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Bottari F, Iacobone AD, Radice D, Preti EP, Preti M, Franchi D, Boveri S, Sandri MT, Passerini R. HPV Tests Comparison in the Detection and Follow-Up after Surgical Treatment of CIN2+ Lesions. Diagnostics (Basel) 2022; 12:diagnostics12102359. [PMID: 36292048 PMCID: PMC9600734 DOI: 10.3390/diagnostics12102359] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: HPV tests differ for technology, targets, and information on genotyping of high risk (HR) HPV. In this study, we evaluated the performance of 6 HPV DNA tests and one mRNA test in the detection of cervical intraepithelial lesions (CIN) and as a test-of-cure in the follow-up after surgical conservative treatment. Methods: One hundred seventy-two women referred to the European Institute of Oncology, Milan, for surgical treatment of pre-neoplastic cervical lesions, were enrolled in this study (IEO S544) from January 2011 to June 2015. For all women, a cervical sample was taken before treatment (baseline) and at the first follow-up visit (range 3 to 9 months): on these samples Qiagen Hybrid Capture 2 (HC2), Roche Linear Array HPV Test (Linear Array), Roche Cobas 4800 HPV test (Cobas), Abbott RealTime High Risk HPV test (RT), BD Onclarity HPV assay (Onclarity), Seegene Anyplex II HPV HR Detection (Anyplex), and Hologic Aptima HPV Assay (Aptima) histology and cytology were performed at baseline, and the same tests and cytology were performed at follow-up. Results: At baseline 158/172 (92%), histologies were CIN2+, and 150/172 (87%) women were recruited at follow-up. Assuming HC2 as a comparator, the concordance of HPV tests ranges from 91% to 95% at baseline and from 76% to 100% at follow-up (PABAK ranging from 0.81 to 0.90 at baseline and PABAK ranging from 0.53 to 1 at follow-up). All HPV showed a very good sensitivity in CIN2+ detection at baseline, more than 92%, and a very good specificity at follow-up, more than 89%. Conclusions: HPV tests showed a good concordance with HC2 and a very good and comparable sensitivity in CIN2+ detection. Hence, an HPV test represents a valid option as test-of-cure in order to monitor patients treated for CIN2+ lesions during follow-up.
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Affiliation(s)
- Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, 20139 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence: ; Fax: +39-0294379237
| | - Anna Daniela Iacobone
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Eleonora Petra Preti
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Mario Preti
- Department of Surgical Sciences, University of Torino, 10124 Torino, Italy
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, 20097 San Donato, Italy
| | | | - Rita Passerini
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, 20139 Milan, Italy
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Clerico A, Zaninotto M, Aimo A, Musetti V, Perrone M, Padoan A, Dittadi R, Sandri MT, Bernardini S, Sciacovelli L, Trenti T, Malloggi L, Moretti M, Burgio MA, Manno ML, Migliardi M, Fortunato A, Plebani M. Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers. A consensus document by the Inter-Society Study Group on Cardiac Biomarkers of the Italian Societies of Clinical Biochemistry: European Ligand Assay Society (ELAS), Italian section; Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC); Società Italiana di Patologia Clinica e Medicina di Laboratorio (SIPMel). Clin Chem Lab Med 2022; 60:1525-1542. [PMID: 35858238 DOI: 10.1515/cclm-2022-0481] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022]
Abstract
Major adverse cardiovascular events are frequently observed in patients undergoing major non-cardiac surgery during the peri-operative period. At this time, the possibility to predict cardiovascular events remains limited, despite the introduction of several algorithms to calculate the risk of adverse events, mainly death and major adverse cardiovascular events (MACE) based on the clinical history, risk factors (sex, age, lipid profile, serum creatinine) and non-invasive cardiac exams (electrocardiogram, echocardiogram, stress tests). The cardiac-specific biomarkers natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the peri-operative period, particularly for the identification of myocardial injury in patients undergoing major non-cardiac surgery. The prognostic information from the measurement of BNP/NT-proBNP and hs-cTn is independent and complementary to other important indicators of risk, also including ECG and imaging techniques. Elevated levels of cardiac-specific biomarkers before surgery are associated with a markedly higher risk of MACE during the peri-operative period. BNP/NT-proBNP and hs-cTn should be measured in all patients during the clinical evaluation before surgery, particularly during intermediate- or high-risk surgery, in patients aged >65 years and/or with comorbidities. Several questions remain to be assessed in dedicated clinical studies, such as how to optimize the management of patients with raised cardiac specific biomarkers before surgery, and whether a strategy based on biomarker measurement improves patient outcomes and is cost-effective.
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Affiliation(s)
- Aldo Clerico
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Martina Zaninotto
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | - Alberto Aimo
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Veronica Musetti
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Marco Perrone
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma, Italy
| | - Andrea Padoan
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | | | | | - Sergio Bernardini
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma, Italy
| | - Laura Sciacovelli
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio e Anatomia Patologica, Azienda Ospedaliera Universitaria e USL di Modena, Modena, Italy
| | - Lucia Malloggi
- Laboratorio Analisi, Azienda Ospedaliera-Universitaria di Pisa, Pisa, Italy
| | - Marco Moretti
- Medicina di Laboratorio, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | | | | | - Marco Migliardi
- Laboratorio Analisi, Ospedale Ordine Mauriziano, Torino, Italy
| | | | - Mario Plebani
- Dipartimento di Medicina di Laboratorio-DIMED, Università di Padova, Padova, Italy
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Personeni N, Giordano L, Michelini A, D’Alessio A, Cammarota A, Bozzarelli S, Pressiani T, Prete MG, Sandri MT, Stioui S, Germagnoli L, Santoro A, Rimassa L, Mineri R. Implementing Pre-Therapeutic UGT1A1 Genotyping in Clinical Practice: A Real-Life Study. J Pers Med 2022; 12:jpm12020204. [PMID: 35207692 PMCID: PMC8875990 DOI: 10.3390/jpm12020204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
Current guidelines recommend pre-therapeutic UGT1A1 genotyping to guide irinotecan dosing, but the usefulness of this approach remains to be clarified. In 247 patients with advanced gastrointestinal cancers undergoing irinotecan-based chemotherapy, we prospectively performed UGT1A1*28 genotyping and we analyzed the incidence of severe neutropenia according to genotype-guided dose reductions. Overall, 28 (11.3%) and 92 (37.2%) patients were homozygous or heterozygous UGT1A1*28 carriers, respectively. Grade ≥ 3 neutropenia was reported in 39% of homozygous patients receiving an upfront dose reduction of irinotecan (median 40%, range 22–58%), in 20% of heterozygous or wild-type patients receiving full dose (ORvs*28/*28 genotype = 0.38; 95% CI: 0.14–1.03; p = 0.058), and in 15.3% of those receiving a reduced dose for clinical reasons (OR vs*28/*28 genotype = 0.28, 95% IC: 0.12–0.67; p = 0.004). Occurrence of severe neutropenia was inversely associated with dose reduction in UGT1A1*28 homozygous carriers (ORx10 unit = 0.62, 95% CI: 0.27–1.40, p = 0.249) and UGT1A1 heterozygous or wild-type patients (ORx10 unit = 0.87, 95% CI: 0.59–1.28, p = 0.478). Incidence of severe neutropenia was related to irinotecan doses and UGT1A1 polymorphisms. Upfront irinotecan dose reductions do not reduce the burden of grade ≥ 3 neutropenia in UGT1A1*28 homozygous carriers.
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Affiliation(s)
- Nicola Personeni
- Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (N.P.); (A.M.); (A.D.); (A.C.); (A.S.)
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
| | - Laura Giordano
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Angelica Michelini
- Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (N.P.); (A.M.); (A.D.); (A.C.); (A.S.)
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
| | - Antonio D’Alessio
- Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (N.P.); (A.M.); (A.D.); (A.C.); (A.S.)
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0HS, UK
| | - Antonella Cammarota
- Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (N.P.); (A.M.); (A.D.); (A.C.); (A.S.)
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
| | - Silvia Bozzarelli
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
| | - Maria Giuseppina Prete
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
| | - Maria Teresa Sandri
- Medical Genetics Section, Laboratory Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.S.); (S.S.); (L.G.)
- Bianalisi Laboratory, Via Mattavelli 3, 20841 Carate Brianza, Italy
| | - Sabine Stioui
- Medical Genetics Section, Laboratory Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.S.); (S.S.); (L.G.)
- CDI—Genetic and Cytogenetic Laboratory, Via Saint Bon 20, 20147 Milan, Italy
| | - Luca Germagnoli
- Medical Genetics Section, Laboratory Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.S.); (S.S.); (L.G.)
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (N.P.); (A.M.); (A.D.); (A.C.); (A.S.)
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (N.P.); (A.M.); (A.D.); (A.C.); (A.S.)
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.B.); (T.P.); (M.G.P.)
- Correspondence: (L.R.); (R.M.); Tel.: +39-02-82244573 (L.R.); +39-02-82244748 (R.M.)
| | - Rossana Mineri
- Medical Genetics Section, Laboratory Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (M.T.S.); (S.S.); (L.G.)
- Correspondence: (L.R.); (R.M.); Tel.: +39-02-82244573 (L.R.); +39-02-82244748 (R.M.)
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Vallejo-Garcia JL, Balia L, Raimondi R, Rustioni G, Camesasca FI, Borgia A, Fossati G, Confalonieri F, Legrottaglie EF, Casari E, Sandri MT, Vinciguerra P. Conjunctivitis as a sign of persistent SARS-COV-2 infection? An observational study and report of late symptoms. Eur J Ophthalmol 2021; 32:11206721211056594. [PMID: 34761693 PMCID: PMC8935141 DOI: 10.1177/11206721211056594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate if symptomatic conjunctivitis during the recovery phase of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. METHODS An observational study including consecutive COVID19 patients treated at Humanitas Clinical and Research Hospital who were attending for nasopharyngeal swab to confirm the resolution of SARS-CoV-2 infection and end of isolation. We examined 129 consecutive patients from May to June 2020. The primary end point was to determine if symptomatic conjunctivitis at this point of the disease could be associated to a persistent presence of SARS-CoV-2 in the upper respiratory tract. Secondary end points were to analyze the presence of SARS-CoV-2 in the conjunctiva of ocular symptomatic patients and to record the presence of ocular disturbances at this point of the disease. RESULTS One hundred twenty eight patients were included, 9.38% had conjunctivitis, none resulted positive to conjunctival PCR swab test, while two of them had positive nasopharyngeal result. Mean time elapsed since the first COVID-19 positive swab to the time of examination was 6 weeks ( ± 3). The only significant association was the presence of conjunctivitis with older age (65.3 ± 12.7 vs 56.7 + 13.5. p = 0.046). Nasopharyngeal swab resulted positive in 22 patients (17.19%). While 88 patients (68.2%) did not have any ocular complain during their COVID19 disease. The 40 patients (31.8%) reporting ocular disturbances complained about: redness (25.43%), tearing (19.53%), burning (18.35%), foreign body sensation (17.18%), itching (15.62%), and discharge (12.5%). CONCLUSION This study showed that late conjunctivitis cannot be considered as a marker of persistent infection when patients are sent to confirm the resolution of SARS-CoV-2 infection.
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Affiliation(s)
- Jose Luis Vallejo-Garcia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - L Balia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - R Raimondi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - G Rustioni
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - FI Camesasca
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Borgia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - G Fossati
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - F Confalonieri
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - E Casari
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - MT Sandri
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - P Vinciguerra
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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5
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Mazziotti G, Lavezzi E, Brunetti A, Mirani M, Favacchio G, Pizzocaro A, Sandri MT, Di Pasquale A, Voza A, Ciccarelli M, Lania AG. Vitamin D deficiency, secondary hyperparathyroidism and respiratory insufficiency in hospitalized patients with COVID-19. J Endocrinol Invest 2021; 44:2285-2293. [PMID: 33666876 PMCID: PMC7934807 DOI: 10.1007/s40618-021-01535-2] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Hypovitaminosis D has emerged as potential risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the general population with variable effects on the outcome of the coronavirus disease-19 (COVID-19). The aim of this retrospective single-center study was to investigate the impact of hypovitaminosis D and secondary hyperparathyroidism on respiratory outcomes of COVID-19. METHODS Three-hundred-forty-eight consecutive patients hospitalized for COVID-19 at the IRCCS Humanitas Research Hospital, Rozzano, Milan (Italy) were evaluated for arterial partial pressure oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, serum 25hydroxy-vitamin D [25(OH)D], parathyroid hormone (PTH) and inflammatory parameters at study entry and need of ventilation during the hospital stay. RESULTS In the entire population, vitamin D deficiency (i.e., 25(OH)D values < 12 ng/mL) was significantly associated with acute hypoxemic respiratory failure at the study entry [adjusted odds ratio (OR) 2.48, 95% confidence interval 1.29-4.74; P = 0.006], independently of age and sex of subjects, serum calcium and inflammatory parameters. In patients evaluated for serum PTH (97 cases), secondary hyperparathyroidism combined with vitamin D deficiency was significantly associated with acute hypoxemic respiratory failure at study entry (P = 0.001) and need of ventilation during the hospital stay (P = 0.031). CONCLUSION This study provides evidence that vitamin D deficiency, when associated with secondary hyperparathyroidism, may negatively impact the clinical outcome of SARS-CoV-2-related pneumonia.
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Affiliation(s)
- G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - E Lavezzi
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A Brunetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - M Mirani
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - G Favacchio
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A Pizzocaro
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - M T Sandri
- Laboratory Medicine Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A Di Pasquale
- Pneumology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A Voza
- Emergency Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - M Ciccarelli
- Pneumology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
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6
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Levi R, Ubaldi L, Pozzi C, Angelotti G, Sandri MT, Azzolini E, Salvatici M, Savevski V, Mantovani A, Rescigno M. The antibody response to SARS-CoV-2 infection persists over at least 8 months in symptomatic patients. Commun Med 2021; 1:32. [PMID: 35072166 PMCID: PMC8767777 DOI: 10.1038/s43856-021-00032-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background Persistence of antibodies to SARS-CoV-2 viral infection may depend on several factors and may be related to the severity of disease or to the different symptoms. Methods We evaluated the antibody response to SARS-CoV-2 in personnel from 9 healthcare facilities and an international medical school and its association with individuals’ characteristics and COVID-19 symptoms in an observational cohort study. We enrolled 4735 subjects (corresponding to 80% of all personnel) for three time points over a period of 8–10 months. For each participant, we determined the rate of antibody increase or decrease over time in relation to 93 features analyzed in univariate and multivariate analyses through a machine learning approach. Results Here we show in individuals positive for IgG (≥12 AU/mL) at the beginning of the study an increase [p = 0.0002] in antibody response in paucisymptomatic or symptomatic subjects, particularly with loss of taste or smell (anosmia/dysgeusia: OR 2.75, 95% CI 1.753 – 4.301), in a multivariate logistic regression analysis in the first three months. The antibody response persists for at least 8–10 months. Conclusions SARS-CoV-2 infection induces a long lasting antibody response that increases in the first months, particularly in individuals with anosmia/dysgeusia. This may be linked to the lingering of SARS-CoV-2 in the olfactory bulb. Levi and Ubaldi et al. evaluate SARS-CoV-2 seroprevalence in a cohort of 4735 healthcare workers in northern Italy. In seropositive individuals, they show that antibodies are maintained over a period of 8 to 10 months and associate changes in antibody levels over this period with symptoms and specific subgroups of participants. SARS-CoV-2 infection activates the body’s immune system to fight off infection. This immune response results in the production of proteins in the blood that target the virus called antibodies. The extent and duration of this antibody response may be associated with the type of symptoms the infected person is experiencing. Here, we analyzed SARS-CoV-2 antibody levels in individuals with asymptomatic, mild symptomatic (paucisymptomatic) and symptomatic disease in relation to the type of symptoms. We find that the antibody response is higher in people with symptoms and increases in the first three months, particularly in individuals with loss of smell or taste. In all people with SARS-CoV-2 antibodies at the start of the study, levels in the blood last for at least 8–10 months. Hence, SARS-CoV-2 infection is characterized by a long lasting antibody response which may protect from subsequent infections.
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Iacobone AD, Radice D, Sandri MT, Preti EP, Guerrieri ME, Vidal Urbinati AM, Pino I, Franchi D, Passerini R, Bottari F. Human Papillomavirus Same Genotype Persistence and Risk of Cervical Intraepithelial Neoplasia2+ Recurrence. Cancers (Basel) 2021; 13:cancers13153664. [PMID: 34359566 PMCID: PMC8345074 DOI: 10.3390/cancers13153664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/17/2021] [Accepted: 07/18/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Women diagnosed with cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and treated by excisional procedures remain at high risk for recurrence over time. “Treatment failure” has been reported in up to 23% of women within two years after treatment. The aim of this study was to investigate the impact of HPV same genotype persistence on CIN2+ recurrence. Our findings confirm that HPV same genotype persistence has 30-fold increased odds of developing CIN2+ recurrence (p < 0.001), whereas histological grade, glandular crypt involvement, and margin status are not significantly related with treatment failure. Persistence of multiple genotypes and of HPV 16/18 with or without other HR genotypes show a significant impact on relapse free survival. HPV genotyping as “test-of-cure” enables a personalized risk-based management, by identifying women at higher risk of relapse who need intensive follow-up and avoiding risk of over-treatment in women with new HPV genotype infection after surgery. Abstract To evaluate the significance of HPV persistence as a predictor for the development of CIN2+ recurrence and the impact of multiple genotypes and of HPV 16/18 on recurrence risk. A prospective cohort observational study was carried out at the European Institute of Oncology, Milan, Italy, from December 2006 to December 2014. A total of 408 women surgically treated by excisional procedure for pre-neoplastic and neoplastic cervical lesions were enrolled. HPV test was performed at baseline and at first follow-up visit planned at 6 ± 3 months after treatment. Two-year cumulative incidences for relapse were estimated and compared by the Gray’s test. Overall, 96 (23.5%) patients were persistent for at least one genotype at three to nine months from baseline and 21 (5.1%) patients relapsed. The two-year cumulative relapse incidence was higher in HPV persistent patients compared to not-persistent (CIF = 27.6%, 95% CI: 16.2–40.2% versus CIF = 1.7%, 95% CI: 0.3–5.8%, p < 0.001), in women with persistent multiple infections (CIF = 27.2%, 95% CI: 7.3–52.3%, p < 0.001), and with the persistence of at least one genotype between 16 and 18, irrespective of the presence of other HR genotypes (CIF = 32.7%, 95% CI: 17.9–48.3%, p < 0.001), but not significantly different from women positive for single infections or any other HR genotype, but not for 16 and 18. The risk of CIN2+ recurrence should not be underestimated when same HPV genotype infection persists after treatment.
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Affiliation(s)
- Anna Daniela Iacobone
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.P.P.); (M.E.G.); (A.M.V.U.); (I.P.); (D.F.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
- Correspondence: ; Tel.: +39-02-57489120
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | | | - Eleonora Petra Preti
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.P.P.); (M.E.G.); (A.M.V.U.); (I.P.); (D.F.)
| | - Maria Elena Guerrieri
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.P.P.); (M.E.G.); (A.M.V.U.); (I.P.); (D.F.)
| | - Ailyn Mariela Vidal Urbinati
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.P.P.); (M.E.G.); (A.M.V.U.); (I.P.); (D.F.)
| | - Ida Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.P.P.); (M.E.G.); (A.M.V.U.); (I.P.); (D.F.)
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.P.P.); (M.E.G.); (A.M.V.U.); (I.P.); (D.F.)
| | - Rita Passerini
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Fabio Bottari
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, 20141 Milan, Italy;
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8
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Sandri MT, Azzolini E, Torri V, Carloni S, Pozzi C, Salvatici M, Tedeschi M, Castoldi M, Mantovani A, Rescigno M. SARS-CoV-2 serology in 4000 health care and administrative staff across seven sites in Lombardy, Italy. Sci Rep 2021; 11:12312. [PMID: 34112899 PMCID: PMC8192543 DOI: 10.1038/s41598-021-91773-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/19/2020] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Lombardy is the Italian region most affected by COVID-19. We tested the presence of plasma anti-SARS-CoV-2 IgG antibodies in 3985 employees across 7 healthcare facilities in areas of Lombardy with different exposure to the SARS-CoV-2 epidemic. Subjects filled a questionnaire to self-report on COVID-19 symptoms, comorbidities, smoking, regular or remote working, and the exposure to COVID-infected individuals. We show that the number of individuals exposed to the virus depended on the geographical location of the facility, ranging between 3 and 43%, consistent with the spatial variation of COVID-19 incidence in Lombardy, and correlated with family interactions. We observed a higher prevalence of females than males positive for IgG, however the level of antibodies was similar, suggesting a comparable magnitude of the anti-spike antibody response. IgG positivity among smokers was lower (7.4% vs 13.5%) although without difference in IgG plasma levels. We observed 11.9% of IgG positive asymptomatic individuals and another 23.1% with one or two symptoms. Interestingly, among the IgG positive population, 81.2% of subjects with anosmia/dysgeusia and fever were SARS-CoV-2 infected, indicating that these symptoms are strongly associated to COVID-19. In conclusion, the frequency of IgG positivity and SARS-CoV-2 infection is dependent on the geographical exposure to the virus and primarily to family rather than hospital exposure.
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Affiliation(s)
| | - Elena Azzolini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valter Torri
- Istituto Di Ricerche Farmacologiche, Mario Negri" - IRCCS, Milan, Italy
| | - Sara Carloni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Chiara Pozzi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Maria Rescigno
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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9
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Origoni M, Cristoforoni P, Mariani L, Costa S, Preti M, Sandri MT, Preti EP, Ghelardi A, Perino A. Extending Human Papillomavirus (HPV) vaccination beyond female adolescents and after treatment for high grade CIN: the Italian HPV Study Group (IHSG) review and position paper. Eur Rev Med Pharmacol Sci 2021; 24:8510-8528. [PMID: 32894557 DOI: 10.26355/eurrev_202008_22648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Human PapillomaVirus (HPV) vaccination has been introduced in recent years in clinical practice as the most effective primary prevention strategy for cervical cancer and HPV-induced lesions, either pre-malignant or benign. Since its introduction, HPV vaccination has been progressively demonstrated as extremely effective in preventing extra-genital and male diseases also; furthermore, non only adolescents but adult subjects have been investigated and reported as positively responding to vaccine immunostimulation. More recently, effectiveness of post-treatment vaccine administration has been preliminarily investigated with very promising results in terms of decreased recurrences. On this basis, we report an Italian-focused picture of the state of the art and take a position in favour of the extension of HPV vaccination to male adolescents, to older age groups and to already treated subjects.
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Affiliation(s)
- M Origoni
- Department of Gynecology and Obstetrics, Vita Salute San Raffaele University School of Medicine, Milan, Italy.
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10
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Bottari F, Iacobone AD, Radice D, Preti EP, Preti M, Franchi D, Piana AF, Sandri MT, Passerini R. Anyplex II HPV test in detection and follow-up after surgical treatment of CIN2+ lesions. J Med Virol 2021; 93:6340-6346. [PMID: 33565607 DOI: 10.1002/jmv.26862] [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: 08/27/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
Human papillomavirus (HPV) tests differ for technology, targets, and information on the genotype and viral load. In this study, we evaluated the performance of the Seegene Anyplex II HPV HR (Anyplex) assay in the detection of cervical intraepithelial lesions (CIN) and as a test-of-cure in the follow-up after surgical treatment. One hundred and sixty-seven women referred to the European Institute of Oncology, Milan, for surgical treatment of CIN2+ were enrolled. A cervical sample was taken before treatment and at the first follow-up visit: on these samples, Qiagen Hybrid Capture 2 (HC2), Roche Linear Array HPV Test (Linear Array), cytology and histology were performed at baseline, HC2, and cytology at follow-up. Anyplex genotyping HPV test was performed on a post aliquot from liquid-based cytology specimens when available. The concordance between Anyplex and HC2 was 93.6% at baseline and 76.7% at follow-up (3-9 months after treatment), respectively. The concordance between Anyplex and Linear Array was evaluable only at baseline (92.9%). No recurrence occurred in women without the persistence of the same genotype at follow-up. Seven women relapsed: six had persistence of the same genotypes (five HPV16, one HPV33, and one HPV39), while one tested negative not only with Anyplex but also with HC2 for the persistence of low-risk genotype infection (HPV73 only detected by Linear Array). Anyplex test represents a valid option for HPV detection and genotyping in order to stratify women at risk of high-grade lesions at baseline and to monitor patients treated for CIN2+ lesions during follow-up.
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Affiliation(s)
- Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Anna Daniela Iacobone
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Turin, Italy
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Fausto Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Rita Passerini
- Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
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11
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Salvatici M, Barbieri B, Cioffi SMG, Morenghi E, Leone FP, Maura F, Moriello G, Sandri MT. Association between cardiac troponin I and mortality in patients with COVID-19. Biomarkers 2020; 25:634-640. [PMID: 33003961 PMCID: PMC7711728 DOI: 10.1080/1354750x.2020.1831609] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe pneumonia is pathological manifestation of Coronavirus Disease 2019 (COVID-19), however complications have been reported in COVID-19 patients with a worst prognosis. Aim of this study was to evaluate the role of high sensitivity cardiac troponin I (hs-TnI) in patients with SARS-CoV-2 infection. METHODS we retrospectively analysed hs-TnI values measured in 523 patients (median age 64 years, 68% men) admitted to a university hospital in Milan, Italy, and diagnosed COVID-19. RESULTS A significant difference in hs-TnI concentrations was found between deceased patients (98 patients) vs discharged (425 patients) [36.05 ng/L IQR 16.5-94.9 vs 6.3 ng/L IQR 2.6-13.9, p < 0.001 respectively]. Hs-TnI measurements were independent predictors of mortality at multivariate analysis adjusted for confounding parameters such as age (HR 1.004 for each 10 point of troponin, 95% CI 1.002-1.006, p < 0.001). The survival rate, after one week, in patients with hs-TnI values under 6 ng/L was 97.94%, between 6 ng/L and the normal value was 90.87%, between the normal value and 40 ng/L was 86.98, and 59.27% over 40 ng/L. CONCLUSION Increase of hs-TnI associated with elevated mortality in patients with COVID-19. Troponin shows to be a useful biomarker of disease progression and worse prognosis in COVID-19 patients.
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Affiliation(s)
- Michela Salvatici
- Laboratory Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Barbara Barbieri
- Laboratory Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | | | - Emanuela Morenghi
- Biostatistic Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | | | - Federica Maura
- Laboratory Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Giuseppe Moriello
- Laboratory Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Maria Teresa Sandri
- Laboratory Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
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12
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Lania A, Sandri MT, Cellini M, Mirani M, Lavezzi E, Mazziotti G. Thyrotoxicosis in patients with COVID-19: the THYRCOV study. Eur J Endocrinol 2020; 183:381-387. [PMID: 32698147 PMCID: PMC9494315 DOI: 10.1530/eje-20-0335] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/06/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study assessed thyroid function in patients affected by the coronavirus disease-19 (COVID-19), based on the hypothesis that the cytokine storm associated with COVID-19 may influence thyroid function and/or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may directly act on thyroid cells, such as previously demonstrated for SARS-CoV-1 infection. DESIGN AND METHODS This single-center study was retrospective and consisted in evaluating thyroid function tests and serum interleukin-6 (IL-6) values in 287 consecutive patients (193 males, median age: 66 years, range: 27-92) hospitalized for COVID-19 in non-intensive care units. RESULTS Fifty-eight patients (20.2%) were found with thyrotoxicosis (overt in 31 cases), 15 (5.2%) with hypothyroidism (overt in only 2 cases), and 214 (74.6%) with normal thyroid function. Serum thyrotropin (TSH) values were inversely correlated with age of patients (rho -0.27; P < 0.001) and IL-6 (rho -0.41; P < 0.001). In the multivariate analysis, thyrotoxicosis resulted to be significantly associated with higher IL-6 (odds ratio: 3.25, 95% confidence interval: 1.97-5.36; P < 0.001), whereas the association with age of patients was lost (P = 0.09). CONCLUSIONS This study provides first evidence that COVID-19 may be associated with high risk of thyrotoxicosis in relationship with systemic immune activation induced by the SARS-CoV-2 infection.
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Affiliation(s)
- Andrea Lania
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Maria Teresa Sandri
- Laboratory Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Miriam Cellini
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Marco Mirani
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Elisabetta Lavezzi
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Gherardo Mazziotti
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Correspondence should be addressed to G Mazziotti;
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13
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Giannitto C, Sposta FM, Repici A, Vatteroni G, Casiraghi E, Casari E, Ferraroli GM, Fugazza A, Sandri MT, Chiti A, Luca B. Chest CT in patients with a moderate or high pretest probability of COVID-19 and negative swab. Radiol Med 2020; 125:1260-1270. [PMID: 32862406 PMCID: PMC7456362 DOI: 10.1007/s11547-020-01269-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 06/04/2020] [Accepted: 08/16/2020] [Indexed: 12/23/2022]
Abstract
Objectives We aimed to assess the diagnostic performance of CT in patients with a negative first RT-PCR testing and to identify typical features of COVID-19 pneumonia that can guide diagnosis in this case. Methods Patients suspected of COVID-19 with a negative first RT-PCR testing were retrospectively revalued after undergoing CT. CT was reviewed by two radiologists and classified as suspected COVID-19 pneumonia, non-COVID-19 pneumonia or negative. The performance of both first RT-PCR result and CT was evaluated by using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) and by using the second RT-PCR test as the reference standard. CT findings for confirmed COVID-19 positive or negative were compared by using the Pearson chi-squared test (P values < 0.05) Results Totally, 337 patients suspected of COVID-19 underwent CT and nasopharyngeal swabs in March 2020. Eighty-seven out of 337 patients had a negative first RT-PCR result; of these, 68 repeated RT-PCR testing and were included in the study. The first RT-PCR test showed SE 0, SP = 100%, PPV = NaN, NPV = 70%, AUC = 50%, and CT showed SE = 70% SP = 79%, PPV = 86%, NPV = 76%, AUC = 75%. The most relevant CT variables were ground glass opacity more than 50% and peripheral and/or perihilar distribution. Discussion Negative RT-PCR test but positive CT features should be highly suggestive of COVID-19 in a cluster or community transmission scenarios, and the second RT-PCR test should be promptly requested to confirm the final diagnosis.
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Affiliation(s)
- Caterina Giannitto
- Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.
| | - Federica Mrakic Sposta
- Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulia Vatteroni
- Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.,Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Elena Casiraghi
- Department of Computer Science (DI), University of Milan, Via G. Celoria 18, Milan, Italy
| | - Erminia Casari
- Laboratory Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Giorgio Maria Ferraroli
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Maria Teresa Sandri
- Laboratory Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Balzarini Luca
- Radiology Division, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
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14
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Clerico A, Cardinale DM, Zaninotto M, Aspromonte N, Sandri MT, Passino C, Migliardi M, Perrone M, Fortunato A, Padoan A, Trenti T, Bernardini S, Sciacovelli L, Colivicchi F, Gabrielli D, Plebani M. High-sensitivity cardiac troponin I and T methods for the early detection of myocardial injury in patients on chemotherapy. Clin Chem Lab Med 2020; 59:513-521. [PMID: 32441665 DOI: 10.1515/cclm-2020-0362] [Citation(s) in RCA: 5] [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: 03/22/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
Important advances achieved in pharmacological cancer treatment have led progressively to a reduction in mortality from many forms of cancer, and increasing numbers of previously incurable patients can now hope to become cancer-free. Yet, to achieve these improved outcomes a high price has been paid in terms of untoward side effects associated with treatment, cardio-toxicity in particular. Several recent studies have reported that cardiac troponin assay using high-sensitivity methods (hs-cTn) can enable the early detection of myocardial injury related to chemotherapy or abuse of drugs that are potentially cardiotoxic. Several authors have recently suggested that changes in hs-cTn values enable the early diagnosis of cardiac injury from chemotherapy, thus potentially benefitting cancer patients with increased troponin values by initiating early cardioprotective therapy. However, large randomised clinical trials are needed in order to evaluate the cost/benefit ratio of standardised protocols for the early detection of cardiotoxicity using the hs-cTn assay in patients treated with chemotherapy.
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Affiliation(s)
- Aldo Clerico
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine, Scuola Superiore Sant'Anna e Fondazione CNR - Regione Toscana G. Monasterio, Pisa, Italy
| | | | - Martina Zaninotto
- Dipartimento di Medicina di Laboratorio, Azienda Ospedaliera Universitaria di Padova, and Dipartimento di Medicina - Università di Padova, Padova, Italy
| | - Nadia Aspromonte
- Dipartimento Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS (FANMCO, FACC, Consigliere ANMCO Nazionale), Rome, Italy
| | - Maria Teresa Sandri
- Unità Operativa Laboratorio Analisi, Humanitas Medical-Care, Rozzano, Milan, Italy
| | - Claudio Passino
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine, Scuola Superiore Sant'Anna e Fondazione CNR - Regione Toscana G. Monasterio, Pisa, Italy
| | - Marco Migliardi
- Struttura Complessa Laboratorio Analisi, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - Marco Perrone
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Rome, Italy
| | - Antonio Fortunato
- U.O.C. Patologia Clinica, ASUR Marche Area Vasta 5, Ascoli Piceno, Italy
| | - Andrea Padoan
- Dipartimento di Medicina di Laboratorio, Azienda Ospedaliera Universitaria di Padova, and Dipartimento di Medicina - Università di Padova, Padova, Italy
| | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio and Anatomia Patologica, Azienda Ospedaliera Universitaria and USL di Modena, Modena, Italy
| | - Sergio Bernardini
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Rome, Italy
| | - Laura Sciacovelli
- Dipartimento di Medicina di Laboratorio, Azienda Ospedaliera Universitaria di Padova, and Dipartimento di Medicina - Università di Padova, Padova, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia, P.O. San Filippo Neri - ASL Roma 1, Rome (Società Scientifica ANMCO), Roma, Italy
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Ospedale Civile Augusto Murri, Fermo (Società Scientifica ANMCO), Fermo, Italy
| | - Mario Plebani
- Dipartimento di Medicina di Laboratorio, Azienda Ospedaliera Universitaria di Padova, and Dipartimento di Medicina - Università di Padova, Padova, Italy
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15
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Personeni N, Mineri R, Michelini A, Bozzarelli S, Pressiani T, Smiroldo V, Sandri MT, Giordano L, Santoro A, Rimassa L. Do irinotecan (IRI) dose reductions driven by UGT1A1*28 genotyping prevent IRI-related severe neutropenia? A real-world study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16116 Background: IRI is widely used in the treatment of gastrointestinal cancers. Consistent with current guidelines, UGT1A1 genotyping may drive IRI dose reductions, but the usefulness of this approach is still unclear. We assessed potential clinical variables that may predict grade ≥3 neutropenia and more specifically the upfront genotyping of UGT1A1 polymorphisms associated with IRI toxicity, according to predefined IRI dose reductions. Methods: We genotyped UGT1A1*28 polymorphisms in 247 patients with metastic colorectal, gastric and pancreatic cancers who received second or third-line IRI-based chemotherapy in clinical practice at a single academic center. Concomitant DPYD sequencing was undertaken in 179 patients receiving also fluoropyrimidines. We compared the incidence of severe neutropenia with full-dose IRI in UGT1A1 6/6 and 6/7 carriers, and in UGT1A1 7/7 carriers who underwent initial IRI dose reductions by at least 30%. Results: The incidence of UGT1A1 7/7, 6/7, 6/6 genotypes was 11.3%, 51.4%, and 37.2%, respectively. IRI dose reductions were significantly more frequent with UGT1A 7/7 and 6/7 genotypes (odds ratio [OR] = 9.5; 95% confidence interval [CI]: 4.3-21.7), and combination chemotherapy (OR = 3.8; 95%CI: 1.3 – 11.1). Other clinical parameters, including sex, cancer type, baseline neutrophils levels, performance status were not significantly associated with IRI dose reductions. Despite initial IRI reductions driven by the UGT1A1 panel, patients with UGT1A1 7/7 genotype had an increased, albeit non-significant, risk of grade ≥3 neutropenia, compared to patients with UGT1A1 6/6 and 6/7 genotypes who received full dose IRI (incidence: 39% versus 21%; OR = 2.4; 95%CI: 0.85 – 7.03). Conclusions: UGT1A1 testing is a determinant of IRI dose reductions, however this strategy does not reduce the burden of grade ≥3 neutropenia in UGT1A1 7/7 carriers. Further studies beyond the UGT1A1*28 genotype are needed to fully understand the increased risk of neutropenia in patients candidate to IRI-based chemotherapy.
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Affiliation(s)
| | - Rossana Mineri
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | | | | | | | | | | | - Laura Giordano
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
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Gioffré S, Chiesa M, Cardinale DM, Ricci V, Vavassori C, Cipolla CM, Masson S, Sandri MT, Salvatici M, Ciceri F, Latini R, Staszewsky LI, Pompilio G, Colombo GI, D’Alessandra Y. Circulating MicroRNAs as Potential Predictors of Anthracycline-Induced Troponin Elevation in Breast Cancer Patients: Diverging Effects of Doxorubicin and Epirubicin. J Clin Med 2020; 9:jcm9051418. [PMID: 32403263 PMCID: PMC7290665 DOI: 10.3390/jcm9051418] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 03/05/2020] [Revised: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Anthracyclines are anti-neoplastic drugs presenting cardiotoxicity as a side effect. Cardiac troponins (cTn) and echocardiography are currently used to assess cardiac damage and dysfunction, but early biomarkers identifying patients in need of preventive treatments remain a partially met need. Circulating microRNAs (miRNAs) represent good candidates, so we investigated their possible roles as predictors of troponin elevation upon anthracycline treatment. Eighty-eight female breast cancer patients administered with doxorubicin (DOX) or epirubicin (EPI) were divided into four groups basing on drug type and cTn positive (cTn+) or negative (cTn−) levels: DOX cTn−, DOX cTn+, EPI cTn− and EPI cTn+. Blood was collected at baseline, during treatment, and at follow-up. We identified plasma miRNAs of interest by OpenArray screening and single assay validation. Our results showed miR-122-5p, miR-499a-5p and miR-885-5p dysregulation in DOX patients at T0, identifying a signature separating, with good accuracy, DOX cTn− from DOX cTn+. No miRNAs showed differential expression in EPI subjects. Conversely, an anthracycline-mediated modulation (regardless of cTn) was observed for miR-34a-5p, -122-5p and -885-5p. Our study indicates specific circulating miRNAs as possible prediction markers for cardiac troponin perturbation upon anthracycline treatment. Indeed, our findings hint at the possible future use of plasma miRNAs to predict the cardiac responsiveness of patients to different anticancer agents.
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Affiliation(s)
- Sonia Gioffré
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
| | - Mattia Chiesa
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
| | - Daniela Maria Cardinale
- Cardiology Division, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.M.C.); (C.M.C.)
| | - Veronica Ricci
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80138 Napoli, Italy
| | - Chiara Vavassori
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carlo Maria Cipolla
- Cardiology Division, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.M.C.); (C.M.C.)
| | - Serge Masson
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (S.M.); (R.L.); (L.I.S.)
| | - Maria Teresa Sandri
- Laboratory Medicine Division, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (M.T.S.); (M.S.)
| | - Michela Salvatici
- Laboratory Medicine Division, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (M.T.S.); (M.S.)
| | - Fabio Ciceri
- Hematology/Transplant Unit, Istituto Scientifico H. San Raffaele IRCCS, 20132 Milan, Italy;
| | - Roberto Latini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (S.M.); (R.L.); (L.I.S.)
| | - Lidia Irene Staszewsky
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (S.M.); (R.L.); (L.I.S.)
| | - Giulio Pompilio
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy;
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Gualtiero I. Colombo
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
| | - Yuri D’Alessandra
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
- Correspondence: ; Tel.: +39-02-5800-2852; Fax: +39-02-5800-2750
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Meessen JMTA, Cardinale D, Ciceri F, Sandri MT, Civelli M, Bottazzi B, Cucchi G, Menatti E, Mangiavacchi M, Condorelli G, Barbieri E, Gori S, Colombo A, Curigliano G, Salvatici M, Pastori P, Ghisoni F, Bianchi A, Falci C, Cortesi P, Farolfi A, Monopoli A, Milandri C, Bregni M, Malossi A, Nassiacos D, Verusio C, Staszewsky L, Leone R, Novelli D, Balconi G, Nicolis EB, Franzosi MG, Masson S, Garlanda C, Mantovani A, Cipolla CM, Latini R. Circulating biomarkers and cardiac function over 3 years after chemotherapy with anthracyclines: the ICOS-ONE trial. ESC Heart Fail 2020; 7:1452-1466. [PMID: 32358917 PMCID: PMC7373944 DOI: 10.1002/ehf2.12695] [Citation(s) in RCA: 11] [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: 10/23/2019] [Revised: 01/10/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS A multicentre trial, ICOS-ONE, showed increases above the upper limit of normality of cardiac troponin (cTn) in 27% of patients within 12 months after the end of cancer chemotherapy (CT) with anthracyclines, whether cardiac protection with enalapril was started at study entry in all (prevention arm) or only upon first occurrence on supra-normal cTn (troponin-triggered arm). The aims of the present post hoc analysis were (i) to assess whether anthracycline-based treatment could induce cardiotoxicity over 36 month follow-up and (ii) to describe the time course of three cardiovascular biomarkers (i.e. troponin I cTnI-Ultra, B-type natriuretic peptide BNP, and pentraxin 3 PTX3) and of left ventricular (LV) function up to 36 months. METHODS AND RESULTS Eligible patients were those prescribed first-in-life CT, without evidence of cardiovascular disease, normal cTn, LV ejection fraction (EF) >50%, not on renin-angiotensin aldosterone system antagonists. Patients underwent echocardiography and blood sampling at 24 and 36 months. No differences were observed in biomarker concentration between the two study arms, 'prevention' vs. 'troponin-triggered'. During additional follow-up 13 more deaths occurred, leading to a total of 23 (9.5%), all due to a non-cardiovascular cause. No new occurrences of LV-dysfunction were reported. Two additional patients were admitted to the hospital for cardiovascular causes, both for acute pulmonary embolism. No first onset of raised cTnI-Ultra was reported in the extended follow-up. BNP remained within normal range: at 36 months was 23.4 ng/L, higher (N.S.) than at baseline, 17.6 ng/L. PTX3 peaked at 5.2 ng/mL 1 month after CT and returned to baseline values thereafter. cTnI-Ultra peaked at 26 ng/L 1 month after CT and returned to 3 ng/L until the last measurement at 36 months. All echocardiographic variables remained stable during follow-up with a median LVEF of 63% and left atrial volume index about 24 mL/m2 . CONCLUSIONS First-in-life CT with median cumulative dose of anthracyclines of 180 mg/m2 does not seem to cause clinically significant cardiac injury, as assessed by circulating biomarkers and echocardiography, in patients aged 51 years (median), without pre-existing cardiac disease. This may suggest either a 100% efficacy of enalapril (given as preventive or troponin-triggered) or a reassuringly low absolute cardiovascular risk in this cohort of patients, which may not require intensive cardiologic follow-up.
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Affiliation(s)
- Jennifer M T A Meessen
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Fabio Ciceri
- Haematology/Transplant Unit, IRCCS Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Maria Teresa Sandri
- Laboratory Medicine, Humanitas Clinical and Reseach Center - IRCCS - Rozzano, Milan, Italy
| | - Maurizio Civelli
- Department of Cardiology, European Institute of Oncology, Milan, Italy
| | - Barbara Bottazzi
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | | | | | - Maurizio Mangiavacchi
- Department of Cardiology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Gianluigi Condorelli
- Department of Cardiology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Enrico Barbieri
- Department of Cardiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Stefania Gori
- Department of Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapy, Department of Oncology and Hemato-Oncology, University of Milano, European Institute of Oncology, Milan, Italy
| | - Michela Salvatici
- Laboratory Medicine, Humanitas Clinical and Reseach Center - IRCCS - Rozzano, Milan, Italy
| | - Paolo Pastori
- Department of Cardiology, Ospedale di Vaio, Fidenza, Italy
| | - Francesco Ghisoni
- Unità Operativa Complessa Cure Palliative, Ospedale di Vaio, Fidenza, Italy
| | - Alessandra Bianchi
- Department of Cardiology, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Cristina Falci
- Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Pietro Cortesi
- Department of Cardiology, IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, Meldola, Italy
| | - Alberto Farolfi
- Department of Oncology, IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, Meldola, Italy
| | - Anna Monopoli
- Department of Cardiology, Nuovo Ospedale San Giuseppe, Empoli, Italy
| | - Carlo Milandri
- Department of Oncology, Nuovo Ospedale San Giuseppe, Empoli, Italy
| | - Marco Bregni
- Department of Oncology, Presidio Ospedaliero di Busto Arsizio, Busto Arsizio, Italy
| | | | - Daniele Nassiacos
- Department of Cardiology, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Claudio Verusio
- Department of Oncology, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Lidia Staszewsky
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Roberto Leone
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Deborah Novelli
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giovanna Balconi
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Enrico B Nicolis
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Grazia Franzosi
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Serge Masson
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cecilia Garlanda
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Humanitas University, Milan, Italy
| | - Alberto Mantovani
- Department of Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Humanitas University, Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Carlo M Cipolla
- Department of Cardiology, European Institute of Oncology, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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De Cesare R, Morenghi E, Cirillo F, Ronchetti C, Canevisio V, Persico P, Baggiani A, Sandri MT, Levi-Setti PE. The Role of hCG Triggering Progesterone Levels: A Real-World Retrospective Cohort Study of More Than 8000 IVF/ICSI Cycles. Front Endocrinol (Lausanne) 2020; 11:547684. [PMID: 33071968 PMCID: PMC7538643 DOI: 10.3389/fendo.2020.547684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 12/05/2022] Open
Abstract
Objective: To assess the association between serum ovulation trigger progesterone (P) levels and the outcome of in vitro fertilization cycles. Design Setting: Real world single-center retrospective cohort study. Patient Intervention(s): All fresh cleavage and blastocyst-stage embryo transfers (ETs) performed from January 2012 to December 2016. Main outcome Measure(s): The impact of premature high serum P levels cycles in terms of clinical pregnancy rates (CPRs) and live birth rates (LBRs). Results: 8,034 ETs were performed: 7,597 cleavage-stage transfers and 437 blastocyst transfers. Serum P levels demonstrated to be inversely related to CPR (OR 0.72, p < 0.001) and LBR (OR 0.73, p < 0.001). The progressive decrease of LBR and CPR started when P levels were >1 ng/ml in a good prognosis cleavage ET subgroup, whereas in patients with worse prognosis only for P ≥ 1.75 ng/ml. In the blastocyst ET subgroup, the negative effect of P elevation was reported only if P was >1.75 ng/ml. CPR (OR 0.71 (0.62-0.80), p < 0.001) and LBR (OR 0.73 (0.63-0.84), p < 0.001) in thawed cycles resulted statistically significantly higher than in fresh cycles in the cleavage-stage subgroup. In the blastocyst group, no significant difference resulted between thawed and fresh cycles, independently of P levels [CPR OR 0. 37 (0.49-1.09), p = 0.123; LBR OR 0.71 (0.46-1.10), p = 0.126]. Conclusion: High P levels decrease CPR as well as LBR in both cleavage and blastocyst ET. In the cleavage group, for P levels below 1.75 ng/ml, our data suggest the possibility to wait until day 5 for ET, and if P level is ≥1.75 ng/ml, it should be considered to freeze all embryos and postpone the ET. Clinical Trial Registration: ClinicalTrials.gov, ID: NCT04253470.
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Affiliation(s)
- Raffaella De Cesare
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Federico Cirillo
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Camilla Ronchetti
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Valentina Canevisio
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Paola Persico
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Annamaria Baggiani
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
| | - Maria Teresa Sandri
- Clinical Analysis Laboratory, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center—IRCCS, Milan, Italy
- *Correspondence: Paolo Emanuele Levi-Setti
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Introcaso G, Nafi M, Bonomi A, L'Acqua C, Salvi L, Ceriani R, Carcione D, Cattaneo A, Sandri MT. Improvement of neutrophil gelatinase-associated lipocalin sensitivity and specificity by two plasma measurements in predicting acute kidney injury after cardiac surgery. Biochem Med (Zagreb) 2019; 28:030701. [PMID: 30429668 PMCID: PMC6214698 DOI: 10.11613/bm.2018.030701] [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: 12/28/2017] [Accepted: 04/26/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction Acute kidney injury (AKI) remains among the most severe complication after cardiac surgery. The aim of this study was to evaluate the neutrophil gelatinase-associated lipocalin (NGAL) as possible biomarker for the prediction of AKI in an adult cardiac population. Materials and methods Sixty-nine consecutive patients who underwent cardiac surgeries in our hospital were prospectively evaluated. In the intensive care unit (ICU) NGAL was measured as a new biomarker of AKI besides serum creatinine (sCrea). Patients with at least two factors of AKI risk were selected and samples collected before the intervention and soon after the patient's arrival in ICU. As reference standard, sCrea measurements and urine outputs were evaluated to define the clinical AKI. A Triage Meter for plasma NGAL fluorescence immunoassay was used. Results Acute kidney injury occurred in 24 of the 69 patients (35%). Analysis of post-operative NGAL values demonstrated an AUC of 0.71, 95% CI (0.60 - 0.82) with a cut-off = 154 ng/mL (sensitivity = 76%, specificity = 59%). Moreover, NGAL after surgery had a good correlation with the AKI stage severity (P ≤ 0.001). Better diagnostic results were obtained with two consecutive tests: sensitivity 86% with a negative predictive value (NPV) of 87%. At 10-18 h after surgery sCrea measurement, as confirmatory test, allowed to reach a more sensitivity and specificity with a NPV of 96%. Conclusions The assay results showed an improvement of NGAL diagnostic accuracy evaluating two tests. Consequently, NGAL may be useful for a timely treatment or for the AKI rule out in ICU patients.
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Affiliation(s)
- Giovanni Introcaso
- Unit of Laboratory Medicine, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Matteo Nafi
- Intensive Care Unit, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Alice Bonomi
- Units of Biostatistics, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Camilla L'Acqua
- Intensive Care Unit, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Luca Salvi
- Intensive Care Unit, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Roberto Ceriani
- Intensive Care Unit, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Davide Carcione
- Unit of Laboratory Medicine, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Annalisa Cattaneo
- Unit of Laboratory Medicine, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
| | - Maria Teresa Sandri
- Unit of Laboratory Medicine, Centro Cardiologico ''Monzino'', IRCCS, Milan, Italy
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Ferro M, Musi G, Serino A, Cozzi G, Mistretta FA, Costa B, Bianchi R, Cordima G, Luzzago S, Di Trapani E, Tagliabue E, Vartolomei MD, Terracciano D, Cassatella MC, Salvatici M, Conti A, Sandri MT, Cioffi A, Turetti M, Catellani M, Bottero D, Matei DV, Mirone V, de Cobelli O. Neutrophil, Platelets, and Eosinophil to Lymphocyte Ratios Predict Gleason Score Upgrading in Low-Risk Prostate Cancer Patients. Urol Int 2018; 102:43-50. [PMID: 30408799 DOI: 10.1159/000494259] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 08/06/2018] [Accepted: 10/01/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several biochemical and clinical markers have been proposed for selecting patients for active surveillance (AS). However, some of these are expensive and not easily accessible. Moreover, currently about 30% of patients on AS harbor aggressive disease. Hence, there is an urgent need for other tools to accurately identify patients with low-risk prostate cancer (PCa). PATIENTS We retrospectively reviewed the medical records of 260 patients who underwent radical prostatectomy and were eligible for AS according to the following criteria: clinical stage T2a or less, prostate-specific antigen level < 10 ng/mL, 2 or fewer cores involved with cancer, Gleason score (GS) ≤6 grade, and prostate-specific antigen density < 0.2 ng/mL/cc. METHODS Univariate and multivariate analyses were performed to evaluate the association of patient and tumor characteristics with reclassification, defined as upstaged (pathological stage >pT2) and upgraded (GS ≥7) disease. A base model (age, prostate-specific antigen, prostate volume, and clinical stage) was compared with models considering neutrophil to lymphocyte ratio (NLR) or platelets to lymphocyte ratio (PLR), monocyte to lymphocyte (MLR), and eosinophil to lymphocyte ratio (ELR). OR and 95% CI were calculated. Finally, a decision curve analysis was performed. RESULTS Univariate and multivariate analyses showed that NLR, PLR, and ELR upgrading were significantly associated with upgrading (ORs ranging from 2.13 to 4.13), but not with upstaging except for MLR in multivariate analysis, showing a protective effect. CONCLUSION Our results showed that NLR, PLR, and ELR are predictors of Gleason upgrading. Therefore, these inexpensive and easily available tests might be useful in the assessment of low-risk PCa, when considering patients for AS.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy,
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Beatrice Costa
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Bianchi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giovanni Cordima
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Stefano Luzzago
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Elena Tagliabue
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Mihai Dorin Vartolomei
- Division of Urology, European Institute of Oncology, Milan, Italy.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Daniela Terracciano
- Department. of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria C Cassatella
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Michela Salvatici
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Andrea Conti
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Maria Teresa Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Antonio Cioffi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Matteo Turetti
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Danilo Bottero
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Vincenzo Mirone
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, Milan, Italy.,Università Degli Studi Di Milano, Milan, Italy
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Gioffre' S, Chiesa M, Alfieri I, Masson S, Latini R, Sandri MT, Cardinale D, Pompilio G, Colombo GI, D'Alessandra Y. P4763Circulating microRNAs as selective markers of anthracyclines-based therapies in breast cancer patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4763] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Gioffre'
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Chiesa
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - I Alfieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Masson
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - R Latini
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - M T Sandri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Cardinale
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Pompilio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G I Colombo
- Cardiology Center Monzino IRCCS, Milan, Italy
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22
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Magini A, Farina S, Riggio D, Sandri MT, Agostoni P. ST2 and B-type natriuretic peptide kinetics during exercise in severe heart failure. Eur J Heart Fail 2018; 20:1494-1495. [DOI: 10.1002/ejhf.1246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/10/2018] [Accepted: 05/21/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS; Milan Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
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Cardinale D, Ciceri F, Latini R, Franzosi MG, Sandri MT, Civelli M, Cucchi G, Menatti E, Mangiavacchi M, Cavina R, Barbieri E, Gori S, Colombo A, Curigliano G, Salvatici M, Rizzo A, Ghisoni F, Bianchi A, Falci C, Aquilina M, Rocca A, Monopoli A, Milandri C, Rossetti G, Bregni M, Sicuro M, Malossi A, Nassiacos D, Verusio C, Giordano M, Staszewsky L, Barlera S, Nicolis EB, Magnoli M, Masson S, Cipolla CM. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial. Eur J Cancer 2018; 94:126-137. [PMID: 29567630 DOI: 10.1016/j.ejca.2018.02.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Troponin changes over time have been suggested to allow for an early diagnosis of cardiac injury ensuing cancer chemotherapy; cancer patients with troponin elevation may benefit of therapy with enalapril. It is unknown whether a preventive treatment with enalapril may further increase the benefit. METHODS The International CardioOncology Society-one trial (ICOS-ONE) was a controlled, open-label trial conducted in 21 Italian hospitals. Patients were randomly assigned to two strategies: enalapril in all patients started before chemotherapy (CT; 'prevention' arm), and enalapril started only in patients with an increase in troponin during or after CT ('troponin-triggered' arm). Troponin was assayed locally in 2596 blood samples, before and after each anthracycline-containing CT cycle and at each study visit; electrocardiogram and echocardiogram were done at baseline, and at 1, 3, 6 and 12-month follow-up. Primary outcome was the incidence of troponin elevation above the threshold. FINDINGS Of the 273 patients, 88% were women, mean age 51 ± 12 years. The majority (76%) had breast cancer, 3% had a history of hypertension and 4% were diabetic. Epirubicin and doxorubicin were most commonly prescribed, with median cumulative doses of 360 [270-360] and 240 [240-240] mg/m2, respectively. The incidence of troponin elevation was 23% in the prevention and 26% in the troponin-triggered group (p = 0.50). Three patients (1.1%) -two in the prevention, one in the troponin-triggered group-developed cardiotoxicity, defined as 10% point reduction of LV ejection fraction, with values lower than 50%. INTERPRETATION Low cumulative doses of anthracyclines in adult patients with low cardiovascular risk can raise troponins, without differences between the two strategies of giving enalapril. Considering a benefit of enalapril in the prevention of LV dysfunction, a troponin-triggered strategy may be more convenient.
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Affiliation(s)
| | - Fabio Ciceri
- Haematology/Transplant Unit, Istituto Scientifico H. San Raffaele, Milano, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy.
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | | | - Maurizio Civelli
- Cardioncology Division, European Institute of Oncology, Milano, Italy
| | | | | | | | | | | | | | | | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapy, Department of Oncology and Hemato-Oncology, University of Milano, European Institute of Oncology, Milano, Italy
| | - Michela Salvatici
- Laboratory Medicine Division, European Institute of Oncology, Milano, Italy
| | | | - Francesco Ghisoni
- Unità Operativa Complessa Cure Palliative, Ospedale di Vaio, Fidenza, Italy
| | | | | | - Michele Aquilina
- Cardiology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - IRCCS, Meldola, Italy
| | - Andrea Rocca
- Oncology, IRCCS-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Anna Monopoli
- Cardiology, Nuovo Ospedale San Giuseppe, Empoli, Italy
| | | | | | - Marco Bregni
- Oncology, Presidio Ospedaliero di Busto Arsizio, Italy
| | - Marco Sicuro
- Cardiology, Ospedale Regionale Umberto Parini, Aosta, Italy
| | | | | | | | - Monica Giordano
- Oncology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Lidia Staszewsky
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Simona Barlera
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Enrico B Nicolis
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Michela Magnoli
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Serge Masson
- Department of Cardiovascular Research, IRCCS - Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Carlo M Cipolla
- Cardioncology Division, European Institute of Oncology, Milano, Italy
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Bottari F, Boveri S, Iacobone AD, Gulmini C, Igidbashian S, Cassatella MC, Landoni F, Sandri MT. Transition from Hybrid Capture 2 to Cobas 4800 in Hpv detection: sensitivity and specificity for Cin2+ in two time periods. Infect Dis (Lond) 2018; 50:554-559. [DOI: 10.1080/23744235.2018.1441538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Fabio Bottari
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Sara Boveri
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | | | - Chiara Gulmini
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Sarah Igidbashian
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | | | - Fabio Landoni
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | - Maria Teresa Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
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Cardinale D, Biasillo G, Salvatici M, Sandri MT, Cipolla CM. Using biomarkers to predict and to prevent cardiotoxicity of cancer therapy. Expert Rev Mol Diagn 2017; 17:245-256. [DOI: 10.1080/14737159.2017.1283219] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gina Biasillo
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
| | - Michela Salvatici
- Division of Laboratory Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Teresa Sandri
- Division of Laboratory Medicine, European Institute of Oncology, IRCCS, Milan, Italy
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Mariani L, Igidbashian S, Sandri MT, Vici P, Landoni F. The clinical implementation of primary HPV screening. Int J Gynaecol Obstet 2017; 136:266-271. [PMID: 28099686 DOI: 10.1002/ijgo.12065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/06/2016] [Accepted: 11/17/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate, from a gynecology perspective, the transition from cytology-based HPV screening to primary HPV screening. METHODS Studies examining switching from cytology-based screening to primary HPV-DNA testing with triaging of patients with positive test results were retrieved and reviewed, with a particular focus on screening in an Italian setting. RESULTS The increased complexity of patient-management decisions when implementing HPV-based screening was a critical issue discussed in the literature. The change in strategy represents a paradigm shift in moving from a medical perspective of identifying the disease in individual patients, to a public-healthcare perspective of excluding HPV from the healthy population and identifying a small sub-group of individuals at increased risk of HPV. CONCLUSION With knowledge about HPV screening evolving rapidly, new programs and related algorithms need to be sufficiently flexible to be adjusted according to ongoing research and the validation of new assays. The establishment of a national working group (including epidemiologists, gynecologists, pathologists, and healthcare providers) will be necessary to properly implement and govern this important technical and cultural transition.
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Affiliation(s)
- Luciano Mariani
- HPV Unit, Department of Gynecologic Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Sarah Igidbashian
- Preventive Gynaecology Unit, European Institute of Oncology, Milan, Italy
| | | | - Patrizia Vici
- Department of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Landoni
- Preventive Gynaecology Unit, European Institute of Oncology, Milan, Italy
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27
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Marenzi G, Cosentino N, Boeddinghaus J, Trinei M, Giorgio M, Milazzo V, Moltrasio M, Cardinale D, Sandri MT, Veglia F, Bonomi A, Kaech M, Twerenbold R, Nestelberger T, Reichlin T, Wildi K, Shrestha S, Kohzuharov N, Sabti Z, Cipolla CM, Mueller C, Bartorelli AL. Diagnostic and Prognostic Utility of Circulating Cytochrome c in Acute Myocardial Infarction. Circ Res 2016; 119:1339-1346. [PMID: 27799252 PMCID: PMC5627527 DOI: 10.1161/circresaha.116.309792] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 01/09/2023]
Abstract
Supplemental Digital Content is available in the text. Rationale: In contrast to cardiomyocyte necrosis, which can be quantified by cardiac troponin, functional cardiomyocyte impairment, including mitochondrial dysfunction, has escaped clinical recognition in acute myocardial infarction (AMI) patients. Objective: To investigate the diagnostic accuracy for AMI and prognostic prediction of in-hospital mortality of cytochrome c. Methods and Results: We prospectively assessed cytochrome c serum levels at hospital presentation in 2 cohorts: a diagnostic cohort of patients presenting with suspected AMI and a prognostic cohort of definite AMI patients. Diagnostic accuracy for AMI was the primary diagnostic end point, and prognostic prediction of in-hospital mortality was the primary prognostic end point. Serum cytochrome c had no diagnostic utility for AMI (area under the receiver-operating characteristics curve 0.51; 95% confidence intervals 0.44–0.58; P=0.76). Among 753 AMI patients in the prognostic cohort, cytochrome c was detectable in 280 (37%) patients. These patients had higher in-hospital mortality than patients with nondetectable cytochrome c (6% versus 1%; P<0.001). This result was mainly driven by the high mortality rate observed in ST-segment–elevation AMI patients with detectable cytochrome c, as compared with those with nondetectable cytochrome c (11% versus 1%; P<0.001). At multivariable analysis, cytochrome c remained a significant independent predictor of in-hospital mortality (odds ratio 3.0; 95% confidence interval 1.9–5.7; P<0.001), even after adjustment for major clinical confounders (odds ratio 4.01; 95% confidence interval 1.20–13.38; P=0.02). Conclusions: Cytochrome c serum concentrations do not have diagnostic but substantial prognostic utility in AMI.
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Affiliation(s)
- Giancarlo Marenzi
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.).
| | - Nicola Cosentino
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Jasper Boeddinghaus
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Mirella Trinei
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Marco Giorgio
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Valentina Milazzo
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Marco Moltrasio
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Daniela Cardinale
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Maria Teresa Sandri
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Fabrizio Veglia
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Alice Bonomi
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Max Kaech
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Raphael Twerenbold
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Thomas Nestelberger
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Tobias Reichlin
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Karin Wildi
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Samyut Shrestha
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Nikola Kohzuharov
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Zaid Sabti
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Carlo M Cipolla
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Christian Mueller
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
| | - Antonio L Bartorelli
- From the Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy (G.M., N.C., V.M., M.M., M.T.S., F.V., A.B., A.L.B.); European Institute of Oncology, Milan, Italy (M.T., M.G., D.C., M.T.S., C.M.C.); and Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Switzerland (J.B., M.K., R.T., T.N., T.R., K.W., S.S., N.K., Z.S., C.M.)
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Bottari F, Igidbashian S, Boveri S, Tricca A, Gulmini C, Sesia M, Spolti N, Sideri M, Landoni F, Sandri MT. HPV self-sampling in CIN2+ detection: sensitivity and specificity of different RLU cut-off of HC2 in specimens from 786 women. J Clin Pathol 2016; 70:327-330. [PMID: 27672216 DOI: 10.1136/jclinpath-2016-204044] [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: 07/22/2016] [Accepted: 08/26/2016] [Indexed: 11/04/2022]
Abstract
AIMS Mortality for cervical cancer varies between the different regions of the world, with high rates in low-income countries where screening programmes are not present and organised. However, increasing screening coverage is still a priority in all countries: one way to do that is to base screening on self-sampled screening. The success of a self-sampling screening strategy depends on capacity to recruit unscreened women, on the performance and acceptability of the device and on the clinical performance of the high-risk human papillomavirus (HPV) test. METHODS This study based on 786 enrolled women investigates the best cut-off value of Hybrid Capture 2 HPV test (HC2) for self-sampled specimens in terms of sensitivity and specificity. RESULTS In this population, we found that the sensitivity and the specificity for cervical intraepithelial neoplasia grade 2 or more detection of HC2 performed on self-sampled specimens were 82.5% and 82.8%, respectively considering the relative light units (RLU) cut-off value of 1. Increasing the cut-off value the sensitivity decreases and the specificity raises and the best area under the curve for the RLU cut-off value is 1. CONCLUSIONS Our results confirm that the cut-off value of 1 suggested by Qiagen for PreservCyt specimen is the best cut-off value also for self-sampled specimens.
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Affiliation(s)
- F Bottari
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - S Igidbashian
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | - S Boveri
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | - A Tricca
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - C Gulmini
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - M Sesia
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - N Spolti
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | | | - F Landoni
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | - M T Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
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Aurilio G, Sandri MT, Pruneri G, Zorzino L, Botteri E, Munzone E, Adamoli L, Facchi G, Cullurà D, Verri E, Rocca MC, Zurrida S, Iacovelli R, Nolè F. Serum HER2 extracellular domain levels and HER2 circulating tumor cell status in patients with metastatic breast cancer. Future Oncol 2016; 12:2001-8. [DOI: 10.2217/fon-2016-0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To shed light on the clinical role of HER2 status in serum as extracellular domain (ECD) and corresponding circulating tumor cells (CTCs) in metastatic breast cancer patients. Methods: 68 patients were analyzed. Serum HER2 was determined by ADVIA Centaur® Serum HER2 test. CellSearch System was performed for CTC quantification. Results: HER2 was overexpressed in 21 primary tumors. In total, 19 patients had ECD >15 ng/ml (the cut-off used), 48 patients had at least one CTC. ECD positivity was associated with CTC number (p = 0.01), HER2-positive CTC (p = 0.01) and the ratio HER2-positive CTC/total CTC (p = 0.02). ECD was not associated with survival. Conclusion: ECD in combination with HER2 CTC status would deserve further investigation in larger series for addressing its putative prognostic relevance.
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Affiliation(s)
- Gaetano Aurilio
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
| | - Maria Teresa Sandri
- European Institute of Oncology, Laboratory of Medicine, via Ripamonti 435, Milan, Italy
| | - Giancarlo Pruneri
- European Institute of Oncology, Division of Pathology & Laboratory Medicine, via Ripamonti 435, Milan, Italy & School of Medicine, University of Milan, Italy
| | - Laura Zorzino
- European Institute of Oncology, Laboratory of Medicine, via Ripamonti 435, Milan, Italy
| | - Edoardo Botteri
- European Institute of Oncology, Division of Epidemiology & Biostatistics, via Ripamonti 435, Milan
| | - Elisabetta Munzone
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
| | - Laura Adamoli
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
| | - Giuseppina Facchi
- European Institute of Oncology, Laboratory of Medicine, via Ripamonti 435, Milan, Italy
| | - Daniela Cullurà
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
| | - Elena Verri
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
| | - Maria Cossu Rocca
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
| | - Stefano Zurrida
- European Institute of Oncology, Division of Senology, via Ripamonti 435, Milan, Italy
| | - Roberto Iacovelli
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
| | - Franco Nolè
- European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy
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Pelosi G, Petrella F, Sandri MT, Spaggiari L, Galetta D, Viale G. A Primary Pure Yolk Sac Tumor of the Lung Exhibiting CDX-2 Immunoreactivity and Increased Serum Levels of Alkaline Phosphatase Intestinal Isoenzyme. Int J Surg Pathol 2016; 14:247-51. [PMID: 16959714 DOI: 10.1177/1066896906290657] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Malignant extragonadal germ cell tumors primary to the lung are quite uncommon lesions, but pure yolk sac tumor is even more exceptional. This is believed to be the first reported case of yolk sac tumor of the lung in which an intense and diffuse immunoreactivity for CDX2, a marker of intestinal differentiation reportedly expressed also in gonadal yolk sac tumor, was associated with increased serum levels of the alkaline phosphatase intestinal isoform. Nine months after radical surgery and adjuvant chemotherapy, the patient is alive and well without evidence of recurrent or metastatic disease and with serum levels of the alkaline phosphatase intestinal isoform within normal limits. The pathologist should be aware of yolk sac tumor arising in the lung and that alkaline phosphatase intestinal isoform could become an additional serum marker for such a tumor.
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Affiliation(s)
- Giuseppe Pelosi
- Division of Pathology, European Institute of Oncology and University of Milan School of Medicine, Milan, Italy.
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31
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Lauri G, Rossi C, Rubino M, Cosentino N, Milazzo V, Marana I, Cabiati A, Moltrasio M, De Metrio M, Grazi M, Campodonico J, Assanelli E, Riggio D, Sandri MT, Bonomi A, Veglia F, Marenzi G. B-type natriuretic peptide levels in patients with pericardial effusion undergoing pericardiocentesis. Int J Cardiol 2016; 212:318-23. [DOI: 10.1016/j.ijcard.2016.03.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/29/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
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Jones RL, Sandri MT. Cardio-oncology: a special focus issue from Future Oncology. Future Oncol 2016. [PMID: 26198823 DOI: 10.2217/fon.15.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, UK
| | - Maria Teresa Sandri
- Laboratory Medicine Division, European Institute of Oncology, Via Ripamonti 435, 20141, Milano, Italy
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Marzi MJ, Montani F, Carletti RM, Dezi F, Dama E, Bonizzi G, Sandri MT, Rampinelli C, Bellomi M, Maisonneuve P, Spaggiari L, Veronesi G, Bianchi F, Di Fiore PP, Nicassio F. Optimization and Standardization of Circulating MicroRNA Detection for Clinical Application: The miR-Test Case. Clin Chem 2016; 62:743-54. [DOI: 10.1373/clinchem.2015.251942] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/19/2016] [Indexed: 01/05/2023]
Abstract
Abstract
BACKGROUND
The identification of circulating microRNAs (miRNAs) in the blood has been recently exploited for the development of minimally invasive tests for the early detection of cancer. Nevertheless, the clinical transferability of such tests is uncertain due to still-insufficient standardization and optimization of methods to detect circulating miRNAs in the clinical setting.
METHODS
We performed a series of tests to optimize the quantification of serum miRNAs that compose the miR-Test, a signature for lung cancer early detection, and systematically analyzed variables that could affect the performance of the test. We took advantage of a large-scale (>1000 samples) validation study of the miR-Test that we recently published, to evaluate, in clinical samples, the effects of analytical and preanalytical variables on the quantification of circulating miRNAs and the clinical output of the signature (risk score).
RESULTS
We developed a streamlined and standardized pipeline for the processing of clinical serum samples that allows the isolation and analysis of circulating miRNAs by quantitative reverse-transcription PCR, with a throughput compatible with screening trials. The major source of analytical variation came from RNA isolation from serum, which could be corrected by use of external (spike-in) or endogenous miRNAs as a reference for normalization. We also introduced standard operating procedures and QC steps to check for unspecific fluctuations that arise from the lack of standardized criteria in the collection or handling of the samples (preanalytical factors).
CONCLUSIONS
We propose our methodology as a reference for the development of clinical-grade blood tests on the basis of miRNA detection.
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Affiliation(s)
- Matteo Jacopo Marzi
- Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, Milan, Italy
| | - Francesca Montani
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
| | - Rose Mary Carletti
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
- The FIRC Institute for Molecular Oncology Foundation (IFOM), Milan, Italy
| | - Fabio Dezi
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
| | - Elisa Dama
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
- Division of Epidemiology and Biostatistics
| | - Giuseppina Bonizzi
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
| | | | | | | | | | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Giulia Veronesi
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
- Humanitas Research Hospital, Thoracic Surgery, Rozzano, Milan, Italy
| | - Fabrizio Bianchi
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
| | - Pier Paolo Di Fiore
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
- The FIRC Institute for Molecular Oncology Foundation (IFOM), Milan, Italy
- Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
| | - Francesco Nicassio
- Center for Genomic Science of IIT@SEMM, Istituto Italiano di Tecnologia, Milan, Italy
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
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Mariani L, Sandri MT, Preti M, Origoni M, Costa S, Cristoforoni P, Bottari F, Sideri M. HPV-Testing in Follow-up of Patients Treated for CIN2+ Lesions. J Cancer 2016; 7:107-14. [PMID: 26722366 PMCID: PMC4679387 DOI: 10.7150/jca.13503] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 08/08/2015] [Accepted: 11/01/2015] [Indexed: 11/08/2022] Open
Abstract
Persistent positivity of HPV-DNA testing is considered a prognostic index of recurrent disease in patients treated for CIN2+. HPV detection, and particularly genotyping, has an adequate high rate of sensitivity and specificity (along with an optimal reproducibility), for accurately predicting treatment failure, allowing for an intensified monitoring activity. Conversely, women with a negative HPV-test 6 months after therapy have a very low risk for residual/recurrent disease, which leads to a more individualized follow-up schedule, allowing for a gradual return to the normal screening scheme. HPV testing should be routinely included (with or without cytology) in post-treatment follow-up of CIN2+ patients for early detection of recurrence and cancer progression. HPV genotyping methods, as a biological indicator of persistent disease, could be more suitable for a predictive role and risk stratification (particularly in the case of HPV 16/18 persistence) than pooled HPV-based testing. However, it is necessary to be aware of the performance of the system, adhering to strict standardization of the process and quality assurance criteria.
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Affiliation(s)
- Luciano Mariani
- 1. HPV-UNIT, Regina Elena National Cancer Institute of Rome, Italy
| | - Maria Teresa Sandri
- 2. Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Mario Preti
- 3. Department of Obstetrics and Gynecology - University of Turin, Italy
| | - Massimo Origoni
- 4. Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Fabio Bottari
- 2. Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Mario Sideri
- 1. HPV-UNIT, Regina Elena National Cancer Institute of Rome, Italy
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Costa S, Venturoli S, Origoni M, Preti M, Mariani L, Cristoforoni P, Sandri MT. Performance of HPV DNA testing in the follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ (AIS) and microinvasive carcinoma. Ecancermedicalscience 2015; 9:528. [PMID: 25987897 PMCID: PMC4431402 DOI: 10.3332/ecancer.2015.528] [Citation(s) in RCA: 20] [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] [Received: 12/18/2014] [Indexed: 11/12/2022] Open
Abstract
Background Over the last two decades it has become clear that distinct types of human papillomavirus (HPV), the so-called high-risk types (hrHPV), are the major cause of cervical cancer. The hrHPV-DNA testing has shown excellent performance in several clinical applications from screening to the follow-up of conservatively treated patients. Methods We conducted a systematic review of the recent literature on the performance of HPV DNA testing in follow-up after treatment of high-grade cervical lesions, adenocarcinoma in situ, and microinvasive carcinoma compared to Pap smear cytology. Results Observational studies have demonstrated that the high risk hrHPV-DNA test is significantly more sensitive (95%) compared to follow-up cytology(70%) in detecting post-treatment squamous intraepithelial high-grade lesions. Moreover, in patients treated conservatively for cervical adenocarcinoma in situ, the hrHPV-DNA test is the most significant independent predictor of recurrent disease or progression to invasive cancer, and the combination of viral DNA testing and cytology reaches 90% sensitivity in detecting persistent lesions at the first follow-up visit and 100% at the second follow-up visit. The cause of microinvasive squamous cervical carcinoma is increasingly treated with conservative therapies in order to preserve fertility, and an effective strategy allowing early detection of residual or progressive disease has become more and more important in post-treatment follow-up. Primary results seem to indicate that the median time for viral clearance is relatively longer compared with patients treated for CIN and suggest a prolonged surveillance for these patients. However, the potential clinical value of HPV-DNA testing in this clinical setting needs to be confirmed by further observations. Conclusions The excellent sensitivity, negative predictive value, and optimal reproducibility of the hrHPV DNA testing, currently is considered a powerful tool in the clinicians’ hands to better manage post-treatment follow-up either in cervical squamous lesion or in situ adenocarcinoma.
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Affiliation(s)
- Silvano Costa
- Obstetrics & Gynaecology Unit, Policlinico S Orsola-Malpighi University Hospital, Bologna, Italy Present address: MF Toniolo Hospital, via Toscana, 42, Bologna 40138, Italy ; The Italian HPV Study Group (IHSG)
| | - Simona Venturoli
- Unit of Microbiology, Department of Diagnostic Medicine and Prevention, S Orsola-Malpighi Hospital, University of Bologna, Bologna 40138, Italy
| | - Massimo Origoni
- Department of Obstetrics & Gynaecology, School of Medicine, Vita-Salute San Raffaele University, Milano 20132, Italy ; The Italian HPV Study Group (IHSG)
| | - Mario Preti
- Preventive Gynaecology Unit, European Institute of Oncology, Milano 20141, Italy ; The Italian HPV Study Group (IHSG)
| | - Luciano Mariani
- HPV Unit, Gynaecologic Oncology, Regina Elena National Cancer Institute of Rome, Rome 00144, Italy ; The Italian HPV Study Group (IHSG)
| | - Paolo Cristoforoni
- National Institute on Cancer Research (IST), Genova 16132, Italy ; The Italian HPV Study Group (IHSG)
| | - Maria Teresa Sandri
- Preventive Gynaecology Unit, European Institute of Oncology, Milano 20141, Italy ; The Italian HPV Study Group (IHSG)
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Origoni M, Cristoforoni P, Carminati G, Stefani C, Costa S, Sandri MT, Mariani L, Preti M. E6/E7 mRNA testing for human papilloma virus-induced high-grade cervical intraepithelial disease (CIN2/CIN3): a promising perspective. Ecancermedicalscience 2015; 9:533. [PMID: 26015802 PMCID: PMC4435751 DOI: 10.3332/ecancer.2015.533] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 12/10/2014] [Indexed: 11/15/2022] Open
Abstract
Since the introduction of biomolecular testing for the identification of high-risk human papillomavirus DNA (hrHPV-DNA) in cervical cancer preventive strategies, many interesting aspects have emerged in this field; firstly, HPV-DNA testing has been demonstrated to have better sensitivity than conventional cytology in several settings: screening, triage of ASC-US and in follow-up after treatment. Despite this, some limitations of these new technologies have also been underlined: the major issue is the low specificity of the tests, which cannot discriminate between regressive and progressive infections. Thus, recent research has moved the attention towards novel markers of progression that could more precisely detect cases at real risk of cancer development. In view of the fact that progression to cancer is dependable of the E6/E7 proteins integration and transforming action, the overexpression of E6/E7 transcripts has been seen as a valuable marker of this risk. This review aims to summarise the literature data on this topic and to provide a clear view of the emerging perspectives.
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Affiliation(s)
- Massimo Origoni
- Department of Gynaecology & Obstetrics, Vita Salute San Raffaele University, School of Medicine, Milano 20132, Italy
| | | | - Guia Carminati
- Department of Gynaecology & Obstetrics, Vita Salute San Raffaele University, School of Medicine, Milano 20132, Italy
| | - Chiara Stefani
- Department of Gynaecology & Obstetrics, Vita Salute San Raffaele University, School of Medicine, Milano 20132, Italy
| | | | - Maria Teresa Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milano 20141, Italy
| | - Luciano Mariani
- HPV-UNIT, Regina Elena National Cancer Institute, Roma 00144, Italy
| | - Mario Preti
- Unit of Preventive Gynaecology, European Institute of Oncology, Milano 20141, Italy
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Bissolati M, Sandri MT, Burtulo G, Zorzino L, Balzano G, Braga M. Portal vein-circulating tumor cells predict liver metastases in patients with resectable pancreatic cancer. Tumour Biol 2014; 36:991-6. [DOI: 10.1007/s13277-014-2716-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022] Open
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Ewer M, Gianni L, Pane F, Sandri MT, Steiner RK, Wojnowski L, Yeh ET, Carver JR, Lipshultz SE, Minotti G, Armstrong GT, Cardinale D, Colan SD, Darby SC, Force TL, Kremer LC, Lenihan DJ, Sallan SE, Sawyer DB, Suter TM, Swain SM, van Leeuwen FE. Report on the international colloquium on cardio-oncology (rome, 12-14 march 2014). Ecancermedicalscience 2014; 8:433. [PMID: 24932213 PMCID: PMC4039411 DOI: 10.3332/ecancer.2014.433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/24/2022] Open
Abstract
Cardio-oncology is a relatively new discipline that focuses on the cardiovascular sequelae of anti-tumour drugs. As any other young adolescent discipline, cardio-oncology struggles to define its scientific boundaries and to identify best standards of care for cancer patients or survivors at risk of cardiovascular events. The International Colloquium on Cardio-Oncology was held in Rome, Italy, 12–14 March 2014, with the aim of illuminating controversial issues and unmet needs in modern cardio-oncology. This colloquium embraced contributions from different kind of disciplines (oncology and cardiology but also paediatrics, geriatrics, genetics, and translational research); in fact, cardio-oncology goes way beyond the merging of cardiology with oncology. Moreover, the colloquium programme did not review cardiovascular toxicity from one drug or the other, rather it looked at patients as we see them in their fight against cancer and eventually returning to everyday life. This represents the melting pot in which anti-cancer therapies, genetic backgrounds, and risk factors conspire in producing cardiovascular sequelae, and this calls for screening programmes and well-designed platforms of collaboration between one key professional figure and another. The International Colloquium on Cardio-Oncology was promoted by the Menarini International Foundation and co-chaired by Giorgio Minotti (Rome), Joseph R Carver (Philadelphia, Pennsylvania, United States), and Steven E Lipshultz (Detroit, Michigan, United States). The programme was split into five sessions of broad investigational and clinical relevance (what is cardiotoxicity?, cardiotoxicity in children, adolescents, and young adults, cardiotoxicity in adults, cardiotoxicity in special populations, and the future of cardio-oncology). Here, the colloquium chairs and all the session chairs briefly summarised what was said at the colloquium. Topics and controversies were reported on behalf of all members of the working group of the International Colloquium on Cardio-Oncology.
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Affiliation(s)
- Michael Ewer
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Fabrizio Pane
- Federico II University School of Medicine, Naples 80131, Italy
| | | | | | | | - Edward T Yeh
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joseph R Carver
- University of Pennsylvania and Abramson Cancer Center, 1600 Penn Tower, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Steven E Lipshultz
- Wayne State University and Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA
| | - Giorgio Minotti
- University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome 00128, Italy
| | - Gregory T Armstrong
- Working Group of the International Colloquium on Cardio-Oncology (St Jude Children's Research Hospital, Memphis, TN 38105, USA)
| | - Daniela Cardinale
- Working Group of the International Colloquium on Cardio-Oncology (European Institute of Oncology, Milan 20141, Italy)
| | - Steven D Colan
- Working Group of the International Colloquium on Cardio-Oncology (Harvard Medical School, Boston, MA 02115, USA)
| | - Sarah C Darby
- Working Group of the International Colloquium on Cardio-Oncology (University of Oxford, Oxford OX3 7LF, UK)
| | - Thomas L Force
- Working Group of the International Colloquium on Cardio-Oncology (Vanderbilt University School of Medicine, Nashville 37232, TN, USA)
| | - Leontien Cm Kremer
- Working Group of the International Colloquium on Cardio-Oncology (Emma Children's Hospital-Academic Medical Center, Amsterdam 1100 DD, The Netherlands)
| | - Daniel J Lenihan
- Working Group of the International Colloquium on Cardio-Oncology (Vanderbilt University School of Medicine, Nashville 37232, TN, USA)
| | - Stephen E Sallan
- Working Group of the International Colloquium on Cardio-Oncology (Dana-Farber Cancer Institute, Boston, MA 02215, USA)
| | - Douglas B Sawyer
- Working Group of the International Colloquium on Cardio-Oncology (Vanderbilt University School of Medicine, Nashville 37232, TN, USA)
| | - Thomas M Suter
- Working Group of the International Colloquium on Cardio-Oncology (Bern University Hospital, Bern 3012, Switzerland)
| | - Sandra M Swain
- Working Group of the International Colloquium on Cardio-Oncology (Washington Cancer Institute, Washington, DC 20010, USA)
| | - Flora E van Leeuwen
- Working Group of the International Colloquium on Cardio-Oncology (Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands)
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Passerini R, Cassatella MC, Salvatici M, Bottari F, Mauro C, Radice D, Sandri MT. Recovery and time to growth of isolates in blood culture bottles: Comparison of BD Bactec Plus Aerobic/F and BD Bactec Plus Anaerobic/F bottles. ACTA ACUST UNITED AC 2014; 46:288-93. [DOI: 10.3109/00365548.2013.876510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Johansson H, Bonanni B, Gandini S, Guerrieri-Gonzaga A, Cazzaniga M, Serrano D, Macis D, Puccio A, Sandri MT, Gulisano M, Formelli F, Decensi A. Circulating hormones and breast cancer risk in premenopausal women: a randomized trial of low-dose tamoxifen and fenretinide. Breast Cancer Res Treat 2013; 142:569-78. [PMID: 24241787 DOI: 10.1007/s10549-013-2768-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
Abstract
Tamoxifen and fenretinide have been extensively studied and exhibit breast cancer-preventing activity. We aimed to assess their effect on sex hormones, sex hormone binding globulin (SHBG) and retinol, and their association with mammographic density (MD) and breast cancer events. In a double-blind, placebo-controlled trial, premenopausal women at risk for breast cancer were randomized to tamoxifen 5 mg/day, fenretinide, both agents, or placebo for 2 years. We measured MD and circulating concentrations of follicle-stimulating hormone, luteinizing hormone (LH), estradiol, progesterone, testosterone, androstenedione, dehydro-epiandrosteronesulfate, prolactin, SHBG, and retinol at baseline and on yearly intervals. The associations with breast cancer events were evaluated through competing risk and Cox regression survival models. Low-dose tamoxifen markedly and enduringly increased SHBG, whereas the increases in testosterone, estradiol, and prolactin and reduction in LH weakened after 1 year. Fenretinide increased testosterone and androstenedione and decreased retinol. MD correlated directly with SHBG and inversely with retinol. After a median follow-up of 12 years, the 10-year cumulative incidence of breast cancer events was 37 % in women with SHBG ≤ 59.3 nmol/L, 22 % in women with SHBG between 59.3 and 101 nmol/L, and 19 % in women with SHBG > 101 nmol/L (P = 0.018). The difference among SHBG tertiles remained statistically significant at multivariable analysis: HR = 2.26 (95 % CI 1.04, 4.89) for the lowest versus the highest tertile. We conclude that low-dose tamoxifen or fenretinide exhibits favorable hormonal profiles as single agents, further supporting their administration for prevention of breast cancer in premenopause. Notably, SHBG levels were inversely associated with breast neoplastic events.
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Affiliation(s)
- Harriet Johansson
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy,
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Rao A, Sandri MT, Sideri M, Young S, Sharma A, Behrens C. Comparison of hybrid capture 2 High-Risk HPV results in the low positive range with cobas® HPV Test results from the ATHENA study. J Clin Virol 2013; 58:161-7. [PMID: 23895930 DOI: 10.1016/j.jcv.2013.06.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 12/10/2012] [Revised: 05/29/2013] [Accepted: 06/29/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing importance of high-risk human papillomavirus (hrHPV) testing in cervical cancer screening warrants evaluation of HPV DNA tests with an equivocal zone requiring retesting of samples in the low positive range. OBJECTIVES To compare the results of the digene hc2 High Risk HPV DNA Test (hc2), which has a manufacturer's recommended retesting zone with the cobas HPV Test, a real-time polymerase chain reaction amplification test without an equivocal range. STUDY DESIGN A retrospective subanalysis of the ATHENA study comparing results for hc2 High Risk HPV DNA Test and the cobas HPV Test using the LINEAR ARRAY HPV Genotyping Test (LA) and Sanger sequencing as comparators was performed. The ability of each test to detect high-grade cervical disease in the equivocal range was also evaluated. RESULTS 5.2% of samples fell within the equivocal zone (RLU/CO 1.0-2.5) and required retesting with the hc2 High Risk HPV DNA Test. In this low-positive range the cobas HPV Test showed better positive percent agreement (PPA) than hc2 High Risk HPV DNA Test for LA and sequencing (84.2% vs.70.9% and 92.1% vs.82.5%, respectively). hc2 High Risk HPV DNA Test and the cobas HPV Test demonstrated comparable sensitivity for detection of high-grade disease in the equivocal range. In the low cobas HPV Test range (cycle threshold [Ct] 40-35), the cobas HPV test again demonstrated a better PPA than hc2 High Risk HPV DNA Test with LA and sequencing as comparators and more high-grade disease was detected by the cobas HPV Test than hc2 High Risk HPV DNA Test. CONCLUSION The cobas HPV Test demonstrates reliable performance in the hc2 High Risk HPV DNA Test equivocal zone, thus supporting it as an option for HPV testing that avoids the need for retesting.
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Affiliation(s)
- Arundhati Rao
- Scott & White Healthcare-Round Rock Hospital, 300 University Boulevard, Round Rock, TX 78665, United States.
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Abstract
Evaluation of: Powell AA, Talasaz AH, Zhang H et al. Single cell profiling of circulating tumor cells: transcriptional heterogeneity and diversity from breast cancer cell lines. PLoS ONE 7(5), e33788 (2012). Circulating tumor cells (CTCs) may represent a possible useful tool to better define the prognosis of patients. The presence of CTCs can help to predict an increased risk for disease relapse, and they might be an early marker for treatment efficacy that could help in deciding treatment continuation. Cancer metastasis occurs when cells, shed from the primary tumor, enter the circulation and begin to grow in distant locations around the body. In metastatic stages, shed cells may differ from those of the primary tumor, as the tumor phenotype can change during the course of the disease. It is important to identify relevant targets expressed on these cells to provide clinical information on therapy choice, efficacy and drug resistance. Many efforts are now devoted to the characterization of the single cell. This article focuses on the possibility of profiling single CTCs in patients with breast cancer.
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Affiliation(s)
- M C Cassatella
- Laboratory Medicine Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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Zampino MG, Magni E, Ravenda SP, Botteri E, Bertani E, Chiappa A, Valvo M, Zorzino L, Adamoli L, Nole F, Sandri MT. Detection of circulating tumor cells (CTCs) in stage T3-4 and/or N positive rectal cancer (RC) patients undergoing neoadjuvant therapy followed by curative surgery. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e22078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22078 Background: CTCs count at baseline and during treatment is an independent prognostic factor in metastatic colorectal cancer, while its role in early stages is still an open issue. No data are available in RC patients suitable for neoadjuvant chemoradiotherapy (CT-RT). Aim of the study: To investigate the role of CTCs in patients with locally advancedRC undergoing neo-adjuvant CT-RT. Methods: In a prospective single Institution study, cT3-4 and/or N+RC staged by rectal EUS and/or pelvic MRI and chest-abdomen CT scan, received capecitabine (825 mg/mq, orally, tid) with concurrent pelvic radiotherapy (50.4 Gy/28 fractions), followed by two cycles of intermittent capecitabine (1250 mg/mq, tid 14/21 days) and by low anterior resection or abdominopelvic resection with TME. Primary endpoints are evaluation of CTCs at baseline (t0), after CT-RT (t1), within 7 days after surgery (t2), and at 6-month from surgery (t3) and its correlation with main patient/tumor characteristics, CEA and response to neoadjuvant therapy. CTCs are enumerated with CellSearch System in 22.5 ml peripheral blood at over-mentioned time-points. A repeated measure analysis for binary outcome was used to evaluate changes in time of the percentage of patients with CTCs>0. Results: 85/90 patients are evaluable: 52M/33F, median age 63 yrs (range 37-82); median follow up 25 months (range 6-52). At baseline (t0) 13 pts had 1 CTC (15.3%), two had 2 CTCs (2.4%) and one had 27 CTCs(1.2%) while in 69 cases (81.2%) no CTCs were detected. Information on CTCs was available for 67 patients at t1, 68 patients at t2 and 62 at t3. CTCs>0 was reported on 16 (18.8%) at t0, 5 (7.5%) at t1, 6 (8.8%) at t2 and 3 (4.8% ) at t3 (P-value for trend: 0.039). CTCs at t0 was not statistically associated with any patient/tumor characteristics except for ultrasound T-stage that showed a trend CTCs (0% in uT2, 18.9% in uT3 and 40% in uT4, p-value 0.093), while no correlation with pCR was reported. Conclusions: CTCs count ≥ 1 was observed in 18.8% of patients with trend reduction over time probably due to therapy. Statistical correlation will be planned between CTCs and outcome.
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Affiliation(s)
- M. Giulia Zampino
- VD Unità di Cure Mediche, Istituto Europeo di Oncologia, Milano, Italy
| | - Elena Magni
- Clinical Care Unit, European Institute of Oncology, Milan, Italy
| | | | | | | | | | | | | | - Laura Adamoli
- European Institute of Oncology, Data Management, Milan, Italy
| | - Franco Nole
- Unit for Medical Care, European Institute of Oncology, Milan, Italy
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Aristarco V, Radice D, Joahnsson H, Macis D, Mora S, Cazzaniga M, Cortesi L, Marchi I, Sandri MT, Bonanni B. Abstract 161: Effect of Simvastatin and Nimesulide on inflammation and cardiovascular risk biomarkers in a phase II breast cancer prevention trial. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Almost one-third of breast cancers (BC) will not be influenced by hormonal interventions because of the absence of ER expression. Thus, there is an urgent need to confirm in the clinical setting the potential efficacy of new compounds in contrasting hormone non-responsive BC, which are often marked by higher biological aggressiveness, early onset and worse prognosis. Over expression of COX-2 and HMG-CoA pathway seems to be involved in breast carcinogenesis and several studies have shown the ability of NSAIDs and statins to reduce the incidence of BC.
Material and Methods: We conducted a randomized phase II, double blind, placebo controlled trial with simvastatin (20 mg/day) and nimesulide (100 mg/day) for 1 year in 150 high risk women for ER negative BC in a 1:1:1 fashion. Participants were treated for one year and followed-up for an additional year. The primary endpoint was the change in prevalence of atypical cells obtained by ductal lavage or ultrasound guided fine needle aspirate and cellular proliferation (measured by Ki-67), while the secondary objective was to analyze the efficacy of these drugs in modifying the levels of circulating inflammatory and cardiovascular risk biomarkers. Circulating concentrations of high-sensitivity C-reactive protein (hsCRP), triglycerides, total cholesterol, LDL-cholesterol, HDL-cholesterol, antithrombin III and fibrinogen were measured on morning fasting blood samples drawn at baseline and after 12 and 24 months.
Results: Analysis of the primary endpoint is ongoing and here we present results on circulating biomarkers. After 12 months of treatment, simvastatin was associated to a statistically significant mean decrease of hsCRP compared to the placebo arm (0,90 mg/L vs 3,57 mg/L; p=0.008), while an attenuated effect of nimesulide was observed (1.61 mg/L vs 3.57 mg/L; p=0.077). As expected, simvastatin significantly decreased LDL and total cholesterol levels with respect to placebo (89.1 vs 130 mg/dL and 176.8 vs 218 mg/dL respectively; both p<0.0001). Interestingly, after 1 year of treatment interruption, at 24 months from baseline, hsCRP serum levels were significantly lower with both simvastatin (p = 0.012) and nimesulide (p = 0.017) as compared to placebo. We did not observe a significant change in mean concentrations of triglycerides, antithrombin III and fibrinogen during treatment and follow-up.
Conclusions: Our findings demonstrate a favourable anti-inflammatory effect of both agents on circulating levels of hsCRP, although simvastatin achieved a greater decrease. These results will be correlated with the main endpoint to further assess the potential role of simvastatin and nimesulide in breast carcinogenesis and the potential use of hsCRP as a surrogate endpoint biomarker.
Citation Format: Valentina Aristarco, Davide Radice, Harriet Joahnsson, Debora Macis, Serena Mora, Massimiliano Cazzaniga, Laura Cortesi, Isabella Marchi, Maria Teresa Sandri, Bernardo Bonanni. Effect of Simvastatin and Nimesulide on inflammation and cardiovascular risk biomarkers in a phase II breast cancer prevention trial. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 161. doi:10.1158/1538-7445.AM2013-161
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Affiliation(s)
| | | | | | | | | | | | - Laura Cortesi
- 2University of Modena and Reggio; Department of Oncology and Haematology, Milano, Italy
| | - Isabella Marchi
- 2University of Modena and Reggio; Department of Oncology and Haematology, Milano, Italy
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Munzone E, Botteri E, Sandri MT, Esposito A, Adamoli L, Zorzino L, Sciandivasci A, Cassatella MC, Rotmensz N, Aurilio G, Curigliano G, Goldhirsch A, Nolè F. Prognostic value of circulating tumor cells according to immunohistochemically defined molecular subtypes in advanced breast cancer. Clin Breast Cancer 2013; 12:340-6. [PMID: 23040002 DOI: 10.1016/j.clbc.2012.07.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 05/25/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Breast cancer is a heterogeneous disease. Circulating tumor cell (CTC) enumeration might be useful to identify different risk categories within each molecular subtype. METHODS We retrospectively analyzed 203 consecutive patients with metastatic breast cancer with baseline CTC enumeration performed with CellSearch (Veridex Corp, Warren, NJ) between March 2005 and July 2011. Patients were categorized into 3 prognostic groups based on the number of CTCs (0, 1-4, and ≥ 5) and into 5 categories based on tumor biological characteristics: luminal-A (estrogen receptor [ER] and progesterone receptor [PR] > 1%, grade 1/2, human epidermal growth factor 2 [HER2]-negative [HER2(-)], Ki67 value < 14%); luminal-B (ER and/or PR > 1%, grade 3, HER2(-), Ki67 value > 14%); luminal-B HER2-positive [HER2(+)] (ER and/or PR > 1%, any grade, HER2(+), Ki-67 value any); HER2(+) (HER2 overexpressed/fluorescence in situ hybridization [FISH] amplified, ER and PR absent); triple negative (TN) (ER and PR 0%, HER2 not overexpressed/FISH not amplified). RESULTS Median age was 57 years (range 31-78 years). Twenty-seven patients (13.3%) had luminal-A category, 105 (51.7%) patients had luminal-B, 29 (14.3%) patients had luminal-B HER2(+), 24 patients (11.8%) had HER2(+), and 18 patients (8.9%) had TN. CTCs were mostly found in patients with luminal-A/luminal-B HER2(-) subtype. At multivariable analysis, CTC count was a significant predictive factor for overall survival (OS) in all molecular subtypes (log-rank P < .01). Patients with 0 CTCs/7.5 mL blood and all subtypes, except HER2(+), seem to perform better compared with other categories. CONCLUSION These findings confirm CTCs as an important prognostic factor for metastatic breast cancer in all molecular subtypes. Larger studies could help identify metastatic breast cancer subgroups in which CTC analysis would be particularly useful.
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Affiliation(s)
- Elisabetta Munzone
- Division of Medical Oncology, Istituto Europeo di Oncologia, Milan, Italy.
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De Simone C, Caldarola G, Coco V, Palumbo S, Pocino K, Sgambato A, Maiorino A, Corbi M, Sandri MT, Vendittelli F, Capoluongo E. Circulating endothelial cell levels in psoriatic patients and their modification after an anti-TNF-alpha (Etanercept) treatment. J Eur Acad Dermatol Venereol 2013; 28:590-6. [PMID: 23506557 DOI: 10.1111/jdv.12140] [Citation(s) in RCA: 3] [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] [Received: 12/16/2012] [Accepted: 02/18/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endothelial function in psoriatic patients has been mainly evaluated through a high-resolution ultrasound measurement of flow-mediated vasodilation in the brachial artery, which is an operator-dependent and technically demanding technique: this characteristic, together with different patient selection criteria, could account for the conflicting results emerging from different studies. Recently, Circulating Endothelial Cells (CECs) level has been suggested as a novel biomarker of vascular injury. METHODS The number of CECs was determined by a semi-automated immunomagnetic system (CellSearch system) in peripheral blood of psoriatic patients (n = 48) and healthy subjects (n = 50). In 15 patients, CEC level was also evaluated after 6 months of treatment with an anti-TNF-alpha agent, Etanercept. The plasma levels of high-sensitivity C-reactive Protein (CRP), E-selectin, VEGF and PAI-1 were measured by ELISA. The psoriasis severity was assessed by PASI score. RESULTS A statistically significant difference (P = 0.001) was found between CEC level in psoriatic patients (10.6 ± 9.4 cells/mL) vs. the control group (3.9 ± 0.9 cells/mL). This count inversely correlated with sE-selectin levels (r(2) = 0.16; P = 0.03). After 6 months of therapy, patients experienced a significant (P < 0.05) decrease in CEC levels (3.4 ± 1.3 cells/mL) and in PASI score (from 11.7 ± 8.1 to 2.1 ± 4.0). CONCLUSIONS The elevated CECs level that we found in a sample of high selected psoriatic patients could be expression of endothelial damage. Lowering of CECs count after treatment with Etanercept support the hypothesis that an effective systemic therapy of psoriasis may also improve the endothelial function.
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Affiliation(s)
- C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
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Curigliano G, Cardinale D, Suter T, Plataniotis G, de Azambuja E, Sandri MT, Criscitiello C, Goldhirsch A, Cipolla C, Roila F. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol 2013; 23 Suppl 7:vii155-66. [PMID: 22997448 DOI: 10.1093/annonc/mds293] [Citation(s) in RCA: 528] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular (CV) toxicity is a potential short- or long-term complication of various anticancer therapies. Some drugs, such as anthracyclines or other biological agents, have been implicated in causing potentially irreversible clinically important cardiac dysfunction. Although targeted therapies are considered less toxic and better tolerated by patients compared with classic chemotherapy agents, rare but serious complications have been described, and longer follow-up is needed to determine the exact profile and outcomes of related cardiac side-effects. Some of these side-effects are irreversible, leading to progressive CV disease, and some others induce reversible dysfunction with no long-term cardiac damage to the patient. Assessment of the prevalence, type and severity of cardiac toxicity caused by various cancer treatments is a breakthrough topic for patient management. Guidelines for preventing, monitoring and treating cardiac side-effects are a major medical need. Efforts are needed to promote strategies for cardiac risk prevention, detection and management, avoiding unintended consequences that can impede development, regulatory approval and patient access to novel therapy. These new ESMO Clinical Practice Guidelines are the result of a multidisciplinary cardio-oncology review of current evidence with the ultimate goal of providing strict criteria-based recommendations on CV risk prevention, assessment, monitoring and management during anticancer treatment.
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Affiliation(s)
- G Curigliano
- Department of Medicine, Division of Medical Oncology, European Institute of Oncology, Milan, Italy
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Halfon P, Lindemann MLM, Raimondo A, Ravet S, Camus C, Khiri H, Pénaranda G, Sideri M, Sandri MT. HPV genotype distribution according to severity of cervical neoplasia using the Digene HPV genotyping LQ test. Arch Virol 2013; 158:1143-9. [PMID: 23299934 PMCID: PMC3668127 DOI: 10.1007/s00705-012-1584-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/17/2012] [Indexed: 01/27/2023]
Abstract
A new genotyping-based DNA assay (Digene LQ®) was developed recently. The primary aim was to assess the distribution of HPV types using this new assay in atypical squamous cells of undeterminate significance (ASCUS). The secondary aim was to correlate the HPV types with the severity of the disease. The study population comprised 376 ASCUS women. The women were all Hybrid Capture II (HCII) positive and were admitted in three European referral gynecology clinics between 2007 and 2010. A colposcopy with histological examination was performed in all these patients. HPV 16 was typed in 40 % of patients, HPV 18 in 7 %, and HPV 31 in 17 %, and 18 % of patients had mixed genotypes. Patients aged over 30 more often had the HPV 16 genotype than patients aged under 30 (29 % vs. 11 %, chi-square test p < 0.001). The risk of cervical intra-epithelial neoplasia of grade 2 or more (CIN2 +) when HPV 18 positive is lower than the probability associated with HPV 16 or HPV 31: 28 % vs. 58 % and 52 %, respectively (chi-square test, p = 0.005 and p = 0.05, respectively). The Digene LQ®, a new sequence-specific hybrid capture sample preparation, is fast and efficient and allows high-throughput genotyping of 18 HR HPV types by PCR compared to traditional non-sequence-specific sample preparation methods.
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Affiliation(s)
- Philippe Halfon
- Laboratoire Alphabio, 23 Rue de Friedland, 13006 Marseille, France.
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Sandri MT, Bottari F, Franchi D, Boveri S, Candiani M, Ronzoni S, Peiretti M, Radice D, Passerini R, Sideri M. Comparison of HE4, CA125 and ROMA algorithm in women with a pelvic mass: correlation with pathological outcome. Gynecol Oncol 2012. [PMID: 23200911 DOI: 10.1016/j.ygyno.2012.11.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The quality of first surgery is one of the most important prognostic factors in ovarian cancer patients. Pre-surgical distinction of benign and malignant pelvic mass plays a critical role in ovarian cancer management and survival. The aim of this study was to evaluate the clinical performance of ROMA algorithm and of CA125 and HE4 in the triage of patients with a pelvic mass undergoing surgery, in order to discriminate benign from malignant disease. METHODS Three hundred and forty-nine pre- and post-menopausal women, aged 18 years or older undergoing surgery because of a pelvic mass were enrolled: serum concentrations of CA125 and HE4 were determined and ROMA was calculated for each sample. RESULTS Median serum CA125 and HE4 levels were higher in patients with EOC compared to subjects with benign disease (p<0.0001). The resultant accuracy (using Receiver Operating Characteristics, ROC Area) values for HE4, CA125 and ROMA showed a good performance ranging from 89.8% for CA125 in pre-menopausal patients to 93.3% for ROMA in post-menopausal patients: AUC for ROMA resulted significantly higher in comparison to CA125 alone (93.3% vs 90.3%, p=0.0018) in post menopausal patients. A sub-analysis considering the 40 patients with endometrioid disease showed the highest accuracy of HE4 in these patients. CONCLUSIONS Data presented confirm the accuracy of HE4 and of the ROMA algorithm in the distinction of ovarian carcinoma from benign disease, with a trend towards better performance for ROMA than for CA125 alone, statistically significant in postmenopausal patients.
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Affiliation(s)
- M T Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy.
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Aurilio G, Sciandivasci A, Munzone E, Sandri MT, Zorzino L, Cassatella MC, Verri E, Rocca MC, Nolè F. Prognostic value of circulating tumor cells in primary and metastatic breast cancer. Expert Rev Anticancer Ther 2012; 12:203-14. [PMID: 22316368 DOI: 10.1586/era.11.208] [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] [Indexed: 12/11/2022]
Abstract
In patients with breast cancer, there is evidence correlating the presence of circulating tumor cells (CTCs) with disease-free survival, progression-free survival and overall survival. The detection of CTCs may be useful in gaining a better understanding of the mechanisms of tumor growth and in the improvement of patient management. This review analyzes the prognostic and predictive relevance of CTCs through the principal published studies, cytometric techniques and nucleic acid-based approaches to detect CTCs, phenotypic expression of specific receptors, molecular pathways and genetic signatures for potential tailored therapies.
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Affiliation(s)
- Gaetano Aurilio
- European Institute of Oncology, Medical Care Unit, Department of Medical Oncology, Ripamonti Street 435, Milan 20141, Italy.
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