of GlycA and hsCRP with cancer mortality appears to be driven by men.
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Affiliation(s)
- E G Gruppen
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.,Translational Health Sciences, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - L M Kieneker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B van der Vegt
- Division of Pathology, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M A Connelly
- Laboratory Corporation of America® Holdings (LabCorp), Morrisville, NC, USA
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R T Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R P F Dullaart
- Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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van der Sluis FJ, Couwenberg AM, de Bock GH, Intven MPW, Reerink O, van Leeuwen BL, van Westreenen HL. Population-based study of morbidity risk associated with pathological complete response after chemoradiotherapy for rectal cancer. Br J Surg 2019; 107:131-139. [DOI: 10.1002/bjs.11324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer may induce a pathological complete response (pCR) but increase surgical morbidity due to radiation-induced fibrosis. In this study the association between pCR and postoperative surgical morbidity was investigated.
Methods
Patients in the Netherlands with rectal cancer who underwent nCRT followed by total mesorectal excision between 2009 and 2017 were included. Data were stratified into patients who underwent resection with creation of a primary anastomosis and those who had a permanent stoma procedure. The association between pCR and postoperative morbidity was investigated in univariable and multivariable logistic regression analyses.
Results
pCR was observed in 976 (12·2 per cent) of 8003 patients. In 3472 patients who had a primary anastomosis, the presence of pCR was significantly associated with surgical complications (122 of 443 (27·5 per cent) versus 598 of 3029 (19·7 per cent) in those without pCR) and anastomotic leak (35 of 443 (7·9 per cent) versus 173 of 3029 (5·7 per cent) respectively). Multivariable analysis also showed associations between pCR and surgical complications (adjusted odds ratio (OR) 1·53, 95 per cent c.i. 1·22 to 1·92) and pCR and anastomotic leak (adjusted OR 1·41, 1·03 to 2·05). Of 4531 patients with a permanent stoma, surgical complications were observed in 120 (22·5 per cent) of 533 patients with a pCR, compared with 798 (20·0 per cent) of 3998 patients with no pCR (adjusted OR 1·17, 0·94 to 1·46).
Conclusion
Patients with a pCR in whom an anastomosis was created were at increased risk of developing an anastomotic leak.
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Affiliation(s)
| | - A M Couwenberg
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - O Reerink
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - B L van Leeuwen
- Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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19
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Te Grootenhuis NC, Pouwer AW, de Bock GH, Hollema H, Bulten J, van der Zee AGJ, de Hullu JA, Oonk MHM. Margin status revisited in vulvar squamous cell carcinoma. Gynecol Oncol 2019; 154:266-275. [PMID: 31109660 DOI: 10.1016/j.ygyno.2019.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 02/11/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the incidence of local recurrence of vulvar squamous cell carcinoma in relation to tumor- and/or precursor lesion free pathologic margins. METHODS Consecutive patients with primary vulvar squamous cell carcinoma surgically treated in two Dutch expert centers between 2000 and 2010 were included. All pathology slides were independently reviewed by two expert gynecopathologists, and local recurrence was defined as any recurrent disease located on the vulva. Time to first local recurrence was compared for different subgroups using univariable and multivariable Cox-regression analyses. RESULTS In total 287 patients with a median follow-up of 80months (range 0-204) were analyzed. The actuarial local recurrence rate ten years after treatment was 42.5%. Pathologic tumor free margin distance did not influence the risk on local recurrence (HR 1.03 (95% CI 0.99-1.06)), neither using a cutoff of eight, five, or three millimeters. Multivariable analyses showed a higher local recurrence rate in patients with dVIN and LS in the margin (HR 2.76 (95% CI 1.62-4.71)), in patients with dVIN in the margin (HR 2.14 (95% CI 1.11-4.12)), and a FIGO stage II or higher (HR 1.62 (95% CI 1.05-2.48)). CONCLUSIONS Local recurrences frequently occur in patients with primary vulvar carcinoma and are associated with dVIN (with or without LS) in the pathologic margin rather than any tumor free margin distance. Our results should lead to increased awareness among physicians of an ongoing risk for local recurrence and need for life-long follow-up. Intensified follow-up and treatment protocols for patients with dVIN in the margin should be evaluated in future research.
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Affiliation(s)
- N C Te Grootenhuis
- University of Groningen, University Medical Center Groningen, Groningen, Department of Obstetrics and Gynecology, the Netherlands
| | - A W Pouwer
- Department of Obstetrics and Gynecology, Radboud university medical center, Nijmegen, the Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Groningen, Department of Epidemiology, the Netherlands
| | - H Hollema
- University of Groningen, University Medical Center Groningen, Groningen, Department of Pathology, the Netherlands
| | - J Bulten
- Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - A G J van der Zee
- University of Groningen, University Medical Center Groningen, Groningen, Department of Obstetrics and Gynecology, the Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynecology, Radboud university medical center, Nijmegen, the Netherlands
| | - M H M Oonk
- University of Groningen, University Medical Center Groningen, Groningen, Department of Obstetrics and Gynecology, the Netherlands.
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20
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de Hosson LD, Bouma G, Stelwagen J, van Essen H, de Bock GH, de Groot DJA, de Vries EGE, Walenkamp AME. Web-based personalised information and support for patients with a neuroendocrine tumour: randomised controlled trial. Orphanet J Rare Dis 2019; 14:60. [PMID: 30819238 PMCID: PMC6394034 DOI: 10.1186/s13023-019-1035-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/27/2018] [Accepted: 02/17/2019] [Indexed: 01/16/2023] Open
Abstract
Background Patients with a neuroendocrine tumour (NET) frequently have physical and psychosocial complaints. Aim of this study is to determine whether a web-based, personalised information and support system (WINS) reduces distress and/or improves patients’ perception of and satisfaction with information received. Methods Patients with NET, stratified for those newly diagnosed (< 6 months, n = 28) and with a longer history of disease (n = 74), were randomised between standard care (n = 49) and intervention, consisting of access to WINS (n = 53). Primary outcome was change of distress and satisfaction with perceived information measured with the distress thermometer and problem list and the QoL questionnaire (QLQ)-INFO25. The intervention group also completed a questionnaire based on the technical acceptance model (TAM). Results We observed no difference in distress slope and slope of median global score on perceived information and satisfaction between the intervention and control group. Interestingly, 55% of patients wished to receive more information at baseline. Conclusions In a population of NET patients, access to WINS did not improve indicators for distress, perception of information and satisfaction with information received, more than standard care only. Despite the need for more information, the WINS does not have added value to the information and care provided by health care professionals. Clinical trial registration ClinicalTrials.gov (NCT02472678). Registered 6th Jan 2015. Retrospectively registered 1st May 2017. Electronic supplementary material The online version of this article (10.1186/s13023-019-1035-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L D de Hosson
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, DA11, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - G Bouma
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, DA11, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - J Stelwagen
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, DA11, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - H van Essen
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, DA11, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - D J A de Groot
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, DA11, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, DA11, PO Box 30.001, 9700, RB, Groningen, The Netherlands
| | - A M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, DA11, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
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21
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Sadok N, Krabbe-Timmerman IS, de Bock GH, Werker PMN, Jansen L. The Effect of Smoking and Body Mass Index on The Complication Rate of Alloplastic Breast Reconstruction. Scand J Surg 2019; 109:143-150. [PMID: 30712467 DOI: 10.1177/1457496919826711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the effect of smoking and body mass index on the occurrence of complications after alloplastic breast reconstruction. MATERIALS AND METHODS A consecutive series of 56 patients treated with immediate or delayed alloplastic breast reconstruction, including six cases combined with latissimus dorsi flap, at three hospitals between 2012 and 2018 were included. Complications were scored and defined according to Clavien-Dindo. To evaluate the impact of smoking, body mass index, and other potential risk factors on the occurrence of any and severe complications, univariate and multivariate logistic regression analyses were applied to estimate odds ratios and 95% confidence intervals. RESULTS In 56 patients, 22 patients had a complication. As much as 46% of smokers had severe complications compared to 18% of non-smokers. Of patients with body mass index ⩾ 25, 40% had severe complications compared to 10% with body mass index < 25. Smokers had eight times more chance of developing severe complications than non-smokers (ORadjusted = 8.0, p = 0.02). Patients with body mass index ⩾ 25 had almost 10 times more severe complications compared to patients with body mass index ⩽ 25 (ORadjusted = 9.9, p = 0.009). No other risk factors were significant. CONCLUSION Smoking and body mass index ⩾ 25 both increased the complication rate to such an extent that patients should be informed about their increased risk for complications following alloplastic breast reconstruction and on these grounds surgeons may delay alloplastic breast reconstruction. It is an ethical dilemma whether one should deny overweight and obese patients and those who smoke an immediate alloplastic breast reconstruction. For both life style interventions, adequate guidance should be made available.
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Affiliation(s)
- N Sadok
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - I S Krabbe-Timmerman
- Department of Plastic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - L Jansen
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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22
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Leimkühler M, Hemmer PHJ, Reyners AKL, de Groot DJA, van Ginkel RJ, Been LB, de Bock GH, van Leeuwen BL. Neoadjuvant chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: a feasibility and safety study. World J Surg Oncol 2019; 17:14. [PMID: 30635070 PMCID: PMC6330449 DOI: 10.1186/s12957-018-1554-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/08/2018] [Accepted: 12/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background Standard treatment for colorectal peritoneal carcinomatosis typically involves cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and if possible, postoperative adjuvant chemotherapy. However, a substantial percentage of patients never receive adjuvant chemotherapy because of postoperative complications. Neoadjuvant chemotherapy could be beneficial in this setting, so we assessed its feasibility and safety when used before cytoreductive surgery and HIPEC. Methods In this non-randomized, single-center, observational feasibility study, patients were scheduled to receive six cycles of capecitabine and oxaliplatin before cytoreductive surgery and HIPEC. Computed tomography was performed after the third and sixth chemotherapy cycles to evaluate tumor response, and patients underwent cytoreductive surgery and HIPEC if there were no pulmonary and/or hepatic metastases. Postoperative complications, graded according to the Clavien–Dindo classification, were compared with those of a historic control group that received postoperative adjuvant chemotherapy. Results Of the 14 patients included in the study, 4 and 3 had to terminate neoadjuvant chemotherapy early because of toxicity and tumor progression, respectively. Cytoreductive surgery and HIPEC were performed in eight patients, and the timing and severity of complications were comparable to those of patients in the historic control group treated without neoadjuvant chemotherapy. Conclusion Patients with peritoneal metastases due to colorectal carcinoma can be treated safely with neoadjuvant chemotherapy before definitive therapy with cytoreductive surgery and HIPEC. Trial registration number NTR 3905, registered on 20th march, 2013, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3905
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Affiliation(s)
- M Leimkühler
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - P H J Hemmer
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
| | - A K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - D J A de Groot
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - R J van Ginkel
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - L B Been
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
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23
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van Driel C, de Bock GH, Schroevers MJ, Mourits MJ. Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): a randomised controlled trial. BJOG 2018; 126:402-411. [PMID: 30222235 PMCID: PMC6587763 DOI: 10.1111/1471-0528.15471] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
Abstract
Objective To assess the short‐ and long‐term effects of mindfulness‐based stress reduction (MBSR) on the resulting quality of life, sexual functioning, and sexual distress after risk‐reducing salpingo‐oophorectomy (RRSO). Design Randomised controlled trial. Setting A specialised family cancer clinic of the university medical center Groningen. Population Sixty‐six women carriers of the BRCA1/2 mutation who developed at least two moderate‐to‐severe menopausal symptoms after RRSO. Methods Women were randomised to an 8‐week MBSR training programme or to care as usual (CAU). Main outcome measures Change in the Menopause‐Specific Quality of Life Questionnaire (MENQOL), the Female Sexual Function Index, and the Female Sexual Distress Scale, administered from baseline at 3, 6, and 12 months. Linear mixed modelling was applied to compare the effect of MBSR with CAU over time. Results At 3 and 12 months, there were statistically significant improvements in the MENQOL for the MBSR group compared with the CAU group (both P = 0.04). At 3 months, the mean MENQOL scores were 3.5 (95% confidence interval, 95% CI 3.0–3.9) and 3.8 (95% CI 3.3–4.2) for the MBSR and CAU groups, respectively; at 12 months, the corresponding values were 3.6 (95% CI 3.1–4.0) and 3.9 (95% CI 3.5–4.4). No significant differences were found between the MBSR and CAU groups in the other scores. Conclusion Mindfulness‐based stress reduction was effective at improving quality of life in the short‐ and long‐term for patients with menopausal symptoms after RRSO; however, it was not associated with an improvement in sexual functioning or distress. Tweetable abstract Mindfulness improves menopause‐related quality of life in women after risk‐reducing salpingo‐oophorectomy. Mindfulness improves menopause‐related quality of life in women after risk‐reducing salpingo‐oophorectomy. This paper includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights15471
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Affiliation(s)
- Cmg van Driel
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M J Mourits
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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24
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Versluis M, Plat A, de Bruyn M, Matias-Guiu X, Trovic J, Krakstad C, Nijman HW, Bosse T, de Bock GH, Hollema H. L1CAM expression in uterine carcinosarcoma is limited to the epithelial component and may be involved in epithelial-mesenchymal transition. Virchows Arch 2018; 473:591-598. [PMID: 30140948 DOI: 10.1007/s00428-018-2444-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/19/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/24/2022]
Abstract
Uterine carcinosarcoma (UCS) has been proposed as a model for epithelial-mesenchymal transition (EMT), a process characterized by a functional change facilitating migration and metastasis in many types of cancer. L1CAM is an adhesion molecule that has been involved in EMT as a marker for mesenchymal phenotype. We examined expression of L1CAM in UCS in a cohort of 90 cases from four different centers. Slides were immunohistochemically stained for L1CAM and scored in four categories (0%, < 10%, 10-50%, and > 50%). A score of more than 10% was considered positive for L1CAM. The median age at presentation was 68.6 years, and half of the patients (53.3%) presented with FIGO stage 1 disease. Membranous L1CAM expression was positive in the epithelial component in 65.4% of cases. Remarkably, expression was negative in the mesenchymal component. In cases where both components were intermingled, expression limited to the epithelial component was confirmed by a double stain for L1CAM and keratin. Expression of L1CAM did not relate to overall or disease-free survival. Our findings suggest L1CAM is either not a marker for the mesenchymal phenotype in EMT, or UCS is not a good model for EMT.
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Affiliation(s)
- Mac Versluis
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - A Plat
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - M de Bruyn
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - X Matias-Guiu
- Department of Pathology and Molecular Genetics/Oncologic Pathology Group, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Oncología (CIBERONC), Madrid, Spain.,Department of Pathology, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain
| | - J Trovic
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Center for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - C Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Center for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - H W Nijman
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Hollema
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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25
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Lodder WL, Dorgelo B, Lancaster J, Hanlon R, Wieshmann H, de Bock GH, van der Laan BFAM. Semi-automatic tumour volume measurements on MR-Imaging using smartbrush ® in oropharyngeal carcinomas; our experience in 5 patients. Clin Otolaryngol 2018. [PMID: 29543405 DOI: 10.1111/coa.13097] [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: 11/29/2022]
Affiliation(s)
- W L Lodder
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology/Head and Neck Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - B Dorgelo
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Lancaster
- Department of Otorhinolaryngology/Head and Neck Surgery, Aintree University Hospital, Liverpool, England
| | - R Hanlon
- Department of Radiology, Aintree University Hospital, Liverpool, England
| | - H Wieshmann
- Department of Radiology, Aintree University Hospital, Liverpool, England
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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26
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van Driel CM, Stuursma A, Schroevers MJ, Mourits MJ, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG 2018. [PMID: 29542222 PMCID: PMC6585818 DOI: 10.1111/1471-0528.15153] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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] [Indexed: 11/28/2022]
Abstract
Background During menopause women experience vasomotor and psychosexual symptoms that cannot entirely be alleviated with hormone replacement therapy (HRT). Besides, HRT is contraindicated after breast cancer. Objectives To review the evidence on the effectiveness of psychological interventions in reducing symptoms associated with menopause in natural or treatment‐induced menopausal women. Search strategy Medline/Pubmed, PsycINFO, EMBASE and AMED were searched until June 2017. Selection criteria Randomised controlled trials (RCTs) concerning natural or treatment‐induced menopause, investigating mindfulness or (cognitive‐)behaviour‐based therapy were selected. Main outcomes were frequency of hot flushes, hot flush bother experienced, other menopausal symptoms and sexual functioning. Data collection and analysis Study selection and data extraction were performed by two independent researchers. A meta‐analysis was performed to calculate the standardised mean difference (SMD). Main results Twelve RCTs were included. Short‐term (<20 weeks) effects of psychological interventions in comparison to no treatment or control were observed for hot flush bother (SMD −0.54, 95% CI −0.74 to −0.35, P < 0.001, I2 = 18%) and menopausal symptoms (SMD −0.34, 95% CI −0.52 to −0.15, P < 0.001, I2 = 0%). Medium‐term (≥20 weeks) effects were observed for hot flush bother (SMD −0.38, 95% CI −0.58 to −0.18, P < 0.001, I2 = 16%). [Correction added on 9 July 2018, after first online publication: there were miscalculations of the mean end point scores for hot flush bother and these have been corrected in the preceding two sentences.] In the subgroup treatment‐induced menopause, consisting of exclusively breast cancer populations, as well as in the subgroup natural menopause, hot flush bother was reduced by psychological interventions. Too few studies reported on sexual functioning to perform a meta‐analysis. Conclusions Psychological interventions reduced hot flush bother in the short and medium‐term and menopausal symptoms in the short‐term. These results are especially relevant for breast cancer survivors in whom HRT is contraindicated. There was a lack of studies reporting on the influence on sexual functioning. Tweetable abstract Systematic review: psychological interventions reduce bother by hot flushes in the short‐ and medium‐term. Systematic review: psychological interventions reduce bother by hot flushes in the short‐ and medium‐term.
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Affiliation(s)
- C M van Driel
- Department of Obstetrics & Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Stuursma
- Department of Obstetrics & Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - M J Schroevers
- Department of Health Psychology, University Medical Centre Groningen, Groningen, the Netherlands
| | - M J Mourits
- Department of Obstetrics & Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
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27
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de Hosson LD, Stelwagen J, Bouma G, Sijtema B, Huitema S, van Faassen HJR, de Bock GH, de Groot DJA, Campmans-Kuijpers MJE, Kema IP, de Vries EGE, Walenkamp AME. Towards optimal personalized diet and vitamin supplementation in NET patients. Endocr Relat Cancer 2018; 25:L23-L26. [PMID: 29431642 DOI: 10.1530/erc-17-0549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/20/2017] [Accepted: 01/09/2018] [Indexed: 12/16/2022]
Affiliation(s)
- L D de Hosson
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Stelwagen
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Bouma
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B Sijtema
- DieticiansDepartment of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Huitema
- DieticiansDepartment of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H J R van Faassen
- Department of Laboratory MedicineUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of EpidemiologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J A de Groot
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J E Campmans-Kuijpers
- Department of GastroenterologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - I P Kema
- Department of Laboratory MedicineUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E G E de Vries
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A M E Walenkamp
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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28
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van Dijk R, van Assen M, Vliegenthart R, de Bock GH, van der Harst P, Oudkerk M. Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis. J Cardiovasc Magn Reson 2017; 19:92. [PMID: 29178905 PMCID: PMC5702972 DOI: 10.1186/s12968-017-0393-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. METHOD Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the 'Quality Assessment of Diagnostic Accuracy Studies Tool' (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. RESULTS Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory analysis our results show similar diagnostic accuracy comparing anatomical (AUC 0.86(0.83-0.89)) and functional reference standards (AUC 0.88(0.84-0.90)). Only the per territory analysis sensitivity did not show significant heterogeneity. None of the groups showed signs of publication bias. CONCLUSIONS The clinical value of semi-quantitative and quantitative CMR perfusion analysis remains uncertain due to extensive inter-study heterogeneity and large differences in CMR perfusion acquisition protocols, reference standards, and methods of assessment of myocardial perfusion parameters. For wide spread implementation, standardization of CMR perfusion techniques is essential. TRIAL REGISTRATION CRD42016040176 .
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Affiliation(s)
- R. van Dijk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M. van Assen
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
| | - R. Vliegenthart
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G. H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P. van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M. Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1 EB 45, Groningen, The Netherlands
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Versluis MAC, Marchal S, Plat A, de Bock GH, van Hall T, de Bruyn M, Hollema H, Nijman HW. The prognostic benefit of tumour-infiltrating Natural Killer cells in endometrial cancer is dependent on concurrent overexpression of Human Leucocyte Antigen-E in the tumour microenvironment. Eur J Cancer 2017; 86:285-295. [PMID: 29059634 DOI: 10.1016/j.ejca.2017.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 04/28/2017] [Accepted: 09/14/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Human Leucocyte Antigen- E (HLA-E) has been reported as both a positive and negative prognostic marker in cancer. This apparent discrepancy may be due to opposing actions of HLA-E on tumour-infiltrating immune cells. Therefore, we evaluated HLA-E expression and survival in relation to the presence of intratumoural natural killer (NK) cells and cytotoxic T cells (CTLs). METHODS Tissue microarrays (TMAs) of endometrial tumours were used for immunohistochemical staining of parameters of interest. The combined impact of clinical, pathological and immune parameters on survival was analysed using log rank testing and Cox regression analyses. RESULTS Upregulation of HLA-E was associated with an improved disease-free and disease-specific survival in univariate analysis (HR 0.58 95% CI 0.37-0.89; HR 0.42 95% CI 0.25-0.73, respectively). In multivariate analysis, the presence of NK cells predicts survival with a hazard ratio (HR) 0.28 (95% confidence interval (CI) 0.09-0.91) when HLA-E expression is upregulated; but it is associated with a worse prognosis when HLA-E expression is normal (HR 13.43, 95% CI 1.70-106.14). By contrast, the prognostic benefit of T cells was not modulated by HLA-E expression. CONCLUSIONS Taken together, we demonstrate that the prognostic benefit of NK cells, but not T-cells, is influenced by HLA-E expression in endometrial cancer (EC) and propose a model to explain our observations.
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Affiliation(s)
- M A C Versluis
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
| | - S Marchal
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Plat
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T van Hall
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M de Bruyn
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - H Hollema
- Department of Pathology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - H W Nijman
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Brandenbarg D, Berendsen AJ, de Bock GH. Patients' expectations and preferences regarding cancer follow-up care. Maturitas 2017; 105:58-63. [PMID: 28705438 DOI: 10.1016/j.maturitas.2017.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 06/29/2017] [Accepted: 07/04/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Most survivors of cancer enter a follow-up routine after their treatment, the aim of which is to detect recurrence, provide psychological support, monitor treatment-related side-effects, and to evaluate care. Due to rising numbers of people with cancer and better survival of these patients, current follow-up routines are under pressure. We reviewed the literature on patients' expectations and preferences regarding this care. METHODS We systematically searched the databases of Pubmed, CINAHL, and PsychInfo. Studies were screened and data extraction was double performed by three authors. Data were collected from quantitative and qualitative studies and described thematically. RESULTS After screening, 12 full-text articles were included, comprising 849 patients aged from 28 to 90 years. Patients expect follow-up visits to detect recurrence of cancer. They want to undergo extensive testing to get reassurance. Furthermore, patients expect relevant information to be provided and to get advice about different aspects of their illness. Psychosocial support is also expected. Patients express a desire for consistency of care as well as continuity of care, and prefer long and intensive follow-up. DISCUSSION AND CONCLUSION After cancer, patients appear to lose confidence in their bodies and fear cancer recurrence after the end of treatment, which may lead to intensive screening wishes. This is not desirable, since care for cancer is already under pressure due to rising numbers of survivors. We have to ensure that follow-up routines are sustainable and effective. Patients should receive good information about the need for follow-up tests. Doctors should be trained to give this information.
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Affiliation(s)
- D Brandenbarg
- University of Groningen, University Medical Center Groningen, Department of General Practice, P.O. Box 196, 9700 AD Groningen, The Netherlands
| | - A J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice, P.O. Box 196, 9700 AD Groningen, The Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
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Mourits MJ, de Bock GH. European/U.S. Comparison and Contrasts in Ovarian Cancer Screening and Prevention in a High-Risk Population. Am Soc Clin Oncol Educ Book 2017; 37:124-127. [PMID: 28561729 DOI: 10.1200/edbk_180330] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The history of screening and prevention of ovarian cancer among high-risk women in the United States and Europe is one of mutual inspiration, with researchers learning from each others' findings and insights and collaborating with investigators from both sides of the Atlantic ocean. Examples of simultaneous and joint development of knowledge and scientific points of view include the paradigm shift from ovarian to fallopian tube high-grade serous cancer and the cessation of simultaneous adoption of ovarian cancer screening by clinicians in both the United States and Europe. Examples of joint efforts with fruitful results include international collaboration in large population-based, genome-wide association studies and in epidemiologic database studies. Research in the field of hereditary ovarian cancer is a great example of mutual inspiration and joint efforts for the purpose of improving knowledge and health care for women with hereditary ovarian cancer.
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Affiliation(s)
- Marian J Mourits
- From the Departments of Gynecologic Oncology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - G H de Bock
- From the Departments of Gynecologic Oncology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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van der Velde JL, Blanker MH, Stegmann ME, de Bock GH, Berger MY, Berendsen AJ. A systematic review of the psychological impact of false-positive colorectal cancer screening: What is the role of the general practitioner? Eur J Cancer Care (Engl) 2017; 26. [PMID: 28493375 DOI: 10.1111/ecc.12709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/28/2022]
Abstract
Screening for colorectal cancer (CRC) has both advantages (e.g. reduction in morbidity and mortality) and disadvantages (e.g. false positives and distress). A systematic review was therefore performed to improve our understanding of how false-positive CRC screening results affect patients psychologically (and to make recommendations for primary care). The PubMed, Embase, PsychINFO, CINAHL and Cochrane databases were searched in October 2014 and supplemented in December 2016 to identify studies on the psychological impact of false-positive CRC screening. Original studies were eligible when they assessed psychological impact in a screening setting, provided they also included false-positive CRC screening results. Two authors independently assessed 2,367 available manuscripts and included seven. Heterogeneity in their outcome measures meant that data could not be pooled. Two studies showed that a false-positive CRC screening result caused some moderate psychological distress shortly before and after colonoscopy. The remaining five studies illustrated that the psychological distress of patients with true-positive and false-positive CRC screening results was comparable. We conclude that a false-positive CRC screening result may cause some moderate psychological distress, especially just before or after colonoscopy. We recommend that general practitioners mention this when discussing CRC screening with patients and monitor those with a false-positive outcome for psychological distress.
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Affiliation(s)
- J L van der Velde
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M H Blanker
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M E Stegmann
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Y Berger
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A J Berendsen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Verberne CJ, Zhan Z, van den Heuvel ER, Oppers F, de Jong AM, Grossmann I, Klaase JM, de Bock GH, Wiggers T. Survival analysis of the CEAwatch multicentre clustered randomized trial. Br J Surg 2017; 104:1069-1077. [PMID: 28376235 DOI: 10.1002/bjs.10535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/30/2016] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The CEAwatch randomized trial showed that follow-up with intensive carcinoembryonic antigen (CEA) monitoring (CEAwatch protocol) was better than care as usual (CAU) for early postoperative detection of colorectal cancer recurrence. The aim of this study was to calculate overall survival (OS) and disease-specific survival (DSS). METHODS For all patients with recurrence, OS and DSS were compared between patients detected by the CEAwatch protocol versus CAU, and by the method of detection of recurrence, using Cox regression models. RESULTS Some 238 patients with recurrence were analysed (7·5 per cent); a total of 108 recurrences were detected by CEA blood test, 64 (55·2 per cent) within the CEAwatch protocol and 44 (41·9 per cent) in the CAU group (P = 0·007). Only 16 recurrences (13·8 per cent) were detected by patient self-report in the CEAwatch group, compared with 33 (31·4 per cent) in the CAU group. There was no significant improvement in either OS or DSS with the CEAwatch protocol compared with CAU: hazard ratio 0·73 (95 per cent 0·46 to 1·17) and 0·78 (0·48 to 1·28) respectively. There were no differences in survival when recurrence was detected by CT versus CEA measurement, but both of these methods yielded better survival outcomes than detection by patient self-report. CONCLUSION There was no direct survival benefit in favour of the intensive programme, but the CEAwatch protocol led to a higher proportion of recurrences being detected by CEA-based blood test and reduced the number detected by patient self-report. This is important because detection of recurrence by blood test was associated with significantly better survival than patient self-report, indirectly supporting use of the CEAwatch protocol.
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Affiliation(s)
- C J Verberne
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Z Zhan
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E R van den Heuvel
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - F Oppers
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A M de Jong
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - I Grossmann
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Gastrointestinal Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - J M Klaase
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - G H de Bock
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - T Wiggers
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Brandenbarg D, Roorda C, Groenhof F, de Bock GH, Berger MY, Berendsen AJ. Primary healthcare use during follow-up after curative treatment for colorectal cancer. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- D. Brandenbarg
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - C. Roorda
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - F. Groenhof
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - G. H. de Bock
- Department of Epidemiology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - M. Y. Berger
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - A. J. Berendsen
- Department of General Practice; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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van Driel CMG, Oosterwijk JC, Meijers-Heijboer EJ, van Asperen CJ, Zeijlmans van Emmichoven IA, de Vries J, Mourits MJE, Henneman L, Timmermans DRM, de Bock GH. Psychological factors associated with the intention to choose for risk-reducing mastectomy in family cancer clinic attendees. Breast 2016; 30:66-72. [PMID: 27639031 DOI: 10.1016/j.breast.2016.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 03/22/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Women seeking counseling because of familial breast cancer occurrence face difficult decisions, such as whether and when to opt for risk-reducing mastectomy (RRM) in case of BRCA1/2 mutation. Only limited research has been done to identify the psychological factors associated with the decision for RRM. This study investigated which psychological factors are related to the intention to choose for RRM. MATERIALS & METHODS A cohort of 486 cancer-unaffected women with a family history of breast cancer completed the following questionnaires prior to genetic counseling: the Cancer Worry Scale, Positive And Negative Affect Scale, Perceived Personal Control Scale, Hospital Anxiety and Depression Scale and State Anxiety Scale and questions regarding socio-demographic characteristics, family history, risk perception and RRM intention. Multivariate logistic regression was used to analyze the relation between psychological factors and women's intention to choose for RRM. RESULTS Factors associated with RRM intention were high positive affect (OR = 1.86, 95%CI = 1.12-3.08), high negative affect (OR = 2.52, 95%CI = 1.44-4.43), high cancer worry (OR = 1.65, 95%CI = 1.00-2.72), high perceived personal control (OR = 3.58, 95%CI = 2.18-5.89), high risk-perception (OR = 1.85, 95%CI = 1.15-2.95) and having children (OR = 2.06, 95%CI = 1.21-3.50). CONCLUSION Negative and positive affects play an important role in the intention for RRM. Furthermore, perceived personal control over the situation is associated with an intention for RRM. In addition to focusing on accurate risk communication, counseling should pay attention to the influence of perceived control and emotions to facilitate decision-making.
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Affiliation(s)
- C M G van Driel
- Department of Obstetrics & Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | - J C Oosterwijk
- Department of Genetics, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - E J Meijers-Heijboer
- Department of Clinical Genetics, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - C J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - I A Zeijlmans van Emmichoven
- Department of Medical Psychology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - J de Vries
- Department of Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - M J E Mourits
- Department of Obstetrics & Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - L Henneman
- Department of Clinical Genetics, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - D R M Timmermans
- EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Public and Occupational Health, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Boers A, Wang R, van Leeuwen RW, Klip HG, de Bock GH, Hollema H, van Criekinge W, de Meyer T, Denil S, van der Zee AGJ, Schuuring E, Wisman GBA. Discovery of new methylation markers to improve screening for cervical intraepithelial neoplasia grade 2/3. Clin Epigenetics 2016; 8:29. [PMID: 26962367 PMCID: PMC4784352 DOI: 10.1186/s13148-016-0196-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/02/2016] [Indexed: 11/16/2022] Open
Abstract
Background Assessment of DNA promoter methylation markers in cervical scrapings for the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer is feasible, but finding methylation markers with both high sensitivity as well as high specificity remains a challenge. In this study, we aimed to identify new methylation markers for the detection of high-grade CIN (CIN2/3 or worse, CIN2+) by using innovative genome-wide methylation analysis (MethylCap-seq). We focused on diagnostic performance of methylation markers with high sensitivity and high specificity considering any methylation level as positive. Results MethylCap-seq of normal cervices and CIN2/3 revealed 176 differentially methylated regions (DMRs) comprising 164 genes. After verification and validation of the 15 best discriminating genes with methylation-specific PCR (MSP), 9 genes showed significant differential methylation in an independent cohort of normal cervices versus CIN2/3 lesions (p < 0.05). For further diagnostic evaluation, these 9 markers were tested with quantitative MSP (QMSP) in cervical scrapings from 2 cohorts: (1) cervical carcinoma versus healthy controls and (2) patients referred from population-based screening with an abnormal Pap smear in whom also HPV status was determined. Methylation levels of 8/9 genes were significantly higher in carcinoma compared to normal scrapings. For all 8 genes, methylation levels increased with the severity of the underlying histological lesion in scrapings from patients referred with an abnormal Pap smear. In addition, the diagnostic performance was investigated, using these 8 new genes and 4 genes (previously identified by our group: C13ORF18, JAM3, EPB41L3, and TERT). In a triage setting (after a positive Pap smear), sensitivity for CIN2+ of the best combination of genes (C13ORF18/JAM3/ANKRD18CP) (74 %) was comparable to hrHPV testing (79 %), while specificity was significantly higher (76 % versus 42 %, p ≤ 0.05). In addition, in hrHPV-positive scrapings, sensitivity and specificity for CIN2+ of this best-performing combination was comparable to the population referred with abnormal Pap smear. Conclusions We identified new CIN2/3-specific methylation markers using genome-wide DNA methylation analysis. The diagnostic performance of our new methylation panel shows higher specificity, which should result in prevention of unnecessary colposcopies for women referred with abnormal cytology. In addition, these newly found markers might be applied as a triage test in hrHPV-positive women from population-based screening. The next step before implementation in primary screening programs will be validation in population-based cohorts. Electronic supplementary material The online version of this article (doi:10.1186/s13148-016-0196-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Boers
- Department of Gynecologic Oncology, internal postal code DA13, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands
| | - R Wang
- Department of Gynecologic Oncology, internal postal code DA13, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands
| | - R W van Leeuwen
- Department of Gynecologic Oncology, internal postal code DA13, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands
| | - H G Klip
- Department of Gynecologic Oncology, internal postal code DA13, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Hollema
- Department of Pathology, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W van Criekinge
- Department of Mathematical Modeling, Statistics and Bioinformatics, Ghent University, Ghent, Belgium
| | - T de Meyer
- Department of Mathematical Modeling, Statistics and Bioinformatics, Ghent University, Ghent, Belgium
| | - S Denil
- Department of Mathematical Modeling, Statistics and Bioinformatics, Ghent University, Ghent, Belgium
| | - A G J van der Zee
- Department of Gynecologic Oncology, internal postal code DA13, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands
| | - E Schuuring
- Department of Pathology, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G B A Wisman
- Department of Gynecologic Oncology, internal postal code DA13, Cancer Reserch Center Groningen, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands
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Verberne CJ, Wiggers T, Grossmann I, de Bock GH, Vermeulen KM. Cost-effectiveness of a carcinoembryonic antigen (CEA) based follow-up programme for colorectal cancer (the CEA Watch trial). Colorectal Dis 2016; 18:O91-6. [PMID: 26757353 DOI: 10.1111/codi.13273] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/18/2015] [Indexed: 02/08/2023]
Abstract
AIM The study CEA Watch (Netherlands Trial Register 2182) has shown that an intensified follow-up schedule with more frequent carcinoembryonic antigen (CEA) measurements but fewer outpatient visits detects more curable recurrences compared with the usual follow-up protocol in colorectal cancer (CRC) patients. The aim of the study was to compare the cost and cost-effectiveness between various follow-up programmes. METHOD In total, 3223 patients with stage I-III CRC were followed between October 2010 and October 2012. Direct medical costs were calculated per patient adding the costs for all visits, CEA measurements and imaging. Productivity losses and travel expenses were calculated using answers from questionnaires. The cost-effectiveness displayed the additional costs per additional patient with recurrent disease and used an incremental cost-effectiveness ratio (ICER) to compare them. RESULTS The mean yearly cost per patient was €548 in the intensified protocol and €497 in the control protocol. The ICER was €94 (95% CI €76-€157) per cent; to detect one additional patient with a recurrence in the intervention protocol compared with the control protocol would require an additional €9400. For curable recurrences, the ICER was €607 (95% CI €5695-€5728). Annual patient-reported costs were €509 per year in the intervention protocol and €488 in the control protocol. CONCLUSION The current study demonstrates that the direct medical and patient-reported cost of a newly introduced, safe and effective way of CRC follow-up was comparable to that of standard care. The ICER per curable recurrence was considered acceptably low.
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Affiliation(s)
- C J Verberne
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - T Wiggers
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - I Grossmann
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Versluis MA, de Jong RA, Plat A, Bosse T, Smit VT, Mackay H, Powell M, Leary A, Mileshkin L, Kitchener HC, Crosbie EJ, Edmondson RJ, Creutzberg CL, Hollema H, Daemen T, de Bock GH, Nijman HW. Prediction model for regional or distant recurrence in endometrial cancer based on classical pathological and immunological parameters. Br J Cancer 2015. [PMID: 26217922 PMCID: PMC4559831 DOI: 10.1038/bjc.2015.268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 01/21/2023] Open
Abstract
Background: Adjuvant therapy increases disease-free survival in endometrial cancer (EC), but has no impact on overall survival and negatively influences the quality of life. We investigated the discriminatory power of classical and immunological predictors of recurrence in a cohort of EC patients and confirmed the findings in an independent validation cohort. Methods: We reanalysed the data from 355 EC patients and tested our findings in an independent validation cohort of 72 patients with EC. Predictors were selected and Harrell's C-index for concordance was used to determine discriminatory power for disease-free survival in the total group and stratified for histological subtype. Results: Predictors for recurrence were FIGO stage, lymphovascular space invasion and numbers of cytotoxic and memory T-cells. For high risk cancer, cytotoxic or memory T-cells predicted recurrence as well as a combination of FIGO stage and lymphovascular space invasion (C-index 0.67 and 0.71 vs 0.70). Recurrence was best predicted when FIGO stage, lymphovascular space invasion and numbers of cytotoxic cells were used in combination (C-index 0.82). Findings were confirmed in the validation cohort. Conclusions: In high-risk EC, clinicopathological or immunological variables can predict regional or distant recurrence with equal accuracy, but the use of these variables in combination is more powerful.
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Affiliation(s)
- M A Versluis
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A de Jong
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Plat
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - V T Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Mackay
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Canada
| | - M Powell
- Department of Clinical Oncology, Barts Health NHS trust, London, UK
| | - A Leary
- Department of Medicine, Gynecology Unit, Gustave Roussy, Villejuif, France
| | - L Mileshkin
- Division of Medical Oncology, Peter MacCallum Cancer Center, Victoria, Australia
| | - H C Kitchener
- Department of Gynecology, St Marys Hospital, Manchester, UK
| | - E J Crosbie
- Department of Gynecology, St Marys Hospital, Manchester, UK
| | - R J Edmondson
- Department of Gynecology, St Marys Hospital, Manchester, UK
| | - C L Creutzberg
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Daemen
- Department of Medical Microbiology, Molecular Virology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H W Nijman
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Huisman MG, Audisio RA, Ugolini G, Montroni I, Vigano A, Spiliotis J, Stabilini C, de Liguori Carino N, Farinella E, Stanojevic G, Veering BT, Reed MW, Somasundar PS, de Bock GH, van Leeuwen BL. Screening for predictors of adverse outcome in onco-geriatric surgical patients: A multicenter prospective cohort study. Eur J Surg Oncol 2015; 41:844-51. [PMID: 25935371 DOI: 10.1016/j.ejso.2015.02.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 01/16/2015] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022] Open
Abstract
AIMS The aim of this study was to investigate the predictive ability of screening tools regarding the occurrence of major postoperative complications in onco-geriatric surgical patients and to propose a scoring system. METHODS 328 patients ≥ 70 years undergoing surgery for solid tumors were prospectively recruited. Preoperatively, twelve screening tools were administered. Primary endpoint was the incidence of major complications within 30 days. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using logistic regression. A scoring system was derived from multivariate logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was applied to evaluate model performance. RESULTS At a median age of 76 years, 61 patients (18.6%) experienced major complications. In multivariate analysis, Timed Up and Go (TUG), ASA-classification and Nutritional Risk Screening (NRS) were predictors of major complications (TUG>20 OR 3.1, 95% CI 1.1-8.6; ASA ≥ 3 OR 2.8, 95% CI 1.2-6.3; NRS impaired OR 3.3, 95% CI 1.6-6.8). The scoring system, including TUG, ASA, NRS, gender and type of surgery, showed good accuracy (AUC: 0.81, 95% CI 0.75-0.86). The negative predictive value with a cut-off point >8 was 93.8% and the positive predictive value was 40.3%. CONCLUSIONS A substantial number of patients experience major postoperative complications. TUG, ASA and NRS are screening tools predictive of the occurrence of major postoperative complications and, together with gender and type of surgery, compose a good scoring system.
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Affiliation(s)
- M G Huisman
- University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - R A Audisio
- University of Liverpool, St. Helens Teaching Hospital, Department of Surgery, Marshalls Cross Road, St. Helens, WA9 3DA, United Kingdom
| | - G Ugolini
- University of Bologna, S. Orsola Malpighi Hospital, Department of Surgery, Via Pietro Albertoni, 15, 40138 Bologna, Italy
| | - I Montroni
- University of Bologna, S. Orsola Malpighi Hospital, Department of Surgery, Via Pietro Albertoni, 15, 40138 Bologna, Italy
| | - A Vigano
- McGill University Health Center, Montreal General Hospital, Department of Oncology, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada
| | - J Spiliotis
- Metaxa Cancer Hospital, Department of Surgery, Mpotasi 51, 185 37 Piraeus, Greece; Regional University Hospital of Patras, Department of Surgery, Patras, Greece
| | - C Stabilini
- San Martino University Hospital, Department of Surgery, Largo Rosanna Benzi, 10, 16132 Genua, Italy
| | - N de Liguori Carino
- Central Manchester University Hospitals, Manchester Royal Infirmary, Department of Hepato-Pancreato-Biliary Surgery, Oxford Road, Manchester M13 9WL, United Kingdom
| | - E Farinella
- S. Maria Hospital, Department of Surgery, Azienda Ospedaliera di Perugia Via Brunamonti, 51 06122 Perugia, Italy
| | - G Stanojevic
- Clinic for General Surgery, Clinical Center Nis, Bulevar Zorana Djindjica 48, 1800 Nis, Serbia
| | - B T Veering
- University of Leiden, Leiden University Medical Center, Department of Anesthesiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - M W Reed
- University of Sheffield, Department of Oncology, Beech Hill Road, Sheffield, South Yorkshire S10 2RX, United Kingdom
| | - P S Somasundar
- Roger Williams Medical Center, Division of Surgical Oncology, Affiliate of Boston University, 50 Maude Street, Providence, RI 02908, United States
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - B L van Leeuwen
- University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Melchers LJ, Mastik MF, Samaniego Cameron B, van Dijk BAC, de Bock GH, van der Laan BFAM, van der Vegt B, Speel EJM, Roodenburg JLN, Witjes MJH, Schuuring E. Detection of HPV-associated oropharyngeal tumours in a 16-year cohort: more than meets the eye. Br J Cancer 2015; 112:1349-57. [PMID: 25867270 PMCID: PMC4402463 DOI: 10.1038/bjc.2015.99] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 10/31/2014] [Revised: 02/08/2015] [Accepted: 02/16/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Accurate assessment of the prevalence of the human papilloma virus (HPV) in oropharyngeal tumours (OpSCC) is important because HPV-positive OpSCC are consistently associated with an improved overall survival. Recently, an algorithm has become available that reliably detects clinically relevant HPV in tumour tissue, however, no complete cohorts have been tested. The aim was to determine the prevalence of active high-risk HPV infection in a complete cohort of OpSCC collected over a 16-year period. METHODS Using a triple algorithm of p16 immunohistochemistry, HPV-BRISH and HPV-PCR, we assessed the prevalence of active HPV infection in all OpSCC diagnosed in our hospital from 1997 to 2012 (n=193) and a random selection of 200 oral tumours (OSCC). RESULTS Forty-seven OpSCC (24%) were HPVGP PCR-positive; 42 cases were HPV16+, 1 HPV18+, 3 HPV33+ and 1 HPV35+. Brightfield in situ hybridisation did not identify additional HPV-positive cases. Human papilloma virus-associated tumour proportion increased from 13% (1997-2004) to 30% (2005-2012). Human papilloma virus-positivity was an independent predictor for longer disease-specific survival (HR=0.22; 95%CI:0.10-0.47). Only one OSCC was HPV+. CONCLUSIONS In our cohort, the incidence of HPV-associated OpSCC is low but increasing rapidly. The strict detection algorithm, analysis of disease-specific survival and the complete cohort, including palliatively treated patients, may influence the reported prevalence and prognostic value of HPV in OpSCC.
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Affiliation(s)
- L J Melchers
- 1] Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands [2] Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - M F Mastik
- Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - B Samaniego Cameron
- Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - B A C van Dijk
- 1] Department of Research, Comprehensive Cancer Center The Netherlands, P.O. Box 19079, 3501 DB Utrecht, The Netherlands [2] Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - B F A M van der Laan
- Department of Otorhinolaryngology/Head & Neck surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - B van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - E J M Speel
- Department of Pathology, Maastricht University Medical Center, P.O. Box 5800, 6202AZ Maastricht, The Netherlands
| | - J L N Roodenburg
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - M J H Witjes
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
| | - E Schuuring
- Department of Pathology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands
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van der Sluis FJ, Espin E, Vallribera F, de Bock GH, Hoekstra HJ, van Leeuwen BL, Engel AF. Predicting postoperative mortality after colorectal surgery: a novel clinical model. Colorectal Dis 2014; 16:631-9. [PMID: 24506067 DOI: 10.1111/codi.12580] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/15/2013] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to develop and externally validate a clinically, practical and discriminative prediction model designed to estimate in-hospital mortality of patients undergoing colorectal surgery. METHOD All consecutive patients who underwent elective or emergency colorectal surgery from 1990 to 2005, at the Zaandam Medical Centre, The Netherlands, were included in this study. Multivariate logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) linking the explanatory variables to the outcome variable in-hospital mortality, and a simplified Identification of Risk in Colorectal Surgery (IRCS) score was constructed. The model was validated in a population of patients who underwent colorectal surgery from 2005 to 2011 in Barcelona, Spain. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve. RESULTS The strongest predictors of in-hospital mortality were emergency surgery (OR = 6.7, 95% CI 4.7-9.5), tumour stage (OR = 3.2, 95% CI 2.8-4.6), age (OR = 13.1, 95% CI 6.6-26.0), pulmonary failure (OR = 4.9, 95% CI 3.3-7.1) and cardiac failure (OR = 3.7, 95% CI 2.6-5.3). These parameters were included in the prediction model and simplified scoring system. The IRCS model predicted in-hospital mortality and demonstrated a predictive performance of 0.83 (95% CI 0.79-0.87) in the validation population. In this population the predictive performance of the CR-POSSUM score was 0.76 (95% CI 0.71-0.81). CONCLUSIONS The results of this study have shown that the IRCS score is a good predictor of in-hospital mortality after colorectal surgery despite the relatively low number of model parameters.
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Affiliation(s)
- F J van der Sluis
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Loeffen EAH, Brinksma A, Miedema KGE, de Bock GH, Tissing WJE. Clinical implications of malnutrition in childhood cancer patients—infections and mortality. Support Care Cancer 2014; 23:143-50. [DOI: 10.1007/s00520-014-2350-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/29/2014] [Indexed: 11/28/2022]
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Griepsma M, de Roy van Zuidewijn DBW, Grond AJK, Siesling S, Groen H, de Bock GH. Residual Breast Tissue after Mastectomy: How Often and Where Is It Located? Ann Surg Oncol 2013; 21:1260-6. [DOI: 10.1245/s10434-013-3383-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Indexed: 11/18/2022]
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Grossmann I, Doornbos PM, Klaase JM, de Bock GH, Wiggers T. Changing patterns of recurrent disease in colorectal cancer. Eur J Surg Oncol 2013; 40:234-9. [PMID: 24295727 DOI: 10.1016/j.ejso.2013.10.028] [Citation(s) in RCA: 18] [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: 08/08/2013] [Revised: 10/12/2013] [Accepted: 10/30/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Due to changes in staging, (neo)-adjuvant treatment and surgical techniques for colorectal cancer (CRC), it is expected that the recurrence pattern will change as well. This study aims to report the current incidence of, and time to recurrent disease (RD), further the localization(s) and the eligibility for successive curative treatment. METHODS A consecutive cohort of CRC patients, whom were routinely staged with CT and underwent curative treatment according to the national guidelines, was analyzed (n = 526). RESULTS After a mean and median FU of 39 months, 20% of all patients and 16% of all AJCC stage 0-III patients had developed RD. The annual incidences were the highest in the first two years but tend to retain in the succeeding years for stage 0-III patients. The majority of RD was confined to one organ (58%) and 28% of these patients were again treated with curative intent. CONCLUSIONS In follow-up nowadays, less recurrences are found than reported in historical studies but these can more often be treated with curative intent. A main cause for the decreased incidence of RD, next to improvements in treatment, is probably stage shift elicited by pre-operative staging. The outcomes support continuation of follow-up in colorectal cancer.
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Affiliation(s)
- I Grossmann
- Department of Surgery, Medical Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, The Netherlands.
| | - P M Doornbos
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J M Klaase
- Department of Surgery, Medical Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, The Netherlands.
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - T Wiggers
- Department of Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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Melchers LJ, Bruine de Bruin L, Schnell U, Slagter-Menkema L, Mastik MF, de Bock GH, van Dijk BAC, Giepmans BNG, van der Laan BFAM, van der Wal JE, Roodenburg JLN, Schuuring E. Lack of claudin-7 is a strong predictor of regional recurrence in oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2013; 49:998-1005. [PMID: 23953778 DOI: 10.1016/j.oraloncology.2013.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 05/02/2013] [Revised: 06/24/2013] [Accepted: 07/18/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Adequate treatment of oral and oropharyngeal squamous cell carcinoma (OSCC) is dependent on correctly predicting the presence of lymph node metastases. Current methods to diagnose nodal metastases partly result in overtreatment with associated morbidity and undertreatment with decreased disease-free survival. E-cadherin has been studied extensively as potential marker for lymph node metastases. EpCAM and claudin-7 have a functional relationship with E-cadherin, forming a complex that promotes tumourigenicity in vitro. We hypothesize that the co-expression patterns of these related molecules is a better prognostic marker for nodal status and regional recurrences. MATERIALS AND METHODS We constructed separate tissue microarrays of tumour centre and tumour invasive front of 227 OSCC with complete clinicopathological and follow-up data, including HPV status, and performed immunohistochemistry for these molecules. RESULTS Lack of E-cadherin and presence of cytoplasmic EpCAM expression in the tumour front were predictive for nodal metastasis, but no co-expression pattern was found clinically relevant. Lack of claudin-7 in the tumour centre was highly and independently predictive for shorter regional disease-free survival (HR=0.19; 95%CI: 0.06-0.62) and disease-specific survival (HR=0.43; 95%CI: 0.21-0.87). High-risk HPV was not associated with any marker. CONCLUSIONS The expression of E-cadherin and EpCAM, depending on the specific tumour sublocalization, is predictive for nodal status. However, co-expression did not improve the prediction of nodal status, indicating that the proposed in vitro complex is not functional in clinical samples. Additionally, lack of claudin-7 expression in the tumour centre may be used to identify patients with increased risk for regional recurrence.
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Affiliation(s)
- L J Melchers
- Dept. of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands; Dept. of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
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Bantema-Joppe EJ, van den Heuvel ER, de Munck L, de Bock GH, Smit WGJM, Timmer PR, Dolsma WV, Jansen L, Schröder CP, Siesling S, Langendijk JA, Maduro JH. Impact of primary local treatment on the development of distant metastases or death through locoregional recurrence in young breast cancer patients. Breast Cancer Res Treat 2013; 140:577-85. [PMID: 23912958 DOI: 10.1007/s10549-013-2650-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/20/2013] [Indexed: 11/30/2022]
Abstract
In this study, we tested the hypothesis whether breast conserving therapy (BCT) compared with mastectomy is associated with a negative outcome in terms of distant metastases or death (DMD) and investigated the relation between locoregional recurrence (LRR) and DMD in young breast cancer (BC) patients. This study included a consecutive series of 536 patients ≤40 years of age at diagnosis with pathological T1N0-3M0 BC, treated between 1989 and 2005. A multistate survival model was used to evaluate the influences of local treatment and LRR on DMD, adjusted for potential prognostic factors. Patients were treated with mastectomy (N = 213) or BCT (N = 323). Median age at diagnosis was 36.3 years, with a median follow-up of 9.0 years. The 10-year actuarial cumulative incidence of DMD was 30.6 % after mastectomy and 26.3 % after BCT (P = 0.04). In total, 81 (15 %) LRRs were observed. After BCT, patients had a threefold higher risk of LRR than after mastectomy (HR 2.9; 95 % CI 1.6-5.3). Patients with LRR had a higher risk of DMD compared with patients without LRR (HR 5.5; 95 % CI 2.1-14.5). However, BCT was not negatively associated with DMD-after-LRR (HR 0.47; 95 % CI 0.2-1.1, BCT vs mastectomy). In conclusion, although LRR significantly affected DMD, the increased risk of LRR after BCT compared with mastectomy did not lead to a worse DMD outcome in BC patients ≤40 years of age.
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Affiliation(s)
- E J Bantema-Joppe
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands
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de Bock GH, Vermeulen KM, Jansen L, Oosterwijk JC, Siesling S, Dorrius MD, Feenstra T, Houssami N, Greuter MJW. Which screening strategy should be offered to women with BRCA1 or BRCA2 mutations? A simulation of comparative cost-effectiveness. Br J Cancer 2013; 108:1579-86. [PMID: 23579217 PMCID: PMC3668482 DOI: 10.1038/bjc.2013.149] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 11/21/2022] Open
Abstract
Background: There is no consensus on the most effective strategy (mammography or magnetic resonance imaging (MRI)) for screening women with BRCA1 or BRCA2 mutations. The effectiveness and cost-effectiveness of the Dutch, UK and US screening strategies, which involve mammography and MRI at different ages and intervals were evaluated in high-risk women with BRCA1 or BRCA2 mutations. Methods: Into a validated simulation screening model, outcomes and cost parameters were integrated from published and cancer registry data. Main outcomes were life-years gained and incremental cost-effectiveness ratios. The simulation was situated in the Netherlands as well as in the United Kingdom, comparing the Dutch, UK and US strategies with the population screening as a reference. A discount rate of 3% was applied to both costs and health benefits. Results: In terms of life-years gained, the strategies from least to most cost-effective were the UK, Dutch and US screening strategy, respectively. However, the differences were small. Applying the US strategy in the Netherlands, the costs were €43 800 and 68 800 for an additional life-year gained for BRCA1 and BRCA2, respectively. At a threshold of €20 000 per life-year gained, implementing the US strategy in the Netherlands has a very low probability of being cost-effective. Stepping back to the less-effective UK strategy would save relatively little in costs and results in life-years lost. When implementing the screening strategies in the United Kingdom, the Dutch, as well as the US screening strategy have a high probability of being cost-effective. Conclusion: From a cost-effectiveness perspective, the Dutch screening strategy is preferred for screening high-risk women in the Netherlands as well as in the United Kingdom.
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Affiliation(s)
- G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands.
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Vencken PMLH, Reitsma W, Kriege M, Mourits MJE, de Bock GH, de Hullu JA, van Altena AM, Gaarenstroom KN, Vasen HFA, Adank MA, Schmidt MK, van Beurden M, Zweemer RP, Rijcken F, Slangen BFM, Burger CW, Seynaeve C. Outcome of BRCA1- compared with BRCA2-associated ovarian cancer: a nationwide study in the Netherlands. Ann Oncol 2013; 24:2036-42. [PMID: 23543211 DOI: 10.1093/annonc/mdt068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Recent studies suggested an improved overall survival (OS) for BRCA2- versus BRCA1-associated epithelial ovarian cancer (EOC), whereas the impact of chemotherapy is not yet clear. In a nationwide cohort, we examined the results of primary treatment, progression-free survival (PFS), treatment-free interval (TFI), and OS of BRCA1 versus BRCA2 EOC patients. METHODS Two hundred and forty-five BRCA1- and 99 BRCA2-associated EOC patients were identified through all Dutch university hospitals. Analyses were carried out with the Pearson's Chi-square test, Kaplan-Meier, and Cox regression methods. RESULTS BRCA1 patients were younger at EOC diagnosis than BRCA2 patients (51 versus 55 years; P < 0.001), without differences regarding histology, tumor grade, and International Federation of Gynecology and Obstetrics (FIGO) stage. Complete response rates after primary treatment, including chemotherapy, did not differ between BRCA1 (86%) and BRCA2 patients (90%). BRCA1 versus BRCA2 patients had a shorter PFS (median 2.2 versus 3.9 years, respectively; P = 0.006), TFI (median 1.7 versus 2.8 years; P = 0.009), and OS (median 6.0 versus 9.7 years; P = 0.04). Differences could not be explained by age at diagnosis, FIGO stage or type of treatment. CONCLUSIONS PFS and OS were substantially longer in BRCA2- than in BRCA1-associated EOC patients. While response rates after primary treatment were similarly high in both groups, TFI, as surrogate for chemosensitivity, was significantly longer in BRCA2 patients.
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Affiliation(s)
- P M L H Vencken
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Lu W, Greuter MJW, Schaapveld M, Vermeulen KM, Wiggers T, de Bock GH. Safety and cost-effectiveness of shortening hospital follow-up after breast cancer treatment. Br J Surg 2012; 99:1227-33. [PMID: 22828861 DOI: 10.1002/bjs.8850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND In the Netherlands, the first 5 years of follow-up after treatment for breast cancer are carried out in hospital with yearly mammography. After this, for patients aged over 60 years who have undergone mastectomy, there is a shift of care to the National Screening Programme (NSP) for mammography every 2 years. After breast-conserving therapy follow-up is perfomed by the general practitioner (GP), with mammography every second year and physical examination annually. The aim of this study was to evaluate the clinical effects and costs of four different strategies for follow-up after breast cancer treatment. METHODS An extended and validated simulation model for breast cancer follow-up was used. The current guidelines for follow-up (baseline strategy) and three less intensive follow-up strategies were evaluated. The main outcome measure was the detection rate of small tumours (2 cm or smaller) and associated costs for each strategy. RESULTS Shortening the follow-up time in hospital by shifting care to the NSP or GP after 2 years instead of 5 years of hospital follow-up, lowering the age of referral to the NSP or GP from 60 to 50 years, and termination of annual physical examination by the GP after hospital follow-up did not decrease the detection of small tumours. In addition, a substantial decrease in costs was observed with simplified follow-up. CONCLUSION Decreasing hospital follow-up time, lowering the age of referral to the NSP or GP, and termination of annual physical examinations would lead to a substantial reduction in costs while maintaining the possibility of detecting small breast cancers.
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Affiliation(s)
- W Lu
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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