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Schuler M, Cuppens K, Plönes T, Wiesweg M, Du Pont B, Hegedus B, Köster J, Mairinger F, Darwiche K, Paschen A, Maes B, Vanbockrijck M, Lähnemann D, Zhao F, Hautzel H, Theegarten D, Hartemink K, Reis H, Baas P, Schramm A, Aigner C. Neoadjuvant nivolumab with or without relatlimab in resectable non-small-cell lung cancer: a randomized phase 2 trial. Nat Med 2024:10.1038/s41591-024-02965-0. [PMID: 38689060 DOI: 10.1038/s41591-024-02965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
Antibodies targeting the immune checkpoint molecules PD-1, PD-L1 and CTLA-4, administered alone or in combination with chemotherapy, are the standard of care in most patients with metastatic non-small-cell lung cancers. When given before curative surgery, tumor responses and improved event-free survival are achieved. New antibody combinations may be more efficacious and tolerable. In an ongoing, open-label phase 2 study, 60 biomarker-unselected, treatment-naive patients with resectable non-small-cell lung cancer were randomized to receive two preoperative doses of nivolumab (anti-PD-1) with or without relatlimab (anti-LAG-3) antibody therapy. The primary study endpoint was the feasibility of surgery within 43 days, which was met by all patients. Curative resection was achieved in 95% of patients. Secondary endpoints included pathological and radiographic response rates, pathologically complete resection rates, disease-free and overall survival rates, and safety. Major pathological (≤10% viable tumor cells) and objective radiographic responses were achieved in 27% and 10% (nivolumab) and in 30% and 27% (nivolumab and relatlimab) of patients, respectively. In 100% (nivolumab) and 90% (nivolumab and relatlimab) of patients, tumors and lymph nodes were pathologically completely resected. With 12 months median duration of follow-up, disease-free survival and overall survival rates at 12 months were 89% and 93% (nivolumab), and 93% and 100% (nivolumab and relatlimab). Both treatments were safe with grade ≥3 treatment-emergent adverse events reported in 10% and 13% of patients per study arm. Exploratory analyses provided insights into biological processes triggered by preoperative immunotherapy. This study establishes the feasibility and safety of dual targeting of PD-1 and LAG-3 before lung cancer surgery.ClinicalTrials.gov Indentifier: NCT04205552 .
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Affiliation(s)
- Martin Schuler
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany.
- Medical Faculty, University Duisburg-Essen, Essen, Germany.
- National Center for Tumor Diseases (NCT) West, Essen, Germany.
| | - Kristof Cuppens
- Department of Pulmonology and Thoracic Oncology, and Jessa and Science, Jessa Hospital, Hasselt, Belgium.
- Faculty of Medicine and Life Sciences LCRC, UHasselt, Diepenbeek, Belgium.
| | - Till Plönes
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, Essen, Germany
- University Hospital Carl Gustav Carus, Department of Surgery, Division of Thoracic Surgery, Technical University Dresden, Dresden, Germany
| | - Marcel Wiesweg
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
| | - Bert Du Pont
- Department of Thoracic and Vascular Surgery, Jessa Hospital, Hasselt, Belgium
| | - Balazs Hegedus
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Johannes Köster
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- Bioinformatics and Computational Oncology, Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Fabian Mairinger
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Institute for Pathology, University Hospital Essen, Essen, Germany
| | - Kaid Darwiche
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- West German Cancer Center, Department of Pulmonary Medicine, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Annette Paschen
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Brigitte Maes
- Laboratory Medicine Department, Laboratory for Molecular Diagnostics, Jessa Hospital, Hasselt, Belgium
| | | | - David Lähnemann
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- Bioinformatics and Computational Oncology, Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Fang Zhao
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases (NCT) West, Essen, Germany
- West German Cancer Center, Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Dirk Theegarten
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Institute for Pathology, University Hospital Essen, Essen, Germany
| | - Koen Hartemink
- Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henning Reis
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Institute for Pathology, University Hospital Essen, Essen, Germany
- University Hospital Frankfurt, Dr Senckenberg Institute of Pathology, Goethe University, Frankfurt, Germany
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alexander Schramm
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- West German Cancer Center, Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, Essen, Germany
- General Hospital Vienna, Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
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2
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Schuler M, Hense J, Darwiche K, Michels S, Hautzel H, Kobe C, Lueong S, Metzenmacher M, Herold T, Zaun G, Laue K, Drzezga A, Theegarten D, Nensa F, Wolf J, Herrmann K, Wiesweg M. Early Metabolic Response by PET Predicts Sensitivity to Next-Line Targeted Therapy in EGFR-Mutated Lung Cancer with Unknown Mechanism of Acquired Resistance. J Nucl Med 2024:jnumed.123.266979. [PMID: 38575188 DOI: 10.2967/jnumed.123.266979] [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: 11/06/2023] [Revised: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
Targeted therapy with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has established the precision oncology paradigm in lung cancer. Most patients with EGFR-mutated lung cancer respond but eventually acquire resistance. Methods: Patients exhibiting the EGFR p.T790M resistance biomarker benefit from sequenced targeted therapy with osimertinib. We hypothesized that metabolic response as detected by 18F-FDG PET after short-course osimertinib identifies additional patients susceptible to sequenced therapy. Results: Fourteen patients with EGFR-mutated lung cancer and resistance to first- or second-generation EGFR TKI testing negatively for EGFR p.T790M were enrolled in a phase II study. Five patients (36%) achieved a metabolic 18F-FDG PET response and continued osimertinib. In those, the median duration of treatment was not reached (95% CI, 24 mo to not estimable), median progression-free survival was 18.7 mo (95% CI, 14.6 mo to not estimable), and median overall survival was 41.5 mo. Conclusion: Connecting theranostic osimertinib treatment with early metabolic response assessment by PET enables early identification of patients with unknown mechanisms of TKI resistance who derive dramatic clinical benefit from sequenced osimertinib. This defines a novel paradigm for personalization of targeted therapies in patients with lung cancer dependent on a tractable driver oncogene.
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Affiliation(s)
- Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany;
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
| | - Kaid Darwiche
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
- Department of Pulmonary Medicine, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Sebastian Michels
- National Center for Tumor Diseases West, Essen, Germany
- Department of Medicine I, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Hubertus Hautzel
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Carsten Kobe
- National Center for Tumor Diseases West, Essen, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
- Department of Nuclear Medicine, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Smiths Lueong
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
- Bridge Institute for Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
| | - Thomas Herold
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany; and
| | - Gregor Zaun
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
| | - Katharina Laue
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Alexander Drzezga
- National Center for Tumor Diseases West, Essen, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
- Department of Nuclear Medicine, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Dirk Theegarten
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany; and
| | - Felix Nensa
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Jürgen Wolf
- National Center for Tumor Diseases West, Essen, Germany
- Department of Medicine I, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Ken Herrmann
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases West, Essen, Germany
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Stockhammer P, Baumeister H, Ploenes T, Bonella F, Theegarten D, Dome B, Pirker C, Berger W, Hegedüs L, Baranyi M, Schuler M, Deshayes S, Bölükbas S, Aigner C, Blanquart C, Hegedüs B. Krebs von den Lungen 6 (KL-6) is a novel diagnostic and prognostic biomarker in pleural mesothelioma. Lung Cancer 2023; 185:107360. [PMID: 37713954 DOI: 10.1016/j.lungcan.2023.107360] [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: 01/28/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Pleural mesothelioma (PM) is a rare disease with dismal outcome. Systemic treatment options include chemotherapy and immunotherapy, but biomarkers for treatment personalization are missing. The only FDA-approved diagnostic biomarker is the soluble mesothelin-related protein (SMRP). Krebs von den Lungen-6 (KL-6) is a human mucin 1 (MUC1) glycoprotein, which has shown diagnostic and prognostic value as a biomarker in other malignancies. The present study investigated whether KL-6 can serve as a diagnostic and/or prognostic biomarker in PM. MATERIALS AND METHODS Using a fully-automated chemiluminescence enzyme immunoassay (CLEIA) for KL-6 and SMRP, pleural effusion samples from 87 consecutive patients with PM and 25 patients with non-malignant pleural disorders were studied. In addition, KL-6 and SMRP levels were determined in corresponding patient sera, and in an independent validation cohort (n = 122). MUC1 mRNA and protein expression, and KL-6 levels in cell line supernatants were investigated in PM primary cell lines in vitro. RESULTS PM patients had significantly higher KL-6 levels in pleural effusion than non-malignant controls (AUC 0.78, p < 0.0001). Among PM patients, levels were highest in those with epithelioid or biphasic histologies. There was a strong positive correlation between pleural effusion levels of KL-6 and SMRP (p < 0.0001). KL-6 levels in sera similarly associated with diagnosis of PM, however, to a lesser extent (AUC 0.71, p = 0.008). PM patients with high pleural effusion KL-6 levels (≥303 IU/mL) had significantly better overall survival (OS) compared to those with low KL-6 levels (HR 0.51, p = 0.004). Congruently, high tumor cell MUC1 mRNA expression in primary cell lines associated with prolonged corresponding patient OS (HR 0.35, p = 0.004). These findings were confirmed in an independent validation cohort. CONCLUSION This is the first study demonstrating KL-6 as a potential novel liquid-based diagnostic and prognostic biomarker in PM.
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Affiliation(s)
- Paul Stockhammer
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany; Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA
| | - Hannah Baumeister
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany; Division of Thoracic Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Helmholtzstr. 10, 01069 Dresden, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Disease Unit, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Balazs Dome
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Ráth György u. 7-9, 1122 Budapest, Hungary; National Korányi Institute of Pulmonology, Korányi Frigyes út 1, 1122 Budapest, Hungary; Department of Translational Medicine, Lund University, Box 117, 221 00 Lund, Sweden
| | - Christine Pirker
- Center for Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Walter Berger
- Center for Cancer Research and Comprehensive Cancer Center, Department of Medicine I, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Luca Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany
| | - Marcell Baranyi
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Üllöi ut 93, 195, Budapest, Hungary
| | - Martin Schuler
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122 Essen, Germany; Department of Medical Oncology, West German Cancer Center, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, German
| | - Sophie Deshayes
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, F-44000 Nantes, France
| | - Servet Bölükbas
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122 Essen, Germany; Karl-Landsteiner-Institute for Clinical and Translational Thoracic Surgery Research, Bruenner Strasse 68, 1210 Vienna, Austria
| | - Christophe Blanquart
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, F-44000 Nantes, France
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Tueschener Weg 40, 45239 Essen, Germany.
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Spetsotaki K, Koch A, Taube C, Theegarten D, Kamler M, Pizanis N. Incidence of malignancies after lung transplantation and their effect on the outcome. 26 years' experience. Heliyon 2023; 9:e20592. [PMID: 37810874 PMCID: PMC10550624 DOI: 10.1016/j.heliyon.2023.e20592] [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: 04/14/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Malignancy is a significant, life-limiting complication after lung transplantation (LuTx) and the second common long-term cause of death. We aimed to investigate its incidence and effect on the outcome. Methods This is a retrospective observational study. Between 1996 and 2022, n = 627 lung transplantations (LuTx) were performed in our department. We used our institutional database to identify recipients with malignancies after LuTx and examined the malignancies' incidence and mortality. Results N = 59 malignancies occurred in n = 55 (8.8%) LuTx recipients. The post-LTx malignancies incidence was 9.4% (59/627). We report the following rates based on their location: n = 17/55 (28,8% of all recipients diagnosed with malignancies) skin, n = 10/55 (16,95%) gastrointestinal, n = 9/55 (15,3%) respiratory, n = 5/55 (8,48%) lymphatic, n = 13/55 (23,6%) other, n = 5 (8,48%) multiple synchronous.During this study period, a total of n = 328 deaths after LuTx was determined. N = 29 (8,84% of all deaths) were malignancy induced, corresponding to a total malignancy-induced mortality of 4.6% (n = 29/627). The majority of deaths were attributed to GI adenocarcinoma and PTLD. Malignancies' origin, primary COPD diagnosis, type, and specific age group were significantly survival-related (p-values <0.05). The most affected organ was skin and showed the best prognosis. PTLD had the fastest and pancreatic the latest onset. Conclusions This is the first report of its kind in a large cohort of german LuTx recipients. The prevalence ranking of the three commonest malignancy were skin > colorectal > PTLD. Post-LTx malignancy was the second commonest cause of death. Further studies are needed, while post-LuTx malignomas remain a serious impairment of long-term LuTx survival.
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Affiliation(s)
- Konstantina Spetsotaki
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
| | - Achim Koch
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
| | - Christian Taube
- Department of Pneumology, Ruhrland Clinic, University Hospital Essen, Germany
| | | | - Markus Kamler
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
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Zec K, Thiebes S, Bottek J, Siemes D, Spangenberg P, Trieu DV, Kirstein N, Subramaniam N, Christ R, Klein D, Jendrossek V, Loose M, Wagenlehner F, Jablonska J, Bracht T, Sitek B, Budeus B, Klein-Hitpass L, Theegarten D, Shevchuk O, Engel DR. Comparative transcriptomic and proteomic signature of lung alveolar macrophages reveals the integrin CD11b as a regulatory hub during pneumococcal pneumonia infection. Front Immunol 2023; 14:1227191. [PMID: 37790937 PMCID: PMC10544576 DOI: 10.3389/fimmu.2023.1227191] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Streptococcus pneumoniae is one of the main causes of community-acquired infections in the lung alveoli in children and the elderly. Alveolar macrophages (AM) patrol alveoli in homeostasis and under infectious conditions. However, the molecular adaptations of AM upon infections with Streptococcus pneumoniae are incompletely resolved. Methods We used a comparative transcriptomic and proteomic approach to provide novel insights into the cellular mechanism that changes the molecular signature of AM during lung infections. Using a tandem mass spectrometry approach to murine cell-sorted AM, we revealed significant proteomic changes upon lung infection with Streptococcus pneumoniae. Results AM showed a strong neutrophil-associated proteomic signature, such as expression of CD11b, MPO, neutrophil gelatinases, and elastases, which was associated with phagocytosis of recruited neutrophils. Transcriptomic analysis indicated intrinsic expression of CD11b by AM. Moreover, comparative transcriptomic and proteomic profiling identified CD11b as the central molecular hub in AM, which influenced neutrophil recruitment, activation, and migration. Discussion In conclusion, our study provides novel insights into the intrinsic molecular adaptations of AM upon lung infection with Streptococcus pneumoniae and reveals profound alterations critical for effective antimicrobial immunity.
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Affiliation(s)
- Kristina Zec
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Stephanie Thiebes
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Jenny Bottek
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Devon Siemes
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Philippa Spangenberg
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Duc Viet Trieu
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Nils Kirstein
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Nirojah Subramaniam
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Robin Christ
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Diana Klein
- Institute for Cell Biology (Cancer Research), University Hospital Essen, Essen, Germany
| | - Verena Jendrossek
- Institute for Cell Biology (Cancer Research), University Hospital Essen, Essen, Germany
| | - Maria Loose
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Jadwiga Jablonska
- Department of Otorhinolaryngology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thilo Bracht
- Medical Faculty, Medizinisches Proteom‐Center, Ruhr‐University Bochum, Bochum, Germany
- Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschafts-krankenhaus Bochum, Bochum, Germany
| | - Barbara Sitek
- Medical Faculty, Medizinisches Proteom‐Center, Ruhr‐University Bochum, Bochum, Germany
- Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschafts-krankenhaus Bochum, Bochum, Germany
| | - Bettina Budeus
- Institute of Cell Biology (Cancer Research), Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Ludger Klein-Hitpass
- Institute of Cell Biology (Cancer Research), Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Olga Shevchuk
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
| | - Daniel R. Engel
- Institute for Experimental Immunology and Imaging, Department of Immunodynamics, University Hospital Essen, Essen, Germany
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Meetschen M, Sandach P, Darwiche K, Theegarten D, Moter A, Schaarschmidt BM, Herrmann K, Fendler WP, Hautzel H, Opitz M. Rabbit fever: granulomatous inflammation by Francisella tularensis mimics lung cancer in dual tracer 18FDG and 68Ga-FAPI PET/CT. Eur J Nucl Med Mol Imaging 2023; 50:2567-2569. [PMID: 36907901 PMCID: PMC10008710 DOI: 10.1007/s00259-023-06175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Mathias Meetschen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - Patrick Sandach
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Annette Moter
- Institute of Microbiology, Infectious Diseases and Immunology, Biofilmcenter Charité-Universitätsmedizin Berlin, Berlin, Germany
- Moter Diagnostics, Berlin, Germany
| | - Benedikt Michael Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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7
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Plönes T, Slama A, Seebacher G, Viehof J, Okumus Ö, Theegarten D, Darwiche K, Taube C, Aigner C. The nodule in the emphysematous lung: an appeal for surgery in a lung volume reduction concept. J Thorac Dis 2023; 15:3166-3171. [PMID: 37426167 PMCID: PMC10323600 DOI: 10.21037/jtd-22-915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/03/2023] [Indexed: 07/11/2023]
Abstract
Background Emphysema patients, who are candidates for lung volume reduction surgery (LVRS) usually present with an extensive smoking history and thus have an increased risk for lung. The incidence of pulmonary nodules in emphysematous lungs is high. We therefore aimed to analyse the incidence and histological findings of pulmonary nodules in our LVRS program. Methods We conducted a retrospective review of all patients who underwent LVRS between 2016 and 2018. Data concerning preoperative workup, 30 days mortality and histopathological findings analysed. Results Between 2016 and 2018, LVRS was performed in 66 patients. In 18 (27%) a nodule was found in the preoperative computed tomography (CT) scan. Histological findings revealed in two cases squamous cell lung cancer. In two other cases, histopathological findings revealed an anthracotic intrapulmonary lymph node. In eight cases, a tuberculoma was found with a positive culture in one case. The other six histopathological findings were hamartoma, granuloma or sequelae of pneumonia. Conclusions Malignancy was found in 11.1% of patients presenting with a nodule in preoperative LVRS workup. The relative risk of lung cancer in emphysema patients is increased and if LVRS criteria are fulfilled surgical resection of a pulmonary nodule is a meaningful way to verify the histology.
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Affiliation(s)
- Till Plönes
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Alexis Slama
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Gernot Seebacher
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jan Viehof
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Özlem Okumus
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, German
| | - Christian Taube
- Department of Pulmonary Medicine, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, German
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Schuler M, Bölükbas S, Darwiche K, Theegarten D, Herrmann K, Stuschke M. Personalized Treatment for Patients With Lung Cancer. Dtsch Arztebl Int 2023:arztebl.m2023.012. [PMID: 36790172 DOI: 10.3238/arztebl.m2023.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Lung cancer is the most common cause of death among all types of cancer in Germany, with an annual death rate of 45 000 patients. Over the past 15 years, innovations in diagnosis and treatment have prolonged the survival of patients with non-small-cell lung cancer in all tumor stages. METHODS This review of the diagnosis and treatment of lung cancer is based on current national and international guidelines, and on prospective trials with the highest possible level of evidence that were retrieved by a selective search of the literature. RESULTS Improved outcomes in patients with non-small-cell lung cancer (85% of new diagnoses) were achieved with the aid of precise diagnostic techniques, including functional imaging and endobronchial procedures for localized disease stage. Contemporary surgical and radio-oncological technologies reduce the morbidity and expand the boundaries of local therapy. Molecular pathology, including the assessment of predictive biomarkers, is an integral part of the diagnostic evaluation of non-small-cell lung cancer in all tumor stages; it enables stratified cytotoxic/molecularly targeted treatments and immunotherapies and improves patient-reported outcomes. The percentage of long-term survivors in the metastatic stage has doubled by the introduction of immunotherapy. In contrast, there has been no major improvement in the survival of patients with small-cell lung cancer (15% of new diagnoses). CONCLUSION In addition to the implementation of lung cancer screening in high-risk populations, the further development and consistent implementation of personalized diagnosis and treatment in certified lung cancer centers can be expected to prolong survival and improve the patients' quality of life.
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9
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Hegedüs L, Okumus Ö, Mairinger F, Ploenes T, Reuter S, Schuler M, Welt A, Vega-Rubin-de-Celis S, Theegarten D, Bankfalvi A, Aigner C, Hegedüs B. TROP2 expression and SN38 antitumor activity in malignant pleural mesothelioma cells provide a rationale for antibody-drug conjugate therapy. Lung Cancer 2023; 178:237-246. [PMID: 36907051 DOI: 10.1016/j.lungcan.2023.03.003] [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: 10/12/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Malignant pleural mesothelioma (MPM) is an aggressive cancer which at large is not amenable to curative surgery. Despite the recent approval of immune checkpoint inhibitor therapy, the response rates and survival following systemic therapy is still limited. Sacituzumab govitecan is an antibody-drug conjugate targeting the topoisomerase I inhibitor SN38 to trophoblast cell-surface antigen 2 (TROP-2)-positive cells. Here we have explored the therapeutic potential of sacituzumab govitecan in MPM models. MATERIALS AND METHODS TROP2 expression was analyzed in a panel of two well established and 15 pleural effusion derived novel lines by RT-QPCR and immunoblotting, TROP2 membrane-localization was studied by flow cytometry and immunohistochemistry. Cultured mesothelial cells and pneumothorax pleura served as controls. The sensitivity of MPM cell lines to irinotecan and SN38 was studied using cell viability, cell cycle, apoptosis and DNA damage assays. Drug sensitivity of cell lines was correlated with RNA expression of DNA repair genes. Drug sensitivity was defined as an IC50 below 5 nM in the cell viability assay. RESULTS TROP2 expression was detected at RNA and protein level in 6 of the 17 MPM cell lines, but not in in cultured mesothelial control cells or in the mesothelial layer of the pleura. TROP2 was detectable on the cell membrane in 5 MPM lines and was present in the nucleus in 6 cell models. Ten of 17 MPM cell lines showed sensitivity to SN38 treatment, among those 4 expressed TROP2. High AURKA RNA expression and high proliferation rate correlated with sensitivity to SN38-induced cell death, DNA damage response, cell cycle arrest and cell death. Sacituzumab govitecan treatment effectively induced cell cycle arrest and cell death in TROP2-positive MPM cells. CONCLUSION TROP2 expression and sensitivity to SN38 in MPM cell lines support biomarker-selected clinical exploration of sacituzumab govitecan in patients with MPM.
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Affiliation(s)
- Luca Hegedüs
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Özlem Okumus
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Fabian Mairinger
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Sebastian Reuter
- Department of Pulmonology, University Medicine Essen - Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Anja Welt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Silvia Vega-Rubin-de-Celis
- Institute of Cell Biology (Cancer Research), University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Agnes Bankfalvi
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239 Essen, Germany.
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Jehn LB, Costabel U, Boerner E, Wälscher J, Theegarten D, Taube C, Bonella F. Serum KL-6 as a Biomarker of Progression at Any Time in Fibrotic Interstitial Lung Disease. J Clin Med 2023; 12:jcm12031173. [PMID: 36769819 PMCID: PMC9917700 DOI: 10.3390/jcm12031173] [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: 01/09/2023] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
The development of a progressive phenotype of interstitial lung disease (ILD) is still unpredictable. Whereas tools to predict mortality in ILD exist, scores to predict disease progression are missing. The aim of this study was to investigate whether baseline serum KL-6 as an established marker to assess disease activity in ILD, alone or in combination with clinical variables, could improve stratification of ILD patients according to progression risk at any time. Consecutive patients with fibrotic ILD, followed at our institution between 2008 and 2015, were investigated. Disease progression was defined as relative decline of ≥10% in forced vital capacity (FVC) or ≥15% in diffusing capacity of the lung for carbon monoxide (DLco)% from baseline at any time. Serum KL-6 was measured using an automated immunoassay (Fujirebio Europe, Gent, Belgium). A stepwise logistic regression was performed to select variables to be included in the score. A total of 205 patients (49% idiopathic pulmonary fibrosis (IPF), 51% fibrotic nonspecific interstitial pneumonia (NSIP)) were included, of them 113 (55%) developed disease progression during follow up. Male gender (G) and serum KL-6 strata (K) were significant predictors of progression at regression analysis and were included in the GK score. A threshold of 2 GK score points was best for discriminating patients at high risk versus low risk to develop disease progression at any time. Serum KL-6 concentration, alone or combined in a simple score with gender, allows an effective stratification of ILD patients for risk of disease progression at any time.
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Affiliation(s)
- Lutz B. Jehn
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239 Essen, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239 Essen, Germany
| | - Eda Boerner
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239 Essen, Germany
| | - Julia Wälscher
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239 Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, 45239 Essen, Germany
| | - Christian Taube
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239 Essen, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239 Essen, Germany
- Correspondence: ; Tel.: +49-201-433-4502; Fax: +49-201-433-4152
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Okumus Ö, Mardanzai K, Plönes T, Theegarten D, Darwiche K, Schuler M, Nensa F, Hautzel H, Hermann K, Stuschke M, Hegedus B, Aigner C. Preoperative PET-SUVmax and volume based PET parameters of the primary tumor fail to predict nodal upstaging in early-stage lung cancer. Lung Cancer 2023; 176:82-88. [PMID: 36623341 DOI: 10.1016/j.lungcan.2022.12.013] [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: 09/20/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Accurate nodal staging is of utmost importance in patients with lung cancer. FDG-PET/CT imaging is now part of the routine staging. Despite thorough preoperative staging nodal upstaging still occurs in early-stage lung cancer. However, the predictive value of preoperative PET metrics of the primary tumor on nodal upstaging remains to be unexplored. Our aim was to assess the association of these preoperative PET-parameters with nodal upstaging in histologically confirmed lung adenocarcinoma and squamous cell carcinoma. METHODS From January 2016 to November 2018, 500 patients with pT1-T2/cN0 lung cancer received an anatomical resection with curative intent. 171 patients with adenocarcinoma and squamous cell carcinoma and available PET-CTs were retrospectively included. We analyzed the the association of nodal upstaging with preoperative PET-SUVmax and metabolic PET metrics including total lesion glycolysis (TLG) and metabolic tumor volume (MTV) with different defined thresholds. RESULTS High values of preoperative PET-SUVmax of the primary tumor were associated with squamous cell carcinoma (p < 0.0001) and with larger tumors (p < 0.0001). Increased preoperative C-reactive protein levels (<1mg/dL) correlated significantly with high preoperative PET-SUVmax values (p < 0.0001). No significant relationship between PET-SUVmax and lactate dehydrogenase activity (p = 0.6818), white blood cell count (p = 0.7681), gender (p = 0.1115) or age (p = 0.9284) was observed. Nodal upstaging rate was 14.0 % with 8.8 % N1 and 5.3 % N2 upstaging. Tumor size (p = 0.0468) and number of removed lymph nodes (p = 0.0461) were significant predictors of nodal upstaging but no significant association was found with histology or PET parameters. Of note, increased MTV - regardless of the threshold - tended to associate with nodal upstaging. CONCLUSION Early-stage lung cancer patients with squamous histology and T2 tumors presented increased preoperative PET-SUVmax values. Nevertheless, beyond tumor size and number of removed lymph nodes neither SUVmax nor metabolic PET parameters MTV and TLG were significant predictors of nodal upstaging.
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Affiliation(s)
- Özlem Okumus
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Khaled Mardanzai
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Department of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Ken Hermann
- Department of Nuclear Medicine, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Martin Stuschke
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany; Department of Radiation Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Balazs Hegedus
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
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12
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Sandach P, Seifert R, Slama A, Theegarten D, Hautzel H. Histological Validation of FDG and PSMA-Targeted PET/CT Imaging in a Rare Tracheal Adenoid Cystic Carcinoma. Clin Nucl Med 2023; 48:e16-e18. [PMID: 36469074 DOI: 10.1097/rlu.0000000000004441] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT Adenoid cystic carcinomas are the second most common entity of tracheal malignancies, which have an overall incidence as low as only 0.2 in 100,000 persons per year. We present the case of a 64-year-old man with a histologically confirmed adenoid cystic carcinoma who sequentially underwent 18F-FDG PET/CT and 68Ga-PSMA-11 PET/CT within 1 day for staging 3 days before surgical resection of the tumor. Immunohistochemistry revealed PSMA expression of the tumor corroborating the PSMA PET findings.
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Affiliation(s)
- Patrick Sandach
- From the Department of Nuclear Medicine, University Hospital Essen
| | - Robert Seifert
- From the Department of Nuclear Medicine, University Hospital Essen
| | - Alexis Slama
- Department of Thoracic Surgery and Thoracic Bronchoscopy, Ruhrlandklinik
| | - Dirk Theegarten
- Department of Pathology, University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- From the Department of Nuclear Medicine, University Hospital Essen
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13
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Baraniskin A, Baba HA, Theegarten D, Mika T, Schroers R, Klein-Scory S. Liquid biopsy can cure early colorectal cancer recurrence - Case Report. Front Oncol 2023; 13:1141833. [PMID: 37207159 PMCID: PMC10188995 DOI: 10.3389/fonc.2023.1141833] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
In the context of colorectal cancer (CRC), circulating tumor DNA (ctDNA) is frequently used to monitor the minimal residual disease (MRD). ctDNA has become an excellent biomarker to predict which patients with CRC are likely to relapse due to the persistence of micrometastases. MRD diagnosis via analysis of ctDNA may allow much earlier detection of relapse compared with conventional diagnosis during follow-up. It should lead to an increased rate of curative-intended complete resection of an asymptomatic relapse. Besides, ctDNA can provide crucial information on whether and how intensively adjuvant or additive therapy should be administered. In the present case, analysis of ctDNA gave us a crucial hint to the use of more intensive diagnostics (MRI and Positron emission tomography-computed tomography PET-CT) which led to earlier detection of CRC relapse. Metastasis detected early are more likely to be completely resectable with curative intent.
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Affiliation(s)
- Alexander Baraniskin
- Department of Hematology and Oncology, Evangelisches Krankenhaus Hamm, Hamm, Germany
- Department of Medicine, Hematology and Oncology, University Hospital Knappschaftskrankenhaus Bochum GmbH, Ruhr University of Bochum, Bochum, Germany
- *Correspondence: Alexander Baraniskin,
| | - Hideo A. Baba
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Mika
- Department of Medicine, Hematology and Oncology, University Hospital Knappschaftskrankenhaus Bochum GmbH, Ruhr University of Bochum, Bochum, Germany
| | - Roland Schroers
- Department of Medicine, Hematology and Oncology, University Hospital Knappschaftskrankenhaus Bochum GmbH, Ruhr University of Bochum, Bochum, Germany
| | - Susanne Klein-Scory
- Department of Medicine, Hematology and Oncology, University Hospital Knappschaftskrankenhaus Bochum GmbH, Ruhr University of Bochum, Bochum, Germany
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Okumus O, Mardanzai K, Ploenes T, Theegarten D, Darwiche K, Schuler M, Nensa F, Hautzel H, Stuschke M, Hegedues B, Aigner C. EP02.01-010 Preoperative PET-SUVmax and Volume Based PET Metrics of the Tumor Fail to Predict Nodal Upstaging in Early-Stage Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Exner JP, Nadjm S, Hepp de los Rios R, Metzenmacher M, Hoffmann AC, Gauler T, Aigner C, Stamatis G, Oezkan F, Schulte C, Darwiche K, Taube C, Theegarten D, Plönes T, Pöttgen C, Umutlu L, Hautzel H, Schuler M, Stuschke M, Eberhardt W. EP04.01-016 First Comprehensive Lung Cancer Long-Term Survivorship Analysis - Late Toxicities and Overall Survival. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.428] [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: 12/01/2022]
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Hegedüs L, Okumus Ö, Mairinger F, Plönes T, Reuter S, Schuler M, Theegarten D, Bánkfalvi Á, Aigner C, Hegedüs B. P1.14-05 TROP2 Expression and SN38 Antitumor Activity in Malignant Pleural Mesothelioma Cells. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.196] [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: 11/30/2022]
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Exner JP, Nadjm S, Hepp de los Rios R, Metzenmacher M, Hoffmann AC, Gauler T, Aigner C, Stamatis G, Oezkan F, Schulte C, Darwiche K, Taube C, Theegarten D, Plönes T, Poettgen C, Umutlu L, Hautzel H, Schuler M, Stuschke M, Eberhardt W. EP04.02-005 First Comprehensive Lung Cancer Long-Term Survivorship Program - Late Toxicities and Overall Survival. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.445] [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: 12/01/2022]
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Schuler M, Cuppens K, Ploenes T, Vanbockrijck M, Wiesweg M, Darwiche K, Schramm A, Maes B, Hegedus B, Schildhaus HU, Hautzel H, Theegarten D, Baas P, Hartemink K, Du Pont B, Aigner C. LBA37 A randomized, multicentric phase II study of preoperative nivolumab plus relatlimab or nivolumab in patients with resectable non-small cell lung cancer (NEOpredict-Lung). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.034] [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: 11/01/2022] Open
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Nadjm S, Exner JP, Hepp De Los Rios R, Metzenmacher M, Hoffmann AC, Gauler T, Aigner C, Stamatis G, Oezkan F, Schulte C, Darwiche K, Taube C, Theegarten D, Plönes T, Pöttgen C, Umutlu L, Hautzel H, Schuler M, Stuschke M, Eberhardt W. EP04.02-007 First Comprehensive Lung Cancer Long-Term Survivorship Program- Competing Risks. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Jehn LB, Costabel U, Boerner E, Wessendorf TE, Theegarten D, Taube C, Bonella F. IL-9 and IL-9 receptor expression in lymphocytes from bronchoalveolar lavage fluid of patients with interstitial lung disease. Immunobiology 2022; 227:152258. [PMID: 35998415 DOI: 10.1016/j.imbio.2022.152258] [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: 04/06/2022] [Revised: 07/08/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION IL-9, mainly produced by T helper 9 (Th9) cells, promotes allergic airway inflammation and remodeling through the interaction with its receptor (IL-9R). Th9 cells and IL-9 have also been implicated in tissue fibrosis and autoimmunity pathways. However, the role of IL-9/IL-9R in the pathogenesis of interstitial lung disease (ILD) is unknown. AIM To evaluate IL-9/IL-9R expression in bronchoalveolar lavage fluid (BALF) lymphocytes of patients with various ILDs. METHODS Consecutive patients with ILD, who underwent BAL for diagnostic purposes, were studied. As control group, consecutive patients without evidence of ILD were included. Immunocytochemical staining of BALF lymphocytes for IL-9 and IL-9R was performed and evaluated by two independent readers. RESULTS 45 patients, of them 8 had idiopathic pulmonary fibrosis (IPF), 12 nonspecific interstitial pneumonia (NSIP), 10 sarcoidosis, 9 hypersensitivity pneumonitis (HP), 6 cryptogenic organizing pneumonia (COP), and 24 controls were studied. In the ILD group, the highest BALF lymphocyte count was seen in HP followed by NSIP, COP, sarcoidosis, and IPF (p < 0.05 for HP vs IPF). The highest percentages of IL-9 and IL-9R positive lymphocytes were seen in COP. Conversely, NSIP showed the lowest rate of IL-9, and sarcoidosis the lowest rate of IL-9R positive lymphocytes. Only in NSIP, a direct correlation between IL and 9 and IL-9R positive lymphocytes was seen (r = 0.639, p = 0.025). CONCLUSION BALF lymphocytes IL-9 and IL-9R expression differs between various ILDs and could reflect different pathogenetic mechanisms.
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Affiliation(s)
- Lutz B Jehn
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Eda Boerner
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Thomas E Wessendorf
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany.
| | - Christian Taube
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Disease, Department of Pneumology, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
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21
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Guberina N, Pöttgen C, Schuler M, Guberina M, Stamatis G, Plönes T, Metzenmacher M, Theegarten D, Gauler T, Darwiche K, Aigner C, Eberhardt WEE, Stuschke M. Long-term survival of patients with central or > 7 cm T4 N0/1 M0 non-small-cell lung cancer treated with definitive concurrent radiochemotherapy in comparison to trimodality treatment. Radiat Oncol 2022; 17:126. [PMID: 35842712 PMCID: PMC9288731 DOI: 10.1186/s13014-022-02080-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background To examine long-term-survival of cT4 cN0/1 cM0 non-small-cell lung carcinoma (NSCLC) patients undergoing definitive radiochemotherapy (ccRTx/CTx) in comparison to the trimodality treatment, neoadjuvant radiochemotherapy followed by surgery, at a high volume lung cancer center. Methods All consecutive patients with histopathologically confirmed NSCLC (cT4 cN0/1 cM0) with a curative-intent-to-treat ccRTx/CTx were included between 01.01.2001 and 01.07.2019. Mediastinal involvement was excluded by systematic EBUS-TBNA or mediastinoscopy. Following updated T4-stage-defining-criteria initial staging was reassessed by an expert-radiologist according to UICC-guidelines [8th edition]. Outcomes were compared with previously reported results from patients of the same institution with identical inclusion criteria, who had been treated with neoadjuvant radiochemotherapy and resection. Factors for treatment selection were documented. Endpoints were overall-survival (OS), progression-free-survival (PFS), and cumulative incidences of isolated loco-regional failures, distant metastases, secondary tumors as well as non-cancer deaths within the first year. Results Altogether 46 consecutive patients with histopathologically confirmed NSCLC cT4 cN0/1 cM0 [cN0 in 34 and cN1 in 12 cases] underwent ccRTx/CTx after induction chemotherapy (iCTx). Median follow-up was 133 months. OS-rates at 3-, 5-, and 7-years were 74.9%, 57.4%, and 57.4%, respectively. Absolute OS-rate of ccRTx/CTx at 5 years were within 10% of the trimodality treatment reference group (Log-Rank p = 0.184). The cumulative incidence of loco-regional relapse was higher after iCTx + ccRT/CTx (15.2% vs. 0% at 3 years, p = 0.0012, Gray’s test) while non-cancer deaths in the first year were lower than in the trimodality reference group (0% vs 9.1%, p = 0.0360, Gray’s test). None of the multiple recorded prognostic parameters were significantly associated with survival after iCTx + ccRT/CTx: Propensity score weighting for adjustment of prognostic factors between iCTx + ccRT/CTx and trimodality treatment did not change the results of the comparisons. Conclusions Patients with cT4 N0/1 M0 NSCLC have comparable OS with ccRTx/CTx and trimodality treatment. Loco-regional relapses were higher and non-cancer related deaths lower with ccRTx/CTx. Definitive radiochemotherapy is an adequate alternative for patients with an increased risk of surgery-related morbidity. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02080-9.
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Affiliation(s)
- Nika Guberina
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Christoph Pöttgen
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Maja Guberina
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Thomas Gauler
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, West German Cancer Center, Section of Interventional Pneumology, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Clemens Aigner
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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22
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Guberina M, Guberina N, Pöttgen C, Gauler T, Richlitzki C, Metzenmacher M, Wiesweg M, Plönes T, Forsting M, Wetter A, Herrmann K, Hautzel H, Darwiche K, Theegarten D, Aigner C, Schuler M, Stuschke M, Eberhardt WE. Effectiveness of durvalumab consolidation in stage III non-small-cell lung cancer: focus on treatment selection and prognostic factors. Immunotherapy 2022; 14:927-944. [PMID: 35822656 DOI: 10.2217/imt-2021-0341] [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: 11/21/2022] Open
Abstract
The pivotal PACIFIC trial defined durvalumab consolidation as the new standard of care in patients with stage III non-small-cell lung cancer treated with definitive radiochemotherapy. The authors characterized the durvalumab effect after induction chemotherapy according to the ESPATUE trial and definitive radiochemotherapy. All consecutive patients with stage III non-small-cell lung cancer receiving definitive radiochemotherapy between January 2017 and February 2020 were included. Primary end points were progression-free survival and overall survival. Altogether, 160 patients (75 PD-L1-positive, 62 PD-L1-negative, 23 unknown) received definitive radiochemotherapy, 146 (91%) of whom received prior induction chemotherapy. Durvalumab consolidation showed high effectiveness overall and in the good-risk group according to the PACIFIC trial (log-rank test: p < 0.005). Hazard ratios for progression-free survival and overall survival were at the lower limits of those in the PACIFIC trial. These results were robust to adjustment for potential confounders by propensity score weighting. Eastern Cooperative Oncology Group (ECOG) performance status was the most important pretreatment prognostic factor.
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Affiliation(s)
- Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany
| | - Thomas Gauler
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany
| | - Cedric Richlitzki
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany.,Division of Thoracic Oncology, University Medicine Essen-Ruhrlandklinik, Essen, 45239, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany.,Division of Thoracic Oncology, University Medicine Essen-Ruhrlandklinik, Essen, 45239, Germany
| | - Till Plönes
- Department of Thoracic Surgery and Endoscopy, University Medicine Essen-Ruhrlandklinik, West German Cancer Center, University Hospital Essen, Essen, 45239, Germany
| | - Michael Forsting
- Institute of Diagnostic, Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, 45147, Germany
| | - Axel Wetter
- Institute of Diagnostic, Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, 45147, Germany
| | - Ken Herrmann
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, 45147, Germany
| | - Hubertus Hautzel
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, 45147, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, 45239, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, 45147, Germany
| | - Clemens Aigner
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Department of Thoracic Surgery and Endoscopy, University Medicine Essen-Ruhrlandklinik, West German Cancer Center, University Hospital Essen, Essen, 45239, Germany
| | - Martin Schuler
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany.,Division of Thoracic Oncology, University Medicine Essen-Ruhrlandklinik, Essen, 45239, Germany
| | - Martin Stuschke
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Wilfried Ee Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, 45147, Germany.,Division of Thoracic Oncology, University Medicine Essen-Ruhrlandklinik, Essen, 45239, Germany
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23
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Rawitzer J, Langehegermann L, Aigner C, Repnik U, Schönfeld A, Theegarten D. [Mediastinal pseudotumor-necrotizing and sclerosing mediastinitis with pseudomembranes]. Pathologie (Heidelb) 2022; 43:311-316. [PMID: 35237866 DOI: 10.1007/s00292-022-01059-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Mediastinal tumors present a rather rare phenomenon with a variety of underlying causes. Important differential diagnoses include benign and malignant tumors as well as idiopathic sclerosing mediastinitis and parasitic infection.Here, we present the case of a mediastinal pseudotumor with compression of the superior vena cava in a young adult male who spent several years abroad in Brazil. Clinicians suspected either a mediastinal lymphoma, malignant mesenchymal tumor, teratoma, sarcoidosis, or tuberculosis. Biopsy tissue failed to provide a definite diagnosis. The subsequently resected mediastinal mass showed a necrotizing, granulomatous inflammation with prominent eosinophilia and sclerosis. Membranous structures were detected in the necrotic areas, which presented as collagen bundles ultrastructurally. Therefore, these membranes were proven to be constituents of lipid pseudomembranes. Consequently the lesion shows characteristics of sclerosing mediastinitis next to characteristics of adipose tissue necrosis with lipid pseudomembranes. Parasitic infection could not be proven.
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Affiliation(s)
- Josefine Rawitzer
- Institut für Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Linda Langehegermann
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen, Ruhrlandklinik, Essen, Deutschland
| | - Clemens Aigner
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen, Ruhrlandklinik, Essen, Deutschland
| | - Urska Repnik
- Zentrale Mikroskopie der Sektion Biologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Andreas Schönfeld
- Klinik für Infektiologie, Westdeutsches Zentrum für Infektiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Dirk Theegarten
- Institut für Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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24
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von Stillfried S, Bülow RD, Röhrig R, Meybohm P, Boor P, Böcker J, Schmidt J, Tholen P, Majeed R, Wienströer J, Weis J, Bremer J, Knüchel R, Breitbach A, Cacchi C, Freeborn B, Wucherpfennig S, Spring O, Braun G, Römmele C, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Hirschbühl K, Wittmann M, Kling E, Kröncke T, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Mahlke N, Esposito I, Crudele G, Seidl M, Amann KU, Coras R, Hartmann A, Eichhorn P, Haller F, Lange F, Schmid KW, Ingenwerth M, Rawitzer J, Theegarten D, Birngruber CG, Wild P, Gradhand E, Smith K, Werner M, Schilling O, Acker T, Gattenlöhner S, Stadelmann C, Metz I, Franz J, Stork L, Thomas C, Zechel S, Ströbel P, Wickenhauser C, Fathke C, Harder A, Ondruschka B, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Glatzel M, Krasemann S, Matschke J, Jonigk D, Werlein C, Schirmacher P, Domke LM, Hartmann L, Klein IM, Schwab C, Röcken C, Friemann J, Langer D, Roth W, Strobl S, Rudelius M, Stock KF, Weichert W, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weirich G, Barth P, Wardelmann E, Schnepper A, Evert K, Büttner A, Manhart J, Nigbur S, Bittmann I, Fend F, Bösmüller H, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Kurz F, Vogt N. Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report. Crit Care 2022; 26:83. [PMID: 35346314 PMCID: PMC8958804 DOI: 10.1186/s13054-022-03945-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
Background In severe cases, SARS-CoV-2 infection leads to acute respiratory distress syndrome (ARDS), often treated by extracorporeal membrane oxygenation (ECMO). During ECMO therapy, anticoagulation is crucial to prevent device-associated thrombosis and device failure, however, it is associated with bleeding complications. In COVID-19, additional pathologies, such as endotheliitis, may further increase the risk of bleeding complications. To assess the frequency of bleeding events, we analyzed data from the German COVID-19 autopsy registry (DeRegCOVID). Methods The electronic registry uses a web-based electronic case report form. In November 2021, the registry included N = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites. Findings The registry data showed that ECMO was used in younger male patients and bleeding events occurred much more frequently in ECMO cases compared to non-ECMO cases (56% and 9%, respectively). Similarly, intracranial bleeding (ICB) was documented in 21% of ECMO cases and 3% of non-ECMO cases and was classified as the immediate or underlying cause of death in 78% of ECMO cases and 37% of non-ECMO cases. In ECMO cases, the three most common immediate causes of death were multi-organ failure, ARDS and ICB, and in non-ECMO cases ARDS, multi-organ failure and pulmonary bacterial ± fungal superinfection, ordered by descending frequency. Interpretation Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03945-x.
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25
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von Stillfried S, Bülow RD, Röhrig R, Boor P, Böcker J, Schmidt J, Tholen P, Majeed R, Wienströer J, Weis J, Bremer J, Knüchel R, Breitbach A, Cacchi C, Freeborn B, Wucherpfennig S, Spring O, Braun G, Römmele C, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Hirschbühl K, Wittmann M, Kling E, Kröncke T, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Mahlke N, Esposito I, Crudele G, Seidl M, Amann KU, Coras R, Hartmann A, Eichhorn P, Haller F, Lange F, Schmid KW, Ingenwerth M, Rawitzer J, Theegarten D, Birngruber CG, Wild P, Gradhand E, Smith K, Werner M, Schilling O, Acker T, Gattenlöhner S, Stadelmann C, Metz I, Franz J, Stork L, Thomas C, Zechel S, Ströbel P, Wickenhauser C, Fathke C, Harder A, Ondruschka B, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Glatzel M, Krasemann S, Matschke J, Jonigk D, Werlein C, Schirmacher P, Domke LM, Hartmann L, Klein IM, Schwab C, Röcken C, Friemann J, Langer D, Roth W, Strobl S, Rudelius M, Stock KF, Weichert W, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weirich G, Barth P, Wardelmann E, Evert K, Büttner A, Manhart J, Nigbur S, Bittmann I, Fend F, Bösmüller H, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Kurz F, Vogt N. First report from the German COVID-19 autopsy registry. Lancet Reg Health Eur 2022; 15:100330. [PMID: 35531493 PMCID: PMC9073019 DOI: 10.1016/j.lanepe.2022.100330] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Autopsies are an important tool in medicine, dissecting disease pathophysiology and causes of death. In COVID-19, autopsies revealed e.g., the effects on pulmonary (micro)vasculature or the nervous system, systemic viral spread, or the interplay with the immune system. To facilitate multicentre autopsy-based studies and provide a central hub supporting autopsy centres, researchers, and data analyses and reporting, in April 2020 the German COVID-19 Autopsy Registry (DeRegCOVID) was launched. Methods The electronic registry uses a web-based electronic case report form. Participation is voluntary and biomaterial remains at the respective site (decentralized biobanking). As of October 2021, the registry included N=1129 autopsy cases, with 69271 single data points including information on 18674 available biospecimens gathered from 29 German sites. Findings In the N=1095 eligible records, the male-to-female ratio was 1·8:1, with peaks at 65-69 and 80-84 years in males and >85 years in females. The analysis of the chain of events directly leading to death revealed COVID-19 as the underlying cause of death in 86% of the autopsy cases, whereas in 14% COVID-19 was a concomitant disease. The most common immediate cause of death was diffuse alveolar damage, followed by multi-organ failure. The registry supports several scientific projects, public outreach and provides reports to the federal health authorities, leading to legislative adaptation of the German Infection Protection Act, facilitating the performance of autopsies during pandemics. Interpretation A national autopsy registry can provide multicentre quantitative information on COVID-19 deaths on a national level, supporting medical research, political decision-making and public discussion. Funding German Federal Ministries of Education and Research and Health. Hintergrund: Obduktionen sind ein wichtiges Instrument in der Medizin, um die Pathophysiologie von Krankheiten und Todesursachen zu untersuchen. Im Rahmen von COVID-19 wurden durch Obduktionen z.B. die Auswirkungen auf die pulmonale Mikrovaskulatur, das Nervensystem, die systemische Virusausbreitung, und das Zusammenspiel mit dem Immunsystem untersucht. Um multizentrische, auf Obduktionen basierende Studien zu erleichtern und eine zentrale Anlaufstelle zu schaffen, die Obduktionszentren, Forscher sowie Datenanalysen und -berichte unterstützt, wurde im April 2020 das deutsche COVID-19-Autopsieregister (DeRegCOVID) ins Leben gerufen. Methoden: Das elektronische Register verwendet ein webbasiertes elektronisches Fallberichtsformular. Die Teilnahme ist freiwillig und das Biomaterial verbleibt am jeweiligen Standort (dezentrales Biobanking). Im Oktober 2021 umfasste das Register N=1129 Obduktionsfälle mit 69271 einzelnen Datenpunkten, die Informationen über 18674 verfügbare Bioproben enthielten, die von 29 deutschen Standorten gesammelt wurden. Ergebnisse: In den N=1095 ausgewerteten Datensätzen betrug das Verhältnis von Männern zu Frauen 1,8:1 mit Spitzenwerten bei 65-69 und 80-84 Jahren bei Männern und >85 Jahren bei Frauen. Die Analyse der Sequenz der unmittelbar zum Tod führenden Ereignisse ergab, dass in 86 % der Obduktionsfälle COVID-19 die zugrunde liegende Todesursache war, während in 14 % der Fälle COVID-19 eine Begleiterkrankung war. Die häufigste unmittelbare Todesursache war der diffuse Alveolarschaden, gefolgt von Multiorganversagen. Das Register unterstützt mehrere wissenschaftliche Projekte, die Öffentlichkeitsarbeit und liefert Berichte an die Bundesgesundheitsbehörden, was zu einer Anpassung des deutschen Infektionsschutzgesetzes führte und die Durchführung von Obduktionen in Pandemien erleichtert. Interpretation: Ein nationales Obduktionsregister kann multizentrische quantitative Informationen über COVID-19-Todesfälle auf nationaler Ebene liefern und damit die medizinische Forschung, die politische Entscheidungsfindung und die öffentliche Diskussion unterstützen. Finanzierung: Bundesministerien für Bildung und Forschung und für Gesundheit.
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von Stillfried S, Freeborn B, Windeck S, Boor P, Böcker J, Schmidt J, Tholen P, Röhrig R, Majeed R, Wienströer J, Bremer J, Weis J, Knüchel R, Breitbach A, Bülow RD, Cacchi C, Wucherpfennig S, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Spring O, Braun G, Römmele C, Kling E, Kröncke T, Wittmann M, Hirschbühl K, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Friemann J, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Esposito I, Crudele G, Seidl M, Mahlke N, Hartmann A, Haller F, Eichhorn P, Lange F, Amann KU, Coras R, Ingenwerth M, Rawitzer J, Schmid KW, Theegarten D, Gradhand E, Smith K, Wild P, Birngruber CG, Schilling O, Werner M, Acker T, Gattenlöhner S, Franz J, Metz I, Stadelmann C, Stork L, Thomas C, Zechel S, Ströbel P, Fathke C, Harder A, Wickenhauser C, Glatzel M, Matschke J, Krasemann S, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Ondruschka B, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Jonigk D, Werlein C, Domke LM, Hartmann L, Klein I, Schirmacher P, Schwab C, Röcken C, Langer D, Roth W, Strobl S, Rudelius M, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weichert W, Weirich G, Stock K, Barth P, Schnepper A, Wardelmann E, Evert K, Evert M, Büttner A, Manhart J, Nigbur S, Bösmüller H, Fend F, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Vogt N, Kurz F. [Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]. Pathologie (Heidelb) 2022; 43:101-105. [PMID: 36114379 PMCID: PMC9483541 DOI: 10.1007/s00292-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autopsies are a valuable tool for understanding disease, including COVID-19. MATERIALS AND METHODS The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs. RESULTS The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy. CONCLUSIONS Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.
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Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Benita Freeborn
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Svenja Windeck
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Elektronenmikroskopische Einrichtung, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
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Häntschel M, Eberhardt R, Petermann C, Gesierich W, Darwiche K, Hagmeyer L, Colby TV, Fend F, Theegarten D, Wintzer HO, Kreuter M, Spengler W, Behrens-Zemek AF, Lewis RA, Evrard HC, Ehab A, Böckeler M, Hetzel J. Diagnostic Yield of Transbronchial Lung Cryobiopsy Compared to Transbronchial Forceps Biopsy in Patients with Sarcoidosis in a Prospective, Randomized, Multicentre Cross-Over Trial. J Clin Med 2021; 10:jcm10235686. [PMID: 34884387 PMCID: PMC8658102 DOI: 10.3390/jcm10235686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). However, in cases with predominantly peribronchial pathology, such as sarcoidosis, TBLF is considered to be diagnostic in most cases. The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis. Methods: In this post hoc analysis of a prospective, randomized, controlled, multicentre study, 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling were included. TBLF and TBLC were both used for each patient in a randomized order. Histological assessment was undertaken on each biopsy and determined whether sarcoid was a consideration. Results: A histological diagnosis of sarcoidosis was established in 17 of 272 cases for which histopathology was available. In 6 out of 17 patients, compatible findings were seen with both TBLC and TBLF. In 10 patients, where the diagnosis of sarcoidosis was confirmed by TBLC, TBLF did not provide a diagnosis. In one patient, TBLF but not TBLC confirmed the diagnosis of sarcoidosis. Conclusions: In this post hoc analysis, the histological diagnosis of sarcoidosis was made significantly more often by TBLC than by TBLF. As in other idiopathic interstitial pneumonias (IIPs), the use of TBLC should be considered when sarcoidosis is suspected.
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Affiliation(s)
- Maik Häntschel
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Internal Medicine—Pneumology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
- Correspondence: or ; Tel.:+49-7071-29-82711
| | - Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Asklepios-Klinik Barmbek, 22307 Hamburg, Germany;
| | - Christoph Petermann
- Department for Pulmonary Diseases, Asklepios-Klinik Hamburg, 22307 Hamburg, Germany;
| | - Wolfgang Gesierich
- Comprehensive Pneumology Center Munich, Asklepios-Fachkliniken Munich-Gauting, 81377 Munich, Germany;
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik—University Medicine Essen, University of Duisburg-Essen, 47057 Duisburg, Germany;
| | - Lars Hagmeyer
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, 42699 Solingen, Germany;
| | - Thomas V. Colby
- Department of Pathology (Emeritus), Mayo Clinic, Scottsdale, AZ 13400, USA;
| | - Falko Fend
- Institute of Pathology and Neuropathology, Reference Center for Hematopathology University Hospital, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany;
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, 7057 Essen, Germany;
| | - Hanns-Olof Wintzer
- Institute for Pathology, MVZ Hanse Histologikum, 22547 Hamburg, Germany;
- Department of Pathology/Hematopathology, Institute for Hematopathology, 22547 Hamburg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research (DZL), 69117 Heidelberg, Germany;
| | - Werner Spengler
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
| | - Annika Felicitas Behrens-Zemek
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
| | | | - Henry C. Evrard
- Department Physiology of Cognitive Processes, Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany;
- Center for Integrative Neuroscience, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany
- Center for Biomedical Imaging & Neurostimulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Ahmed Ehab
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Pneumology, Klinik Loewenstein, 74245 Loewenstein, Germany
- Chest Medicine Department, Mansoura University, Mansoura 35516, Egypt
| | - Michael Böckeler
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Internal Medicine, Gastroenterology and Tumor Medicine, 73760 Ostfildern-Ruit, Germany
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Internal Medicine—Pneumology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
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Metzenmacher M, Hegedüs B, Forster J, Schramm A, Horn PA, Klein CA, Bielefeld N, Ploenes T, Aigner C, Theegarten D, Schildhaus HU, Siveke JT, Schuler M, Lueong SS. Combined multimodal ctDNA analysis and radiological imaging for tumor surveillance in Non-small cell lung cancer. Transl Oncol 2021; 15:101279. [PMID: 34800919 PMCID: PMC8605355 DOI: 10.1016/j.tranon.2021.101279] [Citation(s) in RCA: 3] [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: 07/29/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiology is the current standard for monitoring treatment responses in lung cancer. Limited sensitivity, exposure to ionizing radiations and related sequelae constitute some of its major limitation. Non-invasive and highly sensitive methods for early detection of treatment failures and resistance-associated disease progression would have additional clinical utility. METHODS We analyzed serially collected plasma and paired tumor samples from lung cancer patients (61 with stage IV, 48 with stages I-III disease) and 61 healthy samples by means of next-generation sequencing, radiological imaging and droplet digital polymerase chain reaction (ddPCR) mutation and methylation assays. RESULTS A 62% variant concordance between tumor-reported and circulating-free DNA (cfDNA) sequencing was observed between baseline liquid and tissue biopsies in stage IV patients. Interestingly, ctDNA sequencing allowed for the identification of resistance-mediating p.T790M mutations in baseline plasma samples for which no such mutation was observed in the corresponding tissue. Serial circulating tumor DNA (ctDNA) mutation analysis by means of ddPCR revealed a general decrease in ctDNA loads between baseline and first reassessment. Additionally, serial ctDNA analyses only recapitulated computed tomography (CT) -monitored tumor dynamics of some, but not all lesions within the same patient. To complement ctDNA variant analysis we devised a ctDNA methylation assay (methcfDNA) based on methylation-sensitive restriction enzymes. cfDNA methylation showed and area under the curve (AUC) of > 0.90 in early and late stage cases. A decrease in methcfDNA between baseline and first reassessment was reflected by a decrease in CT-derive tumor surface area, irrespective of tumor mutational status. CONCLUSION Taken together, our data support the use of cfDNA sequencing for unbiased characterization of the molecular tumor architecture, highlights the impact of tumor architectural heterogeneity on ctDNA-based tumor surveillance and the added value of complementary approaches such as cfDNA methylation for early detection and monitoring.
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Affiliation(s)
- Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen 45122, Germany; Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, Essen 45239, Germany.
| | - Balazs Hegedüs
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen Ruhrlandklinik, University Duisburg-Essen, Essen D-45239, Germany.
| | - Jan Forster
- German Cancer Consortium (DKTK), Partner site University Hospital Essen, Hufelandstrasse 55, Essen 45122, Germany; Chair for Genome Informatics, Department of Human Genetics, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen 45122, Germany.
| | - Alexander Schramm
- Laboratory for Molecular Oncology, Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen 45122, Germany.
| | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital Essen, Essen 45122, Germany.
| | - Christoph A Klein
- Experimental Medicine and Therapy Research, University of Regensburg, Regensburg 93053, Germany; Fraunhofer-Institute for Toxicology and Experimental Medicine, Division of Personalized Tumor Therapy, Regensburg 93053, Germany.
| | - Nicola Bielefeld
- German Cancer Consortium (DKTK), Partner site University Hospital Essen, Hufelandstrasse 55, Essen 45122, Germany; Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen 45122, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany.
| | - Till Ploenes
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen Ruhrlandklinik, University Duisburg-Essen, Essen D-45239, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen Ruhrlandklinik, University Duisburg-Essen, Essen D-45239, Germany.
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | | | - Jens T Siveke
- German Cancer Consortium (DKTK), Partner site University Hospital Essen, Hufelandstrasse 55, Essen 45122, Germany; Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen 45122, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany.
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen 45122, Germany; Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Tüschener Weg 40, Essen 45239, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen, Hufelandstrasse 55, Essen 45122, Germany.
| | - Smiths S Lueong
- German Cancer Consortium (DKTK), Partner site University Hospital Essen, Hufelandstrasse 55, Essen 45122, Germany; Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen 45122, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany.
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29
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Guberina M, Darwiche K, Hautzel H, Pöttgen C, Guberina N, Gauler T, Ploenes T, Umutlu L, Theegarten D, Aigner C, Eberhardt WEE, Metzenmacher M, Wiesweg M, Karpf-Wissel R, Schuler M, Herrmann K, Stuschke M. Patterns of nodal spread in stage III NSCLC: importance of EBUS-TBNA and 18F-FDG PET/CT for radiotherapy target volume definition. Radiat Oncol 2021; 16:176. [PMID: 34526050 PMCID: PMC8442338 DOI: 10.1186/s13014-021-01904-4] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose The aim of this study was to compare the pattern of intra-patient spread of lymph-node (LN)-metastases within the mediastinum as assessed by 18F-FDG PET/CT and systematic endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) for precise target volume definition in stage III NSCLC. Methods This is a single-center study based on our preceding investigation, including all consecutive patients with initial diagnosis of stage IIIA-C NSCLC, receiving concurrent radiochemotherapy (12/2011–06/2018). Inclusion criteria were curative treatment intent, 18F-FDG PET/CT and EBUS-TBNA prior to start of treatment. The lymphatic drainage was classified into echelon-1 (ipsilateral hilum), echelon-2 (ipsilateral LN-stations 4 and 7) and echelon-3 (rest of the mediastinum, contralateral hilum). The pattern of spread was classified according to all permutations of echelon-1, echelon-2, and echelon-3 EBUS-TBNA findings. Results In total, 180 patients were enrolled. Various patterns of LN-spread could be identified. Skip lesions with an involved echelon distal from an uninvolved one were detected in less than 10% of patients by both EBUS-TBNA and PET. The pattern with largest asymmetry was detected in cases with EBUS-TBNA- or PET-positivity at all three echelons (p < 0.0001, exact symmetry test). In a multivariable logistic model for EBUS-positivity at echelon-3, prognostic factors were PET-positivity at echelon-3 (Hazard ratio (HR) = 12.1; 95%-CI: 3.2–46.5), EBUS-TBNA positivity at echelon-2 (HR = 6.7; 95%-CI: 1.31–31.2) and left-sided tumor location (HR = 4.0; 95%-CI: 1.24–13.2). There were significantly less combined ipsilateral upper (LN-stations 2 and 4) and lower (LN-station 7) mediastinal involvements (16.8% of patients) with EBUS-TBNA than with PET (38.9%, p < 0.0001, exact symmetry test). EBUS-TBNA detected a lobe specific heterogeneity between the odds ratios of LN-positivity in the upper versus lower mediastinum (p = 0.0021, Breslow-Day test), while PET did not (p = 0.19). Conclusion Frequent patterns of LN-metastatic spread could be defined by EBUS-TBNA and PET and discrepancies in the pattern were seen between both methods. EBUS-TBNA showed more lobe and tumor laterality specific patterns of LN-metastases than PET and skipped lymph node stations were rare. These systematic relations offer the opportunity to further refine multi-parameter risk of LN-involvement models for target volume delineation based on pattern of spread by EBUS-TBNA and PET. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01904-4.
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Affiliation(s)
- Maja Guberina
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Thomas Gauler
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic, Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Rüdiger Karpf-Wissel
- Department of Pulmonary Medicine, Section of Interventional Pneumology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, University Medicine Essen - Ruhrlandklinik, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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30
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Hautzel H, Alnajdawi Y, Fendler WP, Rischpler C, Darwiche K, Eberhardt WE, Umutlu L, Theegarten D, Stuschke M, Schuler M, Aigner C, Herrmann K, Plönes T. N-staging in large cell neuroendocrine carcinoma of the lung: diagnostic value of [ 18F]FDG PET/CT compared to the histopathology reference standard. EJNMMI Res 2021; 11:68. [PMID: 34292419 PMCID: PMC8298649 DOI: 10.1186/s13550-021-00811-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background Large cell neuroendocrine carcinoma of the lung (LCNEC) is a rare entity occurring in less than 4% of all lung cancers. Due to its low differentiation and high glucose transporter 1 (GLUT1) expression, LCNEC demonstrates an increased glucose turnover. Thus, PET/CT with 2-[18F]-fluoro-deoxyglucose ([18F]FDG) is suitable for LCNEC staging. Surgery with curative intent is the treatment of choice in early stage LCNEC. Prerequisite for this is correct lymph node staging. This study aimed at evaluating the diagnostic performance of [18F]FDG PET/CT validated by histopathology following surgical resection or mediastinoscopy. N-staging interrater-reliability was assessed to test for robustness of the [18F]FDG PET/CT findings. Methods Between 03/2014 and 12/2020, 46 patients with LCNEC were included in this single center retrospective analysis. All underwent [18F]FDG PET/CT for pre-operative staging and subsequently either surgery (n = 38) or mediastinoscopy (n = 8). Regarding the lymph node involvement, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for [18F]FDG PET/CT using the final histopathological N-staging (pN0 to pN3) as reference. Results Per patient 14 ± 7 (range 4–32) lymph nodes were resected and histologically processed. 31/46 patients had no LCNEC spread into the lymph nodes. In 8/46 patients, the final stage was pN1, in 5/46 pN2 and in 2/46 pN3. [18F]FDG PET/CT diagnosed lymph node metastasis of LCNEC with a sensitivity of 93%, a specificity of 87%, an accuracy of 89%, a PPV of 78% and a NPV of 96%. In the four false positive cases, the [18F]FDG uptake of the lymph nodes was 33 to 67% less in comparison with that of the respective LCNEC primary. Interrater-reliability was high with a strong level of agreement (κ = 0.82). Conclusions In LCNEC N-staging with [18F]FDG PET/CT demonstrates both high sensitivity and specificity, an excellent NPV but a slightly reduced PPV. Accordingly, preoperative invasive mediastinal staging may be omitted in cases with cN0 disease by [18F]FDG PET/CT. In [18F]FDG PET/CT cN1-cN3 stages histological confirmation is warranted, particularly in case of only moderate [18F]FDG uptake as compared to the LCNEC primary.
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Affiliation(s)
- Hubertus Hautzel
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. .,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
| | - Yazan Alnajdawi
- Department of Thoracic Surgery and Endoscopy, West German Lung Center, Ruhrlandklinik - University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, West German Lung Center, Ruhrlandklinik - University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Wilfried E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, West German Lung Center, Ruhrlandklinik - University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Division of Thoracic Oncology, West German Lung Center, Ruhrlandklinik - University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Endoscopy, West German Lung Center, Ruhrlandklinik - University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery and Endoscopy, West German Lung Center, Ruhrlandklinik - University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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Ploenes T, Theegarten D, Stehling F, Aigner C. A waterlily sign in an 8-year-old boy. Eur J Cardiothorac Surg 2021; 60:199. [PMID: 33599257 DOI: 10.1093/ejcts/ezab010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Till Ploenes
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Germany
| | - Florian Stehling
- Department of Pediatric Pulmonology, University Children's Hospital Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany
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Guberina M, Pöttgen C, Metzenmacher M, Wiesweg M, Schuler M, Aigner C, Ploenes T, Umutlu L, Gauler T, Darwiche K, Stamatis G, Theegarten D, Hautzel H, Jentzen W, Guberina N, Herrmann K, Eberhardt WE, Stuschke M. PROGNOSTIC VALUE OF POST-INDUCTION CHEMOTHERAPY VOLUMETRIC PET/CT PARAMETERS FOR STAGE IIIA/B NON-SMALL CELL LUNG CANCER PATIENTS RECEIVING DEFINITIVE CHEMORADIOTHERAPY. J Nucl Med 2021; 62:jnumed.120.260646. [PMID: 34016730 PMCID: PMC8612197 DOI: 10.2967/jnumed.120.260646] [Citation(s) in RCA: 3] [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: 11/19/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose/Objective(s): The aim of this follow-up analysis of the ESPATUE phase-3 trial was to explore the prognostic value of post-induction chemotherapy PET metrics in patients with stage III non-small cell lung cancer (NSCLC) who were assigned to receive definitive chemoradiotherapy. Materials/Methods: All eligible patients stage IIIA (cN2) and stage IIIB of the trial received induction chemotherapy consisting of 3 cycles of cisplatin/paclitaxel and chemoradiotherapy up to 45 Gy/1.5 Gy per fraction twice-a-day, followed by a radiation-boost with 2 Gy once per day with concurrent cisplatin/vinorelbine. The protocol definition prescribed a total dose of 65-71 Gy. 18F-FDG-PET/CT (PETpre) was performed at study entry and before concurrent chemoradiotherapy (interim-PET; PETpost). Interim PETpost metrics and known prognostic clinical parameters were correlated in uni- and multivariable survival analyses. Leave-one-out cross-validation was used to show internal validity. Results: Ninety-two patients who underwent 18F-FDG-PET/CT after induction chemotherapy were enrolled. Median MTVpost value was 5.9 ml. Altogether 85 patients completed the whole chemoradiation with the planned total dose of 60-71 Gy. In univariable proportional hazard analysis, each of the parameters MTVpost, SUVmax(post) and TLGmax(post) was associated with overall survival (P < 0.05). Multivariable survival analysis, including clinical and post-induction PET parameters, found TLGmax(post) (hazard ratio: 1.032 (95%-CI: 1.013-1.052) per 100 ml increase) and total radiation dose (hazard ratio: 0.930 (0.902-0.959) per Gray increase) significantly related with overall survival in the whole group of patients, and also in patients receiving a total dose ≥ 60 Gy. The best leave-one-out cross-validated 2 parameter classifier contained TLGmax(post) and total radiation dose. TLGmax(post) was associated with time to distant metastases (P = 0.0018), and SUVmax(post) with time to loco-regional relapse (P = 0.039) in multivariable analysis of patients receiving a total dose ≥ 60 Gy. Conclusion: Post-induction chemotherapy PET parameters demonstrated prognostic significance. Therefore, an interim 18F-FDG-PET/CT is a promising diagnostic modality for guiding individualized treatment intensification.
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Affiliation(s)
- Maja Guberina
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Christoph Pöttgen
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | | | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, West German Lung Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery and Thoracic Endoscopy, West German Lung Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Thomas Gauler
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Kaid Darwiche
- Section of Interventional Pneumology, Department of Pulmonary Medicine, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery and Thoracic Endoscopy, West German Lung Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany; and
| | - Hubertus Hautzel
- Department for Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Walter Jentzen
- Department for Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Nika Guberina
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium, Partner Site University Hospital Essen, Essen
- Department for Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Wilfried E.E. Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Martin Stuschke
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen
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Valdivia D, Cheufou D, Fels B, Puhlvers S, Mardanzai K, Zaatar M, Weinreich G, Taube C, Theegarten D, Stuschke M, Schuler M, Stamatis G, Hegedus B, Aigner C. Potential Prognostic Value of Preoperative Leukocyte Count, Lactate Dehydrogenase and C-Reactive Protein in Thymic Epithelial Tumors. Pathol Oncol Res 2021; 27:629993. [PMID: 34257595 PMCID: PMC8262211 DOI: 10.3389/pore.2021.629993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Thymic epithelial tumors are the most common mediastinal tumors. Surgery is the mainstay of treatment and complete resection provides the best survival rate. However, advanced tumors often require multimodality treatment and thus we analyzed the prognostic potential of routine circulating biomarkers that might help to risk-stratify patients beyond tumor stage and histology. Preoperative values for white blood cell count (WBC), C-reactive protein (CRP) and lactate dehydrogenase (LDH) were analyzed in 220 thymic epithelial tumor patients operated between 1999 and 2018. Increased CRP levels (>1 mg/dl) were significantly more often measured in thymic carcinoma and neuroendocrine tumors when compared to thymoma. LDH serum activity was higher in thymic neuroendocrine tumors when compared to thymoma or thymic carcinoma. The median disease specific survival was significantly longer in thymoma cases than in thymic carcinoma and neuroendocrine tumors. Increased preoperative LDH level (>240 U/L) associated with shorter survival in thymus carcinoma (HR 4.76, p = 0.0299). In summary, higher CRP associated with carcinoma and neuroendocrine tumors, while LDH increased primarily in neuroendocrine tumors suggesting that biomarker analysis should be performed in a histology specific manner. Importantly, preoperative serum LDH might be a prognosticator in thymic carcinoma and may help to risk stratify surgically treated patients in multimodal treatment regimens.
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Affiliation(s)
- Daniel Valdivia
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Danjouma Cheufou
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Benjamin Fels
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Stephan Puhlvers
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Khaled Mardanzai
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Mohamed Zaatar
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Gerhard Weinreich
- Department of Pulmonology, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Department of Pulmonology, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Department of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Balazs Hegedus
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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Bonella F, Campo I, Zorzetto M, Boerner E, Ohshimo S, Theegarten D, Taube C, Costabel U. Potential clinical utility of MUC5B und TOLLIP single nucleotide polymorphisms (SNPs) in the management of patients with IPF. Orphanet J Rare Dis 2021; 16:111. [PMID: 33639995 PMCID: PMC7913255 DOI: 10.1186/s13023-021-01750-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background Genetic variants of TOLLIP and MUC5B, both on chromosome 11, have been reported to be associated with the development and/or prognosis of idiopathic pulmonary fibrosis (IPF). This retrospective study was conducted to investigate the association of MUC5B and TOLLIP SNPs with disease outcome in IPF. 62 IPF patients and 50 healthy controls (HC) from our Institution were genotyped for SNPs within MUC5B (rs35705950) and TOLLIP (rs3750920 and rs5743890). Correlation of SNPs genotypes with survival, acute exacerbation (AE) or disease progression (defined as a decline of ≥ 5% in FVC and or ≥ 10% in DLco in one year) was investigated. Results The MUC5B rs35705950 minor allele (T) was more frequent in IPF subjects than in HC (35% vs 9% p < 0.001). TOLLIP SNPs alleles and genotype distribution did not differ between IPF and HC and did not vary according to gender, age, BMI and lung functional impairment at baseline. The minor allele (C) in TOLLIP rs5743890 was associated with worse survival and with disease progression in all performed analyses. The MUC5B rs35705950 or the TOLLIP rs3750920 minor allele, were not associated with disease progression or AE.
Conclusion We confirm that the minor allele of MUC5B rs35705950 is associated with IPF. The minor allele of TOLLIP rs5743890 appears to be a predictor of worse survival and more rapid disease progression, therefore being of potential utility to stratify IPF patients at baseline.
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Affiliation(s)
- Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239, Essen, Germany.
| | - Ilaria Campo
- SC Pneumologia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Zorzetto
- Clinical Chemistry Laboratory, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eda Boerner
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239, Essen, Germany
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239, Essen, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, 45239, Essen, Germany
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Abstract
Lymphangioleiomyomatosis (LAM) is a rare lung disease that mostly occurs in female patients. A total of 200-400 people are assumed to be infected in Germany. A sporadic form and a form associated with the tuberous sclerosis complex (TSC) can be separated. Mutations of the TSC‑1 and TSC‑2 genes are relevant. Morphologically, pulmonary multicysts and marginal micronodal proliferations of LAM cells are characteristic. Combinations with renal angiomyolipoma are typical and, in cases with TSC glioma, facial angiofibroma and ungual fibroma are seen. Prognosis is favorable (10-year survival: 80%) and with the use of mTORC1 inhibitors it could be improved. Lung transplantation can be considered in some cases.
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Affiliation(s)
- D Theegarten
- Institut für Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 44145, Essen, Deutschland.
| | - T Hager
- Institut für Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 44145, Essen, Deutschland
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36
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Hetzel J, Wells AU, Costabel U, Colby TV, Walsh SLF, Verschakelen J, Cavazza A, Tomassetti S, Ravaglia C, Böckeler M, Spengler W, Kreuter M, Eberhardt R, Darwiche K, Torrego A, Pajares V, Muche R, Musterle R, Horger M, Fend F, Warth A, Heußel CP, Piciucchi S, Dubini A, Theegarten D, Franquet T, Lerma E, Poletti V, Häntschel M. Transbronchial cryobiopsy increases diagnostic confidence in interstitial lung disease: a prospective multicentre trial. Eur Respir J 2020; 56:13993003.01520-2019. [PMID: 32817003 DOI: 10.1183/13993003.01520-2019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 07/15/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The accurate diagnosis of individual interstitial lung diseases (ILD) is often challenging, but is a critical determinant of appropriate management. If a diagnosis cannot be made after multidisciplinary team discussion (MDTD), surgical lung biopsy is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to surgical lung biopsy. METHODS This prospective, multicentre, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic interstitial pneumonia by a central MDTD board (two clinicians, two radiologists, two pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps, as follows: 1) clinicoradiological data alone; 2) addition of bronchoalveolar lavage (BAL) findings; 3) addition of TBLC interpretation; and 4) surgical lung biopsy findings (if available). We evaluated the contribution of TBLC to the formulation of a confident first-choice MDTD diagnosis. RESULTS TBLC led to a significant increase in the percentage of cases with confident diagnoses or provisional diagnoses with high confidence (likelihood ≥70%) from 60.2% to 81.2%. In 32 out of 52 patients nondiagnostic after BAL, TBLC provided a diagnosis with a likelihood ≥70%. The percentage of confident diagnoses (likelihood ≥90%) increased from 22.7% after BAL to 53.9% after TBLC. Pneumothoraces occurred in 16.4% of patients, and moderate or severe bleeding in 15.7% of patients. No deaths were observed within 30 days. INTERPRETATION TBLC increases diagnostic confidence in the majority of ILD patients with an uncertain noninvasive diagnosis, with manageable side-effects. These data support the integration of TBLC into the diagnostic algorithm for ILD.
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Affiliation(s)
- Jürgen Hetzel
- Dept of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany .,Division of Internal Medicine, Dept of Pneumology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK
| | - Ulrich Costabel
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Thomas V Colby
- Dept of Pathology and Laboratory Medicine (retired), Mayo Clinic, Scottsdale, AZ, USA
| | - Simon L F Walsh
- Dept of Radiology, National Heart and Lung Institute, Imperial College, London, UK
| | | | - Alberto Cavazza
- Dept of Pathology, Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Tomassetti
- Dept of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Claudia Ravaglia
- Dept of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Michael Böckeler
- Dept of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Werner Spengler
- Dept of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Ralf Eberhardt
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.,Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Kaid Darwiche
- Dept of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alfons Torrego
- Respiratory Dept, Hospital de la Santa Creu I Sant Pau (HSCSP), Barcelona, Spain
| | - Virginia Pajares
- Respiratory Dept, Hospital de la Santa Creu I Sant Pau (HSCSP), Barcelona, Spain
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Regina Musterle
- Dept of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Marius Horger
- Dept for Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, Reference Center for Hematopathology University Hospital, Tuebingen Eberhard-Karls-University, Tübingen, Germany
| | - Arne Warth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Institute for Pathology, Wetzlar, Germany
| | - Claus Peter Heußel
- Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | | | - Dirk Theegarten
- Dept of Pathology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Tomas Franquet
- Radiology Dept, Hospital de la Santa Creu I Sant Pau (HSCSP), Barcelona, Spain
| | - Enrique Lerma
- Pathology Dept, Hospital de la Santa Creu I Sant Pau (HSCSP), Barcelona, Spain
| | - Venerino Poletti
- Dept of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Maik Häntschel
- Dept of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany.,Division of Internal Medicine, Dept of Pneumology, Kantonsspital Winterthur, Winterthur, Switzerland
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Wilmes D, McCormick-Smith I, Lempp C, Mayer U, Schulze AB, Theegarten D, Hartmann S, Rickerts V. Detection of Histoplasma DNA from Tissue Blocks by a Specific and a Broad-Range Real-Time PCR: Tools to Elucidate the Epidemiology of Histoplasmosis. J Fungi (Basel) 2020; 6:jof6040319. [PMID: 33261008 PMCID: PMC7711923 DOI: 10.3390/jof6040319] [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: 11/10/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022] Open
Abstract
Lack of sensitive diagnostic tests impairs the understanding of the epidemiology of histoplasmosis, a disease whose burden is estimated to be largely underrated. Broad-range PCRs have been applied to identify fungal agents from pathology blocks, but sensitivity is variable. In this study, we compared the results of a specific Histoplasma qPCR (H. qPCR) with the results of a broad-range qPCR (28S qPCR) on formalin-fixed, paraffin-embedded (FFPE) tissue specimens from patients with proven fungal infections (n = 67), histologically suggestive of histoplasmosis (n = 36) and other mycoses (n = 31). The clinical sensitivity for histoplasmosis of the H. qPCR and the 28S qPCR was 94% and 48.5%, respectively. Samples suggestive for other fungal infections were negative with the H. qPCR. The 28S qPCR did not amplify DNA of Histoplasma in FFPE in these samples, but could amplify DNA of Emergomyces (n = 1) and Paracoccidioides (n = 2) in three samples suggestive for histoplasmosis but negative in the H. qPCR. In conclusion, amplification of Histoplasma DNA from FFPE samples is more sensitive with the H. qPCR than with the 28S qPCR. However, the 28S qPCR identified DNA of other fungi in H. qPCR-negative samples presenting like histoplasmosis, suggesting that the combination of both assays may improve the diagnosis.
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Affiliation(s)
- Dunja Wilmes
- Reference Laboratory for Cryptococcosis and Uncommon Invasive Fungal Infections, Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, 13353 Berlin, Germany; (I.M.-S.); (V.R.)
- Correspondence: ; Tel.: +49-30-187-542-862
| | - Ilka McCormick-Smith
- Reference Laboratory for Cryptococcosis and Uncommon Invasive Fungal Infections, Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, 13353 Berlin, Germany; (I.M.-S.); (V.R.)
| | - Charlotte Lempp
- Vet Med Labor GmbH, Division of IDEXX Laboratories, 71636 Ludwigsburg, Germany; (C.L.); (U.M.)
| | - Ursula Mayer
- Vet Med Labor GmbH, Division of IDEXX Laboratories, 71636 Ludwigsburg, Germany; (C.L.); (U.M.)
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany;
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Sylvia Hartmann
- Senckenberg Institute for Pathology, Johann Wolfgang Goethe University Frankfurt, 60323 Frankfurt am Main, Germany;
| | - Volker Rickerts
- Reference Laboratory for Cryptococcosis and Uncommon Invasive Fungal Infections, Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, 13353 Berlin, Germany; (I.M.-S.); (V.R.)
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Albrecht S, Taube C, Aigner C, Theegarten D. [A Rarely Differential Diagnosis of Exertional Dyspnea]. Pneumologie 2020; 75:453-456. [PMID: 32927488 DOI: 10.1055/a-1239-5969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The determination of exercise-induced dyspnea is an important multifaceted task for a differential diagnosis of the pulmonologist. We are reporting the case of a 70-year old female patient at the time of the first presentation with a tumor filling almost the entire left hemithorax. Histologically a solitary pleural fibroma could be diagnosed.
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Affiliation(s)
- S Albrecht
- Ambulantes Lungenzentrum Essen, Essen, MVZ Ruhrlandklinik gGmbH
| | - C Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik, Westdeutsches Lungenzentrum, Essen
| | - C Aigner
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen-Ruhrlandklinik, Westdeutsches Lungenzentrum, Essen
| | - D Theegarten
- Institut für Pathologie, Universitätsklinikum Essen, Essen
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Boerner EB, Cuyas M, Theegarten D, Ohshimo S, Costabel U, Bonella F. Azathioprine for Connective Tissue Disease-Associated Interstitial Lung Disease. Respiration 2020; 99:628-636. [PMID: 32663826 DOI: 10.1159/000508540] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immunosuppressive therapy still is the standard treatment for patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). OBJECTIVES This retrospective study aimed to provide data on the tolerability and efficacy of azathioprine in progressive CTD-ILDs. METHODS A total of 56 patients with CTD-ILD treated with azathioprine between 2003 and 2014 were included in the study. The patients were assessed every 3 months during follow-up. RESULTS The mean treatment duration was 34 months, with a range of 3-105 months. Fifteen patients (27%) discontinued treatment due to side effects, mostly due to elevated liver enzymes, within the first 3 months. Forty-one patients were treated for longer than 3 months, and 27 of those (66%) had stabilization or improvement of pulmonary function during treatment. In patients who remained stable or improved, the mean FVC was 62 ± 17% predicted (% pred) at initiation of treatment and 65 ± 17% pred at the last follow-up visit (p = 0.036), and the mean DLCO was 38 ± 16% pred at initiation of treatment and 39 ± 17% pred at the last follow-up visit (p = 0.06). CONCLUSIONS Azathioprine can stabilize or improve CTD-ILD. While early drug intolerance is frequent, most patients who have tolerated the drug well achieve long-term stabilization or improvement of lung function.
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Affiliation(s)
- Eda B Boerner
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Ruhrlandklinik University Hospital, Essen, Germany
| | - Marta Cuyas
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Ruhrlandklinik University Hospital, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Ruhrlandklinik University Hospital, Essen, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Ruhrlandklinik University Hospital, Essen, Germany,
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Bilecz A, Stockhammer P, Theegarten D, Kern I, Jakopovic M, Samarzija M, Klikovits T, Hoda MA, Döme B, Oberndorfer F, Muellauer L, Fillinger J, Kovács I, Pirker C, Schuler M, Plönes T, Aigner C, Klepetko W, Berger W, Brcic L, Laszlo V, Hegedus B. Comparative analysis of prognostic histopathologic parameters in subtypes of epithelioid pleural mesothelioma. Histopathology 2020; 77:55-66. [PMID: 32170970 DOI: 10.1111/his.14105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/28/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022]
Abstract
AIMS Malignant pleural mesothelioma (MPM) is a rare malignancy with a dismal prognosis. While the epithelioid type is associated with a more favourable outcome, additional factors are needed to further stratify prognosis and to identify patients who can benefit from multimodal treatment. As epithelioid MPM shows remarkable morphological variability, the prognostic role of the five defined morphologies, the impact of the nuclear grading system and the mitosis-necrosis score were investigated in this study. METHODS AND RESULTS Tumour specimens of 192 patients with epithelioid MPM from five European centres were histologically subtyped. Nuclear grading and mitosis-necrosis score were determined and correlated with clinicopathological parameters and overall survival (OS). Digital slides of 55 independent cases from The Cancer Genome Atlas (TCGA) database were evaluated for external validation. Histological subtypes were collapsed into three groups based on their overlapping survival curves. The tubulopapillary/microcystic group had a significantly longer OS than the solid/trabecular group (732 days versus 397 days, P = 0.0013). Pleomorphic tumours had the shortest OS (173 days). The solid/trabecular variants showed a significant association with high nuclear grade and mitosis-necrosis score. The mitosis-necrosis score was a robust and independent prognostic factor in our patient cohort. The prognostic significance of all three parameters was externally validated in the TCGA cohort. Patients with tubulopapillary or microcystic tumours showed a greater improvement in OS after receiving multimodal therapy than those with solid or trabecular tumours. CONCLUSIONS Histological subtypes of epithelioid MPM have a prognostic impact, and might help to select patients for intensive multimodal treatment approaches.
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Affiliation(s)
- Agnes Bilecz
- 2nd Institute of Pathology, Semmelweis University, Budapest, Hungary
| | - Paul Stockhammer
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Izidor Kern
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Marko Jakopovic
- Department for Respiratory Diseases Jordanovac, University Hospital Center, University of Zagreb, Zagreb, Croatia
| | - Miroslav Samarzija
- Department for Respiratory Diseases Jordanovac, University Hospital Center, University of Zagreb, Zagreb, Croatia
| | - Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Mir A Hoda
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Balázs Döme
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Leonhard Muellauer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - János Fillinger
- Department of Pathology, National Koranyi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ildikó Kovács
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Christine Pirker
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research and Comprehensive Cancer Center, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Luka Brcic
- Medical University of Graz, Diagnostic and Research Institute of Pathology, Graz, Austria
| | - Viktória Laszlo
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Balazs Hegedus
- 2nd Institute of Pathology, Semmelweis University, Budapest, Hungary
- Department of Thoracic Surgery, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
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Ploenes T, Schildhaus HU, Theegarten D, Stehling F, Dirksen U, Stefani D, Aigner C. Pleuropulmonary Blastoma Misinterpreted as Spontaneous Pneumothorax in an Infant. Ann Thorac Surg 2020; 110:e79. [PMID: 32305285 DOI: 10.1016/j.athoracsur.2020.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Till Ploenes
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany.
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen & West German Cancer Center, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen & West German Cancer Center, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Department of Pediatric Respiratory Medicine, University Medicine Essen-University Clinic, University Duisburg-Essen, Essen, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology and Oncology, University Medicine Essen-University Clinic, University Duisburg-Essen, Essen, Germany
| | - Dirk Stefani
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
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Chorti E, Kanaki T, Zimmer L, Hadaschik E, Ugurel S, Gratsias E, Roesch A, Bonella F, Wessendorf TE, Wälscher J, Theegarten D, Schadendorf D, Livingstone E. Drug-induced sarcoidosis-like reaction in adjuvant immunotherapy: Increased rate and mimicker of metastasis. Eur J Cancer 2020; 131:18-26. [PMID: 32248071 DOI: 10.1016/j.ejca.2020.02.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 01/06/2020] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anti-[programmed cell death protein 1 (PD-1)] antibodies nivolumab and pembrolizumab were approved for adjuvant treatment of melanoma as they demonstrated improved relapse-free survival. Currently, combined anti-PD-1 plus anti-[cytotoxic T-lymphocyte-associated protein 4 (CTLA4)] blockade is being investigated in adjuvant and neoadjuvant trials. Sarcoidosis-like reactions have been described for immune checkpoint inhibitors and are most likely drug-induced. The reported rate of sarcoidosis/sarcoidosis-like reactions within clinical melanoma trials is <2%. We observed that a remarkably higher number of melanoma patients (10/45 patients, 22%) treated with immune checkpoint inhibitor (ICI) within an adjuvant clinical trial-developed drug induced sarcoidosis-like reaction (DISR) mimicking metastasis. CASE PRESENTATION Of 45 stage III melanoma patients who were treated at our institute with adjuvant ICI (either nivolumab alone or in combination with ipilimumab) within a two-armed, blinded clinical trial, ten developed a DISR. Three of the ten patients were men, median age was 52 years (range, 32-70 years). DISRs were asymptomatic and generally detected radiographically at first radiographic imaging after the start of therapy (median time, 2.8 months) and described as a differential diagnosis to tumour progression. In one patient, DISR was only apparent 13.1 months after start of therapy and 4 weeks after the end of ICI treatment. DISR presented as mediastinal/hilar lymphadenopathy in 8/10 patients (as only site or in addition to lung, skin and/or bone involvement), one patient had only lung and cutaneous, one patient only cutaneous DISR. Biopsies from lymph nodes, skin and bone were taken in 8/10 patients, and histology confirmed sarcoidosis-like reactions (SLRs). As patients were asymptomatic, no treatment for DISR was required, and study treatment was stopped for DISR in only one patient due to bone involvement. DISRs have resolved or are in remission in all patients. At a median follow-up time of 15.3 months (range, 12-17.6 months), two patients experienced melanoma relapse. CONCLUSIONS In most cases, sarcoidosis could only be differentiated from melanoma progression on biopsy. Treating physicians as well as radiologists have to be aware of the potentially higher rate of DISR in patients receiving adjuvant ICI. A thorough interdisciplinary workup is required to discriminate from true melanoma progression and to decide on continuation of adjuvant ICI treatment.
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Affiliation(s)
- Eleftheria Chorti
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.
| | - Theodora Kanaki
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Lisa Zimmer
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Eva Hadaschik
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Selma Ugurel
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Emmanouil Gratsias
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Alexander Roesch
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Francesco Bonella
- Dept. of Pulmonary Medicine, Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Thomas E Wessendorf
- Dept. of Pulmonary Medicine, Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Julia Wälscher
- Dept. of Pulmonary Medicine, Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital Essen, Tüschener Weg 40, 45239 Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Dirk Schadendorf
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Elisabeth Livingstone
- Dept. of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Stockhammer P, Ploenes T, Theegarten D, Schuler M, Maier S, Aigner C, Hegedus B. Detection of TGF-β in pleural effusions for diagnosis and prognostic stratification of malignant pleural mesothelioma. Lung Cancer 2019; 139:124-132. [PMID: 31778960 DOI: 10.1016/j.lungcan.2019.11.013] [Citation(s) in RCA: 9] [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: 08/02/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Malignant pleural mesothelioma (MPM) is an aggressive malignancy with dismal prognosis but variable course of disease. To support diagnosis and to risk stratify patients, more reliable biomarkers are warranted. Emerging evidence underlines a functional role of transforming growth factor-beta (TGF-β) in MPM tumorigenesis though its utility as a clinical biomarker remains unexplored. MATERIALS AND METHODS Corresponding pleural effusions and serum samples taken at primary diagnosis were analyzed for TGF-β by ELISA, and for mesothelin (SMRP) by chemiluminescence enzyme immunoassay. Tumor load was quantified in MPM patients by volumetric analysis of chest CT scans. All findings were correlated with clinicopathological characteristics. RESULTS In total 48 MPM patients, 24 patients with non-malignant pleural disease (NMPD) and 30 patients with stage IV lung cancer were enrolled in this study. Pleural effusions from MPM patients had significantly higher TGF-β levels than from NMPD or lung cancer patients (p < 0.0001; AUC for MPM vs NMPD: 0.78, p = 0.0001). Both epithelioid and non-epithelioid MPM were associated with higher TGF-β levels (epithelioid: p < 0.05; non-epithelioid: p < 0.0001) and levels of TGF-β correlated with disease stage (p = 0.003) and with tumor volume (p = 0.002). Interestingly, high TGF-β levels in pleural effusion, but not in serum, was significantly associated with inferior overall survival (TGF-beta ≥14.36 ng/mL: HR 3.45, p = 0.0001). This correlation was confirmed by multivariate analysis. In contrast, effusion SMRP levels were exclusively high in epithelioid MPM, negatively correlated with effusion TGF-β levels and did not provide prognostic information. CONCLUSION TGF-β levels determined in pleural effusion may be a promising biomarker for diagnosis and prognostic stratification of MPM.
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Affiliation(s)
- Paul Stockhammer
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany; Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Till Ploenes
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany
| | - Sandra Maier
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany
| | - Balazs Hegedus
- Department of Thoracic Surgery, Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany.
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Issa N, Arfanis E, Hager T, Aigner C, Dietz-Terjung S, Theegarten D, Kühl H, Welter S. A prospective comparison of growth patterns with radiomorphology in 232 lung metastases-basis for patient tailored resection planning? J Thorac Dis 2019; 11:2822-2831. [PMID: 31463111 DOI: 10.21037/jtd.2019.07.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The histologic presence of aggressive local growth of pulmonary metastases is associated with an increased risk for local intrapulmonary recurrence after enucleation or wedge resection. Patient tailored resection planning is possible when morphologic pattern of aggressive growth could be identified based on preoperative CT scans. Methods Radiomorphology and microscopic growth characteristics from 232 pulmonary metastases from 87 patients were prospectively compared for the presence or absence of aggressive patterns of local intrapulmonary dissemination. Results Microscopic aggressive local growth was found: pleural involvement (18.5%), lymphatic invasion (6.9%), vascular invasion (7.3%), interstitial growth (38.4%), micro satellite nodules (24.5%), spread through air spaces (STAS) (13.4%), and a smooth, slightly blurred or irregular surface in 34.1%, 43.1% and 22.8%. The radiologic margin demarcation was smooth in 37.1%, blurred in 27.6% or irregular in 35.3% and spiculae were present in 26.3% of the lesions. The microscopic and radiologic description of the metastasis surface correlated well [correlation coefficient (CC) =0.75, P<0.001]. A smooth surface on CT scan corresponded with a smooth microscopic surface in 72/86 (83.7%) of the lesions. The radiomorphologic feature of an irregular or cloudy surface was highly associated with the presence of at least one aggressive pattern of local dissemination (P<0.001). The presence of spiculae on CT scan was well associated with the presence of aggressive local spread (P<0.001) and the microscopic features corresponding with spiculae were interstitial growth, STAS and L1. Conclusions Radiomorphologic characteristics of lung metastases correspond well with the microscopic appearance of the resected lesion. Therefore it seems possible to adjust safety margins based on the radiologic appearance of the metastasis.
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Affiliation(s)
- Nomair Issa
- Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elias Arfanis
- Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Thomas Hager
- Institute of Pathology, University Clinic Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Sarah Dietz-Terjung
- Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Clinic Essen, University of Duisburg-Essen, Essen, Germany
| | - Hilmar Kühl
- Department of Radiology, St. Bernhard-Hospital, Kamp-Lintfort, Germany
| | - Stefan Welter
- Department of Thoracic Surgery, Lung Clinic Hemer, Hemer, Germany
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45
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Cheufou DH, Valdivia D, Puhlvers S, Fels B, Weinreich G, Taube C, Theegarten D, Stuschke M, Schuler M, Hegedus B, Stamatis G, Aigner C. Lymph Node Involvement and the Surgical Treatment of Thymic Epithelial and Neuroendocrine Carcinoma. Ann Thorac Surg 2019; 107:1632-1638. [DOI: 10.1016/j.athoracsur.2019.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023]
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Hasheminasab S, Knoll M, Schwager C, Nowrouzi A, Pfarr N, Weichert W, Rieken S, Pöttgen C, Gauler TC, Eberhardt W, Schuler MH, Theegarten D, Aigner C, Debus J, Stuschke M, Abdollahi A. Clonal tumor evolution under induction chemotherapy and concurrent radiochemotherapy (RCHT) in patients with resectable stage IIIA (N2) and selected IIIb non-small cell lung cancer (NSCLC): Molecular analysis of the ESPATUE randomized phase III trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8543 Background: A better understanding of molecular mechanisms governing clonal tumor evolution under RCHT is of utmost importance for development of novel biomarker and targeted therapies. We report here the first attempt to decipher RCHT induced cellular and molecular perturbation in NSCLC on an integrative multiscale level. Methods: Patients with stage III disease received induction chemotherapy with cisplatin and paclitaxel followed by concurrent RCHT with 45 Gy (1.5 Gy twice daily) and cisplatin/vinorelbine according to the ESPATUE protocol. Tumor tissue was sampled from tumor enriched areas marked by pathologists at diagnosis (biopsies, n= 23) and post RCHT during surgical resection (n=22, ESPATUE-Arm B) corresponding to 16 paired samples (PS). Transcriptome analysis (n=45, 16PS), methylome analysis (n=35, 12PS), deep whole exome sequencing (WES) including copy number variation (CNV) analysis by low-pass whole genome sequencing (WGS, n=34, 13PS) were performed. A confirmatory targeted ultra-deep NGS for 41 genes was conducted (n=20PS). Results: Similarity plots of delta transcriptome data identified three distinct clusters of tumor evolution under RCHT. Cluster 1 was highly enriched for STS (5 out of 7 Pat.) compared to cluster 3 enriched for LTS (4 out of 6), p<0.02. 146 transcripts were differentially expressed as the function of RCHT (FDR <0.05). Among them, 61 genes were upregulated and enriched for ECM and tissue remodeling (COL6A3/4, Col14A1, LAMA2, PAI1, MMP2), p53 signaling (p21, GADD45B) and stress response (FOSB, EGR1) pathways, p<0.01. 39 downregulated genes were enriched for genes attributed to cell cycle- and DDR signaling (FANCI, SLX1A) p<0.05. 4221 CpG were differentially methylated (FDR<0.05). Seven inversely regulated genes were found with SLIT3 and TBX5 being among upregulated and hypomethylated genes. WES analysis revealed patterns of tumor evolution with a range of clonal diversity. In 5/13 pairs the clonal composition remained unchanged after RCHT. Approximately 500 post RCHT exclusive mutations were found. Conclusions: Clonal, transcriptional and methylome dynamic of tumor evolution towards RCHT selection pressure is unrevealed in patients with locally advanced NSCLC. This multi-scale dynamic approach provides novel means for development of biomarker and therapeutic targets. Clinical trial information: ESPATUE.
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Affiliation(s)
- Sayedmohammad Hasheminasab
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center Heidelberg, German Cancer Research Center (DKFZ), Germany, Heidelberg, Germany
| | - Maximilian Knoll
- Departments of Radiation Oncology, Neurology, Neurosurgery, Heidelberg University Hospital, National Center for Tumor Disease (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Core-Center Heidelberg, Heidelberg, Germany
| | - Christian Schwager
- German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
| | - Ali Nowrouzi
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center Heidelberg, German Cancer Research Center (DKFZ), Germany, Heidelberg, Germany
| | - Nicole Pfarr
- DKTK Partner Site Munich and Pathology Department, TUM, Munich, Germany, Munich, Germany
| | - Wilko Weichert
- Technical University Munich, Institute of Pathology, Munich, Germany
| | - Stefan Rieken
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Core Center Heidelb, Heidelberg, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Tumor Centre, Essen, Germany
| | - Thomas Christoph Gauler
- Department of Medicine, West German Cancer Center, University Hospital Essen of the University Duisburg-Essen, Essen, Germany
| | - Wilfried Eberhardt
- Departments of Radiation Oncology, Pathology, Thoracic Surgery and Medical Oncology, West German Cancer Center (WTZ), University Medicine Essen; DKTK partner site University Hospital Essen, Essen, Germany., Essen, Germany
| | | | - Dirk Theegarten
- Department of Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy - Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Juergen Debus
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Core Center Heidelb, Heidelberg, Germany
| | - Martin Stuschke
- German Cancer Consortium (DKTK) Core Center Heidelberg and DKTK Partner Site Essen, Essen, Germany
| | - Amir Abdollahi
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Core Center Heidelb, Heidelberg, Germany
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Lyu Y, Boerner E, Theegarten D, Guzman J, Kreuter M, Costabel U, Bonella F. Utility of Anti-DSF70 Antibodies to Predict Connective Tissue Disease in Patients Originally Presenting with Idiopathic Interstitial Pneumonia. Respiration 2019; 98:29-37. [DOI: 10.1159/000496483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/29/2018] [Indexed: 11/19/2022] Open
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Hagmeyer L, Theegarten D, Wohlschläger J, Hager T, Treml M, Herkenrath SD, Hekmat K, Heldwein M, Randerath WJ. Transbronchial cryobiopsy in fibrosing interstitial lung disease: modifications of the procedure lead to risk reduction. Thorax 2019; 74:711-714. [PMID: 30852561 DOI: 10.1136/thoraxjnl-2018-212095] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/04/2022]
Abstract
Sixty-one subjects with fibrosing interstitial lung disease were prospectively analysed to determine the efficacy of transbronchial cryobiopsy (CryoTBB) and the effect of procedural modifications which were introduced after an interim analysis of the first 19 subjects. The modifications significantly reduced complication rates from 84% to 14% (p<0.001). 30-day-mortality was 2%. The algorithm with initial CryoTBB and surgical lung biopsy (SLB) as optional step-up procedure was feasible. CryoTBB led to a confident diagnosis in 46/61 subjects (75%). Only 21% out of all subjects were forwarded for SLB. As the modified CryoTBB reduced but not eliminated the risk of severe complications, tissue sampling should be limited to patients where confident diagnosis enables life prolonging therapy. Trial registration number: NCT01714518.
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Affiliation(s)
- Lars Hagmeyer
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen, Germany
| | - Dirk Theegarten
- Institute for Pathology and Neuropathology, University Hospital Essen, Essen, Germany
| | | | - Thomas Hager
- Institute for Pathology and Neuropathology, University Hospital Essen, Essen, Germany
| | - Marcel Treml
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen, Germany
| | - Simon Dominik Herkenrath
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen, Germany
| | - Khosro Hekmat
- Clinic for Cardiac and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Matthias Heldwein
- Clinic for Cardiac and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Winfried J Randerath
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen, Germany
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Guberina M, Eberhardt W, Stuschke M, Gauler T, Aigner C, Schuler M, Stamatis G, Theegarten D, Jentzen W, Herrmann K, Pöttgen C. Pretreatment metabolic tumour volume in stage IIIA/B non-small-cell lung cancer uncovers differences in effectiveness of definitive radiochemotherapy schedules: analysis of the ESPATUE randomized phase 3 trial. Eur J Nucl Med Mol Imaging 2019; 46:1439-1447. [PMID: 30710323 DOI: 10.1007/s00259-019-4270-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE According to the ACRIN 6668/RTOG 0235 trial, pretreatment metabolic tumour volume (MTV) as detected by 18F-fluorodeoxyglucose PET/CT is a prognostic factor in patients with stage III non-small-cell lung cancer (NSCLC) after definitive radiochemotherapy (RCT). To validate the prognostic value of MTV in patients with stage III NSCLC after RCT, we analysed mature survival data from the German phase III trial ESPATUE. METHODS This analysis included patients who were staged by PET/CT and who were enrolled in the ESPATUE trial, a randomized study comparing definitive RCT (arm A) with surgery (arm B) after induction chemotherapy and RCT in patients with resectable stage IIIA/IIIB NSCLC. Patients refusing surgery and those with nonresectable disease were scheduled to receive definitive RCT. MTV was measured using a fixed threshold-based approach and a model-based iterative volume thresholding approach. Data were analysed using proportional hazards models and Kaplan-Meier survival functions. RESULTS MTV as a continuous variable did not reveal differences in survival between the 117 patients scheduled to receive definitive RCT and all 169 enrolled patients who underwent pretreatment PET/CT (p > 0.5). Five-year survival rates were 33% (95% CI 17-49%) in patients scheduled for definitive RCT with a high MTV (>95.4 ml) and 32% (95% CI: 22-42%) in those with a low MTV. The hazard ratio for survival was 0.997 (95% CI 0.973-1.022) per 10-ml increase in MTV and the slope was significantly shallower than that in the ACRIN 6668/RTOG 0235 trial (random effects model, p = 0.002). There were no differences in MTV size distributions between the ACRIN and ESPATUE trials (p = 0.97). CONCLUSION Patients with stage III NSCLC and a large MTV in whom definitive RCT had a particularly good survival in the ESPATUE trial. Treatment individualization according to MTV is not supported by this study. The ESPATUE and ACRIN trials differed by the use of cisplatin-containing induction chemotherapy and an intensified radiotherapy regimen that were particularly effective in patients with large MTV disease.
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Affiliation(s)
- Maja Guberina
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany
| | - Wilfried Eberhardt
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany. .,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany.
| | - Thomas Gauler
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany
| | - Clemens Aigner
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany.,Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen Medical School, 45239, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen Medical School, 45239, Essen, Germany
| | - Dirk Theegarten
- Department of Pathology, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Walter Jentzen
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45122, Essen, Germany.,Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen Medical School, 45122, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany
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Oezkan F, Herold T, Darwiche K, Eberhardt WE, Worm K, Christoph DC, Wiesweg M, Freitag L, Schmid KW, Theegarten D, Hager T, Koenig MJ, He K, Taube C, Schuler M, Breitenbuecher F. Rapid and Highly Sensitive Detection of Therapeutically Relevant Oncogenic Driver Mutations in EBUS-TBNA Specimens From Patients With Lung Adenocarcinoma. Clin Lung Cancer 2018; 19:e879-e884. [DOI: 10.1016/j.cllc.2018.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/22/2018] [Accepted: 08/11/2018] [Indexed: 12/18/2022]
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