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Gass P, Thiel FC, Häberle L, Ackermann S, Theuser AK, Hummel N, Boehm S, Kimmig R, Reinthaller A, Becker S, Hilpert F, Janni W, Vergote I, Harter P, Emons J, Hein A, Beckmann MW, Fasching PA, Pöschke P. Primary results of the AGO-Zervix-1 Study: A prospective, randomized phase III study to compare the effects of paclitaxel and topotecan with those of cisplatin and topotecan in the treatment of patients with recurrent and persistent cervical cancer. Gynecol Oncol 2024; 183:25-32. [PMID: 38490057 DOI: 10.1016/j.ygyno.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Before the era of immunotherapies and antibody-drug conjugates, there were limited chemotherapeutic options for patients with recurrent and metastatic cervical cancer. Combination therapies with cisplatin have shown some superiority over monotherapy. This study examined platinum-free treatment regimens, comparing a combination of topotecan and paclitaxel (TP) with topotecan and cisplatin (TC) in patients with recurrent or metastatic cervical cancer, with or without prior platinum-based treatment. METHODS The AGO-Zervix-1 Study (NCT01405235) is a prospective, randomized phase III study in which patients were randomly assigned at a 1:1 ratio to treatment within the control arm with topotecan (0.75 mg/m2) on days 1-3 and cisplatin (50 mg/m2) on day 1 every 3 weeks and in the study arm topotecan (1.75 mg/m2) and paclitaxel (70 mg/m2) on days 1, 8, and 15 every 4 weeks or treatment. The primary study aim was overall survival; progression-free survival, toxicity, and quality of life were secondary aims. The interim and final analysis is here reported after recruitment of 173 of 312 planned patients. RESULTS Median overall survival in the TP arm was 9.6 months, compared with 12.0 months in the TC arm (log-rank test, P = 0.33). Median progression-free survival rates were 4.4 months with TP and 4.2 months with TC (log-rank test, P = 0.47). Leukopenia and nausea/vomiting were more frequent in the cisplatin-containing arm. Otherwise, toxicity profiles were comparable. There were no differences in FACT-G-assessed quality of life. CONCLUSION Platinum-based combination chemotherapy remains the standard of care chemotherapy regimen for patients with recurrent or metastatic cervical cancer.
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Affiliation(s)
- Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Alb Fils Clinics, Klinik am Eichert, Göppingen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Sven Ackermann
- Department of Gynecology and Obstetrics, Klinikum Darmstadt, Darmstadt, Germany
| | | | - Nadine Hummel
- Institut für Frauengesundheit GmbH, Erlangen, Germany
| | - Sibylle Boehm
- Institut für Frauengesundheit GmbH, Erlangen, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, Essen University Hospital, Essen, Germany
| | - Alexander Reinthaller
- Department of Gynecology and Gynecologic Oncology, AKH Vienna University Hospital, Vienna, Austria
| | - Sven Becker
- Department of Gynecology and Obstetrics, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Felix Hilpert
- Onkologisches Therapiezentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Ignace Vergote
- Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Leuven University Hospitals, Leuven, Belgium
| | - Phlipp Harter
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Stuebs FA, Behrens AS, Seibold A, Adler W, Geppert C, Hartmann A, Knöll A, Koch MC, Mehlhorn G, Beckmann MW, Theuser AK, Schulmeyer CE, Gass P, Dietl AK. Impact of the Corona Pandemic on Cervical Cancer Screening Assessment. In Vivo 2024; 38:734-740. [PMID: 38418110 PMCID: PMC10905465 DOI: 10.21873/invivo.13495] [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: 11/13/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM The global impact of the COVID-19 pandemic resulted in disruptions to healthcare systems throughout the world. The numbers of cytology examinations, human papillomavirus (HPV) tests, and women referred for colposcopy decreased in many countries. There have been no reports on cervical cancer screening in Germany. This study aimed to describe changes in the numbers of colposcopies, cytology examinations, HPV tests, and histological results during the pandemic compared to the pre-pandemic years in order to evaluate the impact of the COVID-19 pandemic on cervical cancer screening. PATIENTS AND METHODS The numbers of colposcopies, cytology examinations, HPV tests, and histologic results were analyzed retrospectively for the period January 2018 to December 2022. The 2 years period before the pandemic (2018 and 2019) were compared with the 3 years period of the pandemic (2020-2022). RESULTS In total, 6,518 colposcopies were performed in 5,579 women. The numbers of colposcopies, cytology examinations, and high-risk HPV (hrHPV) tests increased during the pandemic years. The number of biopsies per year taken was stable (range=450-554). The relative numbers of cervical intraepithelial neoplasia (CIN) III/HSIL findings were stable, while the numbers of cervical cancers identified increased slightly from 15 (6.6%) in 2018 to 22 (7.4%) in 2022. CONCLUSION Increases in numbers of women examined and colposcopies were observed in the years 2021 and 2022 during the pandemic, in comparison to the preceding years. These also led to increases in the figures for cytology, hrHPV, histology, and operations. The onset of the pandemic occurred in the same year as a newly organized screening program started in Germany. The increases might therefore be due to the newly organized screening system.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany;
| | - Annika S Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Anja Seibold
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, ANregiomed Ansbach Hospital, Ansbach, Germany
| | - Grit Mehlhorn
- Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC), Certified Gynecological Dysplasia Consultancy Practice, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Wagner P, Gass P, Pöschke P, Eckstein M, Gloßner L, Hartmann A, Beckmann MW, Fasching PA, Ruebner M, Emons J, Erber R. Spatial expression of claudin 18.2 in matched primaries and metastases of tubo-ovarian carcinoma of all subtypes. Virchows Arch 2024:10.1007/s00428-024-03756-1. [PMID: 38326579 DOI: 10.1007/s00428-024-03756-1] [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: 11/09/2023] [Revised: 01/10/2024] [Accepted: 01/27/2024] [Indexed: 02/09/2024]
Abstract
Physiologically, claudin 18 splice variant 2 (CLDN18.2) expression is restricted to the gastric epithelium, but its expression has been detected in solid cancers. Zolbetuximab, a chimeric IgG1 antibody targeting CLDN18.2, has demonstrated promising effects in patients suffering from CLDN18.2-positive, HER2-negative locally advanced gastric cancer and is currently being studied further. To date, little is known about CLDN18.2 expression in other histological subtypes of tubo-ovarian carcinoma (TOC) and their matching metastases.Using a cohort of all histological TOC subtypes, we investigated the immunohistochemical (IHC) CLDN18.2 expression in both TOCs (n = 536), their matching metastatic tissue (n = 385) and in 93 metastases without primary. Tissue microarrays comprised both the tumor center and periphery. IHC positivity was defined as biomarker expression of ≥ 75% in tumor cells with moderate-to-strong membranous staining.Overall CLDN18.2 positivity was 4.1% (21/515) in the TOC centers and 3.6% (18/498) in their peripheries. In primaries of mucinous tubo-ovarian carcinoma (MTOC), CLDN18.2 positivity rates were 45% (18/40) and 36.6% (15/41), respectively. Positivity rates for the corresponding metastases were 33% (4/12, center) and 27% (3/11, periphery). The expression was relatively homogenous throughout all tumor sites. With no expression in 99.5% of nonmucinous tumors, CLDN18.2 positivity was almost exclusively seen in the mucinous subtype.In tubo-ovarian carcinoma, CLDN18.2 expression was, with rare exceptions, restricted to the mucinous subtype. Among them, 33% of metastasized MTOCs presented with CLDN18.2 positivity. Hence, CLDN18.2 might display a promising target for personalized therapy in patients with advanced MTOC.
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Affiliation(s)
- Paul Wagner
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Patrik Pöschke
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Laura Gloßner
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Matthias Wilhelm Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Peter Andreas Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Dietl AK, Beckmann MW, Stuebs FA, Gass P, Emons J, Hartmann A, Erber R. PD-L1 Expression and Silva Invasion Pattern in Villoglandular Adenocarcinoma of the Uterine Cervix. Int J Gynecol Pathol 2024:00004347-990000000-00135. [PMID: 38293999 DOI: 10.1097/pgp.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Villoglandular adenocarcinoma (VGA) of the uterine cervix is a rare subtype of endocervical adenocarcinoma in young women. Between 2007 and 2020, all women with endocervical adenocarcinoma were retrospectively reviewed to find patients with VGA. Eight patients in whom pure VGA had been diagnosed were included. The mean age at initial diagnosis was 36.3 years (range 24-46). After surgical treatment, patients were followed up for 59 months (range 16-150). To date, all patients are alive with no evidence of disease. Neither lymph node involvement nor lymphovascular invasion was found. Furthermore, we examined the samples with a focus on morphological invasion pattern (Silva), stromal tumor-infiltrating lymphocytes (sTILs), and immunohistochemical programmed death ligand-1 (PD-L1) expression. PD-L1 expression was observed in 7/8 using the combined positive score (cutoff≥1%), 1/8 of VGAs using the tumor proportion score (cutoff≥1%), and 7/8 using the immune cell (cutoff≥1%). Using combined positive score and immune cell, PD-L1 expression was seen in 7/8 of pattern B and C tumors, with significantly higher expression in tumors with destructive-type patterns (P<0.05, A vs. B+C). Using tumor proportion score, no significant difference in PD-L1 expression was seen between VGAs with different invasion patterns. VGAs demonstrated twice higher sTILs in tumors with destructive-type invasion patterns. Our observations suggest that PD-L1 expression, tumor invasion patterns, and sTILs do not correlate with the excellent prognosis of pure VGA.
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Behrens A, Wurmthaler L, Heindl F, Gass P, Häberle L, Volz B, Hack CC, Emons J, Erber R, Hartmann A, Beckmann MW, Ruebner M, Dougall WC, Press MF, Fasching PA, Huebner H. RANK and RANKL Expression in Tumors of Patients with Early Breast Cancer. Geburtshilfe Frauenheilkd 2024; 84:77-85. [PMID: 38178900 PMCID: PMC10764119 DOI: 10.1055/a-2192-2998] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/15/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction The receptor activator of nuclear factor-κB (RANK) pathway was associated with the pathogenesis of breast cancer. Several studies attempted to link the RANK/RANKL pathway to prognosis; however, with inconsistent outcomes. We aimed to further contribute to the knowledge about RANK/RANKL as prognostic factors in breast cancer. Within this study, protein expression of RANK and its ligand, RANKL, in the tumor tissue was analyzed in association with disease-free survival (DFS) and overall survival (OS) in a study cohort of patients with early breast cancer. Patients and Methods 607 samples of female primary and early breast cancer patients from the Bavarian Breast Cancer Cases and Controls Study were analyzed to correlate the RANK and RANKL expression with DFS and OS. Therefore, expression was quantified using immunohistochemical staining of a tissue microarray. H-scores were determined with the cut-off value of 8.5 for RANK and 0 for RANKL expression, respectively. Results RANK and RANKL immunohistochemistry were assessed by H-score. Both biomarkers did not correlate (ρ = -0.04). According to molecular subtypes, triple-negative tumors and HER2-positive tumors showed a higher number of RANK-positive tumors (H-score ≥ 8.5), however, no subtype-specific expression of RANKL could be detected. Higher RANKL expression tended to correlate with a better prognosis. However, RANK and RANKL expression could not be identified as statistically significant prognostic factors within the study cohort. Conclusions Tumor-specific RANK and RANKL expressions are not applicable as prognostic factors for DFS and OS, but might be associated with subtype-specific breast cancer progression.
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Affiliation(s)
- Annika Behrens
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Lena Wurmthaler
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Ansbach University of Applied Sciences, Ansbach, Germany
| | - Carolin C. Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Ramona Erber
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - William C. Dougall
- Hematology and Oncology Research, Amgen, Inc., Seattle, WA, USA
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Michael F. Press
- Department of Pathology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
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Behrens A, Fasching PA, Schwenke E, Gass P, Häberle L, Heindl F, Heusinger K, Lotz L, Lubrich H, Preuß C, Schneider MO, Schulz-Wendtland R, Stumpfe FM, Uder M, Wunderle M, Zahn AL, Hack CC, Beckmann MW, Emons J. Predicting mammographic density with linear ultrasound transducers. Eur J Med Res 2023; 28:384. [PMID: 37770952 PMCID: PMC10537934 DOI: 10.1186/s40001-023-01327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND High mammographic density (MD) is a risk factor for the development of breast cancer (BC). Changes in MD are influenced by multiple factors such as age, BMI, number of full-term pregnancies and lactating periods. To learn more about MD, it is important to establish non-radiation-based, alternative examination methods to mammography such as ultrasound assessments. METHODS We analyzed data from 168 patients who underwent standard-of-care mammography and performed additional ultrasound assessment of the breast using a high-frequency (12 MHz) linear probe of the VOLUSON® 730 Expert system (GE Medical Systems Kretztechnik GmbH & Co OHG, Austria). Gray level bins were calculated from ultrasound images to characterize mammographic density. Percentage mammographic density (PMD) was predicted by gray level bins using various regression models. RESULTS Gray level bins and PMD correlated to a certain extent. Spearman's ρ ranged from - 0.18 to 0.32. The random forest model turned out to be the most accurate prediction model (cross-validated R2, 0.255). Overall, ultrasound images from the VOLUSON® 730 Expert device in this study showed limited predictive power for PMD when correlated with the corresponding mammograms. CONCLUSIONS In our present work, no reliable prediction of PMD using ultrasound imaging could be observed. As previous studies showed a reasonable correlation, predictive power seems to be highly dependent on the device used. Identifying feasible non-radiation imaging methods of the breast and their predictive power remains an important topic and warrants further evaluation. Trial registration 325-19 B (Ethics Committee of the medical faculty at Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany).
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Affiliation(s)
- Annika Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Eva Schwenke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Hannah Lubrich
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Caroline Preuß
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael O Schneider
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna L Zahn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, University Breast Center for Franconia, Comprehensive Cancer Center European Metropolitan Area Nuremberg (CCC ER-EMN), Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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7
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Pöschke P, Fasching PA, Adler W, Rübner M, Beckmann MW, Hack CC, Heindl F, Hartmann A, Erber R, Gass P. Clinical Characteristics and Prognosis of HER2-0 and HER2-Low-Positive Breast Cancer Patients: Real-World Data from Patients Treated with Neoadjuvant Chemotherapy. Cancers (Basel) 2023; 15:4678. [PMID: 37835372 PMCID: PMC10571544 DOI: 10.3390/cancers15194678] [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: 09/04/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
In our study, we observed the long-term survival outcomes investigated for HER2-0 and HER2-low-positive breast cancer patients who received neoadjuvant chemotherapy. Between 1998 and 2020, 10,333 patients with primary breast cancer were treated, including 1373 patients with HER2-0 or HER2-low-positive disease with neoadjuvant chemotherapy. Descriptive analyses were performed, and logistic regression models and survival analyses were calculated for disease-free survival (DFS) and overall survival (OS). Among the 1373 patients, 930 (67.73%) had HER2-low-positive and 443 (32.27%) had HER2-0 tumors. Patients with HER2-0 tumors had a significantly better pathological complete response, 29.25% vs. 20.09%, and pathological complete response/in situ, 31.97% vs. 24.08%, than patients with HER2-low-positive tumors (p < 0.001; p = 0.003), regardless of the hormone receptor (HR) status. No statistically significant differences were observed for the HR-positive (p = 0.315; p = 0.43) or HR-negative subgroups (p = 0.573; p = 0.931). DFS and OS were significantly longer for HR-positive, HER2-low-positive patients (log-rank p = 0.02; p = 0.012). OS was significantly longer for HR-negative, HER2-0 patients (log-rank p = 0.032). No significant DFS differences were found for the HR-negative cohort (log-rank p = 0.232). For the overall cohort, no significant differences were noted between HER2-low-positive and HER2-0 patients, either for DFS (log-rank p = 0.220) or OS (log-rank p = 0.403). These results show different survival outcomes for HER2-0 and HER2-low-positive tumors relative to HR status. These different cohorts can be identified using standardized immunohistochemistry, even retrospectively.
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Affiliation(s)
- Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.P.); (P.A.F.); (M.R.); (M.W.B.); (C.C.H.); (F.H.)
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.P.); (P.A.F.); (M.R.); (M.W.B.); (C.C.H.); (F.H.)
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Matthias Rübner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.P.); (P.A.F.); (M.R.); (M.W.B.); (C.C.H.); (F.H.)
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.P.); (P.A.F.); (M.R.); (M.W.B.); (C.C.H.); (F.H.)
| | - Carolin C. Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.P.); (P.A.F.); (M.R.); (M.W.B.); (C.C.H.); (F.H.)
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.P.); (P.A.F.); (M.R.); (M.W.B.); (C.C.H.); (F.H.)
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC-ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (R.E.)
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC-ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (R.E.)
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich-Alexander–Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.P.); (P.A.F.); (M.R.); (M.W.B.); (C.C.H.); (F.H.)
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8
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Stuebs FA, Dietl AK, Koch MC, Adler W, Geppert CI, Hartmann A, Knöll A, Mehlhorn G, Beckmann MW, Schulmeyer CE, Heindl F, Emons J, Seibold A, Behrens AS, Gass P. Cytology and HPV Co-Testing for Detection of Vaginal Intraepithelial Neoplasia: A Retrospective Study. Cancers (Basel) 2023; 15:4633. [PMID: 37760600 PMCID: PMC10526267 DOI: 10.3390/cancers15184633] [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: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Vaginal intraepithelial neoplasia (VaIN) is a rare premalignant disease caused by persistent human papillomavirus (HPV) infection. Diagnosing VaIN is challenging; abnormal cytology and positive HPV tests are usually the first signs, but published data on their accuracy for detecting it are rare and contradictory. The aim of this study is to compare the results of hrHPV and cytology co-testing with the histological findings of the vagina. (2) Methods: In the certified Dysplasia Unit at Erlangen University Hospital, cytology and HPV samples from the uterine cervix or vaginal wall after hysterectomy were obtained between 2015 and 2023 and correlated with histological findings in biopsies from the vaginal wall. Women without vaginal biopsy findings or concomitant cervical disease were excluded. (3) Results: In all, 279 colposcopies in 209 women were included. The histological results were: benign (n = 86), VaIN I/vLSIL (n = 116), VaIN II/vHSIL (n = 41), VaIN III/vHSIL (n = 33), and carcinoma (n = 3). Accuracy for detecting VaIN was higher in women with previous hysterectomies. Positive HPV testing during colposcopy increased the likelihood for VaIN II/III/vHSIL threefold. The detection rate for VaIN III/vHSIL was 50% after hysterectomy and 36.4% without hysterectomy. (4) Conclusions: Women with risk factors for VaIN, including HPV-16 infection or prior HPV-related disease, need careful work-up of the entire vaginal wall. Hysterectomy for HPV-related disease and a history of cervical intraepithelial neoplasia (CIN) also increased the risk for VaIN II/III/vHSIL.
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Affiliation(s)
- Frederik A. Stuebs
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Anna K. Dietl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Martin C. Koch
- Department of Gynecology and Obstetrics, Hospital ANregiomed Ansbach, Escherichstrasse 1, 91522 Ansbach, Germany;
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 6, 91054 Erlangen, Germany
| | - Carol Immanuel Geppert
- Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schlossgarten 4, 91054 Erlangen, Germany
| | - Grit Mehlhorn
- Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC) Certified Gynecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Carla E. Schulmeyer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Anja Seibold
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Annika S. Behrens
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
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9
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Schulmeyer CE, Koch MC, Dietl AK, Stuebs FA, Behrens A, Renner SK, Mehlhorn G, Geppert CC, Hartmann A, Beckmann MW, Gass P. Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program. Geburtshilfe Frauenheilkd 2023; 83:1031-1042. [PMID: 37588259 PMCID: PMC10427204 DOI: 10.1055/a-1934-1686] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/25/2022] [Indexed: 08/18/2023] Open
Abstract
Introduction Gynecologic dysplasia units and dysplasia consultations are obliged to offer diagnosis and treatment in accordance with the guidelines. The organization of the consultation process, management of patient appointments, diagnosis, and treatment algorithms are heterogeneous. The legislation arising from the new Federal Joint Committee decision, dated 22 November 2018, concerning the organized cervical cancer screening program has been in force since 1 January 2020. In this article we provide an overview of the existing structures and interdisciplinary cooperation of specialized dysplasia units incorporated in certified gynecologic cancer center. Materials and Methods We carried out a retrospective database search of data collected prospectively from 1 July 2014 to 31 December 2019 at the dysplasia unit at the Department of Gynecology and Obstetrics, Erlangen University Hospital, which was the first dysplasia unit to be certified in 2014. Results A total of 5594 patients presented at the unit, and 16061 colposcopic, vulvoscopic, and anoscopic examinations were performed. Approximately 4100 examinations of the cervix, vagina, vulva, and anus are carried out each year, 1600 of these were exclusively cervix colposcopies. A total of 12197 cytology results were assessed, as well as 4850 histology results, and 8193 high-risk HPV tests. The quality indicators required by the dysplasia unit for annual recertification were met each year. Conclusion Certified dysplasia units and consultations form the central component in the algorithm for further investigating abnormal screening results; but they are also the first point of contact for a large number of patients with acute or chronic complaints in the genital region.
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Affiliation(s)
- Carla E. Schulmeyer
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Martin C. Koch
- Klinik für Gynäkologie und Geburtshilfe, ANregiomed Klinikum Ansbach, Ansbach, Germany
| | - Anna K. Dietl
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Frederik A. Stuebs
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Annika Behrens
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Simone K. Renner
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
| | - Grit Mehlhorn
- Frauenarztpraxis, DKG und AGCPC zertifizierte Dysplasiesprechstunde, Frauenarztpraxis Erlangen, Erlangen, Germany
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Carol C. Geppert
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartmann
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W. Beckmann
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Paul Gass
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
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10
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Stuebs FA, Koch MC, Dietl AK, Schulmeyer CE, Behrens AS, Seibold A, Adler W, Geppert C, Hartman A, Knoll A, Beckmann MW, Gass P, Mehlhorn G. Management of Cervical Intraepithelial Neoplasia in Pregnant Women. Anticancer Res 2023; 43:3153-3158. [PMID: 37352006 DOI: 10.21873/anticanres.16488] [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: 04/22/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIM The aims of the present study were to evaluate the accuracy of colposcopic findings, investigate the way in which untreated cervical intraepithelial neoplasia (CIN) 2/3 develops during pregnancy, and identify factors associated with regression, persistence, or progression rates. PATIENTS AND METHODS In a tertiary gynecology and obstetrics department, 655 pregnant women were seen for colposcopy. The most common reason for referral was abnormal cytology findings. The follow-up findings were analyzed retrospectively on the basis of colposcopic findings and cytological and histological tests. RESULTS The rate of accuracy for major colposcopic findings was 89.2%. Among the colposcopic findings considered "suspicious for invasion" were invasive carcinoma in 42.9% and CIN 3 in 57.1%. The persistence of CIN 3 postpartum was 80% and the rate of progression 4.1%. The rate of regression for CIN 3 was 21.9%. For CIN 2, the rate of persistence was 37.5%, with a regression rate of 31.3%. The rate of regression was higher after vaginal delivery in comparison with caesarean section. CONCLUSION The accuracy rate of colposcopy is comparatively high, at 89.2%. This might be because pregnant women are seen by more experienced examiners in our dysplasia unit. The rate of progression is comparable with that in other studies. Vaginal delivery increases the regression rate. The newborns' birth weight or birth week did not affect the rates of regression or persistence.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany;
| | - Martin C Koch
- Department of Gynecology and Obstetrics, ANregiomed Ansbach Hospital, Ansbach, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Annika S Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Anja Seibold
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartman
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Antje Knoll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC) certified Gynecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, Erlangen, Germany
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11
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Tempfer C, Horn LC, Ackermann S, Dittrich R, Einenkel J, Günthert A, Haase H, Kratzsch J, Kreißl M, Polterauer S, Ebert A, Steiner E, Thiel F, Eichbaum M, Fehm T, Koch MC, Gass P. Gestational and Non-gestational Trophoblastic Neoplasia. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 032/049, April 2022). Geburtshilfe Frauenheilkd 2023; 83:267-288. [PMID: 37020431 PMCID: PMC10070003 DOI: 10.1055/a-1904-6461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 03/11/2023] Open
Abstract
Abstract
Purpose The aim was to develop and update a guideline which would improve the quality of care offered to women with gestational and non-gestational trophoblastic disease, a group of diseases characterized by their rarity and biological heterogeneity.
Methods In accordance with the method used to compile S2k-guidelines, the guideline authors carried out a search of the literature (MEDLINE) for the period 1/2020 to 12/2021 and evaluated the recent literature. No key questions were formulated. No structured literature search with methodical evaluation and assessment of the level of evidence was carried out. The text of the precursor version of the guideline from 2019 was updated based on the most recent literature, and new statements and recommendations were drafted.
Recommendations The updated guideline contains recommendations for the diagnosis and therapy of women with hydatidiform mole (partial and complete moles), gestational trophoblastic neoplasia after pregnancy or without prior pregnancy, persistent trophoblastic disease after molar pregnancy, invasive moles, choriocarcinoma, placental site nodules, placental site trophoblastic tumor, hyperplasia at the implantation site und epithelioid trophoblastic tumor. Separate chapters cover the determination and assessment of human chorionic gonadotropin (hCG), histopathological evaluation of specimens, and the appropriate molecular pathological and immunohistochemical diagnostic procedures. Separate chapters on immunotherapy, surgical therapy, multiple pregnancies with simultaneous trophoblastic disease, and pregnancy after trophoblastic disease were formulated, and the corresponding recommendations agreed upon.
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Affiliation(s)
- Clemens Tempfer
- Universitätsfrauenklinik der Ruhr-Universität Bochum, Marienhospital Herne, Bochum/Herne, Germany
| | | | - Sven Ackermann
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Darmstadt, Darmstadt, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jens Einenkel
- Klinik für Frauenheilkunde und Geburtshilfe, Sana-Kliniken Leipziger Land, Leipzig, Germany
| | | | | | - Jürgen Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Michael Kreißl
- Universitätsklinik für Radiologie und Nuklearmedizin, Klinikum Magdeburg, Magdeburg, Germany
| | | | - Andreas Ebert
- Praxis für Gynäkologie und Geburtshilfe, Berlin, Germany
| | - Eric Steiner
- Frauenklinik, GPR-Klinikum Rüsselsheim, Rüsselsheim, Germany
| | - Falk Thiel
- Frauenklinik, Klinik am Eichert, Göppingen, Germany
| | - Michael Eichbaum
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Dr. Horst-Schmidt-Kliniken Wiesbaden, Wiesbaden, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Martin C. Koch
- Klinik für Gynäkologie und Geburtshilfe, Ansbach, Germany
| | - Paul Gass
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg (CCC ER-EMN), Erlangen, Germany
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12
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Schulmeyer CE, Fasching PA, Häberle L, Meyer J, Schneider M, Wachter D, Ruebner M, Pöschke P, Beckmann MW, Hartmann A, Erber R, Gass P. Expression of the Immunohistochemical Markers CK5, CD117, and EGFR in Molecular Subtypes of Breast Cancer Correlated with Prognosis. Diagnostics (Basel) 2023; 13:diagnostics13030372. [PMID: 36766486 PMCID: PMC9914743 DOI: 10.3390/diagnostics13030372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Molecular-based subclassifications of breast cancer are important for identifying treatment options and stratifying the prognosis in breast cancer. This study aimed to assess the prognosis relative to disease-free survival (DFS) and overall survival (OS) in patients with triple-negative breast cancer (TNBC) and other subtypes, using a biomarker panel including cytokeratin 5 (CK5), cluster of differentiation 117 (CD117), and epidermal growth factor receptor (EGFR). This cohort-case study included histologically confirmed breast carcinomas as cohort arm. From a total of 894 patients, 572 patients with early breast cancer, sufficient clinical data, and archived tumor tissue were included. Using the immunohistochemical markers CK5, CD117, and EGFR, two subgroups were formed: one with all three biomarkers negative (TBN) and one with at least one of those three biomarkers positive (non-TBN). There were significant differences between the two biomarker subgroups (TBN versus non-TBN) in TNBC for DFS (p = 0.04) and OS (p = 0.02), with higher survival rates (DFS and OS) in the non-TBN subgroup. In this study, we found the non-TBN subgroup of TNBC lesions with at least one positive biomarker of CK5, CD117, and/or EGFR, to be associated with longer DFS and OS.
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Affiliation(s)
- Carla E. Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Michael Schneider
- Würzburg University Hospital, Institut für Pathologie, Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
| | - David Wachter
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
- Institute of Pathology, Weiden Hospital, Weiden in der Oberpfalz, 92637 Weiden in der Oberpfalz, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-(0)9131-85-33553; Fax: +49-(0)9131-85-33938
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13
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Stuebs FA, Mergel F, Koch MC, Dietl AK, Schulmeyer CE, Adler W, Geppert C, Hartman A, Knöll A, Beckmann MW, Gass P, Mehlhorn G. Cervical intraepithelial neoplasia grade 3: development during pregnancy and postpartum. Arch Gynecol Obstet 2022; 307:1567-1572. [PMID: 36271921 PMCID: PMC10110634 DOI: 10.1007/s00404-022-06815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aims of the present study were to evaluate the development of untreated cervical intraepithelial neoplasia (CIN) 3 during pregnancy and to assess persistence, progression, and regression rates postpartum to identify factors associated with regression. METHODS In a tertiary gynecology and obstetrics department, a total of 154 pregnant women with CIN 3 were treated in the dysplasia unit. The follow-up findings were analyzed retrospectively on the basis of histological, cytological, and human papillomavirus (HPV) testing of 154 pregnant women confirmed as having CIN 3 in colposcopically guided biopsies. RESULTS The rates of persistence, regression, and progression of CIN 3 in these women were 76.1%, 20% and 3.2%, respectively. Data for the delivery mode was available for 126 women. The rate of regression was almost twice as high with vaginal delivery as with cesarean section, at 27.4 vs. 15.2%, whereas the rate of progression was lower with vaginal delivery, at 2.7 vs. 6.5%. CONCLUSION The rate of persistence of CIN observed in this study is comparable to that reported in other studies. The study provides strong evidence for greater regression among women who have vaginal deliveries. Careful work-up is recommended postpartum for this group of women in order to rule out persistent CIN 3 or invasive disease.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Franziska Mergel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
- Department of Gynecology and Obstetrics, Ulm University Hospital, Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartman
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
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14
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Hampl M, Jaeger A, Eulenburg C, Prieske K, Hambrecht J, Fuerst S, Klapdor R, Heublein S, Gass P, Rohner A, Canzler U, Becker S, Bommert M, Bauerschlag D, Denecke A, Hanker L, Sehouli J, Dannecker C, Mahner S, Woelber L. 561P When to treat the pelvis in node-positive vulvar cancer: Results from the AGO-VOP.2 QS vulva study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Stuebs FA, Koch MC, Dietl AK, Adler W, Geppert C, Hartmann A, Knöll A, Beckmann MW, Mehlhorn G, Schulmeyer CE, Gass P. Cytology and High-Risk Human Papillomavirus Test for Cervical Cancer Screening Assessment. Diagnostics (Basel) 2022; 12:diagnostics12071748. [PMID: 35885651 PMCID: PMC9318141 DOI: 10.3390/diagnostics12071748] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background: A new nationwide screening strategy was implemented in Germany in January 2020. No data are available for women referred to certified dysplasia units for secondary clarification after primary diagnosis by a local physician. We therefore investigated combined testing with Papanicolaou smears and high-risk human papillomavirus (hrHPV) and compared the data with the final histological findings. Methods: Between January 2015 and October 2020, all referred women who underwent colposcopy of the uterine cervix in our certified dysplasia unit were included. Cytology findings were classified using the Munich III nomenclature. Results: A total of 3588 colposcopies were performed in 3118 women, along with Pap smear and hrHPV co-testing, followed by histology. Women with Pap II-p (ASC-US) and a positive hrHPV co-test had a 22.4% risk for cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesion (HSIL). The risk of CIN 3/HSIL was 83.8% in women with Pap IVa-p (HSIL) and a positive hrHPV co-test. A positive hrHPV co-test increased the risk for HSIL+ (OR 5.942; 95% CI, 4.617 to 7.649; p < 0.001) as compared to a negative hrHPV co-test. Conclusions: The accuracy of Pap smears is comparable with the screening results. A positive hrHPV test increases the risk for HSIL+ fivefold. Colposcopy is necessary to diagnose HSIL+ correctly.
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Affiliation(s)
- Frederik A. Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
- Correspondence:
| | - Martin C. Koch
- Department of Gynecology and Obstetrics, Hospital ANregiomed Ansbach, Escherichstraße 1, 91522 Ansbach, Germany;
| | - Anna K. Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 6, 91054 Erlangen, Germany;
| | - Carol Geppert
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany; (C.G.); (A.H.); (G.M.)
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany; (C.G.); (A.H.); (G.M.)
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schlossgarten 4, 91054 Erlangen, Germany;
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
| | - Grit Mehlhorn
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany; (C.G.); (A.H.); (G.M.)
- Gynecology Consultancy Practice, German Cancer Society [DKG] and Committee on Cervical Pathology and Colposcopy [AG-CPC] Certified Gynaecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, Neustädter Kirchenplatz 1a, 91054 Erlangen, Germany
| | - Carla E. Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
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16
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Stumpfe FM, Faschingbauer F, Kehl S, Pretscher J, Emons J, Gass P, Mayr A, Schmid M, Beckmann MW, Stelzl P. Amniotic-Umbilical-to-Cerebral Ratio - A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term. Ultraschall Med 2022; 43:159-167. [PMID: 32722822 DOI: 10.1055/a-1205-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Introduction of a novel ratio - the amniotic-umbilical-to-cerebral ratio (AUCR) - to predict adverse perinatal outcome in SGA fetuses at term and comparison of its predictive accuracy with established parameters. MATERIALS AND METHODS This retrospective cohort study included 165 singleton pregnancies with SGA fetuses (birth weight < 10th percentile) at term. Cases with planned vaginal delivery and documented pulsatility indices (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and single deepest pocket (SDP) were included. CPR was calculated as the ratio between MCA PI and UA PI, UCR as the ratio between UA PI and MCA PI. AUCR was defined as follows: SDP/(UA PI/MCA PI). Adverse perinatal outcomes were defined as operative intervention (OI), OI due to fetal distress, admission to the neonatal intensive care unit (NICU), and composite adverse perinatal outcome (CAPO). Associations between Doppler parameters and these outcomes were estimated using regression analyses. RESULTS OI was statistically significantly associated with UCR, SDP, and AUCR, whereas no association was observed for UA PI, MCA PI, and CPR. Fetuses requiring OI due to fetal distress revealed a significantly higher UA PI and UCR as well as a lower MCA PI, CPR, and AUCR. With regard to NICU admission and CAPO, a significantly higher UA PI and lower CPR were found. Furthermore, a significant association was shown for SDP, UCR, and AUCR. AUCR achieved the best area under the curve for all outcome parameters. CONCLUSION AUCR leads to an improvement in the prediction of unfavorable outcome in SGA fetuses at term. Furthermore, results of our study show that UCR might be superior to CPR.
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Affiliation(s)
| | | | - Sven Kehl
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Jutta Pretscher
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Julius Emons
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Paul Gass
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Germany
| | | | - Patrick Stelzl
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
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17
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Woelber L, Hampl M, zu Eulenburg C, Prieske K, Hambrecht J, Fuerst S, Klapdor R, Heublein S, Gass P, Rohner A, Canzler U, Becker S, Bommert M, Bauerschlag D, Denecke A, Hanker L, Runnebaumn I, Forner DM, Schochter F, Klar M, Schwab R, Koepke M, Kalder M, Hantschmann P, Ratiu D, Denschlag D, Schroeder W, Tuschy B, Baumann K, Mustea A, Soergel P, Bronger H, Bauerschmitz G, Kosse J, Koch MC, Ignatov A, Sehouli J, Dannecker C, Mahner S, Jaeger A. Risk for Pelvic Metastasis and Role of Pelvic Lymphadenectomy in Node-Positive Vulvar Cancer-Results from the AGO-VOP.2 QS Vulva Study. Cancers (Basel) 2022; 14:cancers14020418. [PMID: 35053582 PMCID: PMC8773532 DOI: 10.3390/cancers14020418] [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: 12/10/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary In node-positive vulvar squamous cell cancer, questions of when and how to perform pelvic lymphadenectomy (LAE) as well as the optimal extent of pelvic treatment in general have been surrounded by considerable controversy. In Germany, systematic pelvic LAE is currently recommended as a staging procedure in patients at risk for pelvic nodal involvement in order to prevent morbidity caused by pelvic radiotherapy (RT) in patients without histologically-confirmed pelvic involvement. However, the population at risk for pelvic metastases remains insufficiently described, resulting in the potential overtreatment of a considerable proportion of patients with groin-positive disease. This applies to the indication to perform surgical staging but also to adjuvant RT of the pelvis without previous pelvic staging. Our study aims to describe the risk for pelvic lymph node metastasis with regard to positive groin nodes and to clarify the indication criteria for pelvic treatment in node-positive vulvar cancer. Abstract The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
- Colposcopy Center at the Jerusalem Hospital Hamburg, 20357 Hamburg, Germany
- Correspondence:
| | - Monika Hampl
- Department of Gynecology, University Medical Center Duesseldorf, 40225 Duesseldorf, Germany;
| | - Christine zu Eulenburg
- Department of Epidemiology, UMCG, Universität Groningen, 9713 Groningen, The Netherlands;
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
- Colposcopy Center at the Jerusalem Hospital Hamburg, 20357 Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Johanna Hambrecht
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
| | - Sophie Fuerst
- Department of Obstetrics and Gynecology, University Hospital, LMU—University of Munich, 80377 Munich, Germany; (S.F.); (S.M.)
| | - Ruediger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, 30625 Hannover, Germany;
| | - Sabine Heublein
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Annika Rohner
- Department of Gynecology, University Medical Center Tuebingen, 72076 Tuebingen, Germany;
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany & National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany;
| | - Sven Becker
- Department of Gynecology and Obstetrics, University Medical Center Frankfurt, 60590 Frankfurt, Germany;
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, 45136 Essen, Germany;
| | - Dirk Bauerschlag
- Department of Gynecology, University Medical Center Kiel, 24105 Kiel, Germany;
| | - Agnieszka Denecke
- Department of Gynecology, Medical Center Wolfsburg, 38440 Wolfsburg, Germany;
| | - Lars Hanker
- Department of Gynecology and Gynecologic Oncology, University Medical Center Luebeck, 23562 Luebeck, Germany;
| | - Ingo Runnebaumn
- Department of Gynecology, Jena University Hospital, 07743 Jena, Germany;
| | - Dirk M. Forner
- Department of Gynecology, Evangelisches Krankenhaus Kalk, 51103 Cologne, Germany;
| | - Fabienne Schochter
- Department of Obstetrics and Gynecology, University of Ulm Medical Center, 89081 Ulm, Germany;
| | - Maximilian Klar
- Department of Gynecology, University Medical Center Freiburg, 79106 Freiburg, Germany;
| | - Roxana Schwab
- Department of Gynecology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Melitta Koepke
- Department of Obstetrics and Gynaecology, University Hospital Augsburg, 86156 Augsburg, Germany; (M.K.); (C.D.)
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Hospital Marburg, 35043 Marburg, Germany;
| | - Peer Hantschmann
- Department of Gynecology and Obstetrics, Medical Center Altoetting, 84503 Altoetting, Germany;
| | - Dominik Ratiu
- Department of Gynecology, University Medical Center Koeln, 50937 Koeln, Germany;
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunuskliniken, 61352 Bad Homburg, Germany;
| | - Willibald Schroeder
- Department of Gynecology, Medical Center Gynaecologicum Bremen, 28209 Bremen, Germany;
| | - Benjamin Tuschy
- Department of Gynecology, University Medical Center Mannheim, 68167 Mannheim, Germany;
| | - Klaus Baumann
- Department of Gynecology, Medical Center Ludwigshafen, 67063 Ludwigshafen, Germany;
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, 53127 Bonn, Germany;
| | - Philipp Soergel
- Department of Gynecology, University Medical Center Minden, 32429 Minden, Germany;
| | - Holger Bronger
- Department of Gynecology and Obstetrics, Technical University of Munich, 81675 Munich, Germany;
| | - Gerd Bauerschmitz
- Department of Gynecology, University Medical Center Goettingen, 37075 Goettingen, Germany;
| | - Jens Kosse
- Department of Gynecology, Sana Klinikum Offenbach, 63069 Offenbach am Main, Germany;
| | - Martin C. Koch
- Department of Gynecology, Medical Center Ansbach, 91522 Ansbach, Germany;
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological SurgeryNOGGO e.V., Charite Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany;
| | - Christian Dannecker
- Department of Obstetrics and Gynaecology, University Hospital Augsburg, 86156 Augsburg, Germany; (M.K.); (C.D.)
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU—University of Munich, 80377 Munich, Germany; (S.F.); (S.M.)
| | - Anna Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
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18
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Heindl F, Fasching PA, Hein A, Hack CC, Heusinger K, Gass P, Pöschke P, Stübs FA, Schulz-Wendtland R, Hartmann A, Erber R, Beckmann MW, Meyer J, Häberle L, Jud SM, Emons J. Mammographic density and prognosis in primary breast cancer patients. Breast 2021; 59:51-57. [PMID: 34157655 PMCID: PMC8237359 DOI: 10.1016/j.breast.2021.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Mammographic density (MD) is one of the strongest risk factors for breast cancer (BC). However, the influence of MD on the BC prognosis is unclear. The objective of this study was therefore to investigate whether percentage MD (PMD) is associated with a difference in disease-free or overall survival in primary BC patients. METHODS A total of 2525 patients with primary, metastasis-free BC were followed up retrospectively for this analysis. For all patients, PMD was evaluated by two readers using a semi-automated method. The association between PMD and prognosis was evaluated using Cox regression models with disease-free survival (DFS) and overall survival (OS) as the outcome, and the following adjustments: age at diagnosis, year of diagnosis, body mass index, tumor stage, grading, lymph node status, hormone receptor and HER2 status. RESULTS After median observation periods of 9.5 and 10.0 years, no influence of PMD on DFS (p = 0.46, likelihood ratio test (LRT)) or OS (p = 0.22, LRT), respectively, was found. In the initial unadjusted analysis higher PMD was associated with longer DFS and OS. The effect of PMD on DFS and OS disappeared after adjustment for age and was caused by the underlying age effect. CONCLUSIONS Although MD is one of the strongest independent risk factors for BC, in our collective PMD is not associated with disease-free and overall survival in patients with BC.
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Affiliation(s)
- Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Frederik A Stübs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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19
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Fleisch MC, Bader W, Balzer K, Bennefeld L, Boeing C, Bremerich D, Gass P, Geissbuehler V, Koch MC, Nothacker MJ, Pietzner K, Renner SP, Römer T, Roth S, Schütz F, Schulte-Mattler W, Sehouli J, Lippach K, Tamussino K, Teichmann A, Tempfer C, Thill M, Tinneberg HR, Zarras K. The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020). Geburtshilfe Frauenheilkd 2021; 81:447-468. [PMID: 33867563 DOI: 10.1055/a-1378-4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose Positioning injuries are relatively common, forensically highly relevant complications of gynecologic surgery. The aim of this official AWMF S2k-guideline is to provide statements and recommendations on how to prevent positioning injuries using the currently available literature. The literature was evaluated by an interdisciplinary group of experts from professional medical societies. The consensus on recommendations and statements was achieved in a structured consensus process. Method The current guideline is based on the expired S1-guideline, which was updated by a systematic search of the literature and a review of relevant publications issued between February 2014 and March 2019. Statements were compiled and voted on by a panel of experts. Recommendations The guideline provides general and specific recommendations on the prevention, diagnosis and treatment of positioning injuries.
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Affiliation(s)
- Markus C Fleisch
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Werner Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Kai Balzer
- Klinik für Gefäßchirurgie, GFO Kliniken, Bonn, Germany
| | - Luisa Bennefeld
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Carsten Boeing
- Klinik für Gynäkologie und Geburtshilfe, AMEOS Klinikum St. Clemens Oberhausen, Oberhausen, Germany
| | | | | | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Monika J Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Universität Marburg, Marburg, Germany
| | - Klaus Pietzner
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Römer
- Frauenklinik, Evangelisches Krankenhaus Weyertal, Köln, Germany
| | - Stephan Roth
- Klinik für Urologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | | | - Jalid Sehouli
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Lippach
- Pflegewissenschaften und Praxisentwicklung, LMU München, München, Germany
| | - Karl Tamussino
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria
| | - Alexander Teichmann
- Sichuan Center for Gynaecology and Breast Surgery, Dept. of Perinatal Medicine, Medical University of Southwest China, Luzhou (Sichuan), China
| | - Clemens Tempfer
- Klinik für Frauenheilkunde und Geburtshilfe, Marienhospital Herne, Universitätsklinikum Bochum, Bochum/Herne, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Konstantinos Zarras
- Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie des VVKD Marienhospitals Düsseldorf, Düsseldorf, Germany
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20
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Stuebs FA, Gass P, Dietl AK, Schulmeyer CE, Adler W, Geppert C, Hartmann A, Knöll A, Beckmann MW, Koch MC. Human papilloma virus genotype distribution in women with premalignant or malignant lesions of the uterine cervix. Arch Gynecol Obstet 2021; 304:751-758. [PMID: 33538863 DOI: 10.1007/s00404-021-05986-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cervical cancer is caused by persistent infection with high-risk human papillomavirus (hrHPV). Cytology-based national screening programs have reduced the incidence and mortality of cervical cancer. Different hrHPV subtypes have different carcinogenic potentials. This study evaluated the distribution of different types of hrHPV relative to age in cervical cancer and its precursor lesions. METHODS HPV testing was performed between November 2018 and February 2020 using the Abbott RealTime high-risk HPV assay on an Abbott m2000sp instrument. This assay separately detects HPV-16, HPV-18, and a pool of 12 additional hrHPV types (HPV-31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68). RESULTS The study included 652 women with HPV samples and biopsies of the cervix or histology samples obtained during surgery. In all, 30.8% (95% CI, 27.3-34.6%) were HPV-negative. Among HPV-positive women, HPV-16, HPV-18, and "HPV other" types were found in 33.5, 4.4, and 49.4%, respectively. Cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesions (HSILs) in women ≤ 34 years were positive for HPV-16 in 54.5% of cases and in those ≥ 35 years in 45.4% of cases. Among women with cervical cancer, 75.8% were infected with HPV-16 or had coinfection with HPV-16 and "HPV other". CONCLUSIONS HPV-16 is the most common type of hrHPV in HSIL + lesions. It is more common in women diagnosed with CIN 3/HSIL who are aged ≤ 35 and is decreasing with age. Therefore, women age ≥ 35 with persistent infection with this type of hrHPV need careful surveillance, as they are at high risk of progression to cervical cancer.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 6, 91054, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Schlossgarten 4, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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21
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Stübs FA, Mehlhorn G, Gass P, Schulmeyer CE, Adler W, Strehl J, Hartmann A, Beckmann MW, Renner SK, Koch MC. Accuracy of vulvoscopic findings in detecting early vulvar neoplasia. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- FA Stübs
- Universitätsklinikum Erlangen, Frauenklinik
| | - G Mehlhorn
- Universitätsklinikum Erlangen, Frauenklinik
| | - P Gass
- Universitätsklinikum Erlangen, Frauenklinik
| | | | - W Adler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE)
| | | | - A Hartmann
- Universitätsklinikum Erlangen, Pathologie
| | | | - SK Renner
- Kliniken Böblingen, Frauenklinik, Böblingen
| | - MC Koch
- Universitätsklinikum Erlangen, Frauenklinik
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22
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FA S, Adler W, MW B, Gass P, Hartmann A, Mehlhorn G, SK R, CE S, Strehl J, Koch MC. Accuracy of colposcopic findings in detecting vaginal intraepithelial neoplasia: a retrospective study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Stübs FA
- Universitätsklinikum Erlangen, Frauenklinik
| | - W Adler
- Universitätsklinikum Erlangen, Frauenklinik
| | | | - P Gass
- Universitätsklinikum Erlangen, Frauenklinik
| | - A Hartmann
- Universitätsklinikum Erlangen, Pathologie
| | - G Mehlhorn
- Universitätsklinikum Erlangen, Frauenklinik
| | | | | | | | - MC Koch
- Universitätsklinikum Erlangen, Frauenklinik
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23
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Wuerfel FM, Huebner H, Häberle L, Gass P, Hein A, Jud SM, Hack CC, Wunderle M, Schulz-Wendtland R, Erber R, Hartmann A, Ekici AB, Beckmann MW, Fasching PA, Ruebner M. HLA-G and HLA-F protein isoform expression in breast cancer patients receiving neoadjuvant treatment. Sci Rep 2020; 10:15750. [PMID: 32978482 PMCID: PMC7519664 DOI: 10.1038/s41598-020-72837-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
The immunosuppressive human leukocyte antigens HLA-G and HLA-F are expressed on trophoblast and malignant cells. Four membrane-bound and three soluble HLA-G protein isoforms have been described, which have different immunosuppressive potentials. HLA-F has three transcript variants, resulting in three different protein isoforms. The aim of this study was to evaluate the prognostic and predictive value of HLA-G and HLA-F protein isoform expression patterns in patients with breast cancer. Core biopsies were taken at diagnosis in patients with HER2+ (n = 28), luminal B-like (n = 49) and triple-negative (n = 38) breast cancers who received neoadjuvant chemotherapy. Expression levels of HLA-F and -G were correlated with the pathological complete response (pCR). Protein expression was determined by Western blot analysis, using two antibodies for each HLA, specific for different isoforms. The protein expression of HLA isoforms did not significantly differ between breast cancer subtypes. However, some initial indications were found for an association between the soluble HLA-G6 protein isoform and pCR in HER2+ breast cancer. The study provides preliminary evidence for the evaluation of HLA-G isoform expression, in particular HLA-G6, as a possible new marker for pCR in HER2+ breast cancer.
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Affiliation(s)
- Franziska M Wuerfel
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Hanna Huebner
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Universitätsstrasse 21-23, 91054, Erlangen, Germany.
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24
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Lux MP, Wasner S, Meyer J, Häberle L, Hack CC, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Krebs J, Erim Y, Beckmann MW, Loehberg CR. Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center Regarding Consensus between the First and Second Opinion and Conformity with the Guidelines. Breast Care (Basel) 2020; 16:291-298. [PMID: 34248471 DOI: 10.1159/000509127] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Oncological second opinions are becoming increasingly important in the era of complex treatments and established certified cancer centers. Oncological guidelines with the highest levels of evidence are available, but these can only be effective to the extent that they are implemented. Therefore, we analyzed the effects of second opinions with regard to their agreement with first opinions and conformity with guidelines. Methods In 164 patients with a diagnosis of breast cancer or gynecological malignancy who requested a second opinion, the first and second opinions, established at the interdisciplinary tumor conference, and conformity with the guidelines were evaluated. Results The first opinion was not in agreement with the guidelines in 34.8% (15.2% diagnosis, 12.8% surgical therapy, 13.4% systemic therapy, and 5.5% radiotherapy), and the recommendations were optimized in the second opinion in 56.7% (28.7% diagnosis, 15.9% surgical therapy, 30.5% systemic therapy, and 8.5% radiotherapy). Conclusions Oncological second opinions showed significant effects and one-third of first opinions were not in conformity with the guidelines. In a significant proportion of cases, the existing treatment plan was changed or supplemented to allow modern and individualized treatment approaches.
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Affiliation(s)
- Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women's Hospital St. Louise, and St. Josefs-Krankenhaus Salzkotten, St. Vincenz Hospital GmbH Paderborn, Paderborn, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sainab Egloffstein
- Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg (CCC Erlangen-EMN), Erlangen, Germany
| | - Jessica Krebs
- Department of Psychosomatic and Psychotherapeutic, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic and Psychotherapeutic, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg (CCC Erlangen-EMN), Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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25
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Wunderle M, Häberle L, Hein A, Jud SM, Lux MP, Hack CC, Emons J, Heindl F, Nabieva N, Loehberg CR, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA, Gass P. Influence of Family History of Breast or Ovarian Cancer on Pathological Complete Response and Long-Term Prognosis in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Breast Care (Basel) 2020; 16:254-262. [PMID: 34248466 DOI: 10.1159/000507475] [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: 09/11/2019] [Accepted: 03/24/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose In breast cancer, a pathological complete response (pCR) has been described as generally resulting in a favorable prognosis. However, there are subgroups, such as patients with a mutation in BRCA1 or BRCA2, in which the effect of pCR on the prognosis is suspected to be weaker. Patients with a family history of breast and/or ovarian cancer may therefore react differently in relation to pCR and prognosis, and this is investigated in this study. Patients and Methods Breast cancer patients were identified from a clinical breast cancer registry. The study subjects had been treated with neoadjuvant chemotherapy from 2001 to 2018 and their pathological and clinical information as well as medical family history were available. They were considered to have a positive family history if they had at least 1 first-degree relative with breast and/or ovarian cancer. Multivariate logistic regression analyses were performed to study the association between family history, pCR (ypT0; ypN0), and disease-free survival (DFS). Results Of 1,480 patients, 228 (15.4%) had a positive family history. The pCR rates were 24.9% in all patients, and 24.4% and 27.6% in those without/with a family history, respectively. Family history was not associated with a higher pCR rate (adjusted odds ratio [OR] 1.23; 95% confidence interval [CI] 0.85-1.76; p = 0.27) or a different disease-free survival (DFS; adjusted hazard ratio [HR] 1.15; 95% CI 0.88-1.52; p = 0.30). pCR did not affect the prognosis differently in relation to family history. Conclusions In this retrospective analysis, family history was not associated with pCR and DFS. pCR improved survival, independently of family history.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise Paderborn, Women's Hospital St. Josefs-Krankenhaus Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Hack CC, Wasner S, Meyer J, Häberle L, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Beckmann MW, Lux MP, Loehberg CR. Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center in Relation to Complementary and Alternative Medicine. Complement Med Res 2020; 27:431-439. [PMID: 32544918 DOI: 10.1159/000508235] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Oncological second opinions are becoming increasingly important given more complex treatment strategies, simultaneously more patients use complementary and alternative medicine (CAM), and many comprehensive cancer centers initiate integrative medicine programs. The present study focuses on analyzing the effects of a second opinion in relation to attitudes toward CAM. METHODS In this prospective study patients (n = 97) with a diagnosis of breast cancer or gynecological malignancies who had requested a second opinion received a questionnaire before and after the second opinion concerning their attitudes toward CAM. RESULTS The majority of patients had breast cancer (72.2%, n = 70). Only 6.2% (n = 6) stated that they had been informed about CAM by the doctors who treated them first, 21.6% (n = 21) had received information about it when seeking the second opinion. After the first opinion, 42.3% (n = 41) wanted to try CAM, the same proportion trusted orthodox medicine alone. After the second opinion, 24 patients (24.7%) wanted to try CAM, while 38.1% (n = 37) relied exclusively on orthodox medicine. There was a significant correlation between an increased patients' need for information and interest in CAM (p = 0.02). CONCLUSIONS Today, aspects of CAM still are very often no part of oncological first and second opinions. This might hence lead to discouraging patients to try out CAM and therefore integrative medicine programs in comprehensive cancer centers might be problem-solving.
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Affiliation(s)
- Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany
| | - Sainab Egloffstein
- Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany.,Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women's Hospital St. Louise, Paderborn, Women's Hospital St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, St. Vincenz Hospital, Paderborn, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Erlangen, Germany,
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27
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Loehberg CR, Meyer J, Häberle L, Hack CC, Jud S, Hein A, Wunderle M, Emons J, Gass P, Fasching PA, Egloffstein S, Krebs J, Erim Y, Beckmann MW, Lux MP, Wasner S. Analysis of motives and patient satisfaction in oncological second opinions provided by a certified university breast and gynecological cancer center. Arch Gynecol Obstet 2020; 301:1299-1306. [PMID: 32274639 PMCID: PMC7181428 DOI: 10.1007/s00404-020-05525-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/28/2020] [Indexed: 01/08/2023]
Abstract
Purpose Second opinions in oncology are becoming increasingly important in an era of more complex treatments and a growing demand for information by patients. Therefore, we analyzed their effects and influencing factors like patients’ motives, subjective extent of information and satisfaction with communications. Methods This prospective study evaluated second opinions for patients with breast cancer or gynecological malignancy. The patients received a questionnaire before and two months after, which inquired expectations, reasons, and satisfaction with the second opinion and the attending physicians. Results A total of 164 patients were included and the majority had breast cancer (75.0%). Receiving the second opinion made 89.7% feel better informed, their need for information decreased (from 75.3% to 39.2%, P < 0.0001), and satisfaction with doctor–patient communications increased (from 61.9 to 91.8%, P = 0.0002). There were various reasons for requesting a second opinion, e.g., the extremely stressful situation of a cancer diagnosis, hope for change in the treatment recommendation or dissatisfaction with the initial physicians. Conclusions Second opinions can lead to significantly greater patient satisfaction, meeting the need for information and leading to better management of patients in the extremely stressful situation of a cancer diagnosis. Doctor–patient communications play a key role. Electronic supplementary material The online version of this article (10.1007/s00404-020-05525-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.
| | - Julia Meyer
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
| | - Sainab Egloffstein
- Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Jessica Krebs
- Psychosomatic and Psychotherapeutic Department, Erlangen University Hospital, Erlangen, Germany
| | - Yesim Erim
- Psychosomatic and Psychotherapeutic Department, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.,Office of the CCC Erlangen-EMN (Comprehensive Cancer Center of the European Metropolitan Region of Nuremberg-Erlangen), Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany.,Breast and Gynecological Cancer Center, Women´s Hospital St. Louise, Paderborn, Women´s Hospital St. Josefs-Krankenhaus, Salzkotten, Frauen- und Kinderklinik St. Louise, St. Vincenz Hospital, Paderborn, Germany
| | - Sonja Wasner
- Department of Gynecology, Erlangen University Hospital, University Breast Center and University Gynecological Cancer Center for Franconia, Universitaetsstr. 21-23, 91054, Erlangen, Germany
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28
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Stuebs FA, Mehlhorn G, Gass P, Schulmeyer CE, Adler W, Strehl J, Hartman A, Beckmann MW, Renner SK, Koch MC. Concordance rate of vulvoscopic findings in detecting early vulvar neoplasia. Gynecol Oncol 2020; 157:463-468. [PMID: 32107046 DOI: 10.1016/j.ygyno.2020.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Colposcopy-guided punch biopsy is a cornerstone method for diagnosing vulvar diseases. The aim of this study was to evaluate the concordance rate of clinical findings in vulvar diseases during examinations, in comparison with colposcopy-directed punch biopsy. We also developed a new classification to simplify the categorization of vulvoscopic findings. METHODS The concordance rate of the clinical findings was compared with the final histology results from punch biopsies. The data were collected between January 2014 and May 2017 at the Erlangen University Hospital. RESULTS A total of 482 colposcopy-directed punch biopsies of the vulva were obtained in 420 women. The overall concordance rate of the clinical findings in comparison with the histological vulvar punch-biopsy findings was 53.9% for all entities - benign lesions, lichen, low- and high-grade squamous intraepithelial lesions (LSIL/HSILs), and vulvar carcinoma. The concordance rate for detecting LSILs was 64.3% (45/70). The concordance rate for detecting HSILs was 62.3% and for Vulvar carcinoma 65.2%. CONCLUSIONS Punch biopsy of suspicious lesions continues to be a cornerstone in diagnosing HSILs and carcinoma of the vulva. Careful work-up of the vulva is recommended when patients have symptoms such as pruritus or pain. The new classification is more specific for diagnosing lesions in the vulva.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany.
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 6, 91054 Erlangen, Germany
| | - Johanna Strehl
- Department of Gynecology and Obstetrics, Fürth Hospital, Jakob-Henle-Strasse 1, 90766 Fürth, Germany
| | - Arndt Hartman
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Simone K Renner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany; Department of Gynecology and Obstetrics, Klinikum Sindelfingen-Böblingen, Bunsenstrasse 120, 71032 Böblingen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
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29
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Jacobsen C, Volkmann I, Wedegärtner F, Harris J, Bertram B, Gass P, Bambas B, Framme C. [Experiences of aggression and violence against ophthalmologists]. Ophthalmologe 2020; 117:775-785. [PMID: 32025792 DOI: 10.1007/s00347-020-01039-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The media have reported an increased willingness of patients and relatives to use violence against medical personnel. So far a few studies have been carried out on this topic and the data situation is correspondingly weak. Ophthalmologists in particular have close contact with patients at the slit lamp and are often alone with patients. METHODS A questionnaire was developed based on the perception of prevalence of aggression scale (POPAS) questionnaire and the survey on aggression and violence among general practitioners. In autumn 2018, all members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists (BVA) received an invitation by e‑mail to complete the questionnaire online. RESULTS Of the 9411 ophthalmologists contacted a total of 1508 (age 49 ± 12 years) took part in the survey (16%). Of the respondents 806 (53.7%) were female and 1139 (75.5%) participants worked in practices. A total of 1264 (83.3%) ophthalmologists had experienced aggression/violence in their work, 986 (65%) respondents had already experienced verbal assaults without threats, 363 (24.1%) doctors reported experiences with threats of physical violence and 30 (2%) participants had received medical treatment for severe physical violence. Sexual intimidation/harassment was affirmed by 322 (21.4%) of respondents, of whom 243 (75.5%) were female and 533 (47.9%) doctors felt that aggressive/violent behavior had increased in the last 5 years. CONCLUSION The high number of participants indicates the high relevance of the topic. The survey produced astonishing results, which should lead to further discussion and action to improve the safety of employees.
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Affiliation(s)
- Christina Jacobsen
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland.
| | - I Volkmann
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - F Wedegärtner
- Universitätsklinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, MHH, Hannover, Deutschland
| | - J Harris
- Berufsverband der Augenärzte Deutschlands e. V., Düsseldorf, Deutschland
| | - B Bertram
- Berufsverband der Augenärzte Deutschlands e. V., Düsseldorf, Deutschland
| | - P Gass
- Deutsche Ophthalmologische Gesellschaft e. V., München, Deutschland
| | - B Bambas
- Berufsverband der Augenärzte Deutschlands e. V., Düsseldorf, Deutschland
| | - C Framme
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
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30
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Hack CC, Häberle L, Brucker SY, Janni W, Volz B, Loehberg CR, Hartkopf AD, Walter CB, Baake G, Fridman A, Malter W, Wuerstlein R, Harbeck N, Hoffmann O, Kuemmel S, Martin B, Thomssen C, Graf H, Wolf C, Lux MP, Bayer CM, Rauh C, Almstedt K, Gass P, Heindl F, Brodkorb T, Willer L, Lindner C, Kolberg HC, Krabisch P, Weigel M, Steinfeld-Birg D, Kohls A, Brucker C, Schulz V, Fischer G, Pelzer V, Rack B, Beckmann MW, Fehm T, Rody A, Maass N, Hein A, Fasching PA, Nabieva N. Complementary and alternative medicine and musculoskeletal pain in the first year of adjuvant aromatase inhibitor treatment in early breast cancer patients. Breast 2020; 50:11-18. [PMID: 31958661 PMCID: PMC7377331 DOI: 10.1016/j.breast.2019.12.017] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/25/2022] Open
Abstract
Background Patients with breast cancer (BC) show strong interest in complementary and alternative medicine (CAM), particularly for adverse effects of adjuvant endocrine treatment — e.g., with letrozole. Letrozole often induces myalgia/limb pain and arthralgia, with potential noncompliance and treatment termination. This analysis investigated whether CAM before aromatase inhibitor (AI) therapy is associated with pain development and the intensity of AI-induced musculoskeletal syndrome (AIMSS) during the first year of treatment. Patients and methods The multicenter phase IV PreFace study evaluated letrozole therapy in postmenopausal, hormone receptor–positive patients with early BC. Patients were asked about CAM use before, 6 months after, and 12 months after treatment started. They recorded pain every month for 1 year in a diary including questions about pain and numeric pain rating scales. Data were analyzed for patients who provided pain information for all time points. Results Of 1396 patients included, 901 (64.5%) had used CAM before AI treatment. Throughout the observation period, patients with CAM before AI treatment had higher pain values, for both myalgia/limb pain and arthralgia, than non-users. Pain increased significantly in both groups over time, with the largest increase during the first 6 months. No significant difference of pain increase was noted regarding CAM use. Conclusions CAM use does not prevent or improve the development of AIMSS. Pain intensity was generally greater in the CAM group. Therefore, because of the risk of non-compliance and treatment discontinuation due to the development of higher pain levels, special attention must be paid to patient education and aftercare in these patients. Pain levels of myalgia/limb pain and arthralgia increase under letrozole intake. Within one year pain levels increase in both, CAM users as well as non-CAM users. In CAM users pain levels were higher at all time points than in non-CAM users. The greatest increase of pain levels was noted in the first six treatment months. CAM does not prevent or improve the development of myalgia/limb pain and arthralgia.
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Affiliation(s)
- C C Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - B Volz
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C R Loehberg
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; St. Theresien Hospital, Nuremberg, Germany
| | - A D Hartkopf
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - C-B Walter
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | - A Fridman
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - W Malter
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany
| | - R Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Cologne Hospital, Cologne, Germany; Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - O Hoffmann
- Department of Gynecology, Essen University Hospital, Essen, Germany
| | - S Kuemmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - B Martin
- Tuttlingen Clinic, Tuttlingen, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - H Graf
- Helios Clinics Meiningen, Meiningen, Germany
| | - C Wolf
- Ulm Medical Center, Ulm, Germany
| | - M P Lux
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - K Almstedt
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Department of Gynecology, Mainz University Hospital, Mainz, Germany
| | - P Gass
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - F Heindl
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Brodkorb
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - L Willer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Lindner
- Agaplesion Diakonie Clinic Hamburg, Hamburg, Germany
| | - H-C Kolberg
- Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
| | - P Krabisch
- Department of Gynecology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - M Weigel
- Department of Gynecology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - D Steinfeld-Birg
- Gynecologic Onocologic Practice Steinfeld-Birg, Augsburg, Germany
| | - A Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - C Brucker
- Department of Gynecology and Obstetrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - V Schulz
- Gynecologic Practice Abts+partner, Kiel, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - V Pelzer
- Department of Gynecology, GFO Clinics Bonn, Bonn, Germany
| | - B Rack
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - M W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany; Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - A Rody
- Department of Gynecology, Campus Lübeck, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - N Maass
- Department of Gynecology, Campus Kiel, Schleswig-Holstein University Hospital, Schleswig-Holstein, Germany
| | - A Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - P A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - N Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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31
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Denschlag D, Ackermann S, Battista MJ, Cremer W, Egerer G, Follmann M, Haas H, Harter P, Hettmer S, Horn LC, Juhasz-Boess I, Kast K, Köhler G, Kröncke T, Lindel K, Mallmann P, Meyer-Steinacker R, Mustea A, Petru E, Reichardt P, Schmidt D, Strauss HG, Tempfer C, Thiel F, Ulrich U, Vogl T, Vordermark D, Gass P, Beckmann MW. Sarcoma of the Uterus. Guideline of the DGGG and OEGGG (S2k Level, AWMF Register Number 015/074, February 2019). Geburtshilfe Frauenheilkd 2019; 79:1043-1060. [PMID: 31656317 DOI: 10.1055/a-0882-4116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
Abstract
Aims This is an official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Because of their rarity and heterogeneous histopathology, uterine sarcomas are challenging in terms of how they should be managed clinically, and treatment requires a multidisciplinary approach. To our knowledge, there are currently no binding evidence-based recommendations for the appropriate management of this heterogeneous group of tumors. Methods This S2k guideline was first published in 2015. The update published here is the result of the consensus of a representative interdisciplinary group of experts who carried out a systematic search of the literature on uterine sarcomas in the context of the guidelines program of the DGGG, OEGGG and SGGG. Members of the participating professional societies achieved a formal consensus after a moderated structured consensus process. Recommendations The consensus-based recommendations and statements include the epidemiology, classification, staging, symptoms, general diagnostic work-up and general pathology of uterine sarcomas as well as the genetic predisposition to develop uterine sarcomas. Also included are statements on the management of leiomyosarcomas, (low and high-grade) endometrial stromal sarcomas and undifferentiated uterine sarcomas and adenosarcomas. Finally, the guideline considers the follow-up and morcellation of uterine sarcomas and the information provided to patients.
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Affiliation(s)
| | | | - Marco Johannes Battista
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | | | | | | | | | - Philipp Harter
- Klinik für Gynäkologie und Gynäkologische Onkologie, Kliniken Essen Mitte, Essen, Germany
| | | | - Lars-Christian Horn
- Abteilung für Mamma-, Urogenital, und Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ingolf Juhasz-Boess
- Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Karin Kast
- Universitätsklinik Dresden, Dresden, Germany
| | - Günter Köhler
- Deutsches klinisches Kompetenzzentrum für genitale Sarkome und Mischtumoren, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Kröncke
- Klinik für Radiologie, Klinikum Augsburg, Augsburg, Germany
| | - Katja Lindel
- Klinik für Radioonkologie, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Peter Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln, Köln, Germany
| | | | | | - Edgar Petru
- Universitäts-Frauenklinik Graz, Graz, Austria
| | - Peter Reichardt
- Klinik für interdisziplinäre Onkologie, Helios Kliniken Berlin-Buch, Berlin, Germany
| | | | - Hans-Georg Strauss
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | | | - Falk Thiel
- Frauenklinik, Alb Fils Kliniken, Göppingen, Germany
| | - Uwe Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus Berlin, Paul Gerhardt Diakonie, Berlin, Germany
| | - Thomas Vogl
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
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32
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Schnürch HG, Ackermann S, Alt-Radtke CD, Angleitner L, Barinoff J, Beckmann MW, Böing C, Dannecker C, Fehm T, Gaase R, Gass P, Gebhardt M, Gieseking F, Günthert A, Hack CC, Hantschmann P, Horn LC, Koch MC, Letsch A, Mallmann P, Mangold B, Marnitz S, Mehlhorn G, Paradies K, Reinhardt MJ, Tholen R, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up of Vaginal Cancer and Its Precursors. Guideline of the DGGG and the DKG (S2k-Level, AWMF Registry No. 032/042, October 2018). Geburtshilfe Frauenheilkd 2019; 79:1060-1078. [PMID: 31680701 DOI: 10.1055/a-0919-4959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose This is an official guideline, published and coordinated by the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Society for Gynecology and Obstetrics (DGGG). Vaginal cancers are rare tumors, which is why there is very little evidence on these tumors. Knowledge about the optimal clinical management is limited. This first German S2k guideline on vaginal cancer has aimed to compile the most current expert knowledge and offer new recommendations on the appropriate treatment as well as providing pointers about individually adapted therapies with lower morbidity rates than were previously generally available. The purpose of this guideline is also to set up a register to record data on treatment data and the course of disease as a means of obtaining evidence in future. Methods The present S2k guideline was developed by members of the Vulvar und Vaginal Tumors Commission of the AGO in an independently moderated, structured, formal consensus process and the contents were agreed with the mandate holders of the participating scientific societies and organizations. Recommendations To optimize the daily care of patients with vaginal cancer: 1. Monitor the spread pattern; 2. Follow the step-by-step diagnostic workup based on initial stage at detection; 3. As part of individualized clinical therapeutic management of vaginal cancer, follow the sentinel lymph node protocol described here, where possible; 4. Participate in the register study on vaginal cancer.
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Affiliation(s)
| | | | - Celine D Alt-Radtke
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf, Germany
| | | | - Jana Barinoff
- St.-Gertrauden-Krankenhaus GmbH Berlin, Berlin, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Carsten Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen, Germany
| | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München, Campus Großhadern, München, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Gaase
- Gemeinschaftspraxis für Frauenheilkunde Gaase+Hugger, Worms, Germany
| | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | | | - Friederike Gieseking
- Dysplasiesprechstunde/Gynäkologisches Laserzentrum in der Frauenarztpraxis Heussweg, Hamburg, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Peer Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting, Germany
| | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Berlin, Berlin, Germany
| | - Peter Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität Köln, Köln, Germany
| | | | - Simone Marnitz
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Berlin, Germany
| | | | - Reina Tholen
- Deutscher Verband für Physiotherapie, Köln, Germany
| | - Uwe Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Hampl
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
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33
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Lux MP, Emons J, Bani MR, Wunderle M, Sell C, Preuss C, Rauh C, Jud SM, Heindl F, Langemann H, Geyer T, Brandl AL, Hack CC, Adler W, Schulz-Wendtland R, Beckmann MW, Fasching PA, Gass P. Diagnostic Accuracy of Breast Medical Tactile Examiners (MTEs): A Prospective Pilot Study. Breast Care (Basel) 2019; 14:41-47. [PMID: 31019442 DOI: 10.1159/000495883] [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] [Indexed: 11/19/2022] Open
Abstract
Background The usefulness of clinical breast examination (CBE) in general and in breast cancer screening programs has been a matter of debate. This study investigated whether adding vision-impaired medical tactile examiners (MTEs) improves the predictiveness of CBE for suspicious lesions and analyzed the feasibility and acceptability of this approach. Methods The prospective study included 104 patients. Physicians and MTEs performed CBEs, and mammography and ultrasound results were used as the gold standard. Sensitivity and specificity were calculated and logistic regression models were used to compare the predictive value of CBE by physicians alone, MTEs alone, and physicians and MTEs combined. Results For CBEs by physicians alone, MTEs alone, and both combined, sensitivity was 71, 82, and 89% and specificity was 55, 45, and 35%, respectively. Using adjusted logistic regression models, the validated areas under the curve were 0.685, 0.692, and 0.710 (median bootstrapped p value (DeLong) = 0.381). Conclusion The predictive value for a suspicious breast lesion in CBEs performed by MTEs in patients without prior surgery was similar to that of physician-conducted CBEs. Including MTEs in the CBE procedure in breast units thus appears feasible and could be a way of utilizing their skills.
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Affiliation(s)
- Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Mayada R Bani
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Charlotte Sell
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Caroline Preuss
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Hanna Langemann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Thomas Geyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Anna-Lisa Brandl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Werner Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | | | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
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34
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Nabieva N, Häberle L, Brucker SY, Janni W, Volz B, Loehberg CR, Hartkopf AD, Walter CB, Baake G, Fridman A, Malter W, Wuerstlein R, Harbeck N, Hoffmann O, Kuemmel S, Martin B, Thomssen C, Graf H, Wolf C, Lux MP, Bayer CM, Rauh C, Hack CC, Almstedt K, Gass P, Heindl F, Brodkorb T, Lindner C, Kolberg HC, Krabisch P, Weigel M, Steinfeld-Birg D, Kohls A, Brucker C, Schulz V, Fischer G, Pelzer V, Rack B, Beckmann MW, Fehm T, Rody A, Maass N, Hein A, Fasching PA. Preexisting musculoskeletal burden and its development under letrozole treatment in early breast cancer patients. Int J Cancer 2019; 145:2114-2121. [PMID: 30901076 DOI: 10.1002/ijc.32294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/16/2018] [Accepted: 01/10/2019] [Indexed: 01/14/2023]
Abstract
One of the most common adverse events (AEs) occurring during treatment with aromatase inhibitors (AIs) is musculoskeletal pain. The aim of our study was to analyze the influence of preexisting muscle/limb pain and joint pain on the development of AI-induced musculoskeletal AEs. Women eligible for upfront adjuvant endocrine therapy with letrozole were included in the PreFace study, a multicenter phase IV trial. During the first treatment year, they were asked to record musculoskeletal AEs monthly by answering questions regarding pain symptoms and rating the pain intensity on a numeric rating scale from 0 (no pain) to 10 (very strong pain). Pain values were compared using nonparametric statistical tests. Overall, 1,416 patients were evaluable. The average pain value over all time points in women with preexisting muscle/limb pain was 4.3 (median 4.3); in those without preexisting pain, it was 2.0 (median 1.7). In patients without preexisting muscle/limb pain, pain levels increased relatively strongly within the first 6 months (mean increase +0.9, p < 0.00001) in comparison with those with preexisting pain (mean increase +0.3, p < 0.001), resulting in a statistically significant difference (p < 0.00001) between the two groups. The development of joint pain was similar in the two groups. Women without preexisting muscle/limb pain or joint pain have the greatest increase in pain after the start of adjuvant AI therapy. Women with preexisting pain have significantly higher pain values. The main increase in pain values takes place during the first 6 months of treatment.
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Affiliation(s)
- Naiba Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Sara Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - Wolfgang Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - Bernhard Volz
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,St. Theresien Hospital, Nuremberg, Germany
| | | | | | - Gerold Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | - Alexander Fridman
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Wolfram Malter
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology and Obstetrics and CCC Munich, University of Munich (LMU), Munich, Germany
| | - Oliver Hoffmann
- Department of Gynecology, Essen University Hospital, Essen, Germany
| | - Sherko Kuemmel
- Breast Unit, Essen Mitte Clinics, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | | | - Christoph Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Heiko Graf
- Helios Clinics Meiningen, Meiningen, Germany
| | | | - Michael P Lux
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christian M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Katrin Almstedt
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Department of Gynecology, Mainz University Hospital, Mainz, Germany
| | - Paul Gass
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Tobias Brodkorb
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | | | - Petra Krabisch
- Department of Gynecology, Clinic of Chemnitz gGmbH, Chemnitz, Germany
| | - Michael Weigel
- Department of Gynecology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | | | - Andreas Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - Cosima Brucker
- Department of Gynecology and Obstetrics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | | | | | - Volker Pelzer
- Department of Gynecology, GFO Clinics Bonn, Bonn, Germany
| | - Brigitte Rack
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - Matthias W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology, University of Tübingen, Tübingen, Germany.,Department of Gynecology, Heinrich Heine University of Dusseldorf, Dusseldorf, Germany
| | - Achim Rody
- Department of Gynecology, Schleswig-Holstein University Hospital, Campus Lübeck, Schleswig-Holstein, Germany
| | - Nicolai Maass
- Department of Gynecology, Schleswig-Holstein University Hospital, Campus Kiel, Schleswig-Holstein, Germany
| | - Alexander Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Fasching PA, Gass P, Häberle L, Volz B, Hein A, Hack CC, Lux MP, Jud SM, Hartmann A, Beckmann MW, Slamon DJ, Erber R. Prognostic effect of Ki-67 in common clinical subgroups of patients with HER2-negative, hormone receptor-positive early breast cancer. Breast Cancer Res Treat 2019; 175:617-625. [PMID: 30868391 DOI: 10.1007/s10549-019-05198-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/06/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Several clinical trials have investigated the prognostic and predictive usefulness of molecular markers. With limited predictive value, molecular markers have mainly been used to identify prognostic subgroups in which the indication for chemotherapy is doubtful and the prognosis is favorable enough for chemotherapy to be avoided. However, limited information is available about which groups of patients may benefit from additional therapy. This study aimed to describe the prognostic effects of Ki-67 in several common subgroups of patients with early breast cancer. METHODS This retrospective study analyzed a single-center cohort of 3140 patients with HER2-, hormone receptor-positive breast cancer. Five-year disease-free survival (DFS) rates were calculated for low (< 10%), intermediate (10-19%), and high (≥ 20%) Ki-67 expression levels, as assessed by immunohistochemistry, and for subgroups relative to age, body mass index, disease stage, tumor grade, and (neo-)adjuvant chemotherapy. It was also investigated whether Ki-67 had different effects on DFS in these subgroups. RESULTS The 5-year DFS rates for patients with low, intermediate, and high levels of Ki-67 expression were 0.90, 0.89, and 0.77, respectively. Ki-67 was able to further differentiate patients with an intermediate prognosis into different prognostic groups relative to common clinical parameters. Patients with stage II breast cancer had 5-year DFS rates of 0.84, 0.88, and 0.79 for low, intermediate, and high levels of Ki-67 expression. Ki-67 had different prognostic effects in subgroups defined by age and tumor grade. CONCLUSIONS Ki-67 may help identify patients in intermediate prognostic groups with an unfavorable prognosis who may benefit from further therapy.
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Affiliation(s)
- Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany. .,Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA.
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN, Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Dennis J Slamon
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Ramona Erber
- Comprehensive Cancer Center Erlangen-EMN, Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Nuremberg, Germany
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Keilmann L, Matthies L, Simoes E, Hartkopf AD, Sokolov AN, Walter CB, Sickenberger N, Wallwiener S, Feisst M, Gass P, Fasching PA, Lux MP, Wallwiener D, Taran FA, Rom J, Schneeweiss A, Brucker SY, Graf J, Wallwiener M. Quality of life measurement in breast cancer patients: Reliability of an ePRO tool using EORTC QLQ-C30. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Matthies LM, Taran FA, Keilmann L, Schneeweiss A, Simoes E, Hartkopf AD, Sokolov AN, Walter CB, Sickenberger N, Wallwiener S, Feisst M, Gass P, Lux MP, Schuetz F, Fasching PA, Sohn C, Brucker SY, Graf J, Wallwiener M. An Electronic Patient-Reported Outcome Tool for the FACT-B (Functional Assessment of Cancer Therapy-Breast) Questionnaire for Measuring the Health-Related Quality of Life in Patients With Breast Cancer: Reliability Study. J Med Internet Res 2019; 21:e10004. [PMID: 30668517 PMCID: PMC6362389 DOI: 10.2196/10004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 01/05/2023] Open
Abstract
Background The most frequent malignant disease in women is breast cancer. In the metastatic setting, quality of life is the primary therapeutic goal, and systematic treatment has only a limited effect on survival rates; therefore, the concept of the health-related quality of life (HRQoL) and measurement of patient-reported outcomes (PROs) are gaining more and more importance in the therapy setting of diseases such as breast cancer. One of the frequently used questionnaires for measuring the HRQoL in patients with breast cancer is the Functional Assessment of Cancer Therapy-Breast (FACT-B). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. ePRO tools for the FACT-B questionnaire with proven reliability are missing so far. Objective The aim of this study was to analyze the reliability of tablet-based measurement of FACT-B in the German language in adjuvant (curative) and metastatic breast cancer patients. Methods Paper- and tablet-based questionnaires were completed by a total of 106 female adjuvant and metastatic breast cancer patients. All patients were required to complete the electronically based (ePRO) and paper-based version of the FACT-B. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability using Wilcoxon test and test of internal consistency using Spearman ρ) and agreement rates for single items, Kendall tau for each subscale, and total score were analyzed. Results High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patients’ response behavior between paper-based and electronically based questionnaires. Regarding the reliability test of parallel forms, no significant differences were found in 35 of 37 single items, while significant correlations in the test for consistency were found in all 37 single items, in all 5 sum individual item subscale scores, as well as in total FACT-B score. Conclusions The ePRO version of the FACT-B questionnaire is reliable for patients with breast cancer in both adjuvant and metastatic settings, showing highly significant correlations with the paper-based version in almost all questions all subscales and the total score.
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Affiliation(s)
- Lina Maria Matthies
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Florin-Andrei Taran
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Lucia Keilmann
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Schneeweiss
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Elisabeth Simoes
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Andreas D Hartkopf
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Alexander N Sokolov
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Section of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Christina B Walter
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Nina Sickenberger
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute for Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Florian Schuetz
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
| | - Christof Sohn
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Sara Y Brucker
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Joachim Graf
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Section of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Emons J, Wunderle M, Hartmann A, Radicke M, Rauh C, Uder M, Gass P, Fasching PA, Langemann H, Beckmann MW, Schulz-Wendtland R, Jud SM. Initial clinical results with a fusion prototype for mammography and three-dimensional ultrasound with a standard mammography system and a standard ultrasound probe. Acta Radiol 2018; 59:1406-1413. [PMID: 29498297 DOI: 10.1177/0284185118762249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Combinations *Equal contributors. of different imaging techniques in fusion devices appear to be associated with improvements in diagnostic assessment. PURPOSE The aim of this study was to test the feasibility of using an automated standard three-dimensional (3D) ultrasound (US) device fused with standard mammography for the first time in breast cancer patients. MATERIAL AND METHODS Digital mammograms and 3D automated US images were obtained in 23 patients with highly suspicious breast lesions. A recently developed fusion machine consisting of an ABVS 3D US transducer from an Acuson S2000 machine and a conventional Mammomat Inspiration device (both Siemens Healthcare GmbH, Erlangen, Germany) were used for the purpose. The feasibility of the examinations, imaging coverage, and patients' experience of the procedure were examined. RESULTS In 15 out of 19 patients, the region of interest (ROI) with the tumor marked in the mammogram was visible on US. The examination was experienced positively by the patients, with no unexpected pain or injury. The examination was time-saving and well tolerated. CONCLUSION In conclusion, we have shown initial clinical feasibility of an US/radiography fusion prototype with good localization and evaluation of the ROIs. The combined examination was well tolerated. The simultaneous evaluation with mammography and US imaging may be able to improve detection and reduce examiner-related variability.
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Affiliation(s)
- Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | | | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Michael Uder
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Hanna Langemann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | | | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
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Fasching PA, Hartkopf AD, Gass P, Häberle L, Akpolat-Basci L, Hein A, Volz B, Taran FA, Nabieva N, Pott B, Overkamp F, Einarson H, Hadji P, Tesch H, Ettl J, Lüftner D, Wallwiener M, Müller V, Janni W, Fehm TN, Schneeweiss A, Untch M, Pott D, Lux MP, Geyer T, Liedtke C, Seeger H, Wetzig S, Hartmann A, Schulz-Wendtland R, Belleville E, Wallwiener D, Beckmann MW, Brucker SY, Kolberg HC. Efficacy of neoadjuvant pertuzumab in addition to chemotherapy and trastuzumab in routine clinical treatment of patients with primary breast cancer: a multicentric analysis. Breast Cancer Res Treat 2018; 173:319-328. [PMID: 30324275 DOI: 10.1007/s10549-018-5008-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE Neoadjuvant combination treatment with chemotherapy (CTX), trastuzumab (TZM), and pertuzumab (PTZ) has been shown to result in higher pathological complete response rates (pCR) in comparison with treatment with chemotherapy and trastuzumab (CTX/TZM). This analysis was aimed at real-world validation of these results from prospective randomized trials. METHODS In a retrospective analysis conducted in the PRAEGNANT network, patients were eligible for inclusion if they had either received neoadjuvant therapy with CTX/TZM or chemotherapy, trastuzumab, and pertuzumab (CTX/TZM/PTZ) and subsequently underwent surgery for their primary breast cancer. The effect of the two neoadjuvant regimens on pCR in addition to commonly applicable predictors of pCR was analyzed in 300 patients from three study sites, using logistic regression analyses with treatment arm, age, clinical tumor stage, grading, and hormone receptor status as predictors. RESULTS pCR with complete disappearance of all tumor cells was seen in 30.2% (n = 58) of patients treated with CTX/TZM and in 52.8% (n = 57) of those treated with CTX/TZM/PTZ. CTX/TZM/PTZ was positively associated with pCR (adjusted odds ratio 2.44; 95% CI 1.49-4.02). Mastectomy rates were not influenced by the therapy. CONCLUSIONS The results of clinical trials were confirmed in this dataset of patients who were treated outside of clinical trials in everyday routine work. pCR rates can be improved by 20% with pertuzumab in routine clinical use.
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Affiliation(s)
- Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | | | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | | | - Hanna Einarson
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Peyman Hadji
- Frankfurter Hormon und Osteoporosezentrum Goethestrasse, Goethestr.23, Frankfurt, Germany
| | - Hans Tesch
- Oncology Practice, Bethanien Hospital, Frankfurt am Main, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases and Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin-Buch, Berlin, Germany
| | - Dirk Pott
- Onkologische Schwerpunktpraxis Bottrop, Bottrop, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Thomas Geyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Cornelia Liedtke
- Department of Gynecology and Breast Center, Charité University Hospital, Campus Mitte, Berlin, Germany
| | - Harald Seeger
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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Emons J, Wunderle M, Hartmann A, Radice M, Rauh C, Uder M, Gass P, Fasching PA, Langemann H, Beckmann MW, Schulz-Wendtland R, Jud SM. Initial clinical results with a fusion prototype for mammography and three-dimensional ultrasound with a standard mammography system and a standard ultrasound probe. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Emons
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - M Wunderle
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - A Hartmann
- Universitätsklinikum Erlangen, Pathologie, Erlangen, Deutschland
| | - M Radice
- Siemens Healthcare GmbH, Erlangen, Deutschland
| | - C Rauh
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - M Uder
- Universitätsklinikum Erlangen, Radiologie, Erlangen, Deutschland
| | - P Gass
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - PA Fasching
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - H Langemann
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | | | - SM Jud
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
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Stübs F, Mehlhorn G, Gass P, Schulmeyer C, Renner S, Geppert C, Adler W, Beckmann MW, Koch M. Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Stübs
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Gynäkologie, Erlangen, Deutschland
| | - G Mehlhorn
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Gynäkologie, Erlangen, Deutschland
| | - P Gass
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Gynäkologie, Erlangen, Deutschland
| | - C Schulmeyer
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Gynäkologie, Erlangen, Deutschland
| | - S Renner
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Gynäkologie, Erlangen, Deutschland
- Klinikum Sindelfingen-Böblingen, Gynäkologie, Böblingen, Deutschland
| | - C Geppert
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Pathologie, Erlangen, Deutschland
| | - W Adler
- Friedrich-Alexander Universität Erlangen-Nürnberg, Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE), Erlangen, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Gynäkologie, Erlangen, Deutschland
| | - M Koch
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Gynäkologie, Erlangen, Deutschland
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Koch M, Stübs F, Schulmeyer C, Kehl S, Gass P, Renner SK, Adler W, Geppert C, Beckmann MW, Mehlhorn G. Colposcopic accuracy in detection of early cervical neoplasia. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Koch
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
| | - F Stübs
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
| | - C Schulmeyer
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
| | - S Kehl
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
| | - P Gass
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
| | - SK Renner
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
- Frauenklinik Klinikum Sindelfingen-Böblingen, Gynäkologische Onkologie, Böblingen, Deutschland
| | - W Adler
- Institut für Medizininformatik, Biometrie und Epidemiologie der Universität Erlangen, (IMBE), Erlangen, Deutschland
| | - C Geppert
- Pathologisches Institut Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - MW Beckmann
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
| | - G Mehlhorn
- Frauenklinik Universitätsklinikum Erlangen, Gynäkologische Onkologie, Erlangen, Deutschland
- Pathologisches Institut Universitätsklinikum Erlangen, Erlangen, Deutschland
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Gass P, Untch M, Müller V, Möbus V, Thomssen C, Häberle L, Erber R, Hein A, Jud SM, Lux MP, Hack CC, Hartmann A, Kolberg HC, Ettl J, Lüftner D, Jackisch C, Beckmann MW, Janni W, Schneeweiss A, Fasching PA, Nabieva N. Using Probability for Pathological Complete Response (pCR) as a Decision Support Marker for Neoadjuvant Chemotherapy in HER2 Negative Breast Cancer Patients - a Survey Among Physicians. Geburtshilfe Frauenheilkd 2018; 78:707-714. [PMID: 30057427 PMCID: PMC6059863 DOI: 10.1055/a-0642-9462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In women with early breast cancer, a pathological complete response (pCR) after neoadjuvant chemotherapy is reported to be associated with an improvement of the survival. The aim of this survey among physicians was to investigate whether the probability of achieving pCR in patients with a hormone receptor-positive, HER2-negative disease encourages physicians to recommend neoadjuvant chemotherapy. METHODS The study was conducted via an online survey that was sent to 493 physicians, who were either known as members of national guideline committees, heads of breast cancer centers, being high recruiters in clinical trials or leading a private practice. Participants were asked about a specific case that should resemble patients for whom it is unclear, whether they should be treated with chemotherapy. RESULTS 113 (24.5%) physicians participated at the survey, out of which 96.5% had a work experience of more than 10 years and 94.7% were board certified in their specialty. A total of 84.1% would consider pCR for a decision concerning neoadjuvant chemotherapy. With regard to the pCR probability, 2.7 and 10.6% of the participants demanded at least a pCR rate of 5 and 10%, respectively, while 25.7% were satisfied with 20% probability, and another 25.7% with a pCR rate of 30%. CONCLUSIONS The vast majority of the long-term experienced physicians would embrace the implementation of a further method such as the prediction of pCR probability in clinical routine to support decision making regarding the necessity of neoadjuvant chemotherapy. The cut-off of around 30% pCR probability seems to be a realizable rate to distinguish patient groups.
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Affiliation(s)
- Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Untch
- Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Volker Möbus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Christoph Thomssen
- Department of Gynecology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Michael Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P. Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C. Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany
| | | | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Wunderle M, Gass P, Häberle L, Flesch VM, Rauh C, Bani MR, Hack CC, Schrauder MG, Jud SM, Emons J, Erber R, Ekici AB, Hoyer J, Vasileiou G, Kraus C, Reis A, Hartmann A, Lux MP, Beckmann MW, Fasching PA, Hein A. BRCA mutations and their influence on pathological complete response and prognosis in a clinical cohort of neoadjuvantly treated breast cancer patients. Breast Cancer Res Treat 2018; 171:85-94. [PMID: 29725888 DOI: 10.1007/s10549-018-4797-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE BRCA1/2 mutations influence the molecular characteristics and the effects of systemic treatment of breast cancer. This study investigates the impact of germline BRCA1/2 mutations on pathological complete response and prognosis in patients receiving neoadjuvant systemic chemotherapy. METHODS Breast cancer patients were tested for a BRCA1/2 mutation in clinical routine work and were treated with anthracycline-based or platinum-based neoadjuvant chemotherapy between 1997 and 2015. These patients were identified in the tumor registry of the Breast Center of the University of Erlangen (Germany). Logistic regression and Cox regression analyses were performed to investigate the associations between BRCA1/2 mutation status, pathological complete response, disease-free survival, and overall survival. RESULTS Among 355 patients, 59 had a mutation in BRCA1 or in BRCA2 (16.6%), 43 in BRCA1 (12.1%), and 16 in BRCA2 (4.5%). Pathological complete response defined as "ypT0; ypN0" was observed in 54.3% of BRCA1/2 mutation carriers, but only in 22.6% of non-carriers. The adjusted odds ratio was 2.48 (95% CI 1.26-4.91) for BRCA1/2 carriers versus non-carriers. Patients who achieved a pathological complete response had better disease-free survival and overall survival rates compared with those who did not achieve a pathological complete response, regardless of BRCA1/2 mutation status. CONCLUSIONS BRCA1/2 mutation status leads to better responses to neoadjuvant chemotherapy in breast cancer. Pathological complete response is the main predictor of disease-free survival and overall survival, independently of BRCA1/2 mutation status.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Vivien M Flesch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mayada R Bani
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael G Schrauder
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Juliane Hoyer
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Georgia Vasileiou
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Cornelia Kraus
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andre Reis
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany. .,Department of Medicine, Division of Hematology and Oncology, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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45
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Huebner H, Fasching PA, Gumbrecht W, Jud S, Rauh C, Matzas M, Paulicka P, Friedrich K, Lux MP, Volz B, Gass P, Häberle L, Meier-Stiegen F, Hartkopf A, Neubauer H, Almstedt K, Beckmann MW, Fehm TN, Ruebner M. Filtration based assessment of CTCs and CellSearch® based assessment are both powerful predictors of prognosis for metastatic breast cancer patients. BMC Cancer 2018; 18:204. [PMID: 29463222 PMCID: PMC5819661 DOI: 10.1186/s12885-018-4115-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/09/2018] [Indexed: 12/17/2022] Open
Abstract
Background The assessment of circulating tumor cells (CTCs) has been shown to enable monitoring of treatment response and early detection of metastatic breast cancer (MBC) recurrence. The aim of this study was to compare a well-established CTC detection method based on immunomagnetic isolation with a new, filtration-based platform. Methods In this prospective study, two 7.5 ml blood draws were obtained from 60 MBC patients and CTC enumeration was assessed using both the CellSearch® and the newly developed filtration-based platform. We analyzed the correlation of CTC-positivity between both methods and their ability to predict prognosis. Overall survival (OS) was calculated and Kaplan-Meier curves were estimated with thresholds of ≥1 and ≥5 detected CTCs. Results The CTC positivity rate of the CellSearch® system was 56.7% and of the filtration-based platform 66.7%. There was a high correlation of CTC enumeration obtained with both methods. The OS for patients without detected CTCs, regardless of the method used, was significantly higher compared to patients with one or more CTCs (p < 0.001). The median OS of patients with no CTCs vs. ≥ 1 CTC assessed by CellSearch® was 1.83 years (95% CI: 1.63–2.02) vs. 0.74 years (95% CI: 0.51–1.52). If CTCs were detected by the filtration-based method the median OS times were 1.88 years (95% CI: 1.74–2.03) vs. 0.59 years (95% CI: 0.38–0.80). Conclusions The newly established EpCAM independently filtration-based system is a suitable method to determine CTC counts for MBC patients. Our study confirms CTCs as being strong predictors of prognosis in our population of MBC patients.
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Affiliation(s)
- Hanna Huebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Walter Gumbrecht
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Sebastian Jud
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Mark Matzas
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Peter Paulicka
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Katja Friedrich
- Siemens Healthcare GmbH, Günther-Scharowsky-Str.1, 91058, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany.,Biostatistics Unit. Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Franziska Meier-Stiegen
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Andreas Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Hans Neubauer
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Katrin Almstedt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstraße 21-23, 91054, Erlangen, Germany.
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46
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Wallwiener M, Matthies L, Simoes E, Keilmann L, Hartkopf AD, Sokolov AN, Walter CB, Sickenberger N, Wallwiener S, Feisst M, Gass P, Fasching PA, Lux MP, Wallwiener D, Taran FA, Rom J, Schneeweiss A, Graf J, Brucker SY. Reliability of an e-PRO Tool of EORTC QLQ-C30 for Measurement of Health-Related Quality of Life in Patients With Breast Cancer: Prospective Randomized Trial. J Med Internet Res 2017; 19:e322. [PMID: 28912116 PMCID: PMC5620457 DOI: 10.2196/jmir.8210] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Breast cancer represents the most common malignant disease in women worldwide. As currently systematic palliative treatment only has a limited effect on survival rates, the concept of health-related quality of life (HRQoL) is gaining more and more importance in the therapy setting of metastatic breast cancer. One of the major patient-reported outcomes (PROs) for measuring HRQoL in patients with breast cancer is provided by the European Organization for Research and Treatment of Cancer (EORTC). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. Facing the possibilities associated with evolving digitalization in medicine, validation of electronic versions of well-established PRO is essential in order to contribute to comprehensive and holistic oncological care and to ensure high quality in cancer research. OBJECTIVE The aim of this study was to analyze the reliability of a tablet-based measuring application for EORTC QLQ-C30 in German language in patients with adjuvant and (curative) metastatic breast cancer. METHODS Paper- and tablet-based questionnaires were completed by a total of 106 female patients with adjuvant and metastatic breast cancer recruited as part of the e-PROCOM study. All patients were required to complete the electronic- (e-PRO) and paper-based versions of the HRQoL EORTC QLQ-C30 questionnaire. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability [Wilcoxon test] and test of internal consistency [Spearman rho and agreement rates for single items, Pearson correlation and Kendall tau for each scale]) were analyzed. RESULTS High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patient's response behavior between paper- and electronic-based questionnaires. Regarding the test of parallel forms reliability, no significant differences were found in 27 of 30 single items and in 14 of 15 scales, whereas a statistically significant correlation in the test of consistency was found in all 30 single items and all 15 scales. CONCLUSIONS The evaluated e-PRO version of the EORTC QLQ-C30 is reliable for patients with both adjuvant and metastatic breast cancer, showing a high correlation in almost all questions (and in many scales). Thus, we conclude that the validated paper-based PRO assessment and the e-PRO tool are equally valid. However, the reliability should also be analyzed in other prospective trials to ensure that usability is reliable in all patient groups. TRIAL REGISTRATION ClinicalTrials.gov NCT03132506; https://clinicaltrials.gov/ct2/show/NCT03132506 (Archived by WebCite at http://www.webcitation.org/6tRcgQuou).
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Affiliation(s)
- Markus Wallwiener
- Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lina Matthies
- Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Elisabeth Simoes
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Lucia Keilmann
- Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas D Hartkopf
- Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Alexander N Sokolov
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Christina B Walter
- Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Nina Sickenberger
- Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute for Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Diethelm Wallwiener
- Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Florin-Andrei Taran
- Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Joachim Rom
- Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Schneeweiss
- Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Graf
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Sara Y Brucker
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
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47
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Wallwiener M, Heindl F, Brucker SY, Taran FA, Hartkopf A, Overkamp F, Kolberg HC, Hadji P, Tesch H, Ettl J, Lux MP, Rauh C, Blum S, Nabieva N, Brodkorb TF, Faschingbauer C, Langemann H, Schulmeyer C, Volz B, Rübner M, Lüftner D, Müller V, Belleville E, Janni W, Fehm TN, Wallwiener D, Ganslandt T, Beckmann MW, Schneeweiss A, Fasching PA, Gass P. Implementation and Feasibility of Electronic Patient-Reported Outcome (ePRO) Data Entry in the PRAEGNANT Real-Time Advanced and Metastatic Breast Cancer Registry. Geburtshilfe Frauenheilkd 2017; 77:870-878. [PMID: 28845051 DOI: 10.1055/s-0043-116223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/09/2017] [Accepted: 07/09/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Patient-reported outcomes (PROs) have been incorporated into clinical trials for many symptoms and medical conditions. A transition from paper-based capture of PROs to electronic PROs (ePROs) has recently started. This study reports on the feasibility of ePRO assessment in a prospective registry including molecular data for patients with advanced breast cancer. METHODS As part of the PRAEGNANT network, patients were invited by clinical trial staff, physicians, and nurses to complete three standardized Internet-based questionnaires (EQ 5D 5 L, CES-D and IPAQ). Feasibility was assessed by the staff members who assigned the user accounts by the patients. The completeness of the questionnaires was also assessed. RESULTS Fifteen of 17 patients who were asked agreed to participate to complete the PRO questionnaires (EQ-5D-5L and CES-D). However, the IPAQ (physical activity) questionnaire was only validly completed by 9 patients. Feasibility was ranked better by the physicians and dedicated clinical trial staff than by the nursing staff. CONCLUSIONS Incorporating ePRO questionnaires into an advanced breast cancer registry is feasible, and no major hurdles were reported. Involving stakeholders from the start, the application is tailored to the capacities and abilities of both patients and clinical staff. The patients' compliance was better with some questionnaires, but others may present difficulties.
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Affiliation(s)
- Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Andreas Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Friedrich Overkamp
- Outpatient Department of Hematology and Oncology, Recklinghausen, Germany
| | | | | | | | - Johannes Ettl
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Simon Blum
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Tobias F Brodkorb
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Cornelia Faschingbauer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Hanna Langemann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Carla Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Matthias Rübner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany.,Institut für Frauengesundheit (IFG), Erlangen, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Thomas Ganslandt
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Andreas Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases and Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University of Erlangen-Nuremberg, Germany
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48
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Neimann J, Knabl J, Puppe J, Bayer CM, Gass P, Gabriel L, Seelbach-Goebel B, Lermann J, Schott S. Duty Rosters and Workloads of Obstetricians in Germany: Results of a Germany-wide Survey. Geburtshilfe Frauenheilkd 2017; 77:894-903. [PMID: 28845054 DOI: 10.1055/s-0043-110863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Compiling a daily hospital roster which complies with existing laws and tariff regulations and meets the requirements for ongoing professional training while also taking the legal regulations on the health of employees into account makes planning the duty roster a challenge. The aim of this study was to obtain a realistic picture of existing duty roster systems and of the current workloads of obstetricians in Germany. METHOD This online survey was sent to 2770 physicians training to become obstetricians or specializing in specific areas of obstetric care. The survey consisted of an anonymized 95-item questionnaire which collected data on different types of duty roster systems and the workload of obstetricians in Germany for the period from 17.02.2015 to 16.05.2015. RESULTS Out of a total of 2770 physicians who were contacted, 437 (16%) completed the questionnaire. Across all forms of care, the care provided outside normal working hours usually (75%) consisted of a combination of regular working times and on-call duty or even consisted entirely of standby duty. Level I perinatal centers were most likely 20% (n = 88) to have a shift system in place. Working a shift system was significantly more common in care facilities which had previously carried out a job analysis. The number of physicians in hospitals who are present during the night shift was higher in facilities with higher numbers of births and in facilities which offered higher levels of care. In addition to regularly working overtime and the fact that often not all the hours worked were recorded, it was notable that the systems used to compile duty rosters often did not comply with legal regulations or with collectively agreed working hours nor were they compatible with the staff planning requirements. OUTLOOK The results of this study show that the conditions of work, the working times, and the organization of working times in obstetric departments are in need of improvement. Recording the actual times worked together with an analysis of the activities performed during working times and while on standby would increase the level of transparency for employers and employees.
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Affiliation(s)
- Johannes Neimann
- Frauenklinik mit Brustzentrum, KRH Klinikum Siloah, Hannover, Germany
| | - Julia Knabl
- Klinikum der Universität München Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Campus Innenstadt, München, Germany.,Department of Obstetrics, Klinik Hallerwiese, Nürnberg, Germany
| | - Julian Puppe
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Uniklinik Köln, Köln, Germany
| | | | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Lena Gabriel
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Birgit Seelbach-Goebel
- Krankenhaus der Barmherzigen Brüder - Klinik St. Hedwig, Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Regensburg, Regensburg, Germany
| | | | - Sarah Schott
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Deutsches Krebsforschungszentrum, Heidelberg, Germany
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49
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Hack CC, Emons J, Jud SM, Heusinger K, Adler W, Gass P, Haeberle L, Heindl F, Hein A, Schulz-Wendtland R, Uder M, Hartmann A, Beckmann MW, Fasching PA, Pöhls UG. Association between mammographic density and pregnancies relative to age and BMI: a breast cancer case-only analysis. Breast Cancer Res Treat 2017; 166:701-708. [PMID: 28828694 DOI: 10.1007/s10549-017-4446-7] [Citation(s) in RCA: 9] [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: 06/29/2017] [Accepted: 08/05/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Percentage mammographic density (PMD) is a major risk factor for breast cancer (BC). It is strongly associated with body mass index (BMI) and age, which are themselves risk factors for breast cancer. This analysis investigated the association between the number of full-term pregnancies and PMD in different subgroups relative to age and BMI. METHODS Patients were identified in the breast cancer database of the University Breast Center for Franconia. A total of 2410 patients were identified, for whom information on parity, age, and BMI, and a mammogram from the time of first diagnosis were available for assessing PMD. Linear regression analyses were conducted to investigate the influence on PMD of the number of full-term pregnancies (FTPs), age, BMI, and interaction terms between them. RESULTS As in previous studies, age, number of FTPs, and BMI were found to be associated with PMD in the expected direction. However, including the respective interaction terms improved the prediction of PMD even further. Specifically, the association between PMD and the number of FTPs differed in young patients under the age of 45 (mean decrease of 0.37 PMD units per pregnancy) from the association in older age groups (mean decrease between 2.29 and 2.39 PMD units). BMI did not alter the association between PMD and the number of FTPs. CONCLUSIONS The effect of pregnancies on mammographic density does not appear to become apparent before the age of menopause. The mechanism that drives the effect of pregnancies on mammographic density appears to be counter-regulated by other influences on mammographic density in younger patients.
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Affiliation(s)
- Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Michael Uder
- Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Uwe G Pöhls
- Practice of Dr. Pöhls, Women's Health Center of Würzburg, Würzburg, Germany
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50
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Hartkopf AD, Graf J, Simoes E, Keilmann L, Sickenberger N, Gass P, Wallwiener D, Matthies L, Taran FA, Lux MP, Wallwiener S, Belleville E, Sohn C, Fasching PA, Schneeweiss A, Brucker SY, Wallwiener M. Electronic-Based Patient-Reported Outcomes: Willingness, Needs, and Barriers in Adjuvant and Metastatic Breast Cancer Patients. JMIR Cancer 2017; 3:e11. [PMID: 28784595 PMCID: PMC5565790 DOI: 10.2196/cancer.6996] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/12/2017] [Accepted: 05/29/2017] [Indexed: 01/04/2023] Open
Abstract
Background Patient-reported outcomes (PROs) play an increasingly important role as an adjunct to clinical outcome parameters in measuring health-related quality of life (HRQoL). In fact, PROs are already the accepted gold standard for collecting data about patients’ subjective perception of their own state of health. Currently, paper-based surveys of PRO still predominate; however, knowledge regarding the feasibility of and barriers to electronic-based PRO (ePRO) acceptance remains limited. Objective The objective of this trial was to analyze the willingness, specific needs, and barriers of adjuvant breast cancer (aBC) and metastatic breast cancer (mBC) patients in nonexposed (no exposure to electronic assessment) and exposed (after exposure to electronic assessment decision, whether a tablet-based questionnaire is favored) settings before implementing digital ePRO assessment in relation to health status. We also investigated whether providing support can increase the patients’ willingness to participate in such programs. Methods The nonexposed patients only answered a paper-based questionnaire, whereas the exposed patients filled out both paper- and tablet-based questionnaires. The assessment comprised socioeconomic variables, HRQoL, preexisting technical skills, general attitude toward electronic-based surveys, and potential barriers in relation to health status. Furthermore, nonexposed patients were asked about the existing need for technological support structures. In the course of data evaluation, we performed a frequency analysis as well as chi-square tests and Wilcoxon signed-rank tests. Subsequently, relative risks analysis, univariate categorical regression (CATREG), and mediation analyses (Hayes’ bias-corrected bootstrap) were performed. Results A total of 202 female breast cancer patients completed the PRO assessment (nonexposed group: n=96 patients; exposed group: n=106 patients). Self-reported technical skills were higher in exposed patients (2.79 vs 2.33, P ≤.001). Significant differences were found in relation to willingness to use ePRO (92.3% in the exposed group vs 59% in the nonexposed group; P=.001). Multiple barriers were identified, and most of them showed statistically significant differences in favor of the exposed patients (ie, data security [13% in the exposed patients vs 30% in the nonexposed patients; P=.003] and no prior technology usage [5% in the exposed group vs 15% in the nonexposed group; P=.02]), whereas the differences in disease burden (somatic dimension: 4% in the exposed group vs 9% in the nonexposed group; P=.13) showed no significance. In nonexposed patients, requests for support services were identified, which could increase their ePRO willingness. Conclusions Significant barriers in relation to HRQoL, cancer-related restrictions, and especially the setting of the survey were identified in this trial. Thus, it is necessary to address and eliminate these barriers to ensure data accuracy and reliability for future ePRO assessments. Exposure seems to be a potential option to increase willingness to use ePRO and to reduce barriers.
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Affiliation(s)
- Andreas D Hartkopf
- Department of Women's Health, University Hospital Tuebingen, Tübingen, Germany
| | - Joachim Graf
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tübingen, Germany
| | - Elisabeth Simoes
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tübingen, Germany
| | - Lucia Keilmann
- Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Nina Sickenberger
- Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Hospital Erlangen, University Breast Center Franconia, Comprehensive Cancer Center Erlangen, Erlangen, Germany
| | - Diethelm Wallwiener
- Department of Women's Health, University Hospital Tuebingen, Tübingen, Germany
| | - Lina Matthies
- Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Florin-Andrei Taran
- Department of Women's Health, University Hospital Tuebingen, Tübingen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, University Hospital Erlangen, University Breast Center Franconia, Comprehensive Cancer Center Erlangen, Erlangen, Germany
| | - Stephanie Wallwiener
- Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Christof Sohn
- Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, University Breast Center Franconia, Comprehensive Cancer Center Erlangen, Erlangen, Germany
| | - Andreas Schneeweiss
- Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Sara Y Brucker
- Research Institute for Women's Health, Department of Women's Health, University Hospital Tuebingen, Tübingen, Germany
| | - Markus Wallwiener
- Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Heidelberg, Germany
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