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van Ruitenbeek NJ, van der Woude LL, van Krieken JH, van Engen-van Grunsven ACH, Willemsen AECAB, van Herpen CML. STAT3 as a predictive biomarker in head and neck cancer: A validation study. Pathol Res Pract 2020; 216:153172. [PMID: 32858373 DOI: 10.1016/j.prp.2020.153172] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 11/27/2022]
Abstract
Locally advanced head and neck squamous cell carcinoma (LAHNSCC) treatment consists of radiotherapy (RT) alone or cisplatin-based concomitant chemoradiotherapy (CCRT). CCRT is accompanied by substantially more toxicity than RT alone. A previous retrospective cohort study found that LAHNSCC patients with tumors negative for nuclear expression of the signal transducer and activator of transcription 3 (STAT3) protein might not benefit from the addition of cisplatin to radiotherapy (RT) treatment. We set out to validate these results in a new cohort. We found that in patients with both STAT3 positive and negative tumors, disease-free survival (DFS) and overall survival (OS) did not differ significantly between treatment with cisplatin-based concomitant chemoradiotherapy (CCRT) and radiotherapy alone. Therefore, our validation study does not confirm that STAT3 is a potential biomarker to predict the effectiveness of the addition of cisplatin to RT in LAHNSCC patients.
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Affiliation(s)
- N J van Ruitenbeek
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10 Nijmegen, the Netherlands.
| | - L L van der Woude
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - J H van Krieken
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - A C H van Engen-van Grunsven
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - A E C A B Willemsen
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10 Nijmegen, the Netherlands
| | - C M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10 Nijmegen, the Netherlands
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Affiliation(s)
- J H van Krieken
- Department of Pathology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, Netherlands
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3
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Affiliation(s)
- J H van Krieken
- Department of Pathology, Radboud University Medical Centre, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
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van Krieken JH. Will the liquid biopsy replace traditional hematopathology? J Hematop 2017. [DOI: 10.1007/s12308-017-0296-9] [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: 11/24/2022] Open
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van Krieken JH. Open access and data. J Hematop 2016. [DOI: 10.1007/s12308-016-0285-4] [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] Open
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van Krieken JH. We need to be (much) better. J Hematop 2016. [DOI: 10.1007/s12308-016-0268-5] [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: 10/22/2022] Open
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8
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van Krieken JH. Paediatric hematopathology: something real special. J Hematop 2015. [DOI: 10.1007/s12308-015-0255-2] [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: 10/23/2022] Open
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Peeters M, Kafatos G, Taylor A, Gastanaga VM, Oliner KS, Hechmati G, Terwey JH, van Krieken JH. Prevalence of RAS mutations and individual variation patterns among patients with metastatic colorectal cancer: A pooled analysis of randomised controlled trials. Eur J Cancer 2015; 51:1704-13. [PMID: 26049686 DOI: 10.1016/j.ejca.2015.05.017] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [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: 01/26/2015] [Revised: 05/13/2015] [Accepted: 05/17/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND The use of epidermal growth factor receptor inhibitors to treat metastatic colorectal cancer (mCRC) patients requires prior confirmation of tumour wild type (WT) RAS mutation status (exons 2/3/4 for KRAS or NRAS). This retrospective pooled analysis aims to robustly estimate RAS mutation prevalence and individual variation patterns in mCRC patients. METHOD Individual patient data from five randomised, controlled panitumumab studies (three phase III, one phase II and one phase Ib/II) were pooled for this analysis. The phase III studies included mCRC patients independent of RAS mutation status; the phase II and Ib/II studies included mCRC patients with confirmed WT KRAS exon 2 status. Four studies conducted RAS testing using Sanger sequencing; one study used a combination of next-generation sequencing and Sanger sequencing. In order to assign overall RAS status, the mutation status of all exons 2/3/4 KRAS or NRAS was required to be known. RESULTS Data from 3196 mCRC patients from 36 countries were included in the analysis. The overall unadjusted RAS mutation prevalence in mCRC patients was 55.9% (95% confidence interval (CI): [53.9-57.9%]), with the following distribution observed: KRAS exon 2 (prevalence 42.6% [40.7-44.5%]); KRAS exon 3 (3.8% [2.9-4.9%]); KRAS exon 4 (6.2% [5.0-7.6%]); NRAS exon 2 (2.9% [2.1-3.9%]); NRAS exon 3 (4.2% [3.2-5.4%]); NRAS exon 4 (0.3% [0.1-0.7%]). Differences in RAS mutation prevalence estimates were observed by study (p=0.001), gender (p=0.030), and by country (p=0.028). CONCLUSIONS This analysis provides robust estimates of overall RAS mutation prevalence and individual variation patterns in mCRC patients.
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Affiliation(s)
- M Peeters
- Department of Oncology, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium.
| | - G Kafatos
- Center for Observational Research, Amgen Ltd, 1 Uxbridge Business Park, Sanderson Road, Uxbridge UB8 1DH, UK
| | - A Taylor
- Center for Observational Research, Amgen Ltd, 1 Uxbridge Business Park, Sanderson Road, Uxbridge UB8 1DH, UK
| | - V M Gastanaga
- Center for Observational Research, Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA 91329-1799, USA
| | - K S Oliner
- Medical Sciences, Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA 91329-1799, USA
| | - G Hechmati
- Health Economics, Amgen (Europe) GmbH, Dammstrasse 23, Opus 105, Zug 6301, Switzerland
| | - J-H Terwey
- Medical Development, Amgen (Europe) GmbH, Zählerweg 6, Opus 192, Zug 6301, Switzerland
| | - J H van Krieken
- Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen (911), The Netherlands
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van Krieken JH. The folly of impact factors: some solutions. J Hematop 2015. [DOI: 10.1007/s12308-015-0248-1] [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: 10/23/2022] Open
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Bokemeyer C, Köhne CH, Ciardiello F, Lenz HJ, Heinemann V, Klinkhardt U, Beier F, Duecker K, van Krieken JH, Tejpar S. FOLFOX4 plus cetuximab treatment and RAS mutations in colorectal cancer. Eur J Cancer 2015; 51:1243-52. [PMID: 25937522 DOI: 10.1016/j.ejca.2015.04.007] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/01/2015] [Accepted: 04/10/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The OPUS study demonstrated that addition of cetuximab to 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX4) significantly improved objective response and progression-free survival (PFS) in the first-line treatment of patients with KRAS exon 2 wild-type metastatic colorectal cancer (mCRC). In patients with KRAS exon 2 mutations, a detrimental effect was seen upon addition of cetuximab to FOLFOX4. The current study reports outcomes in subgroups defined by extended RAS testing. PATIENTS AND METHODS Samples from OPUS study KRAS exon 2 wild-type tumours were reanalysed for other RAS mutations in four additional KRAS codons (exons 3-4) and six NRAS codons (exons 2-4) using BEAMing. A cutoff of ⩾5% mutant/wild-type sequences was selected to define RAS status; we also report an analysis using a cutoff based on the technical lower limit for mutation identification (0.1%). RESULTS Other RAS mutations were detected in 31/118 (26%) evaluable patients. In the extended analysis of RAS wild-type tumours (n=87), objective response was significantly improved by addition of cetuximab to FOLFOX4 (58% versus 29%; odds ratio 3.33 [95% confidence interval 1.36-8.17]; P=0.0084); although limited by population size, there also appeared to be trends favouring the cetuximab arm in terms of PFS and overall survival in the RAS wild-type group compared with the RAS evaluable group. There was no evidence that patients with other RAS mutations benefited from cetuximab, but small numbers precluded precise estimations of treatment effects. In the combined population of patients with any RAS mutation (KRAS exon 2 or other RAS), a clear detrimental effect was associated with addition of cetuximab to FOLFOX4. CONCLUSION Patients with RAS-mutant mCRC, as defined by mutations in KRAS and NRAS exons 2-4, derive no benefit and may be harmed by the addition of cetuximab to FOLFOX4. Restricting cetuximab administration to patients with RAS wild-type tumours will further tailor therapy to maximise benefit.
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Affiliation(s)
- C Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - C-H Köhne
- Klinikum Oldenburg, Oldenburg, Germany
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, Munich, Germany
| | - U Klinkhardt
- Global Clinical Development Unit Oncology, Merck KGaA, Darmstadt, Germany
| | - F Beier
- Global Biostatistics, Merck KGaA, Darmstadt, Germany
| | - K Duecker
- Biomarker Technologies & Operations, Merck KGaA, Darmstadt, Germany
| | - J H van Krieken
- Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S Tejpar
- Molecular Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
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van Krieken JH. New and old questions. J Hematop 2014. [DOI: 10.1007/s12308-014-0217-0] [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: 10/24/2022] Open
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van Krieken JH. Grey zone lymphomas. J Hematop 2014. [DOI: 10.1007/s12308-014-0211-6] [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: 10/25/2022] Open
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Visco C, Li Y, Xu-Monette ZY, Miranda RN, Green TM, Li Y, Tzankov A, Wen W, Liu WM, Kahl BS, d'Amore ESG, Montes-Moreno S, Dybkær K, Chiu A, Tam W, Orazi A, Zu Y, Bhagat G, Winter JN, Wang HY, O'Neill S, Dunphy CH, Hsi ED, Zhao XF, Go RS, Choi WWL, Zhou F, Czader M, Tong J, Zhao X, van Krieken JH, Huang Q, Ai W, Etzell J, Ponzoni M, Ferreri AJM, Piris MA, Møller MB, Bueso-Ramos CE, Medeiros LJ, Wu L, Young KH. Erratum: Comprehensive gene expression profiling and immunohistochemical studies support application of immunophenotypic algorithm for molecular subtype classification in diffuse large B-cell lymphoma: a report from the International DLBCL Rituximab-CHOP Consortium Program Study. Leukemia 2014. [DOI: 10.1038/leu.2014.24] [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: 11/09/2022]
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van Krieken JH. Editorial for the Journal of Hematopathology: crisis in science? J Hematop 2014. [DOI: 10.1007/s12308-014-0197-0] [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] Open
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van de Schans SAM, Strobbe L, van der Holst IM, Meijer J, Mattijssen V, de Kievit IM, Mandigers C, Raemaekers J, Aben KKH, van Krieken JH. Diagnosing and classifying malignant lymphomas is improved by referring cases to a panel of expert pathologists. J Hematop 2013. [DOI: 10.1007/s12308-013-0196-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Frei E, Visco C, Xu-Monette ZY, Dirnhofer S, Dybkær K, Orazi A, Bhagat G, Hsi ED, van Krieken JH, Ponzoni M, Go RS, Piris MA, Møller MB, Young KH, Tzankov A. Addition of rituximab to chemotherapy overcomes the negative prognostic impact of cyclin E expression in diffuse large B-cell lymphoma. J Clin Pathol 2013; 66:956-61. [PMID: 23775435 DOI: 10.1136/jclinpath-2013-201619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND High levels of cyclin E (CCNE) are accompanied by shorter survival in cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP)-treated diffuse large B-cell lymphomas (DLBCL), independent of the international prognostic index (IPI). Data on the prognostic role of CCNE in the 'rituximab (R)-era' are lacking. METHODS To test reproducibility and applicability of observations from the 'pre-R era' to the 'R era', we examined the prognostic role of CCNE expression by immunohistochemistry in 1579 DLBCL on tissue microarrays (TMA); 339 patients were treated by CHOP and 635 by R-CHOP. RESULTS 1209 samples (77%) were evaluable; failures were due to missing TMA punches and fixation artefacts. Mean expression of CCNE was 13% (0-85%); applying a cut-off of >16%, 382 DLBCL (31%) were positive. CCNE did not correlate with any of the known variables (IPI, primary site, cell of origin, proliferation, and BCL2- or C-MYC rearrangements). We were able to reproduce data suggesting an IPI- and response to therapy independent, negative prognostic impact of CCNE in CHOP-treated DLBCL patients: CCNE-positive cases had a median survival of 16 months compared with 57 months in negative ones (p=0.012). In R-CHOP-treated patients the prognostic impact of CCNE was abrogated and only IPI, cell of origin and response to therapy had a prognostic significance. CONCLUSIONS Addition of R to CHOP overcomes the negative prognostic impact of CCNE in DLBCL. Thus, R not only prolongs survival in DLBCL but also serves a cautionary note that prognostic factors should not be transferred into the 'R era' without proper scientific studies.
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Affiliation(s)
- E Frei
- Institute of Pathology, University Hospital, , Basel, Switzerland
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van Krieken JH. To publish or perish. J Hematop 2013. [DOI: 10.1007/s12308-013-0186-8] [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: 11/28/2022] Open
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Abstract
Molecular testing of tumor samples to guide treatment decisions is of increasing importance. Several drugs have been approved for treatment of molecularly defined subgroups of patients, and the number of agents requiring companion diagnostics for their prescription is expected to rapidly increase. The results of such testing directly influence the management of individual patients, with both false-negative and false-positive results being harmful for patients. In this respect, external quality assurance (EQA) programs are essential to guarantee optimal quality of testing. There are several EQA schemes available in Europe, but they vary in scope, size and execution. During a conference held in early 2012, medical oncologists, pathologists, geneticists, molecular biologists, EQA providers and representatives from pharmaceutical industries developed a guideline to harmonize the standards applied by EQA schemes in molecular pathology. The guideline comprises recommendations on the organization of an EQA scheme, defining the criteria for reference laboratories, requirements for EQA test samples and the number of samples that are needed for an EQA scheme. Furthermore, a scoring system is proposed and consequences of poor performance are formulated. Lastly, the contents of an EQA report, communication of the EQA results, EQA databases and participant manual are given.
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Affiliation(s)
- J H van Krieken
- Department of Pathology 824, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Visco C, Li Y, Xu-Monette ZY, Miranda RN, Green TM, Li Y, Tzankov A, Wen W, Liu WM, Kahl BS, d'Amore ESG, Montes-Moreno S, Dybkær K, Chiu A, Tam W, Orazi A, Zu Y, Bhagat G, Winter JN, Wang HY, O'Neill S, Dunphy CH, Hsi ED, Zhao XF, Go RS, Choi WWL, Zhou F, Czader M, Tong J, Zhao X, van Krieken JH, Huang Q, Ai W, Etzell J, Ponzoni M, Ferreri AJM, Piris MA, Møller MB, Bueso-Ramos CE, Medeiros LJ, Wu L, Young KH. Comprehensive gene expression profiling and immunohistochemical studies support application of immunophenotypic algorithm for molecular subtype classification in diffuse large B-cell lymphoma: a report from the International DLBCL Rituximab-CHOP Consortium Program Study. Leukemia 2012; 26:2103-13. [PMID: 22437443 DOI: 10.1038/leu.2012.83] [Citation(s) in RCA: 255] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gene expression profiling (GEP) has stratified diffuse large B-cell lymphoma (DLBCL) into molecular subgroups that correspond to different stages of lymphocyte development-namely germinal center B-cell like and activated B-cell like. This classification has prognostic significance, but GEP is expensive and not readily applicable into daily practice, which has lead to immunohistochemical algorithms proposed as a surrogate for GEP analysis. We assembled tissue microarrays from 475 de novo DLBCL patients who were treated with rituximab-CHOP chemotherapy. All cases were successfully profiled by GEP on formalin-fixed, paraffin-embedded tissue samples. Sections were stained with antibodies reactive with CD10, GCET1, FOXP1, MUM1 and BCL6 and cases were classified following a rationale of sequential steps of differentiation of B cells. Cutoffs for each marker were obtained using receiver-operating characteristic curves, obviating the need for any arbitrary method. An algorithm based on the expression of CD10, FOXP1 and BCL6 was developed that had a simpler structure than other recently proposed algorithms and 92.6% concordance with GEP. In multivariate analysis, both the International Prognostic Index and our proposed algorithm were significant independent predictors of progression-free and overall survival. In conclusion, this algorithm effectively predicts prognosis of DLBCL patients matching GEP subgroups in the era of rituximab therapy.
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Affiliation(s)
- C Visco
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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van Krieken JH. The times they are a-changin'. J Hematop 2011. [DOI: 10.1007/s12308-011-0085-9] [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] Open
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23
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Jansen HJ, van Krieken JH, Römkens TEH. Yellow-white lesions in the upper gastrointestinal tract. Gastric xanthelasmas. Neth J Med 2009; 67:360-361. [PMID: 19915233] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- H J Jansen
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Affiliation(s)
- J H van Krieken
- Department of Pathology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Postma C, Koopman M, Buffart TE, Eijk PP, Carvalho B, Peters GJ, Ylstra B, van Krieken JH, Punt CJA, Meijer GA. DNA copy number profiles of primary tumors as predictors of response to chemotherapy in advanced colorectal cancer. Ann Oncol 2009; 20:1048-56. [PMID: 19150955 DOI: 10.1093/annonc/mdn738] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is biologically a heterogeneous disease, which may affect response to drug therapy. We investigated the correlation of genome-wide DNA copy number profiles of primary tumors with response to systemic chemotherapy in advanced CRC. PATIENTS AND METHODS DNA was isolated from formaldehyde-fixed paraffin-embedded primary tumors of 32 patients with advanced CRC, which were selected based on either a good response (n = 16) or a poor response (n = 16) to first-line combination therapy with capecitabine and irinotecan. High-resolution DNA copy number profiles were obtained by means of 30 K oligonucleotide-based array comparative genomic hybridization (aCGH). RESULTS Unsupervised hierarchical cluster analysis of the aCGH data revealed two clusters of 19 and 13 tumors, respectively, and cluster membership showed a significant correlation with response status (P < 0.03). The nonresponders had fewer chromosomal alterations compared with the responders, in particular less losses were found (P < 0.03). Most prominent differences between the two groups were losses of regions 18p11.32-q11.2 (P < 0.02) and 18q12.1-q23 (P < 0.03), which were more frequently observed in responders. CONCLUSIONS Differences in DNA copy number profiles of primary CRCs are associated with response to systemic combination chemotherapy with capecitabine and irinotecan. Responders overall had more chromosomal alterations, especially loss of chromosome 18.
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Affiliation(s)
- C Postma
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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26
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Koopman M, Venderbosch S, Antonini NF, van Krieken JH, Punt CJ. The correlation between ERCC1 expression and outcome of chemotherapy in patients with advanced colorectal cancer (ACC): A Dutch Colorectal Cancer Group study (DCCG). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koopman M, Kortman GA, Mekenkamp L, Ligtenberg MJ, Hoogerbrugge N, Mol L, Antonini NF, Punt CJ, van Krieken JH. Use of microsatellite instability in non-hereditary advanced colorectal cancer to predict response to chemotherapy and overall survival: A study of the Dutch Colorectal Cancer Group (DCCG). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4118] [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
4118 Background: Microsatellite instability (MSI) is present in 10–20% of patients (pts) with non-hereditary colorectal cancer (CRC) and is generally associated with improved overall survival. The effect of chemotherapy in such pts is uncertain, and most data are derived from early stage CRC. Therefore the outcome of treatment in relation to presence or absence of MSI was studied in pts with non- hereditary advanced CRC. Methods: Data were collected from previously untreated advanced CRC pts randomized between 1st line capecitabine (Cap), 2nd line irinotecan (Iri), and 3rd line Cap + oxaliplatin (CapOx) vs 1st line CapIri and 2nd line CapOx. Formalin-fixed, paraffin embedded blocks of primary tumors and normal tissue were collected and tissue microarrays were made. Expression of the mismatch repair proteins MLH1, MSH2, MSH6 and PMS2 was examined by immunohistochemistry. Additionally MSI analysis and hypermethylation of the MLH1-promoter were performed. Pts with a tumor showing MSI caused by hypermethylation of the MLH1-promoter were included to study the correlation between MSI status and response to 1st line treatment and overall survival. Results: MSI caused by hypermethylation of the MLH1-promoter was found in 14 (3%) of 512 eligible pts. In 461 evaluable pts, disease control (CR+PR+SD=4 months) in 12 pts with MSI was 58% [95% CI 28%- 85%] and in 449 without MSI 83% [95% CI 79%-86%, p= 0.03].The median OS in pts with MSI was 7 months [95% CI 4–17] and in pts without MSI 18 months [95% CI 16–19, log rank p=0.08]. Conclusions: MSI in advanced non-hereditary CRC is very rare, and predicts a significantly worse outcome in terms of response to chemotherapy with a trend towards a decreased OS. No significant financial relationships to disclose.
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Affiliation(s)
- M. Koopman
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - G. A. Kortman
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - L. Mekenkamp
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - M. J. Ligtenberg
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - N. Hoogerbrugge
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - L. Mol
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - N. F. Antonini
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - C. J. Punt
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - J. H. van Krieken
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
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van Krieken JH, Kets CM, Ligtenberg MJ, Hoogerbrugge N. Detecting Lynch syndrome by pathologists. Verh Dtsch Ges Pathol 2007; 91:104-111. [PMID: 18314603] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Lynch syndrome (formerly called hereditary nonpolyposis colorectal cancer) is a hereditary syndrome resulting in a high risk for colorectal cancer at young age. About 2-3% of all colorectal cancers arise in the setting of Lynch syndrome and the tumors are characterized by microsatellite instabillity (MSI)due to a mutation in one of the mismatch repair genes. Of sporadic colorectal cancer about 15 % have MSI too, but due to hypermethylation of the promotor of the MHL1 gene. Recognizing Lynch syndrome is important, since patients and their families need to undergo a screening program. Based on clinical (colorectal cancer in patients younger than 50 years, or multiple colorectal cancer in one patient) and pathological (mucinous carcinoma, intraepithelial lymphocytes) features pathologists are increasingly able to recognize cases of colorectal cancer that are associated with Lynch syndrome. We propose a cost-effective and ethically correct approach for detecting Lynch syndrome by pathologists.
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Affiliation(s)
- J H van Krieken
- Department for Pathology, Radboud University Nijmegen Medical Centre
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29
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Berends MAM, Snoek J, de Jong EMGJ, van de Kerkhof PCM, van Oijen MGH, van Krieken JH, Drenth JPH. Liver injury in long-term methotrexate treatment in psoriasis is relatively infrequent. Aliment Pharmacol Ther 2006; 24:805-11. [PMID: 16918884 DOI: 10.1111/j.1365-2036.2006.03047.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Methotrexate-induced liver damage in psoriasis has led to dermatologic guidelines that stipulate monitoring of liver injury by means of serial liver biopsies. Recent literature data suggest that methotrexate may be considerably less hepatotoxic than previously assumed. AIM To evaluate prevalence and development of liver injury in methotrexate treated psoriasis. METHODS Retrospective chart review (1976-2005). RESULTS Hundred and twenty-five patients (F58/M67; mean age 45.0, SD 12.7 years) received a median cumulative methotrexate dose of 2,113 mg (range 180-20 235) over a median period of 228 weeks (range 16-1763). Two hundred and seventy eight liver biopsies were analysed and 71% were classified as Roenigk grade I, 14% as Roenigk II, 14% grade IIIa, 2% grade IIIB and 2% grade IV. Liver injury was not associated with cumulative dose, weekly prescribed dose, age or duration of treatment. Obesity and diabetes were significant risk factors for liver injury. A total of 68 patients had multiple biopsies, 3% improved, 72% did not change and in 25% liver histology deteriorated. The majority of cases (84%) that progressed to Roenigk 2 had a cumulative dose of 1,500-6,000 mg. CONCLUSIONS Methotrexate-related liver injury is less frequent than previously thought and mostly occurred at cumulative dose of <6,000 mg. Diabetes and being overweight are significantly correlated with liver injury.
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Affiliation(s)
- M A M Berends
- Department of Dermatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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30
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van der meer JWM, Weemaes CMR, van Krieken JH, Blomjous CEM, van Die CE, Netea MG, Bredie SJH. Critical aneurysmal dilatation of the thoracic aorta in young adolescents with variant hyperimmunoglobulin E syndrome. J Intern Med 2006; 259:615-8. [PMID: 16704563 DOI: 10.1111/j.1365-2796.2006.01653.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The autosomal-dominant (AD) form of the hyperimmunoglobulin E syndrome (HIES) has been described as a multisystem disorder including immune, skeletal and dental abnormalities. Recently, the evaluation of patients from families in which HIES was inherited in a manner more consistent with autosomal-recessive (AR) inheritance, showed that AR-HIES is a clinically distinct disease entity. In addition to classical immunologic findings of AD-HIES, the AR form presents with severe recurrent fungal and viral infections with herpes zoster, herpes simplex and characteristic mollusca contagiosa. Furthermore, cerebral vascular sequelae, including vasculitis, infarction and haemorrhage were noted. In this report, we describe the clinical picture of two patients who showed remarkable resemblance to the description of AR-HIES, but also developed fatal aneurysmal dilatation of the thoracic aorta in adolescence. This finding may further consummate the clinical picture of AR-HIES and emphasize the possibility to develop early aortitis, most likely preceding the critical aneurysm formation at older age. This process should be anticipated during childhood in cases with AR-HIES.
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Affiliation(s)
- J W M van der meer
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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31
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van Krieken JH. [Part-time medical specialist training; experiences with job-sharing for trainee internists]. Ned Tijdschr Geneeskd 2004; 148:856-7; author reply 857. [PMID: 15141657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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32
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de Bruin JH, Ligtenberg MJ, Nagengast FM, van Krieken JH. [From gene to disease; E-cadherin and hereditary diffuse gastric cancer]. Ned Tijdschr Geneeskd 2003; 147:2474-7. [PMID: 14708213] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Hereditary diffuse gastric cancer (HDGC) is a rare autosomal dominant syndrome associated with an early-onset, histologically diffuse, signet ring cell type gastric cancer and the occurrence of cancer at other anatomical sites, i.e. breast, colon, prostate and ovary. Inactivating germline mutations in the CDH1 gene, encoding the cell to cell adhesion protein E-cadherin, predispose to HDGC. About 30% of HDGC families have a proven pathogenic CDH1 mutation. Lifetime penetrance of HDGC is about 70%. In HDGC families the recommendation for prophylactic total gastrectomy is restricted to carriers of an inactivating CDH1 mutation.
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Affiliation(s)
- J H de Bruin
- Afd. Antropogenetica, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen.
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33
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van Kouwen MC, Drenth JP, Engels LG, Strijk SP, van Krieken JH, Nagengast FM. [A patient with biliary papillomatosis, a rare condition of the biliary system, with fatal outcome]. Ned Tijdschr Geneeskd 2003; 147:1323-7. [PMID: 12868162] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
A 21-year-old man was admitted because of upper abdominal pain and cholestasis. Endoscopic retrograde cholangiopancreatography was suggestive of primary sclerosing cholangitis. During follow-up the patient developed symptoms which were not compatible with primary sclerosing cholangitis, i.e. icterus and weight loss. Finally the patient died, almost three years after presentation, because of a metastatic adenocarcinoma which had arisen from biliary papillomatosis. Biliary papillomatosis is characterised by papillary adenomatous proliferation of the bile duct epithelium. It has a high chance of malignant degeneration. The only curative option would have been transplantation of the liver and biliary system, but this ought to have happened at an early stage before malignant degeneration had occurred.
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Affiliation(s)
- M C van Kouwen
- Afd. Maag-, Darm- en Leverziekten, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen.
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34
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van Venrooij NA, Lenders JJ, Lammens MM, van Krieken JH. [Autopsy are a useful quality instrument because of unexpected clinical relevant findings and the answering of clinical questions; a retrospective study]. Ned Tijdschr Geneeskd 2003; 147:1318-22. [PMID: 12868161] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To determine the frequency of unexpected, clinically relevant findings in autopsies performed at the University Medical Centre, Nijmegen, the Netherlands, and the number of questions posed by the clinician that were answered by the pathologist performing the autopsy. DESIGN Descriptive. METHOD All 60 complete autopsy reports of patients older than 10 days for the period January 2000 to April 2000 were compared with the information available from the autopsy application forms and discharge letters. RESULTS An unexpected, clinically relevant findings was found in 20 cases (33%). The percentage questions answered by the pathologist was 93% (174 out of 187 questions). CONCLUSION Autopsy is an important instrument for improving the quality of medicine.
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Affiliation(s)
- N A van Venrooij
- Afd. Pathologie, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen
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35
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van Krieken JH. [Diagnostic image (48)]. Ned Tijdschr Geneeskd 2001; 145:1823-4. [PMID: 11582650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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36
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Kapiteijn E, Liefers GJ, Los LC, Kranenbarg EK, Hermans J, Tollenaar RA, Moriya Y, van de Velde CJ, van Krieken JH. Mechanisms of oncogenesis in colon versus rectal cancer. J Pathol 2001; 195:171-8. [PMID: 11592095 DOI: 10.1002/path.918] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Observations support the theory that development of left- and right-sided colorectal cancers may involve different mechanisms. This study investigated different genes involved in oncogenesis of colon and rectal cancers and analysed their prognostic value. The study group comprised 35 colon and 42 rectal cancers. Rectal cancer patients had been treated with standardized surgery performed by an experienced rectal cancer surgeon. Mutation analysis was performed for p53 in eight colon cancers and for APC and p53 in 22 rectal cancers. MLH1, MSH2, Bcl-2, p53, E-cadherin and beta-catenin were investigated by immunohistochemistry in all colorectal tumours. APC mutation analysis of the MCR showed truncating mutations in 18 of 22 rectal tumours (82%), but the presence of an APC mutation was not related to nuclear beta-catenin expression (p=0.75). Rectal cancers showed significantly more nuclear beta-catenin than colon cancers (65% versus 40%, p=0.04). p53 mutation analysis corresponded well with p53 immunohistochemistry (p<0.001). Rectal cancers showed significantly more immunohistochemical expression of p53 than colon cancers (64% versus 29%, p=0.003). In rectal cancers, a significant correlation was found between positive p53 expression and worse disease-free survival (p=0.008), but not in colon cancers. Cox regression showed that p53-expression (p=0.03) was an independent predictor for disease-free survival in rectal cancers. This study concluded that rectal cancer may involve more nuclear beta-catenin in the APC/beta-catenin pathway than colon cancer and/or nuclear beta-catenin may have another role in rectal cancer independently of APC. The p53-pathway seems to be more important in rectal cancer, in which it also has independent prognostic value. When prognostic markers are investigated in larger series, differences in biological behaviour between colon and rectal cancer should be considered.
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Affiliation(s)
- E Kapiteijn
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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37
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Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345:638-46. [PMID: 11547717 DOI: 10.1056/nejmoa010580] [Citation(s) in RCA: 2972] [Impact Index Per Article: 129.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Short-term preoperative radiotherapy and total mesorectal excision have each been shown to improve local control of disease in patients with resectable rectal cancer. We conducted a multicenter, randomized trial to determine whether the addition of preoperative radiotherapy increases the benefit of total mesorectal excision. METHODS We randomly assigned 1861 patients with resectable rectal cancer either to preoperative radiotherapy (5 Gy on each of five days) followed by total mesorectal excision (924 patients) or to total mesorectal excision alone (937 patients). The trial was conducted with the use of standardization and quality-control measures to ensure the consistency of the radiotherapy, surgery, and pathological techniques. RESULTS Of the 1861 patients randomly assigned to one of the two treatment groups, 1805 were eligible to participate. The overall rate of survival at two years among the eligible patients was 82.0 percent in the group assigned to both radiotherapy and surgery and 81.8 percent in the group assigned to surgery alone (P=0.84). Among the 1748 patients who underwent a macroscopically complete local resection, the rate of local recurrence at two years was 5.3 percent. The rate of local recurrence at two years was 2.4 percent in the radiotherapy-plus-surgery group and 8.2 percent in the surgery-only group (P<0.001). CONCLUSIONS Short-term preoperative radiotherapy reduces the risk of local recurrence in patients with rectal cancer who undergo a standardized total mesorectal excision.
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Affiliation(s)
- E Kapiteijn
- Department of Surgery, Leiden University Medical Center, The Netherlands
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38
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Tan AC, van Krieken JH, MacKenzie MA, Naber TH. [Patient with refractory celiac disease and secondary lymphoma]. Ned Tijdschr Geneeskd 2001; 145:1651-5. [PMID: 11552369] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A 50-year-old woman who had suffered from well-regulated coeliac disease for 16 years, presented with weight loss, soft stools and abdominal cramps. She had ulcers in the oesophagus and stomach, and in biopsies localisations of so-called enteropathy-associated T-cell lymphoma (EATL) were detected. During a staging investigation she suffered an enteric perforation and later on repeated haemorrhages, from which she eventually died. Patients with coeliac disease who do not respond to a gluten free diet or who relapse after an initial response should be investigated for the presence of a gastrointestinal malignancy. Weight loss is an important symptom. The most frequently occurring malignant complication is an EATL. This is often difficult to diagnose and the prognosis is poor, with frequent complications such as haemorrhages and perforations.
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Affiliation(s)
- A C Tan
- Afd. Maag-, Darm- en Leverziekten, Universitair Medisch Centrum St Radboud, Nijmegen.
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39
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Takes RP, Baatenburg de Jong RJ, Wijffels K, Schuuring E, Litvinov SV, Hermans J, van Krieken JH. Expression of genetic markers in lymph node metastases compared with their primary tumours in head and neck cancer. J Pathol 2001. [PMID: 11439361 DOI: 10.1002/1096-9896(200107)194:3<298::aid-path900>3.0.co;2-q] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Regional metastasis is an important factor in the prognosis and treatment of head and neck squamous cell carcinoma (HNSCC). The results of earlier studies suggested the possibility of predicting nodal metastasis in HNSCC using biological markers. To identify which factors may be relevant in the metastatic behaviour of these tumours, the expression of several markers involved in tumour progression was studied in both nodal metastases and their corresponding primary tumours. Expression of p53, Rb, cyclin D1, myc, bcl-2, EGFR, neu, E-cadherin, epithelial cell adhesion molecule (Ep-CAM), and nm23 was studied in 54 primary tumours and their corresponding metastases in patients with HNSCC. The expression of most genes involved in tumourigenesis (p53, Rb, cyclin D1, myc, bcl-2, EGFR, neu, and E-cadherin) was similar in primary tumours and metastases. The expression of nm23 and Ep-CAM was found to be more frequently lower than higher in metastases, compared with their primary tumours. Whereas most genetic alterations of primary tumours remain unchanged in metastases, expression of the cell adhesion molecule Ep-CAM and of nm23 is more frequently reduced than increased in metastases, compared with their primary tumours, suggesting relevance to the process of metastasis. This also implies differences in the regulation of markers involved in tumourigenesis and the process of metastasis.
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Affiliation(s)
- R P Takes
- Department of Otolaryngology, Leiden University Medical Center, Leiden, The Netherlands
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40
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Ricciardolo FL, Timmers MC, Geppetti P, van Schadewijk A, Brahim JJ, Sont JK, de Gouw HW, Hiemstra PS, van Krieken JH, Sterk PJ. Allergen-induced impairment of bronchoprotective nitric oxide synthesis in asthma. J Allergy Clin Immunol 2001; 108:198-204. [PMID: 11496234 DOI: 10.1067/mai.2001.116572] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endogenous nitric oxide protects against airway hyperresponsiveness (AHR) to bradykinin in mild asthma, whereas AHR to bradykinin is enhanced by inhaled allergens. OBJECTIVE Hypothesizing that allergen exposure impairs bronchoprotective nitric oxide within the airways, we studied the effect of the inhaled nitric oxide synthase (NOS) inhibitor N(G)-monomethyl-L-arginine (L-NMMA) on AHR to bradykinin before and after allergen challenge in 10 subjects with atopic asthma. METHODS The study consisted of 3 periods (1 diluent and 2 allergen challenges). AHR to bradykinin (PD(20)BK) was examined before and 48 hours after allergen challenge, both after double-blinded pretreatment with L-NMMA or placebo. The accompanying expression of the various NOS isoforms (ecNOS, nNOS, and iNOS) was examined by means of immunohistochemistry in bronchial biopsies obtained after diluent and allergen challenge. RESULTS After placebo, AHR to BK worsened after allergen challenge in comparison with before allergen challenge (PD(20)BK, 70.8 nmol [range, 6.3-331] and 257 nmol [35.5-2041], respectively; P =.0004). After L-NMMA, preallergen and postallergen PD(20)BK values (50.1 nmol [1.8-200] vs 52.5 nmol [6.9-204]; P =.88) were similarly reduced (P <.01) and not different from the postplacebo/postallergen value (P >.05). After allergen challenge, the intensity of staining in bronchial epithelium decreased for ecNOS (P =.03) and increased for iNOS (P =.009). These changes in immunostaining were correlated with the accompanying worsening in AHR to BK (R(s) = -0.66 and 0.71; P <.04). CONCLUSIONS These data indicate that allergen exposure in asthma induces increased airway hyperresponsiveness to bradykinin through impaired release of bronchoprotective nitric oxide associated with downregulation of ecNOS. This suggests that new therapeutic strategies towards restoring the balance among the NOS isoforms during asthma exacerbations are warranted.
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Affiliation(s)
- F L Ricciardolo
- Department of Pulmonology, Leiden University Medical Center, The Netherlands
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41
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Takes RP, Baatenburg de Jong RJ, Wijffels K, Schuuring E, Litvinov SV, Hermans J, van Krieken JH. Expression of genetic markers in lymph node metastases compared with their primary tumours in head and neck cancer. J Pathol 2001; 194:298-302. [PMID: 11439361 DOI: 10.1002/1096-9896(200107)194:3<298::aid-path900>3.0.co;2-q] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [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: 11/09/2022]
Abstract
Regional metastasis is an important factor in the prognosis and treatment of head and neck squamous cell carcinoma (HNSCC). The results of earlier studies suggested the possibility of predicting nodal metastasis in HNSCC using biological markers. To identify which factors may be relevant in the metastatic behaviour of these tumours, the expression of several markers involved in tumour progression was studied in both nodal metastases and their corresponding primary tumours. Expression of p53, Rb, cyclin D1, myc, bcl-2, EGFR, neu, E-cadherin, epithelial cell adhesion molecule (Ep-CAM), and nm23 was studied in 54 primary tumours and their corresponding metastases in patients with HNSCC. The expression of most genes involved in tumourigenesis (p53, Rb, cyclin D1, myc, bcl-2, EGFR, neu, and E-cadherin) was similar in primary tumours and metastases. The expression of nm23 and Ep-CAM was found to be more frequently lower than higher in metastases, compared with their primary tumours. Whereas most genetic alterations of primary tumours remain unchanged in metastases, expression of the cell adhesion molecule Ep-CAM and of nm23 is more frequently reduced than increased in metastases, compared with their primary tumours, suggesting relevance to the process of metastasis. This also implies differences in the regulation of markers involved in tumourigenesis and the process of metastasis.
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Affiliation(s)
- R P Takes
- Department of Otolaryngology, Leiden University Medical Center, Leiden, The Netherlands
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42
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Langerak AW, van Krieken JH, Wolvers-Tettero IL, Kerkhof E, Mulder AH, Vrints LW, Coebergh JW, Schuuring E, Kluin PM, van Dongen JJ. The role of molecular analysis of immunoglobulin and T cell receptor gene rearrangements in the diagnosis of lymphoproliferative disorders. J Clin Pathol 2001; 54:565-7. [PMID: 11429433 PMCID: PMC1731469 DOI: 10.1136/jcp.54.7.565] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To investigate whether the analysis of immunoglobulin (Ig)/T cell receptor (TCR) rearrangements is useful in the diagnosis of lymphoproliferative disorders. METHODS In a series of 107 consecutive cases with initial suspicion of non-Hodgkin's lymphoma (NHL), Southern blot (SB) analysis of Ig/TCR rearrangements was performed. RESULTS In 98 of 100 histopathologically conclusive cases, Ig/TCR gene results were concordant. In one presumed diffuse large B cell lymphoma (DLCL) and one follicular lymphoma (FL) case no clonality could be detected by SB analysis, or by polymerase chain reaction (PCR) at second stage. In the DLCL, sampling error might have occurred; the FL was revised after an initial diagnosis of reactivity. In many of the histopathologically inconclusive cases Ig/TCR gene SB analysis was helpful, giving support for the histopathological suspicion. However, because of a lack of (clinical) follow up data this could not be confirmed in a few cases. CONCLUSIONS Experienced haematopathologists or a pathologist panel can diagnose malignant versus reactive lesions in most cases without the need for Ig/TCR gene analysis and can select the 5-10% of cases that might benefit from molecular clonality studies.
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Affiliation(s)
- A W Langerak
- Department of Immunology, University Hospital Rotterdam/Erasmus University Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
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van Halteren HK, Peters HM, van Krieken JH, Coebergh JW, Roumen RM, van der Worp E, Wagener JT, Vreugdenhil G. Tumor growth pattern and thymidine phosphorylase expression are related with the risk of hematogenous metastasis in patients with Astler Coller B1/B2 colorectal carcinoma. Cancer 2001; 91:1752-7. [PMID: 11335901 DOI: 10.1002/1097-0142(20010501)91:9<1752::aid-cncr1194>3.0.co;2-m] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 01/31/2023]
Abstract
BACKGROUND The benefit of adjuvant chemotherapy appears to be limited for patients with Astler Coller B1/B2 colorectal carcinoma but may be better in a subgroup of patients with a high recurrence risk. In the current case-control analysis, the authors evaluated whether patients with a high risk of hematogenous metastasis could be identified by means of a thorough histologic and immunohistochemical examination of the resection specimens. METHODS A database was built for all patients treated in a general teaching hospital for colorectal carcinoma between 1985 and 1995. From this database, all patients with an Astler Coller B1 or B2 tumor who subsequently had developed hematogenous metastases were taken as cases. For each case, three matched controls (age, Astler Coller, year of diagnosis) without metachronous metastases were selected. The resection specimens of cases and controls were blindly examined by two observers for the following: World Health Organization (WHO) classification; differentiation grade; growth pattern; lymphocytic, fibroblastic, and eosinophilic reaction; angioinvasion; number of lymph nodes examined; expression of E-cadherin, vascular endothelial growth factor and thymidine phosphorylase (TP); P53; microvessel density. RESULTS Twenty-two cases and 65 controls were included in the analysis. Tumor growth pattern and tumor TP expression both independently contributed to recurrence risk. With these 2 variables, 4 subgroups could be identified with a recurrence risk ranging from 0% to 42%. CONCLUSIONS Tumor growth pattern and degree of TP expression both appear to be related to the recurrence risk. Prospective trials should point out whether these variables can be implemented in the decision making concerning adjuvant chemotherapy.
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Affiliation(s)
- H K van Halteren
- Department of Medical Oncology, University Medical Center Nijmegen, The Netherlands.
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44
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Marijnen CA, Nagtegaal ID, Klein Kranenbarg E, Hermans J, van de Velde CJ, Leer JW, van Krieken JH. No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 2001; 19:1976-84. [PMID: 11283130 DOI: 10.1200/jco.2001.19.7.1976] [Citation(s) in RCA: 244] [Impact Index Per Article: 10.6] [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: 12/26/2022] Open
Abstract
PURPOSE In retrospective studies, total mesorectal excision (TME) surgery has been demonstrated to result in a reduction in the number of local recurrences of rectal cancer. Reports on improved local control after preoperative, hypofractionated radiotherapy have led to the introduction of a randomized multicenter trial to evaluate the effect of TME surgery with and without preoperative radiotherapy. Treatment with preoperative radiotherapy might have an effect on the pathologic characteristics that determine staging of rectal cancer. We investigated the occurrence of downstaging in rectal cancer patients treated with and without preoperative radiotherapy. PATIENTS AND METHODS We analyzed the differences in tumor size, number of examined lymph nodes, tumor-node-metastasis stage, and histopathologic features in 1,321 patients entered onto a randomized trial. The trial compared preoperative radiotherapy (5 x 5 Gy) followed by TME surgery with TME surgery alone. Patients who had an interval of more than 10 days between the start of radiotherapy and surgery were excluded from analysis. RESULTS Differences were observed in tumor size (P <.001) and total number of examined lymph nodes (P <.001). No difference in tumor or node classification was detected. The irradiated group demonstrated more poorly differentiated tumors as well as more mucinous tumors. CONCLUSION In rectal cancer patients, short-term, preoperative radiotherapy with 5 x 5 Gy does not lead to downstaging if the interval between the start of radiotherapy and surgery does not exceed 10 days.
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Affiliation(s)
- C A Marijnen
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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Janssen AM, van Duijn W, Oostendorp-Van De Ruit MM, Kruidenier L, Bosman CB, Griffioen G, Lamers CB, van Krieken JH, van De Velde CJ, Verspaget HW. Metallothionein in human gastrointestinal cancer. J Pathol 2001. [PMID: 11054711 DOI: 10.1002/1096-9896(2000)9999:9999<::aid-path712>3.0.co;2-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Metallothionein (MT) is a small thiol-rich metalloprotein with antioxidant properties, involved in tumour pathophysiology and therapy resistance. In order to assess the contribution of MT in gastrointestinal carcinogenesis, this study examined both the MT content by radioimmunoassay and the MT localization by immunohistochemistry in pairs of neoplastic and normal-appearing human gastrointestinal tissues. In addition, the relationship between MT expression and major clinicopathological parameters was assessed. The MT concentration of gastric carcinomas and of colorectal adenomas, carcinomas, and liver metastases was found to be significantly lower than that of corresponding normal-appearing tissue. A relatively high MT content, however, was found to be associated with the villous character of colorectal adenomas and with the Dukes' stage of colorectal carcinomas, indicating a relationship between MT level and malignant potential. Immunohistochemical evaluation showed a fairly good correlation with these quantitative data. MT was found to be expressed at a low level and in a patchy pattern in the gastrointestinal neoplastic and metastatic tissues, whereas in normal-appearing gastrointestinal mucosa MT was uniformly distributed in the cytoplasm and/or nucleus of apical cells. Although in the gastric cancer patients no association was found between the MT concentration and the clinicopathological parameters, the strong MT expression in areas with intestinal metaplasia, known to have neoplastic potential, further points to a relationship between this antioxidant metalloprotein and the malignant character of cells. Gastrointestinal neoplasms are apparently accompanied by a low level and decreased expression of MT, but those with a relatively high level seem to have an increased malignant potential. Further studies will be required to determine the clinical relevance of these observations.
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Affiliation(s)
- A M Janssen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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46
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Abstract
Single tumour cells, or multicellular aggregates, escape into blood and lymphatic vessels from a primary solid tumour as it progresses. However, the ability of such cells to develop into metastatic outgrowths is very limited, as shown by the poor prognostic power of the presence of circulating tumour cells in cancer patients. An explanation for this low efficiency may be a temporary absence of a suitable microenvironment once the tumour cells escape from their original tissue compartment. On the basis of histopathological observations, experimental studies, and the generally accepted poor prognosis of histopathologically confirmed intravascular tumour location, we propose that the structural and functional organisation of intravascular tumour cells as a tissue has a key role in providing the optimum microenvironment for sustained malignant dissemination. Such a tissue may be a fixed or a mobile intravascular microsatellite, or an intravascular micrometastasis, which locally develops into an overt in-transit metastasis.
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Affiliation(s)
- D J Ruiter
- Department of Pathology at the University Medical Centre St Radboud Nijmegen, The Netherlands.
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47
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Schaar CG, van der Pijl JW, van Hoek B, de Fijter JW, Veenendaal RA, Kluin PM, van Krieken JH, Hekman A, Terpstra WE, Willemze R, Kluin-Nelemans HC. Successful outcome with a "quintuple approach" of posttransplant lymphoproliferative disorder. Transplantation 2001; 71:47-52. [PMID: 11211194 DOI: 10.1097/00007890-200101150-00008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The treatment of posttransplant lymphoproliferative disorder (PTLD) remains empirical. We review our treatment of seven cases of PTLD consisting of five interventions: 1) reduction of immunosuppression; 2) antiviral drugs; 3) interferon-alpha; 4) gamma-globulins; and 5) anti-CD19 monoclonal antibodies. METHODS AND RESULTS; Seven consecutive patients who had undergone a simultaneous pancreas-kidney, liver, heart, or kidney transplantation were treated. One patient acquired a primary EBV infection with an oligoclonal immunoblastic lymphoma early after pancreas-kidney transplantation; all others developed a monoclonal polymorphic or immunoblastic lymphoma 2 to 123 months after transplantation. In all patients extranodal sites were involved, in three the graft was also involved. Five patients received the full quintuple approach and all rapidly obtained a complete remission (CR) with a median follow-up of 31 months (7-74 months). Of the two patients who did not receive interferon-alpha for fear of graft rejection one responded slowly with a CR after 7 months, and the other obtained a rapid CR followed by a relapse at 4 months. All three patients with a liver or heart transplant could keep their graft. All patients are still alive with a median follow-up of 31 months (7-74 months). CONCLUSION This combined approach resulted in a favorable outcome in patients with high risk monoclonal PTLD after solid organ transplantation.
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Affiliation(s)
- C G Schaar
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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48
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Abstract
BACKGROUND The blood vessels of a transplanted organ are the interface between donor and recipient. The endothelium in the blood vessels is thought to be the major target for graft rejection. Endothelial cells of a transplanted organ are believed to remain of donor origin after transplantation. We aimed to verify this concept. METHODS We studied biopsy samples from 12 renal transplants for the presence of endothelial cells of recipient origin. We used three different techniques: immunohistochemistry for MHC class-I antigens, immunohistochemistry for ABO-blood-group antigens, and in-situ hybridisation for X and Y chromosomes. After we had confirmed that these techniques did identify endothelial cells of recipient origin, tests were done in a second group of 26 patients to find out whether endothelial chimerism correlated with graft rejection. FINDINGS We found a strong correlation between the percentage of recipient endothelial cells in the peritubular capillaries and the type of graft rejection (r = 0.71, p < 0.0001). These cells were found mainly in grafts of patients who had had rejection, especially among patients with vascular rejection. In grafts of patients without rejection only sporadically recipient endothelial cells were detectable. INTERPRETATION Our data show that endothelial cells of the recipient can replace those of the donor. This replacement is associated with graft rejection. We postulate that endothelium that is damaged by vascular rejection is repaired by endothelial cells of the recipient.
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Affiliation(s)
- E L Lagaaij
- Department of Pathology, Leiden University Medical Centre, The Netherlands.
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Klein Kranenbarg E, Hermans J, van Krieken JH, van de Velde CJ. Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value. Br J Cancer 2001; 84:64-71. [PMID: 11139315 PMCID: PMC2363617 DOI: 10.1054/bjoc.2000.1548] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The main change in the 5th edition (1997) of the TNM classification for gastric cancer compared to the 4th edition (1987) is the use of the number of involved nodes instead of the location of positive nodes. As a result stage grouping is also altered. A second change is the requirement for the examination of at least 15 nodes to justify the N0 status. Patients with fewer examined negative nodes are unclassifiable (Nx). Data were retrieved from a randomized trial database comparing D1 and D2 dissection and 633 curatively operated patients were included. According to the criteria of the 5th edition, 39% of the node-positive patients had another N stage compared to the 4th: 21% had a lower and 18% had a higher stage. 5-year survival rates according to the 4th edition N0, N1 and N2 groups were respectively 72%, 34% and 27%. According to the 5th edition these percentages were for the N0, N1, N2, N3 and Nx groups respectively 75%, 38%, 19%, 8% and 65%. The former 1987 N1 and N2 group were significantly split into three new N 1997 groups (P = 0.006, respectively P< 0.0005). The Cox's regression analysis showed the N 1997 classification to be the most important prognostic variable, with a higher prognostic value than N 1987. In addition, the new TNM stage was also a better prognosticator. The requirement for examining at least 15 nodes, however, could not be fulfilled in 38% of all node-negative patients and we found that a minimum of 5 consecutive negative lymph nodes is a reliable number for staging purposes. We conclude that the 5th edition of the TNM classification provides a better estimation of prognosis, however, examination of at least 15 negative regional lymph nodes is too high a threshold and 5 gives similar prognostic value.
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Affiliation(s)
- E Klein Kranenbarg
- Department of Surgery and Medical Statistics, Medical Statistics, Leiden University Medical Center, PO Box 9600, Leiden, RC, 2300, The Netherlands
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50
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Janssen AM, van Duijn W, Oostendorp-Van De Ruit MM, Kruidenier L, Bosman CB, Griffioen G, Lamers CB, van Krieken JH, van De Velde CJ, Verspaget HW. Metallothionein in human gastrointestinal cancer. J Pathol 2000; 192:293-300. [PMID: 11054711 DOI: 10.1002/1096-9896(2000)9999:9999<::aid-path712>3.0.co;2-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 01/27/2023]
Abstract
Metallothionein (MT) is a small thiol-rich metalloprotein with antioxidant properties, involved in tumour pathophysiology and therapy resistance. In order to assess the contribution of MT in gastrointestinal carcinogenesis, this study examined both the MT content by radioimmunoassay and the MT localization by immunohistochemistry in pairs of neoplastic and normal-appearing human gastrointestinal tissues. In addition, the relationship between MT expression and major clinicopathological parameters was assessed. The MT concentration of gastric carcinomas and of colorectal adenomas, carcinomas, and liver metastases was found to be significantly lower than that of corresponding normal-appearing tissue. A relatively high MT content, however, was found to be associated with the villous character of colorectal adenomas and with the Dukes' stage of colorectal carcinomas, indicating a relationship between MT level and malignant potential. Immunohistochemical evaluation showed a fairly good correlation with these quantitative data. MT was found to be expressed at a low level and in a patchy pattern in the gastrointestinal neoplastic and metastatic tissues, whereas in normal-appearing gastrointestinal mucosa MT was uniformly distributed in the cytoplasm and/or nucleus of apical cells. Although in the gastric cancer patients no association was found between the MT concentration and the clinicopathological parameters, the strong MT expression in areas with intestinal metaplasia, known to have neoplastic potential, further points to a relationship between this antioxidant metalloprotein and the malignant character of cells. Gastrointestinal neoplasms are apparently accompanied by a low level and decreased expression of MT, but those with a relatively high level seem to have an increased malignant potential. Further studies will be required to determine the clinical relevance of these observations.
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Affiliation(s)
- A M Janssen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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