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Baecher H, Gerken M, Knoedler L, Knoedler S, Alfertshofer M, Klinkhammer-Schalke M, Berneburg M, Drexler K, Haferkamp S. Complete lymph node dissection in cutaneous melanoma patients with positive sentinel lymph node: Outcome and predictors in a retrospective cohort study over 16 years. J Plast Reconstr Aesthet Surg 2024; 92:33-47. [PMID: 38489985 DOI: 10.1016/j.bjps.2024.02.056] [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: 12/04/2023] [Revised: 01/29/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND In melanoma treatment, complete lymph node dissection (CLND) has been considered the therapeutic gold standard in patients with positive sentinel lymph node biopsy (SLNB). This long-held approach was revised in 2017, with recent evidence questioning the therapeutic benefit of CLND in malignant melanoma (MM) therapy. In this study, we aimed to fill this knowledge gap by retrospectively analyzing the impact of CLND on MM patients' survival. METHODS We retrospectively analyzed the multi-center population-based Clinical Cancer Registry at the Tumor Center Regensburg (TUDOK) database (2004-2020) to identify patients who had been diagnosed with SLN-positive MM and underwent (non)invasive management thereof. Patient cohorts were subdivided according to the treatment received (CLND and waiving CLND). Primary outcomes included overall survival (OS), recurrence-free survival (RFS), and cumulative recurrence rate. RESULTS We identified 1143 MM patients, of whom 126 (11.0%) had positive SLN status. CLND was waived in the majority of SLN-positive MM cases (n = 71; 56.3%), with 55 (43.7%) patients undergoing CLND. Univariable and multivariable Cox regression revealed no significant advantage for CLND patients compared to non-CLND patients in OS (HR=0.970, p = 0.915 and HR=1.295, p = 0.479, respectively), RFS (HR=1.050, p = 0.849 and HR=1.220, p = 0.544, respectively), and cumulative recurrence rate (HR=1.234, p = 0.441 and HR=1.220, p = 0.544), respectively). CONCLUSION We found that CLND had no significant impact on patient survival and MM recurrence rate, thus corroborating the validity of current clinical guidelines.
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Affiliation(s)
- Helena Baecher
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, 93053 Regensburg, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany.
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Friebel S, Thater A, Völkel V, Klinkhammer-Schalke M, Müller-Nordhorn J, Emmert M. [Quality-assured treatment in certified breast cancer centre networks in Upper Franconia, Germany: An analysis based on data of the Bavarian Cancer Registry]. Gesundheitswesen 2024. [PMID: 38565190 DOI: 10.1055/a-2251-5564] [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: 04/04/2024]
Abstract
OBJECTIVES Breast cancer is the most common cancer and the most common cancer-related cause of death among women in Germany. The treatment in certified breast cancer centre networks is recommended to ensure high-quality care. The aim of the study was to determine the percentage of breast cancer patients receiving cancer treatment in certified breast cancer centre networks in Upper Franconia, Germany. METHODS This study considered the location of treatment and the certification status of providers with regard to initial diagnosis, surgery, chemotherapy, and radiation during breast cancer care. Based on this, we compared patient characteristics receiving cancer care in certified and non-certified cancer centres and their networks. The evaluation was based on a dataset of the Bavarian Cancer Registry (4/2017-3/2022). RESULTS The analysis included 5,545 primary tumors from a total of 5,355 patients (age: 64.5±14.2 years; 99.2% female). The percentage of patients receiving care in certified breast cancer centre networks was 78.8% for initial diagnosis, 82.6% for surgery, 79.5% for chemotherapy, and 99.6% for radiation, respectively. The weighted mean across all treatment sequences was 84.3%. Patients receiving care in certified care networks were significantly younger for three therapy sequences (p+<+0.001). In addition, an above-average proportion of patients with advanced tumor stages were treated in non-certified care networks, especially for diagnosis and surgery (p+<+0.001). CONCLUSIONS Regarding the different treatment sequences, we found differences in the proportion of patients who received quality-assured treatment in certified breast cancer centre networks in Upper Franconia. When comparing similar analysis, the results show an average care percentage of patients receiving care in certified care networks. Furthermore, it should be ensured that patients receive comprehensive information about receiving care in certified cancer centre networks.
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Affiliation(s)
- Sophie Friebel
- Gesundheitsökonomie, Qualitätsmanagement und Präferenzforschung in der Onkologie, Universität Bayreuth, Bayreuth, Germany
| | - Andrea Thater
- Bayerisches Krebsregister, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bayreuth, Germany
- Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth, Germany
| | - Vinzenz Völkel
- Tumorzentrum Regensburg (TZR), Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany, Universität Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg (TZR), Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany, Universität Regensburg, Regensburg, Germany
| | | | - Martin Emmert
- Bayerisches Krebsregister, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bayreuth, Germany
- Gesundheitsökonomie, Qualitätsmanagement und Präferenzforschung in der Onkologie, Universität Bayreuth, Bayreuth, Germany
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Petruch N, Servin Rojas M, Lillemoe KD, Castillo CFD, Braun R, Honselmann KC, Lapshyn H, Deichmann S, Abdalla TSA, Hummel R, Klinkhammer-Schalke M, Tol KKV, Zeissig SR, Keck T, Wellner UF, Qadan M, Bolm L. The impact of surgical-oncologic textbook outcome in patients with stage I to III pancreatic ductal adenocarcinoma: A cross-validation study of two national registries. Surgery 2024; 175:1120-1127. [PMID: 38092633 DOI: 10.1016/j.surg.2023.11.004] [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] [Received: 04/21/2023] [Revised: 09/28/2023] [Accepted: 11/07/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Using national registries, we aimed to evaluate oncologic textbook outcomes in pancreatic ductal adenocarcinoma patients. METHODS Patients with stage I to III pancreatic ductal adenocarcinoma and surgical resection from 2010 to 2020 in the US and Germany were identified using the National Cancer Database and National Cancer Registries data. The surgical-oncologic textbook outcome was defined as complete oncologic resection with no residual tumor and ≥12 harvested lymph nodes. The composite endpoint was defined as surgical-oncologic textbook outcome and receipt of perioperative systemic and/or radiation therapy. RESULTS In total, 33,498 patients from the National Cancer Database and 14,589 patients from the National Cancer Registries were included. In the National Cancer Database, 28,931 (86%) patients had complete oncologic resection with no residual tumor, and 11,595 (79%) in the National Cancer Registries. 8,723 (26%) patients in the National Cancer Database and 556 (4%) in the National Cancer Registries had <12 lymph nodes harvested. The National Cancer Database shows 26,135 (78%) underwent perioperative therapy and 8,333 (57%) in the National Cancer Registries. Surgical-oncologic textbook outcome was achieved in 21,198 (63%) patients in the National Cancer Database and in 11,234 (77%) patients from the National Cancer Registries. 16,967 (50%) patients in the National Cancer Database and 7,878 (54%) patients in the National Cancer Registries had composite textbook outcome. Median overall survival in patients with composite textbook outcomes was 32 months in the National Cancer Database and 27 months in the National Cancer Registries (P < .001). In contrast, those with non-textbook outcomes had a median overall survival of 23 months in the National Cancer Database and 20 months in the National Cancer Registries (P < .001). CONCLUSION Surgical-oncologic textbook outcomes were achieved in > 50% of stage I to III pancreatic ductal adenocarcinoma for both the National Cancer Database and the National Cancer Registries. Failure to achieve textbook outcomes was associated with impaired survival across both registries.
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Affiliation(s)
- Natalie Petruch
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | | | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Ruediger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Kim C Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Steffen Deichmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Thaer S A Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Monika Klinkhammer-Schalke
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality, and Research in Oncology, Berlin, Germany
| | - Kees Kleihues-van Tol
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality, and Research in Oncology, Berlin, Germany
| | - Sylke R Zeissig
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality, and Research in Oncology, Berlin, Germany; Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany.
| | - Ulrich F Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Louisa Bolm
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
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Hatzipanagiotou ME, Pigerl M, Gerken M, Räpple S, Zeltner V, Hetterich M, Ugocsai P, Inwald EC, Klinkhammer-Schalke M, Ortmann O, Seitz S. Clinical impact of delaying initiation of adjuvant chemotherapy in patients with early triple negative breast cancer. Breast Cancer Res Treat 2024; 204:607-615. [PMID: 38238552 PMCID: PMC10959785 DOI: 10.1007/s10549-023-07207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE The optimal time to initiation of adjuvant chemotherapy (TTAC) for triple negative breast cancer (TNBC) patients is unclear. This study evaluates the association between TTAC and survival in TNBC patients. METHODS We conducted a retrospective study using data from a cohort of TNBC patients diagnosed between January 1, 2010 to December 31, 2018, registered in the Tumor Centre Regensburg was conducted. Data included demographics, pathology, treatment, recurrence and survival. TTAC was defined as days from primary surgery to first dose of adjuvant chemotherapy. The Kaplan-Meier method was used to evaluate impact of TTAC on overall survival (OS) and 5-year OS. RESULTS A total of 245 TNBC patients treated with adjuvant chemotherapy and valid TTAC data were included. Median TTAC was 29 days. The group receiving systemic therapy within 22 to 28 days after surgery had the most favorable outcome, with median OS of 10.2 years. Groups receiving systemic therapy between 29-35 days, 36-42 days, and more than 6 weeks after surgery had significantly decreased median survival, with median OS of 8.3 years, 7.8 years, and 6.9 years, respectively. Patients receiving therapy between 22-28 days had significantly better survival compared to those receiving therapy between 29-35 days (p = 0.043), and patients receiving therapy after 22-28 days also demonstrated significantly better survival compared to those receiving therapy after more than 43 days (p = 0.033). CONCLUSION Timing of adjuvant systemic therapy can influence OS in TNBC patients. Efforts should be made to avoid unnecessary delays in administering chemotherapy to ensure timely initiation of systemic therapy and optimize patient outcomes.
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Affiliation(s)
- Maria Eleni Hatzipanagiotou
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany.
| | - Miriam Pigerl
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Sophie Räpple
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Verena Zeltner
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Madeleine Hetterich
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Peter Ugocsai
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Elisabeth Christine Inwald
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg - Centre for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuterstraße 65, 93053, Regensburg, Germany
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Kuenzel J, Duerr S, Vester S, Zeman F, Huppertz G, Koller M, Pfleger G, Woertgen A, Salloum H, Klinkhammer-Schalke M, Pukrop T, Kummer P. The effects of Phoniatric PREhabilitation in Head and Neck Cancer patients on Aspiration and Preservation of Swallowing (PREHAPS): study protocol of a monocentric prospective randomized interventional outcome-blinded trial. Trials 2024; 25:211. [PMID: 38519961 PMCID: PMC10958950 DOI: 10.1186/s13063-024-08010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Dysphagia, with its negative impact on life expectancy and quality of life, is a major side effect of head and neck squamous cell carcinoma (HNSCC). In a typical Head and Neck Cancer Center, more than half of patients are affected. Improving treatment, and ideally prevention respectively prehabilitation, therefore seems more than desirable. METHODS The study is planned as a monocentric, prospective, outcome-blinded, randomized interventional study comparing an advanced phoniatric-logopedic prehabilitation with a control (standard of care). Seventy patients (30 control group, 30 intervention group, 10 drop-out rate of 15%) with an initial diagnosis of invasive HNSCC and curative treatment intention will be included over a period of 17 months. In addition to the previous standard, both groups will undergo both detailed subjective assessment of swallowing function and quality of life by means of various questionnaires and objective analyses by bioelectrical impedance measurements and phoniatric endoscopic swallowing examinations. In the intervention group, risk-related nutritional counseling (face-to-face) and phoniatric-logopedic prehabilitation are provided: detailed counseling with video demonstration and exercises to strengthen and improve the range of motion of the oral, pharyngeal, and laryngeal muscles (guided by exercise diary). Controls are performed at 6 weeks, 3 and 6 months, and 9 or 12 months after the end of therapy during the regular tumor follow-up. Primary study endpoints are swallowing function and emotional distress at 6 weeks of control visit. DISCUSSION Prehabilitation measures have already proven successful in other patient groups, e.g., transplant patients. In the field of head and neck oncology, interest in such concepts has increased significantly in recent years. However, usually, only subgroups, e.g., patients with swallowing problems after radiochemotherapy alone, are in focus. Our study aims to investigate the general benefit of prehabilitation with regard to swallowing function, which is so important for protection of aspiration and quality of life. TRIAL REGISTRATION German Clinical Trials Register DRKS00029676 . International Clinical Trials Registry Platform DRKS00029676 . Registered on 19 July 2022.
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Affiliation(s)
- Julian Kuenzel
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, 93053, Germany.
| | - Stephan Duerr
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Sarah Vester
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Gunnar Huppertz
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Gerda Pfleger
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Annika Woertgen
- Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, 93053, Germany
| | - Hazem Salloum
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Institute for Quality Management and Health Services Research, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Peter Kummer
- Department of Otorhinolaryngology, Section Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
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Schmitt J, Schoffer O, Klinkhammer-Schalke M. In Reply. Dtsch Arztebl Int 2024; 121:203-204. [PMID: 38666679 PMCID: PMC11079799 DOI: 10.3238/arztebl.m2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Affiliation(s)
- Jochen Schmitt
- *Zentrum für Evidenzbasierte Gesundheitsversorgung, Medizinische Fakultät, Carl Gustav Carus,TU Dresden,
| | - Olaf Schoffer
- *Zentrum für Evidenzbasierte Gesundheitsversorgung, Medizinische Fakultät, Carl Gustav Carus,TU Dresden,
| | - Monika Klinkhammer-Schalke
- **Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg
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Abdalla TSA, Bolm L, Klinkhammer-Schalke M, Zeissig SR, Kleihues van Tol K, Bronsert P, Litkevych S, Honselmann KC, Braun R, Gebauer J, Hummel R, Keck T, Wellner UF, Deichmann S. When Should Lymphadenectomy Be Performed in Non-Metastatic Pancreatic Neuroendocrine Tumors? A Population-Based Analysis of the German Clinical Cancer Registry Group. Cancers (Basel) 2024; 16:440. [PMID: 38275882 PMCID: PMC10814740 DOI: 10.3390/cancers16020440] [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: 12/06/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Patient selection for lymphadenectomy remains a controversial aspect in the treatment of pancreatic neuroendocrine tumors (pNETs), given the growing importance of parenchyma-sparing resections and minimally invasive procedures. METHODS This population-based analysis was derived from the German Cancer Registry Group during the period from 2000 to 2021. Patients with upfront resected non-functional non-metastatic pNETs were included. RESULTS Out of 5520 patients with pNET, 1006 patients met the inclusion criteria. Fifty-three percent of the patients were male. The median age was 64 ± 17 years. G1, G2, and G3 pNETs were found in 57%, 37%, and 7% of the patients, respectively. Lymph node metastasis (LNM) was present in 253 (24%) of all patients. LNM was an independent prognostic factor (HR 1.79, CI 95% 1.21-2.64, p = 0.001) for disease-free survival (DFS). The 3-, 5-, and 10-year disease-free survival in nodal negative tumors compared to nodal positive was 82% vs. 53%, 75% vs. 38%, and 48% vs. 16%. LNM was present in 5% of T1 tumors, 25% of T2 tumors, and 49% of T3-T4 tumors. In T1 tumors, G1 was the most predominant tumor grade (80%). However, in T2 tumors, G2 and G3 represented 44% and 5% of all tumors. LNM was associated with tumors located in the pancreatic head (p < 0.001), positive resection margin (p < 0.001), tumors larger than 2 cm (p < 0.001), and higher tumor grade (p < 0.001). The multivariable analysis showed that tumor size, tumor grade, and location were independent prognostic factors associated with LNM that could potentially be used to predict LNM preoperatively. CONCLUSION LNM is an independent negative prognostic factor for DFS in pNETs. Due to the low incidence of LNM in T1 tumors (5%), parenchyma-sparing surgery seems oncologically adequate in small G1 pNETs, while regional lymphadenectomy should be recommended in T2 or G2/G3 pNETs.
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Affiliation(s)
- Thaer S. A. Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Monika Klinkhammer-Schalke
- Network for Care Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Sylke Ruth Zeissig
- Network for Care Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, 97070 Würzburg, Germany
| | - Kees Kleihues van Tol
- Network for Care Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Peter Bronsert
- Department of Pathology, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Stanislav Litkevych
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Kim C. Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Rüdiger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Judith Gebauer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Greifswald, 17475 Greifswald, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Ulrich Friedrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Steffen Deichmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
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8
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Bierbaum V, Bobeth C, Roessler M, Gerken M, Tol KKV, Reissfelder C, Fürst A, Günster C, Dröge P, Ruhnke T, Klinkhammer-Schalke M, Schmitt J, Schoffer O. Treatment in certified cancer centers is related to better survival in patients with colon and rectal cancer: evidence from a large German cohort study. World J Surg Oncol 2024; 22:11. [PMID: 38183134 PMCID: PMC10770882 DOI: 10.1186/s12957-023-03262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Certified cancer centers aim to ensure high-quality care by establishing structural and procedural standards according to evidence-based guidelines. Despite the high clinical and health policy relevance, evidence from a nation-wide study for the effectiveness of care for colorectal cancer in certified centers vs. other hospitals in Germany is still missing. METHODS In a retrospective cohort study covering the years 2009-2017, we analyzed patient data using demographic information, diagnoses, and treatments from a nationwide statutory health insurance enriched with information on certification. We investigated whether patients with incident colon or rectal cancer did benefit from primary therapy in a certified cancer center. We used relative survival analysis taking into account mortality data of the German population and adjustment for patient and hospital characteristics via Cox regression with shared frailty for patients in hospitals with and without certification. RESULTS The cohorts for colon and rectal cancer consisted of 109,518 and 51,417 patients, respectively, treated in a total of 1052 hospitals. 37.2% of patients with colon and 42.9% of patients with rectal cancer were treated in a certified center. Patient age, sex, comorbidities, secondary malignoma, and distant metastases were similar across groups (certified/non-certified) for both colon and rectal cancer. Relative survival analysis showed significantly better survival of patients treated in a certified center, with 68.3% (non-certified hospitals 65.8%) 5-year survival for treatment of colon cancer in certified (p < 0.001) and 65.0% (58.8%) 5-year survival in case of rectal cancer (p < 0.001), respectively. Cox regression with adjustment for relevant covariates yielded a lower hazard of death for patients treated in certified centers for both colon (HR = 0.92, 95% CI = 0.89-0.95) and rectal cancer (HR = 0.92, 95% CI = 0.88-0.95). The results remained robust in a series of sensitivity analyses. CONCLUSIONS This large cohort study yields new important evidence that patients with colorectal cancer have a better chance of survival if treated in a certified cancer center. Certification thus provides one powerful means to improve the quality of care for colorectal cancer. To decrease the burden of disease, more patients should thus receive cancer care in a certified center.
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Affiliation(s)
- Veronika Bierbaum
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - Christoph Bobeth
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Martin Roessler
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Michael Gerken
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Germany
| | - Kees Kleihues-van Tol
- Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung an der Fakultät für Medizin der Universität Regensburg, Regensburg, Germany
| | - Christoph Reissfelder
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Germany
| | - Alois Fürst
- Klinik für Allgemein-, Viszeral-, Thoraxchirurgie, Adipositasmedizin, Caritas-Krankenhaus St. Josef Regensburg, Regensburg, Germany
| | | | | | | | - Monika Klinkhammer-Schalke
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Germany
- Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung an der Fakultät für Medizin der Universität Regensburg, Regensburg, Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Olaf Schoffer
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
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9
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Fischl A, Gerken M, Roos P, Haedenkamp T, Hillberg A, Klinkhammer-Schalke M, Kölbl O, Linker R, Proescholdt M, Pukrop T, Riemenschneider MJ, Schmidt NO, Schön I, Vogelhuber M, Hau P, Bumes E. Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study. Neurooncol Pract 2023; 10:446-453. [PMID: 37720387 PMCID: PMC10502780 DOI: 10.1093/nop/npad023] [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] [Indexed: 09/19/2023] Open
Abstract
Background Malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas impose a high symptomatic and psychological burden. Wide distances from patients' homes to cancer centers may affect the delivery of psycho-oncological care. Here, we investigated, in a large brain tumor center with a rural outreach, the initiation of psycho-oncological care depending on spatial distance and impact of psycho-oncological care on emergency visits. Methods Electronic patient charts, the regional tumor registry, and interviews with the primary care physicians were used to investigate clinical data, psycho-oncological care, and emergency unit visits. Interrelations with socio-demographic, clinical, and treatment aspects were investigated using univariable and multivariable binary logistic regression analysis and the Pearson's Chi-square test. Results Of 491, 229 adult patients of this retrospective cohort fulfilled the inclusion criteria for analysis. During the last three months of their lives, 48.9% received at least one psycho-oncological consultation, and 37.1% visited the emergency unit at least once. The distance from the cancer center did neither affect the initiation of psycho-oncological care nor the rate of emergency unit visits. Receiving psycho-oncological care did not correlate with the frequency of emergency unit visits in the last three months of life. Conclusion We conclude that the distance of IDHwt glioma patients' homes from their cancer center, even in a rural area, does not significantly influence the rate of psycho-oncological care.
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Affiliation(s)
- Anna Fischl
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Michael Gerken
- Center for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Philipp Roos
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Tareq Haedenkamp
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Andrea Hillberg
- Department of Internal Medicine III, Regensburg University Hospital, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Center for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiotherapy, Regensburg University Hospital, Regensburg, Germany
| | - Ralf Linker
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Regensburg University Hospital, Regensburg, Germany
| | | | - Nils Ole Schmidt
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
| | - Ingrid Schön
- Department of Internal Medicine III, Regensburg University Hospital, Regensburg, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, Regensburg University Hospital, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
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10
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Hatzipanagiotou ME, Pigerl M, Gerken M, Räpple S, Zeltner V, Hetterich M, Ugocsai P, Fernandez-Pacheco M, Inwald EC, Klinkhammer-Schalke M, Ortmann O, Seitz S. Does timing of neoadjuvant chemotherapy influence the prognosis in patients with early triple negative breast cancer? J Cancer Res Clin Oncol 2023; 149:11941-11950. [PMID: 37418056 PMCID: PMC10465651 DOI: 10.1007/s00432-023-05060-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE For patients with triple negative breast cancer (TNBC), the optimal time to initiate neoadjuvant chemotherapy (TTNC) is unknown. This study evaluates the association between TTNC and survival in patients with early TNBC. METHODS A retrospective study using data from of a cohort of TNBC patients diagnosed between January 1, 2010 to December 31, 2018 registered in the Tumor Centre Regensburg was performed. Data included demographics, pathology, treatment, recurrence, and survival. Interval to treatment was defined as days from pathology diagnosis of TNBC to first dose of neoadjuvant chemotherapy (NACT). The Kaplan-Meier and Cox regression methods were used to evaluate the impact of TTNC on overall survival (OS) and 5 year OS. RESULTS A total of 270 patients were included. Median follow up was 3.5 years. The 5-year OS estimates according to TTNC were 77.4%, 66.9%, 82.3%, 80.6%, 88.3%, 58.3%, 71.1% and 66.7% in patients who received NACT within 0-14, 15-21, 22-28, 29-35, 36-42, 43-49, 50-56 and > 56 days after diagnosis. Patients who received systemic therapy early had the highest estimated mean OS of 8.4 years, while patients who received systemic therapy after more than 56 days survived an estimated 3.3 years. CONCLUSION The optimal time interval between diagnosis and NACT remains to be determined. However, starting NACT more than 42 days after diagnosis of TNBC seems to reduce survival. Therefore, it is strongly recommended to carry out the treatment in a certified breast center with appropriate structures, in order to enable an adequate and timely care.
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Affiliation(s)
- Maria Eleni Hatzipanagiotou
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
- Department of Gynecology and Obstetrics, Maria Eleni Hatzipanagiotou, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
| | - Miriam Pigerl
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Sophie Räpple
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Verena Zeltner
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Madeleine Hetterich
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Peter Ugocsai
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Miriam Fernandez-Pacheco
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Elisabeth Christine Inwald
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg - Centre for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Gynecology and Obstetrics, University Medical Centre Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
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11
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Schmitt J, Klinkhammer-Schalke M, Bierbaum V, Gerken M, Bobeth C, Rößler M, Dröge P, Ruhnke T, Günster C, Kleihues-van Tol K, Schoffer O. Initial Cancer Treatment in Certified Versus Non-Certified Hospitals. Dtsch Arztebl Int 2023; 120:647-654. [PMID: 37583089 PMCID: PMC10622058 DOI: 10.3238/arztebl.m2023.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND According to the National Cancer Plan in Germany, all cancer patients should receive high-quality care in accordance with evidence-based treatment guidelines. Certification programs were established for this purpose but have not yet been comprehensively evaluated. METHODS In the WiZen project, which was supported by the Innovation Fund (supported project number 01VSF17020), controlled cohort studies were performed to investigate whether initial treatment in hospitals with or without a certificate from the German Cancer Society was associated with a difference in overall survival (primary endpoint) in patients with cancer of the colon, rectum, lung, pancreas, breast, cervix, prostate, endometrium, and ovary, head and neck cancer, and neuro-oncological tumors. The studies were based on nationwide data from adult insurees of the AOK statutory health insurance carrier for the years 2009-2017. RESULTS The majority of patients with all entities except breast cancer received their initial treatment in non-certified hospitals. Initial treatment in a certified hospital was found to be beneficial in terms of overall survival for all cancer entities, even after extensive adjustment for patient- and hospital-related confounders. The hazard ratio (HR) ranged from 0.97 (95% CI: [0.94; 1.00]) for lung cancer to 0.77 [0.74; 0.81] for breast cancer, corresponding to an absolute risk reduction (ARR) for overall survival of 0.62 months for lung cancer to 4.61 months for cervical cancer. CONCLUSION The WiZen study shows for the entities studied that initial cancer treatment in a certified center is associated with lower mortality. Despite the recommendations of the National Cancer Plan, however, more than 40% of all cancer patients still receive their initial treatment in a non-certified hospital. The preferential provision of initial care in certified hospitals would be likely to improve overall survival. Although the study design does not permit any conclusion with regard to causality, the findings seem robust considering that a control group was used, confounders were taken into account, and the study population was of large size.
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Affiliation(s)
- Jochen Schmitt
- *These authors share first authorship
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden
| | - Monika Klinkhammer-Schalke
- *These authors share first authorship
- Tumorzentrum Regensburg Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg
- Association of German Tumor Centers, Berlin
| | - Veronika Bierbaum
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden
| | - Michael Gerken
- Tumorzentrum Regensburg Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg
| | - Christoph Bobeth
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden
| | - Martin Rößler
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden
| | | | | | | | | | - Olaf Schoffer
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden
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12
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Völkel V, Gerken M, Kleihues-van Tol K, Schoffer O, Bierbaum V, Bobeth C, Roessler M, Reissfelder C, Fürst A, Benz S, Rau BM, Piso P, Distler M, Günster C, Hansinger J, Schmitt J, Klinkhammer-Schalke M. Treatment of Colorectal Cancer in Certified Centers: Results of a Large German Registry Study Focusing on Long-Term Survival. Cancers (Basel) 2023; 15:4568. [PMID: 37760537 PMCID: PMC10526771 DOI: 10.3390/cancers15184568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan-Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I-III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers.
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Affiliation(s)
- Vinzenz Völkel
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
| | - Michael Gerken
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, 93053 Regensburg, Germany
| | | | - Olaf Schoffer
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Veronika Bierbaum
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Christoph Bobeth
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Martin Roessler
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Alois Fürst
- Klinik für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Caritas Krankenhaus St., 93053 Regensburg, Germany
| | - Stefan Benz
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V. (ADT), 14057 Berlin, Germany
- Klinik für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie, 71032 Böblingen, Germany
| | - Bettina M. Rau
- Department of General, Visceral and Thoracic Surgery, Hospital of Neumarkt, 92318 Neumarkt in der Oberpfalz, Germany
| | - Pompiliu Piso
- Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus der Barmherzigen Brüder, 93049 Regensburg, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany
| | | | - Judith Hansinger
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V. (ADT), 14057 Berlin, Germany
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13
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Bierbaum V, Schmitt J, Klinkhammer-Schalke M, Schoffer O. Assessment of the Potential of Concentrating Cancer Care in Hospitals With Certification Through Survival Analysis. Gesundheitswesen 2023; 85:S197-S204. [PMID: 37751756 DOI: 10.1055/a-2132-6797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Certification programs seek to improve the quality of complex interdisciplinary models of care such as cancer treatment through structuring the process of care in accordance with evidence-based guidelines. In Germany, the German Cancer Society (Deutsche Krebsgesellschaft, DKG) provides a certification programme for cancer care that covers more than one thousand centers. In a recent retrospective cohort study, it has been shown on a large, nationwide data set based on data from a statutory health insurance and selected clinical cancer registries, that there is a benefit in survival for cancer patients who have received initial treatment in hospitals certified by the DKG. Here, we deduce two absolute measures from the relative benefit in survival with the aim to quantify this benefit if all patients had been treated in a certified center. METHODS The WiZen study analysed survival of adult patients insured by the AOK with a cancer diagnosis between 2009 and 2017 in certified hospitals vs. non-certified hospitals. Besides Kaplan-Meier-estimators, Cox regression with shared frailty was used for 11 types of cancer in total, adjusting for patient-specific information such as demographic characteristics and comorbidities as well as hospital characteristics and temporal trend. Based on this regression, we predict adjusted survival curves that directly address the certification effect. From the adjusted survivals, we calculated years of life lost (YLL) and number needed to treat (NNT), along with a difference in deaths 5 years after diagnosis. RESULTS Based on our estimate for the 537,396 patients that were treated in a non-certified hospital included in the WiZen study, corresponding to 68,7% of the study population, we find a potential of 33,243 YLL per year in Germany based on the size of the German population as of 2017. The potential to avoid death cases 5 years from diagnosis totals 4,729 per year in Germany. CONCLUSION While Cox regression is an important tool to evaluate the benefit that arises from variables with a potential impact on survival such as certification, its direct results are not well suited to quantify this benefit for decision makers in health care. The estimated years of life lost and the number of deaths that could have been avoided 5 years from diagnosis avoid mis-interpretation of the hazard ratios commonly used in survival analysis and should help to inform key stakeholders in health care without specialist background knowledge in statistics. Our measures, directly adressing the effect of certification, can furthermore be used as a starting point for health-economic calculations. Steering the care of cancer patients primarily to certified hospitals would have a high potential to improve outcomes.
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Affiliation(s)
- Veronika Bierbaum
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg (TZR), Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany
| | - Olaf Schoffer
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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14
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Voigtländer S, Hakimhashemi A, Grundmann N, Radespiel-Tröger M, Inwald EC, Ortmann O, Gerken M, Klug SJ, Klinkhammer-Schalke M, Meyer M, Müller-Nordhorn J. Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany. J Cancer Res Clin Oncol 2023; 149:7493-7503. [PMID: 36964405 PMCID: PMC10038367 DOI: 10.1007/s00432-023-04707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE The aim of our study was to explore the impact of the COVID-19 pandemic on reported cancer cases in Bavaria, Germany, by comparing pre-pandemic (March 2019 to February 2020) and pandemic period (March 2020 to February 2021). METHODS Data on incident cases were retrieved from the Bavarian Cancer Registry (until 22nd April 2022). We included patients with malignant and in situ neoplasms reported by pathology departments with consistent reporting. We calculated the number of incident cases during the COVID-19 pandemic and the pre-pandemic period with 95% confidence intervals (CI) with Bonferroni correction (α = 0.0018) based on a Poisson approach. We stratified for malignancy (malignant, in situ), tumor site, and month of year. RESULTS Data was available for 30 out of 58 pathology departments (51.7%) from Bavaria. Incident malignant neoplasms dropped from 42,857 cases in the pre-pandemic period to 39,980 cases in the pandemic period (- 6.7%; 95% CI - 8.7%, - 4.7%). Reductions were higher for colon, rectum, skin/melanoma as well as liver (> 10.0% reduction) and less for breast cancer (4.9% reduction). No case reductions were observed for pancreas, esophagus, ovary, and cervix. Percent changes were largest for April 2020 (- 20.9%; 95% CI - 24.7%, - 16.8%) and January 2021 (- 25.2%; 95% CI - 28.8%, - 21.5%) compared to the previous year. Declines tended to be larger for in situ compared to malignant neoplasms. CONCLUSION Detection and diagnosis of cancer were substantially reduced during the COVID-19 pandemic. Potential effects, e.g. a stage shift of tumors or an increase of cancer mortality, need to be monitored.
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Affiliation(s)
- Sven Voigtländer
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Amir Hakimhashemi
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Nina Grundmann
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Martin Radespiel-Tröger
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Elisabeth C. Inwald
- Department of Gynecology and Obstetrics, University Medical Center, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Michael Gerken
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Stefanie J. Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany
| | - Monika Klinkhammer-Schalke
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Martin Meyer
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Jacqueline Müller-Nordhorn
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
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15
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Veit C, Bierbaum T, Wesselmann S, Stock S, Heidecke CD, Apfelbacher C, Benz S, Dreinhöfer KE, Hauptmann M, Hoffmann F, Hoffmann W, Kaiser T, Klinkhammer-Schalke M, Koller M, Kostuj T, Ortmann O, Schmitt J, Schünemann H, Geraedts M. [Routine Practice Data for Health Care Analyses: Part 3 of the Manual]. Gesundheitswesen 2023; 85:718-724. [PMID: 36535653 PMCID: PMC10444518 DOI: 10.1055/a-1966-0104] [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] [Indexed: 12/24/2022]
Abstract
Analyses of health and health care (hereafter referred to as "health care analyses") usually aim to make transparent the structures, processes, results and interrelationships of health care and to record the degree to which health care systems and their actors have achieved their goals. Health care-related data are an indispensable source of data for many health care analyses. A prerequisite for the examination of a degree of goal achievement is first of all an agreement on those goals that are to be achieved by the system and its substructures, as well as the identification of the determinants of the achievement of the objectives. Primarily it must be examined how safely, effectively and patient-centred systems, facilities and service providers are operating. It also addresses issues of need, accessibility, utilisation, timeliness, appropriateness, patient safety, coordination, continuity, and health economic efficiency and equity of health care. The results of health care include system services (outputs), on the one hand, and results (outcomes), on the other, whereby the results (patient-reported outcomes) and experiences (patient-reported experiences) reported are of particular importance. Health care analyses answer basic questions of health care research: who does what, when, how, why and with which resources and effects in routine health care. Health care analyses thus provide the necessary findings and key figures to further develop health care in order to improve the quality of health care. The applications range from capacity analyses to following innovations up to the concept of regional and supra-regional monitoring of the quality of care given to the population. Given the progress of digitalisation in Health Care, direct data from the care processes will be increasingly available for health care research. This can support care givers significantly if the findings of the studies are applied precisely and correctly within an adequate methodological frame. This can lead to measurable improved health care quality for patients. Data from the process of health care provision have a high potential. Their use needs the same scientific scrutiny as in all other scientific studies.
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Affiliation(s)
- Christof Veit
- BQS Institut für Qualität und Patientensicherheit GmbH,
Hamburg, Germany
| | - Thomas Bierbaum
- Geschäftsstelle, Deutsches Netzwerk Versorgungsforschung,
Berlin, Germany
| | - Simone Wesselmann
- Zertifizierung, Deutsche Krebsgesellschaft eV, Frankfurt am Main,
Germany
| | - Stephanie Stock
- Institut für Gesundheitsökonomie, Uniklinik
Köln, Cologne, Germany
| | - Claus-Dieter Heidecke
- Leitung, Institut für Qualitätssicherung und
Transparenz im Gesundheitswesen (IQTIG), Berlin, Germany
| | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto
von Guericke Universitat Magdeburg, Magdeburg, Germany
| | - Stefan Benz
- Kliniken Böblingen, Klinikverbund Südwest GmbH,
Sindelfingen, Germany
| | - Karsten E. Dreinhöfer
- Orthopädie und Unfallchirurgie, Medical Park AG, Berlin,
Germany
- Orthopädie und Unfallchirurgie, Charite Universitatsmedizin
Berlin, Berlin, Germany
| | - Michael Hauptmann
- Departement für Versorgungsforschung, Medizinische Hochschule
Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky
Universität Oldenburg, Oldenburg, Germany
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universität
Greifswald, Greifswald, Germany
| | - Thomas Kaiser
- Ressort Arzneimittelbewertung, Institut für Qualität
und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Köln,
Germany
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für
Qualitätssicherung und Versorgungsforschung, Universität
Regensburg, Regensburg, Germany
- Tumorcenter Regensburg, Institut for Quality assurance and Health
Services Research, University of Regensburg, Regensburg, Germany
| | - Michael Koller
- Zentrum für Klinische Studien, Universitätsklinikum
Regensburg, Regensburg, Germany
| | - Tanja Kostuj
- Klinik für Orthopädie und Unfallchirurgie, Klinikum
Lippe, Lemgo, Germany
| | - Olaf Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe,
Universität Regensburg Fakultät für Medizin, Regensburg,
Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung,
Universitätsklinikum Carl Gustav Carus an der Technischen
Universität Dresden, Dresden, Germany
| | - Holger Schünemann
- Cochrane Canada and Mc Master GRADE Centre, WHO Collaborating Centre
for Infectious Diseases, Research and Methods, Hamilton, Canada
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology,
Philipps-Universität Marburg, Marburg, Germany
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16
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Abdalla TSA, Pieper L, Kist M, Thomaschewski M, Klinkhammer-Schalke M, Zeissig SR, Tol KKV, Wellner UF, Keck T, Hummel R. Gastrointestinal stromal tumors of the upper GI tract: population-based analysis of epidemiology, treatment and outcome based on data from the German Clinical Cancer Registry Group. J Cancer Res Clin Oncol 2023; 149:7461-7469. [PMID: 36959341 PMCID: PMC10374476 DOI: 10.1007/s00432-023-04690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. They are most frequently located in the stomach but are also found in the esophagus and the gastroesophageal junction (GEJ). Information regarding the prognostic factors associated with upper gastrointestinal GIST is still scarse. METHODS In this study, datasets provided by the German Clinical Cancer Registry Group, including a total of 93,069 patients with malignant tumors in the upper GI tract (C15, C16) between 2000 and 2016 were analyzed to investigate clinical outcomes of GIST in the entire upper GI tract. RESULTS We identified 1361 patients with GIST of the upper GI tract. Tumors were located in the esophagus in 37(2.7%) patients, at the GEJ in 70 (5.1%) patients, and in the stomach in 1254 (91.2%) patients. The incidence of GIST increased over time, reaching 5% of all UGI tumors in 2015. The median age was 69 years. The incidence of GIST was similar between males and females (53% vs 47%, respectively). However, the proportion of GIST in female patients increased continuously with advancing age, ranging from 34.7% (41-50 years) to 71.4% (91-100 years). Male patients were twice as likely to develop tumors in the esophagus and GEJ compared to females (3.4% vs. 1.9% and 6.7% vs. 3.4%, respectively). The median overall survival of upper gastrointestinal GIST was 129 months. The 1-year, 5-year, and 10-year OS was 93%, 79%, and 52% respectively. Nevertheless, tumors located in the esophagus and GEJ were associated with shorter OS compared to gastric GIST (130 vs. 111 months, p = 0.001). The incidence of documented distant metastasis increased with more proximal location of GIST (gastric vs. GEJ vs. esophagus: 13% vs. 16% vs. 27%) at presentation. CONCLUSION GIST of the esophagus and GEJ are rare soft tissue sarcomas with increasing incidence in Germany. They are characterized by worse survival outcomes and increased risk of metastasis compared to gastric GIST.
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Affiliation(s)
- Thaer S A Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany.
| | - Lina Pieper
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Markus Kist
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Michael Thomaschewski
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Monika Klinkhammer-Schalke
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
| | - Sylke Ruth Zeissig
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Kees Kleihues-van Tol
- German Cancer Registry Group of the Society of German Tumor Centers - Network for Care, Quality and Research in Oncology (ADT), Berlin, Germany
| | - Ulrich Friedrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Alle 160, 23564, Lübeck, Germany.
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17
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Bierbaum T, Dreinhöfer K, Klinkhammer-Schalke M, Schmitt J. [Register-based research and clinical studies : Possibilities, limitations and perspectives]. Orthopadie (Heidelb) 2023:10.1007/s00132-023-04383-5. [PMID: 37222751 DOI: 10.1007/s00132-023-04383-5] [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] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/25/2023]
Abstract
Register-based research offers a good opportunity to generate knowledge on questions from the clinical practice. Methodologically high-quality register studies can complement clinical studies, especially for questions that cannot be answered with randomized controlled trials (RCT). The ad hoc committee on healthcare data of the German Network for Health Services Research (DNVF) has set methodological guidelines for register-based studies with a manual for methods and the use of healthcare data. The methodological advantages of both approaches can be integrated through RCTs embedded in registers. In Germany there is a diverse register landscape as shown by the register report commissioned by the Federal Ministry of Health, which, however, show a varying degree of internationally recognized quality criteria. The relevance of register-based studies for the clinical practice (e. g. guideline development) is shown in the examples of applications cited in the article. Although a lot has already been done here in Germany with existing register data, sustainable coordination and promotion of the research infrastructure and research culture, especially in international comparison are necessary.
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Affiliation(s)
- Thomas Bierbaum
- Deutsches Netzwerk Versorgungsforschung e. V., Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland.
| | - Karsten Dreinhöfer
- Klinik für Orthopädie und Unfallchirurgie, Medical Park Berlin Humboldtmühle, Berlin, Deutschland
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Deutschland
| | - Jochen Schmitt
- Deutsches Netzwerk Versorgungsforschung e. V., Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
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18
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Abdalla TSA, Klinkhammer-Schalke M, Zeissig SR, Tol KKV, Honselmann KC, Braun R, Bolm L, Lapshyn H, Litkevych S, Zemskov S, Begum N, Kulemann B, Hummel R, Wellner UF, Keck T, Deichmann S. Prognostic factors after resection of locally advanced non-functional pancreatic neuroendocrine neoplasm: an analysis from the German Cancer Registry Group of the Society of German Tumor Centers. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04785-0. [PMID: 37095413 PMCID: PMC10374814 DOI: 10.1007/s00432-023-04785-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The available literature regarding outcome after pancreatic resection in locally advanced non-functional pNEN (LA-pNEN) is sparse. Therefore, this study evaluates the current survival outcomes and prognostic factors in after resection of LA-pNEN. MATERIALS AND METHODS This population-based analysis was derived from 17 German cancer registries from 2000 to 2019. Patients with upfront resected non-functional non-metastatic LA-pNEN were included. RESULTS Out of 2776 patients with pNEN, 277 met the inclusion criteria. 137 (45%) of the patients were female. The median age was 63 ± 18 years. Lymph node metastasis was present in 45%. G1, G2 and G3 pNEN were found in 39%, 47% and 14% of the patients, respectively. Resection of LA-pNEN resulted in favorable 3-, 5- and 10-year overall survival of 79%, 74%, and 47%. Positive resection margin was the only potentially modifiable independent prognostic factor for overall survival (HR 1.93, 95% CI 1.71-3.69, p value = 0.046), whereas tumor grade G3 (HR 5.26, 95% CI 2.09-13.25, p value < 0.001) and lymphangiosis (HR 2.35, 95% CI 1.20-4.59, p value = 0.012) were the only independent prognostic factors for disease-free survival. CONCLUSION Resection of LA-pNEN is feasible and associated with favorable overall survival. G1 LA-pNEN with negative resection margins and absence of lymph node metastasis and lymphangiosis might be considered as cured, while those not fulfilling these criteria might be considered as a high-risk group for disease progression. Herein, negative resection margins represent the only potentially modifiable prognostic factor in LA-pNEN but seem to be influenced by tumor grade.
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Affiliation(s)
- Thaer S A Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany.
| | - Monika Klinkhammer-Schalke
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Germany
| | - Sylke Ruth Zeissig
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Kees Kleihues-van Tol
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Germany
| | - Kim C Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Rüdiger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Stanislav Litkevych
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Sergii Zemskov
- Department of General Surgery, Bogomolets National Medical University, Kiev, 01601, Ukraine
| | - Nehara Begum
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
- Department of Surgery, Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Birte Kulemann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Ulrich Friedrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany.
| | - Steffen Deichmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
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19
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Scheiter A, Hierl F, Lüke F, Keil F, Heudobler D, Einhell S, Klier-Richter M, Konstandin NP, Weber F, Scheiter A, Kandulski A, Schlosser S, Cosma LS, Tews H, Weiss ARR, Grube M, Bumes E, Hau P, Proescholdt M, Steger F, Troeger A, Haferkamp S, Reibenspies LE, Schnabel MJ, Schulz C, Drexler K, Hatzipanagiotou ME, Seitz S, Klinkhammer-Schalke M, Unberath P, Calvisi DF, Pukrop T, Dietmaier W, Evert M, Utpatel K. Critical evaluation of molecular tumour board outcomes following 2 years of clinical practice in a Comprehensive Cancer Centre. Br J Cancer 2023; 128:1134-1147. [PMID: 36572733 PMCID: PMC10006213 DOI: 10.1038/s41416-022-02120-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recently, molecular tumour boards (MTBs) have been integrated into the clinical routine. Since their benefit remains debated, we assessed MTB outcomes in the Comprehensive Cancer Center Ostbayern (CCCO) from 2019 to 2021. METHODS AND RESULTS In total, 251 patients were included. Targeted sequencing was performed with PCR MSI-evaluation and immunohistochemistry for PD-L1, Her2, and mismatch repair enzymes. 125 treatment recommendations were given (49.8%). High-recommendation rates were achieved for intrahepatic cholangiocarcinoma (20/30, 66.7%) and gastric adenocarcinoma (10/16, 62.5%) as opposed to colorectal cancer (9/36, 25.0%) and pancreatic cancer (3/18, 16.7%). MTB therapies were administered in 47 (18.7%) patients, while 53 (21.1%) received alternative treatment regimens. Thus 37.6% of recommended MTB therapies were implemented (47/125 recommendations). The clinical benefit rate (complete + partial + mixed response + stable disease) was 50.0% for MTB and 63.8% for alternative treatments. PFS2/1 ratios were 34.6% and 16.1%, respectively. Significantly improved PFS could be achieved for m1A-tier-evidence-based MTB therapies (median 6.30 months) compared to alternative treatments (median 2.83 months; P = 0.0278). CONCLUSION The CCCO MTB yielded a considerable recommendation rate, particularly in cholangiocarcinoma patients. The discrepancy between the low-recommendation rates in colorectal and pancreatic cancer suggests the necessity of a weighted prioritisation of entities. High-tier recommendations should be implemented predominantly.
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Affiliation(s)
- Alexander Scheiter
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany. .,Bavarian Center for Cancer Research / BZKF, Regensburg, Bavaria, Germany.
| | - Frederik Hierl
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Florian Lüke
- Bavarian Center for Cancer Research / BZKF, Regensburg, Bavaria, Germany.,Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053, Regensburg, Germany.,Fraunhofer-Institut für Toxikologie und Experimentelle Medizin ITEM-R, Abteilung für personalisierte Onkologie, 93053, Regensburg, Germany
| | - Felix Keil
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Daniel Heudobler
- Bavarian Center for Cancer Research / BZKF, Regensburg, Bavaria, Germany.,Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Sabine Einhell
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053, Regensburg, Germany
| | | | - Nikola P Konstandin
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany.,Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Florian Weber
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Andrea Scheiter
- School of Engineering and Design, Chair of Ergonomics, Technical University of Munich, 85748, Garching, Germany
| | - Arne Kandulski
- Department of Internal Medicine I, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Sophie Schlosser
- Department of Internal Medicine I, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Lidia-Sabina Cosma
- Department of Internal Medicine I, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Hauke Tews
- Department of Internal Medicine I, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Andreas R R Weiss
- Department of Surgery, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Matthias Grube
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, 93053 Regensburg University Hospital, 93053, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, 93053 Regensburg University Hospital, 93053, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Felix Steger
- Department of Radiotherapy, Regensburg University Medical Center, 93053, Regensburg, Germany
| | - Anja Troeger
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, 93053, Regensburg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Lucas E Reibenspies
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Marco J Schnabel
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, 93053, Regensburg, Germany
| | - Christian Schulz
- Department of Pneumology, University Hospital Regensburg, 93053, Regensburg, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Maria E Hatzipanagiotou
- University Medical Centre Regensburg, Department of Gynecology and Obstetrics, 93053, Regensburg, Germany
| | - Stephan Seitz
- University Medical Centre Regensburg, Department of Gynecology and Obstetrics, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumour Center-Institute for Quality Management and Health Services Research, University of Regensburg, 93053, Regensburg, Germany
| | - Philipp Unberath
- Friedrich-Alexander University Erlangen-Nuremberg, Chair of Medical Informatics, 91054, Erlangen, Germany
| | - Diego F Calvisi
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Tobias Pukrop
- Bavarian Center for Cancer Research / BZKF, Regensburg, Bavaria, Germany.,Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053, Regensburg, Germany.,Fraunhofer-Institut für Toxikologie und Experimentelle Medizin ITEM-R, Abteilung für personalisierte Onkologie, 93053, Regensburg, Germany
| | - Wolfgang Dietmaier
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Kirsten Utpatel
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
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20
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Schmitt J, Bierbaum T, Geraedts M, Gothe H, Härter M, Hoffmann F, Ihle P, Kramer U, Klinkhammer-Schalke M, Kuske S, March S, Reese JP, Schoffer O, Swart E, Vollmar HC, Walther F, Hoffmann W. Das Gesundheitsdatennutzungsgesetz – Potenzial für
eine bessere Forschung und Gesundheitsversorgung. Gesundheitswesen 2023; 85:215-222. [PMID: 36977473 PMCID: PMC10125338 DOI: 10.1055/a-2050-0429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
- Deutsches Netzwerk Versorgungsforschung, Berlin
| | | | - Max Geraedts
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg
| | - Holger Gothe
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
- Hochschule Hannover, Fakultät III, Abt. Information und Kommunikation (IK), Hannover
- Lehrstuhl Gesundheitswissenschaften/Public Health, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden
- Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS)
| | - Martin Härter
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin
| | - Falk Hoffmann
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg
| | - Peter Ihle
- Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS)
- PMV forschungsgruppe, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln
| | - Ursula Kramer
- Deutsches Netzwerk Versorgungsforschung, Berlin
- sanawork Gesundheitskommunikation, Waldkirch
| | - Monika Klinkhammer-Schalke
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg
| | - Silke Kuske
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Fliedner Fachhochschule Düsseldorf, Düsseldorf
| | - Stefanie March
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Hochschule Magdeburg-Stendal, Fachbereich Soziale Arbeit, Gesundheit und Medien
| | - Jens-Peter Reese
- Professur für Versorgungsforschung und Public Health Institut für Klinische Epidemiologie und Biometrie Julius-Maximilians-Universität Würzburg
| | - Olaf Schoffer
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
- Deutsches Netzwerk Versorgungsforschung, Berlin
| | - Enno Swart
- Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS)
- Institut für Sozialmedizin und Gesundheitssystemforschung (ISMG), Medizinische Fakultät, Otto-von-Guericke Universität Magdeburg, Magdeburg
| | - Horst Christian Vollmar
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Abteilung für Allgemeinmedizin (AM RUB), Medizinische Fakultät, Ruhr-Universität Bochum, Bochum
| | - Felix Walther
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Wolfgang Hoffmann
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald
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21
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Bobeth C, Tol KKV, Rößler M, Bierbaum V, Gerken M, Günster C, Dröge P, Ruhnke T, Klinkhammer-Schalke M, Schmitt J, Schoffer O. [Methodology and Attribution Success of a Data Linkage of Clinical Registry Data with Health Insurance Data]. Gesundheitswesen 2023; 85:S154-S161. [PMID: 36940697 DOI: 10.1055/a-1984-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The aim of the project "Effectiveness of care in oncological centres" (WiZen), funded by the innovation fund of the federal joint committee, is to investigate the effectiveness of certification in oncology. The project uses nationwide data from the statuory health insurance AOK and data from clinical cancer registries from three different federal states from 2006-2017. To combine the strengths of both data sources, these will be linked for eight different cancer entities in compliance with data protection regulations. METHODS Data linkage was performed using indirect identifiers and validated using the health insurance's patient ID ("Krankenversichertennummer") as a direct identifier and gold standard. This enables quantification of the quality of different linkage variants. Sensitivity and specificity as well as hit accuracy and a score addressing the quality of the linkage were used as evaluation criteria. The distributions of relevant variables resulting from the linkage were validated against the original distributions in the individual datasets. RESULTS Depending on the combination of indirect identifiers, we found a range of 22,125 to 3,092,401 linkage hits. An almost perfect linkage could be achieved by combining information on cancer type, date of birth, gender and postal code. A total of 74,586 one-to-one linkages were achieved with these characteristics. The median hit quality for the different entities was more than 98%. In addition, both the age and sex distributions and the dates of death, if any, showed a high degree of agreement. DISCUSSION AND CONCLUSION SHI and cancer registry data can be linked with high internal and external validity at the individual level. This robust linkage enables completely new possibilities for analysis through simultaneous access to variables from both data sets ("the best of both worlds"): Information on the UICC stage that stems from the registries can now be combined, for instance, with comorbidities from the SHI data at the individual level. Due to the use of readily available variables and the high success of the linkage, our procedure constitutes a promising method for future linkage processes in health care research.
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Affiliation(s)
- Christoph Bobeth
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | | | - Martin Rößler
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Veronika Bierbaum
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Michael Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Germany
| | | | - Patrik Dröge
- Wissenschaftliches Institut der AOK, Berlin, Germany
| | - Thomas Ruhnke
- Wissenschaftliches Institut der AOK, Berlin, Germany
| | - Monika Klinkhammer-Schalke
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V. (ADT), Berlin, Germany
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Olaf Schoffer
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
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22
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Meyer S, Buser L, Haferkamp S, Berneburg M, Maisch T, Klinkhammer-Schalke M, Pauer A, Vogt T, Garbe C. Identification of high-risk patients with a seven-biomarker prognostic signature for adjuvant treatment trial recruitment in American Joint Committee on Cancer v8 stage I-IIA cutaneous melanoma. Eur J Cancer 2023; 182:77-86. [PMID: 36753835 DOI: 10.1016/j.ejca.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
PURPOSE Many patients with resected American Joint Committee on Cancer (AJCC) early-stage cutaneous melanoma nonetheless die of melanoma; additional risk stratification approaches are needed. PATIENTS AND METHODS Using prospectively-collected whole-tissue sections, we assessed in consecutive stage I-IIA patients (N = 439), a previously-validated, immunohistochemistry-based, 7-biomarker signature to prognosticate disease-free survival (DFS), melanoma-specific survival (MSS; primary end-point) and overall survival (OS), independent of AJCC classification. RESULTS Seven-marker signature testing designated 25.1% of patients (110/439) as high-risk (stage IA, 13.3% [43/323], IB, 53.2% [42/79], and IIA, 67.6% [25/37]). A Kaplan-Meier analysis demonstrated high-risk patients to have significantly worse DFS, MSS and OS versus low-risk counterparts (P < 0.001). In multivariable Cox regression modelling also including key clinicopathological/demographic factors, 7-marker signature data independently prognosticated the studied end-points. Models with the 7-marker signature risk category plus clinicopathological/demographic covariates substantially outperformed models with clinicopathological/demographic variables alone in predicting all studied outcomes (areas under the receiver operator characteristic curve 74.1% versus 68.4% for DFS, 81.5% versus 71.2% for MSS, 80.9% versus 73.0% for OS; absolute differences 5.7%, 10.3% and 7.9%, respectively, favouring 7-marker signature risk category-containing models). CONCLUSION In patients with AJCC early-stage disease, the 7-marker signature reliably prognosticates melanoma-related outcomes, independent of AJCC classification, and provides a valuable complement to clinicopathological/demographic factors.
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Affiliation(s)
- Stefanie Meyer
- Department of Dermatology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Lorenz Buser
- Department of Pathology and Molecular Pathology, University Hospital of Zürich, University of Zürich, Schmelzbergstrasse 12, 8091 Zürich, Switzerland.
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Mark Berneburg
- Department of Dermatology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Tim Maisch
- Department of Dermatology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Monika Klinkhammer-Schalke
- Tumour Center Regensburg, Institute for Quality Assurance and Healthcare Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany.
| | - Armin Pauer
- Tumour Center Regensburg, Institute for Quality Assurance and Healthcare Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany.
| | - Thomas Vogt
- Department of Dermatology, Venerology, Allergology, University Hospital Saarland, Kirrbergerstraße, 66424 Homburg, Germany.
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Liebermeisterstr. 25, 72076, Tuebingen, Germany.
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23
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Völkel V, Steinger B, Koller M, Klinkhammer-Schalke M, Lindberg-Scharf P. Colorectal cancer survivors' long-term recollections of their illness and therapy up to seven years after enrolment into a randomised controlled clinical trial. BMC Cancer 2023; 23:149. [PMID: 36782134 PMCID: PMC9926648 DOI: 10.1186/s12885-023-10604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND As a consequence of effective treatment procedures, the number of long-term survivors of colorectal cancer is ever increasing. Adopting the method of a previous study on breast cancer patients, the goal of the present research was to investigate colorectal cancer patients' recollections of their illness and treatment experiences up to seven years after they have been enrolled in a randomised controlled clinical trial on the direct improvement of quality of life (RCT DIQOL). METHODS Colorectal cancer survivors in Bavaria, Germany were mailed a questionnaire on average 78·3 months after the start of their therapy and enrolment into RCT DIQOL. The questionnaire enquired about their worst experience during the colorectal cancer episode, positive aspects of the illness, and any advice they would give to newly diagnosed patients. Patient responses were categorised by two independent raters and cross-checked by a third independent rater. Frequencies of these categories were then quantitatively analysed using descriptive statistics. RESULTS Of 146 remaining survivors initially enrolled in RCT DIQOL, 96 (66%) returned the questionnaire. The majority (33%) of statements regarding the worst experience was referring to "psychological distress", followed by "indigestion and discomfort during defecation" (17%), and "cancer diagnosis" (16%). Among survivors with history of a stoma, the majority (36%) regarded "stoma" as their worst experience. With 45%, "change in life priorities" has been the most frequent positive category before "support by physicians/ nurses" (25%). 43% of the survivors deemed "fighting spirit" as most important advice to overcome the disease. CONCLUSION Even after many years, colorectal cancer survivors clearly remember experiences from the time of their illness. Echoing the results of the previous breast cancer survivors' study, "psychological distress", "change in life priorities" and "fighting spirit" emerged as prominent concepts. In addition, some aspects like the impact of a stoma are of specific importance for colorectal cancer survivors. These findings can be used to inform programmes to improve patient- and quality of life centred aftercare of tumour patients. CLINICAL TRIAL INFORMATION NCT04930016, date of registration 18.06.2021.
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Affiliation(s)
- Vinzenz Völkel
- Tumour Centre Regensburg, Centre of Quality Management and Health Services Research, University of Regensburg, Am BioPark 9, 93053, Regensburg, Germany.
| | - Brunhilde Steinger
- grid.7727.50000 0001 2190 5763Tumour Centre Regensburg, Centre of Quality Management and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Michael Koller
- grid.411941.80000 0000 9194 7179Centre for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- grid.7727.50000 0001 2190 5763Tumour Centre Regensburg, Centre of Quality Management and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Patricia Lindberg-Scharf
- grid.7727.50000 0001 2190 5763Tumour Centre Regensburg, Centre of Quality Management and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
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24
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Röhrmoser K, Ignatov A, Gerken M, Ortmann O, Klinkhammer-Schalke M, Papathemelis T. Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration. J Cancer Res Clin Oncol 2023; 149:803-810. [PMID: 35179644 DOI: 10.1007/s00432-022-03954-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking. METHODS This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan-Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates. RESULTS After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6-4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1-3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1-4.4). CONCLUSION Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients.
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Affiliation(s)
- Katharina Röhrmoser
- Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany
| | - Michael Gerken
- Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany.,Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany.,Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Thomas Papathemelis
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany.
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25
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Teufel A, Li M, Gerken M, Ebert MP, Schlitt HJ, Evert M, Herr W, Klinkhammer-Schalke M. Second Cancer After Additive Chemotherapy in Patients With Colon Cancer. Clin Colorectal Cancer 2022; 21:354-361. [PMID: 35934636 DOI: 10.1016/j.clcc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 12/18/2021] [Accepted: 07/03/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Additive chemotherapeutic treatment of UICC-stage -III / IV colon cancer with fluorouracil, leucovorin and oxaliplatin is widely accepted as current standard of treatment after R0-resection. However, as patients.. survival is increasing, long-term side effects of chemotherapeutic agents such as second cancer development are becoming increasingly important. PATIENTS We therefore investigated a total of 2 856 Patients with UICC-stage III / IV colon cancer, 223 of whom (7.8%) had developed a subsequent second cancer. RESULTS Median follow-up was 73.2 months (range 209.9 months, 95%-CI 69.8-76.9). Most frequent second cancers were prostate cancer (18.4%), colon cancer (16.1%), breast cancers (8.1%), lung cancer (8.1%), rectal cancer (4.9%) and uterine cancer (4.9%). However, in comparison to non-treated patients this did not represent a significantly increased risk for subsequent second cancer in patients after treatment with additive chemotherapy. Of interest, our data suggest a significantly decreased second cancer rate in patients treated with FOLFOX compared to FUFOL for additive treatment. CONCLUSIONS Second cancer development was not increased after additive chemotherapy for colon cancer, which is a novel aspect in the ongoing discussions on reduction of adjuvant treatment to 3 months or treatment of lymph node negative patients. Novelty and Impact Statement To our knowledge, this is the first population-based study analyzing second cancer development after additive chemotherapy in patients with UICC III-IV colon cancer. The results have an important impact on the surveillance and long-term follow-up of cancer patients.
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Affiliation(s)
- Andreas Teufel
- Department of Medicine II, Division of Hepatology, Division of Clinical Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Moying Li
- Department of Medicine II, Division of Hepatology, Division of Clinical Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Gerken
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
| | - Matthias P Ebert
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Evert
- Department of Pathology, University of Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, University Medical Center Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
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26
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Klinkhammer-Schalke M, Wesselmann S, Bruns J, Nettekoven G, Tillack A, Follmann M, Arndt V, Graeven U, Hartz T, Illmer T, Inwald EC, Kaiser T, Nothacker M, Ortmann O, Schmidt S, Schmitt J, Zeissig SR, Seufferlein T. [Further Development and Interoperability in Oncological Care Structures, Quality Control and Research]. Gesundheitswesen 2022. [PMID: 36328158 DOI: 10.1055/a-1926-6818] [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: 11/06/2022]
Abstract
How can we improve the interoperability of medical guidelines and the implementation and measurement of outcomes in medical health care for cancer patients as well as for care providers? This is the aim of the working group "Quality and Cross-linking". The following publication gives an overview of the targets reached in the development of guidelines together with quality indicators and documentation in cancer registries.
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Affiliation(s)
- Monika Klinkhammer-Schalke
- Arbeitsgemeinschaft Deutscher Tumorzentren e. V. (ADT).,Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg.,Deutsches Netzwerk Versorgungsforschung e.V. und ZeGV
| | | | | | | | | | | | | | | | | | - Thomas Illmer
- Berufsverband der Niedergelassenen Hämatologen und Onkologen in Deutschland (BNHO)
| | - Elisabeth C Inwald
- Arbeitsgemeinschaft Deutscher Tumorzentren e. V. (ADT).,Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg.,Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef
| | - Thomas Kaiser
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF)
| | - Olaf Ortmann
- Arbeitsgemeinschaft Deutscher Tumorzentren e. V. (ADT).,Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg.,Deutsche Krebsgesellschaft e. V.,Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef
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27
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Stürzl R, Gerken M, Bruns C, Klinkhammer-Schalke M, Pauer A, Piso P. [Surgical treatment of adenocarcinoma of the esophagogastric junction type II : Comparison between transhiatal extended gastrectomy and thoracoabdominal esophagectomy]. Chirurgie (Heidelb) 2022; 93:1072-1081. [PMID: 35987786 PMCID: PMC9592631 DOI: 10.1007/s00104-022-01703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The incidence of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased. However, the best surgical treatment for AEG type II is still the subject of current research. The goal of this retrospective cohort study is to compare survival and recurrence rates in patients, who underwent either thoracoabdominal esophagectomy (TAE) or transhiatal extended gastrectomy (TEG). MATERIAL AND METHODS The study is based on a cohort of 272 patients diagnosed with AEG type II between 2002 and 2020, recorded by a population-based clinical cancer registry. Of the included patients 63 underwent TAE and 209 TEG. In order to compare overall survival, recurrence rates, and recurrence free survival, we applied the Kaplan-Meier method, univariable and multivariable Cox regression. RESULTS Our analysis showed no statistically significant difference concerning overall survival (p = 0.333). However a tendency towards higher survival rates after TAE for the period from 2016-2020 (p = 0,058) is possible. In contrast a significant difference concerning higher cumulative recurrence rates after TAE was found after Kaplan-Meier analysis (p = 0.049). This trend was not observed for the time after 2016 (p = 0.993), in which over 50% of TAE were performed. No differences were found regarding recurrence-free survival (p = 0.772). CONCLUSION Our findings in a rather small cohort are concordant with most studies showing no differences or a trend towards better survival after TAE. Other studies found no significant difference regarding recurrence-free survival as well. In conclusion, no significant differences were found between TEG and TAE in surgical treatment of AEG type II.
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Affiliation(s)
- Roman Stürzl
- Tumorzentrum, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Michael Gerken
- Tumorzentrum, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
- Bayrisches Krebsregister, Regionalzentrum Regensburg, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Regensburg, Deutschland
| | - Christiane Bruns
- Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - Monika Klinkhammer-Schalke
- Tumorzentrum, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
- Bayrisches Krebsregister, Regionalzentrum Regensburg, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Regensburg, Deutschland
| | - Armin Pauer
- Tumorzentrum, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
- Bayrisches Krebsregister, Regionalzentrum Regensburg, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Regensburg, Deutschland
| | - Pompiliu Piso
- Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
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Fernández-Pacheco M, Gerken M, Ortmann O, Ignatov A, Klinkhammer-Schalke M, Hatzipanagiotou ME, Inwald EC. Impact of cavity shaving on residual tumor rates in patients with primary invasive carcinoma and carcinoma in situ in breast conserving surgery. Arch Gynecol Obstet 2022; 307:1573-1583. [PMID: 36282347 PMCID: PMC10110683 DOI: 10.1007/s00404-022-06803-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Several international studies reported relatively high re-excision rates due to residual tumor in breast conserving surgery (BCS). Cavity shaving (CS) is a surgical strategy to reduce re-excision rates. This study aimed to investigate the effect of circumferential cavity shaving during BCS to reduce residual tumor.
Material and Methods
A total of 591 patients with early invasive carcinoma or carcinoma in situ of the breast (ICD-10, C50 or D05) who were diagnosed between 01/01/2017 and 31/12/2019 and underwent BCS in a certified breast cancer center of the University Regensburg were analyzed regarding surgical excision methods. Patients with CS during BCS and patients with targeted re-excision in a specific direction depending on the result of intraoperative mammography or sonography during BCS were compared. The risk of pathologic residual tumor (R1) was compared between both groups by means of a multivariable binary logistic regression model to determine if there is a benefit of a certain surgical method to avoid a second intervention for re-excision. We adjusted for age, tumor size, nodal status, histologic type, surgeon, breast side, and neoadjuvant chemotherapy.
Results
80 (n = 13.54%) patients had CS and 511 (n = 86.46%) had a targeted re-excision in a specific direction during BCS according to intraoperative mammography or sonography. After comparing both techniques in a multivariable regression model, there was no significant difference regarding risk of residual tumor (p = 0.738) in the total cohort. However, CS showed a tendency to be favorable regarding rates of residual tumor in patients with invasive breast cancer between 60 and 70 years (p = 0.072) and smaller T1-tumors (p = 0.057) compared to targeted intraoperative re-excision following mammographic or sonographic assessment.
Conclusion
CS showed a tendency to reduce residual tumor compared to the standard technique of intraoperative re-excision in specific subgroups, although no statistical significance was reached. Further studies are needed to overcome potential limitations like surgeon-based bias and missing standardized definitions of CS to reduce residual tumor rates.
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Affiliation(s)
- Miriam Fernández-Pacheco
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.
| | - Michael Gerken
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
| | | | - Elisabeth C Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
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Scharl S, Sprötge T, Gerken M, Scharl A, Ortmann O, Kölbl O, Klinkhammer-Schalke M, Papathemelis T. Guideline concordant therapy improves survival in high-grade endometrial cancer patients. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04318-1. [PMID: 36239795 DOI: 10.1007/s00432-022-04318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Data from randomized controlled trials in high-grade endometrial cancer are scarce due to its low prevalence. Therefore, guideline recommendations in this cancer subtype rely on relatively few randomized trials and data from retrospective studies. The aim of this study was to evaluate the benefits from guideline-concordant therapy in high-grade endometrial cancer in a real-world patient group. METHODS The effect of treatment according to German S3 guidelines and the former S2k guideline on overall survival (OS) and recurrence-free survival (RFS) was evaluated in a cohort of 293 high-grade endometrial cancer patients. RESULTS Treatment concordant with the S3 guideline significantly improved OS (HR 0.623, CI 0.420-0.923, p = 0.018) and RFS (HR 0.578, CI 0.387-0.863, p = 0.007). Treatment concordant with the S2k guideline did not result in a significantly higher OS (HR 0.783, CI 0.465-1.316, p = 0.335) or RFS (HR 0.741, CI 0.347-1.740, p = 0.242). CONCLUSION Therapy according to the German S3 guideline improved OS and RFS in univariate as well as multivariate analysis in this cohort of high-grade endometrial cancer patients.
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Affiliation(s)
- Sophia Scharl
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
| | - Tim Sprötge
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Michael Gerken
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Anton Scharl
- Oncology Competence Center, Klinik Bad Trissl, Oberaudorf, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiation Oncology, University Medical Centre Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Thomas Papathemelis
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany
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Teufel A, Meindl-Beinker NM, Hösel P, Gerken M, Roig A, Ebert MP, Herr W, Scheiter A, Pauer A, Schlitt HJ, Klinkhammer-Schalke M. Characteristics and outcome of patients with small bowel adenocarcinoma (SBA). J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04344-z. [PMID: 36163558 DOI: 10.1007/s00432-022-04344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
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Affiliation(s)
- Andreas Teufel
- Division of Hepatology, Division of Clinical Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Nadja M Meindl-Beinker
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Pauline Hösel
- DKFZ-Hector Cancer Institute at the University Medical Center, Mannheim, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
| | - Ana Roig
- Division of Hepatology, Division of Clinical Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias P Ebert
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center, Mannheim, Germany
- Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, University Medical Center Regensburg, Regensburg, Germany
| | | | - Armin Pauer
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
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31
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Braun R, Klinkhammer-Schalke M, Zeissig SR, Kleihus van Tol K, Bolm L, Honselmann KC, Petrova E, Lapshyn H, Deichmann S, Abdalla TSA, Heckelmann B, Bronsert P, Zemskov S, Hummel R, Keck T, Wellner UF. Clinical Outcome and Prognostic Factors of Pancreatic Adenosquamous Carcinoma Compared to Ductal Adenocarcinoma-Results from the German Cancer Registry Group. Cancers (Basel) 2022; 14:cancers14163946. [PMID: 36010939 PMCID: PMC9406158 DOI: 10.3390/cancers14163946] [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: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Adenosquamous carcinoma of the pancreas (ASCP) is a rare malignancy and its pathophysiology is poorly understood. Sparse clinical data suggest that clinical outcome and overall survival is worse in comparison to common pancreatic ductal adenocarcinoma (PDAC). Methods: We evaluated clinical outcome and prognostic factors for overall survival of patients with ASCP in comparison to patients with PDAC recorded between 2000 and 2019 in 17 population-based clinical cancer registries at certified cancer centers within the Association of German Tumor Centers (ADT). Results: We identified 278 (0.5%) patients with ASCP in the entire cohort of 52,518 patients with pancreatic cancer. Significantly, more patients underwent surgical resection in the cohort of ASCP patients in comparison to patients with PDAC (p < 0.001). In the cohort of 142 surgically resected patients with ASCP, the majority of patients was treated by pancreatoduodenectomy (44.4%). However, compared to the cohort of PDAC patients, significantly more patients underwent distal pancreatectomy (p < 0.001), suggesting that a significantly higher proportion of ASCP tumors was located in the pancreatic body/tail. ASCPs were significantly more often poorly differentiated (G3) (p < 0.001) and blood vessel invasion (V1) was detected more frequently (p = 0.01) in comparison with PDAC. Median overall survival was 6.13 months (95% CI 5.20−7.06) for ASCP and 8.10 months (95% CI 7.93−8.22) for PDAC patients, respectively (p = 0.094). However, when comparing only those patients who underwent surgical resection, overall survival of ASCP patients was significantly shorter (11.80; 95% CI 8.20−15.40 months) compared to PDAC patients (16.17; 95% CI 15.78−16.55 months) (p = 0.007). ASCP was a highly significant prognostic factor for overall survival in univariable regression analysis (p = 0.007) as well as in multivariable Cox regression analysis (HR 1.303; 95% CI 1.013−1.677; p = 0.039). Conclusions: In conclusion, ASCP showed poorer differentiation and higher frequency of blood vessel invasion indicative of a more aggressive tumor biology. ASCP was a significant prognostic factor for overall survival in a multivariable analysis. Overall survival of resected ASCP patients was significantly shorter compared to resected PDAC patients. However, surgical resection still improved survival significantly.
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Affiliation(s)
- Rüdiger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Monika Klinkhammer-Schalke
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Sylke Ruth Zeissig
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Kees Kleihus van Tol
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Kim C. Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Ekaterina Petrova
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Steffen Deichmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Thaer S. A. Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Benjamin Heckelmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Faculty of Medicine, Medical Center, University of Freiburg, 79085 Freiburg, Germany
| | - Sergii Zemskov
- Department of General Surgery, Bogomolets National Medical University, 01601 Kiev, Ukraine
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Ulrich F. Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Correspondence:
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32
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Geraedts M, Bierbaum T, Gröne O, Härter M, Hildebrandt H, Hoffmann W, Klinkhammer-Schalke M, Köberlein-Neu J, Schmitt J. Methoden und Indikatorensets für die Evaluation regionaler
sektorverbindender Versorgungsmodelle. Gesundheitswesen 2022. [DOI: 10.1055/a-1824-1627] [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: 10/18/2022]
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Roessler M, Schmitt J, Bobeth C, Gerken M, Kleihues-van Tol K, Reissfelder C, Rau BM, Distler M, Piso P, Günster C, Klinkhammer-Schalke M, Schoffer O, Bierbaum V. Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study. BMC Cancer 2022; 22:621. [PMID: 35672675 PMCID: PMC9172168 DOI: 10.1186/s12885-022-09731-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. METHODS We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009-2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan-Meier estimator and Cox regression with shared frailty. RESULTS The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85-0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. CONCLUSION This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04334239 ).
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Affiliation(s)
- Martin Roessler
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christoph Bobeth
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Michael Gerken
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Germany
| | | | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bettina M Rau
- Department of General, Visceral and Thoracic Surgery, Hospital of Neumarkt, Neumarkt in der Oberpfalz, Germany
| | - Marius Distler
- Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Department of Visceral-, Thoracic and Vascular Surgery, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
| | | | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Veronika Bierbaum
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Fante MA, Felsenstein M, Mayer S, Gerken M, Klinkhammer-Schalke M, Herr W, Vogelhuber M, Reichle A, Heudobler D. All-Oral Low-Dose Chemotherapy TEPIP is Effective and Well-Tolerated in Relapsed/Refractory Patients With Aggressive B-Cell Lymphoma. Front Oncol 2022; 12:852987. [PMID: 35619924 PMCID: PMC9127443 DOI: 10.3389/fonc.2022.852987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Treatment options in patients (pts.) with advanced relapsed and refractory aggressive B-cell lymphoma are limited. Palliative all-oral chemotherapy regimens reduce in-patient visits and contribute to quality of life. The all-oral low-dose chemotherapy regimen TEPIP comprises the conventional chemotherapy agents trofosfamide, etoposide, procarbazine, idarubicin and prednisolone. Methods Safety and efficacy of TEPIP was evaluated in an observational retrospective, single-center study at the University Medical Center Regensburg between 2010 and 2020. Treatment with TEPIP was applied for 7 or 10 days during a 28-days period. In a subgroup of fit and therapy-motivated pts. rituximab was added. End points were overall survival (OS) and progression free survival (PFS). Adverse events ≥ CTCAE grade III were reported. Results 35 highly pre-treated pts. with aggressive B-cell lymphoma were enrolled. Median age at TEPIP start was 67 years and 85% of pts. received TEPIP as ≥ third treatment line. Overall response rate (ORR) was 23% (CR 17%). Pts. benefited from additional rituximab administration (ORR 67%) and a lower number of pre-treatments (ORR 41%). The OS was 3.3 months (m) with a 1y-OS of 25.7% and the PFS amounted to 1.3 m with a 1y-PFS of 8.8%. OS and PFS were significantly prolonged in pts. that responded to treatment or additionally received rituximab. Adverse events were mainly hematological and occurred in 49% of pts. Conclusion TEPIP was well-tolerated and induced respectable response in a difficult-to-treat patient cohort. In particular, the all-oral administration enables out-patient use with palliative intent.
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Affiliation(s)
- Matthias A Fante
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Mona Felsenstein
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Stephanie Mayer
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany.,Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany.,Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Heudobler
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany.,Bavarian Cancer Research Center (BZKF), University Hospital Regensburg, Regensburg, Germany
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35
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Inwald CE, Gerken M, Pauer A, Klinkhammer-Schalke M, Ortmann O. Einfluss der COVID-19-Pandemie auf die Inzidenz, Stadienverteilung und Therapien von Krebserkrankungen. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- C E Inwald
- Klinik für Frauenheilkunde und Geburtshilfe, Klinik St. Caritas, Universitätsklinikum, Regensburg
| | - M Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
| | - A Pauer
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
| | - M Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität, Regensburg
| | - O Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe, Klinik St. Caritas, Universitätsklinikum, Regensburg
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36
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Filippini Velázquez G, Schiele S, Gerken M, Neumaier S, Hackl C, Mayr P, Klinkhammer-Schalke M, Illerhaus G, Schlitt HJ, Anthuber M, Kröncke T, Messmann H, Märkl B, Schmid C, Trepel M, Müller G, Claus R, Hackanson B. Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer. ESMO Open 2022; 7:100470. [PMID: 35461024 PMCID: PMC9271475 DOI: 10.1016/j.esmoop.2022.100470] [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: 11/16/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential. Patients and methods In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC). Results Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC. Conclusions Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice. We identified four variables of adverse outcome for patients treated with surgical resection of liver metastases from CRC. Adverse variables were inflammatory response to the tumor, multiple metastases, right-sided primary tumor, node-positive primary tumor. We developed a preoperative clinical score according to the number of risk factors present. Using easily obtainable variables, this score identified patients with oligometastatic CRC with good prognosis. Patients without risk factors should strongly be considered for surgical resection of their metastases.
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Affiliation(s)
- G Filippini Velázquez
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - S Schiele
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - M Gerken
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - S Neumaier
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - C Hackl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - P Mayr
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Klinkhammer-Schalke
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - G Illerhaus
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - H J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - M Anthuber
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - T Kröncke
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - H Messmann
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - B Märkl
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - C Schmid
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Trepel
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - G Müller
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - R Claus
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; General Pathology and Molecular Diagnostics, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - B Hackanson
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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37
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Deichmann S, Dworschak O, Kulemann B, Höppner J, Bolm L, Klinkhammer-Schalke M, Zeissig SR, Kleihus van Tol K, Braun R, Lapshyn H, Keck T, Wellner UF, Honselmann KC. [Incidence, Treatment and Survival in Pancreatic Cancer- Data of the Nationwide Oncological Quality Conference from a Surgical Perspective]. Zentralbl Chir 2022; 147:147-154. [PMID: 35378553 DOI: 10.1055/a-1768-1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In recent years, there have been changes in the treatment of ductal pancreatic carcinoma with regard to multimodal therapy and also surgical therapy. These changes have not yet been explored in large nationwide studies in Germany. The present work gives an initial overview from a surgical perspective of the developments in diagnosis, therapy and survival of pancreatic cancer within the last 19 years in Germany. METHODS In this cohort of 18 clinical cancer registries in Germany, patients with a diagnosis of ductal pancreatic cancer from 2000-2018 were included. The patients were categorised according to the years of diagnosis (2000-2009 vs. 2010-2018) and treatment modalities and compared. RESULTS In the cohort of approx. 48000 patients with ductal pancreatic cancer, the number of newly diagnosed cases increased from approx. 18000 to 30000 patients in the two ten-year periods. The median overall survival increased slightly but statistically significantly from 7.1 to 7.9 months (p < 0.001). The resection rate increased from 25% to 32%, with the proportion of patients for whom no specific therapy was reported decreased by 11%. The rate of palliative chemotherapy and neoadjuvant chemotherapy also increased from 16% to 20% of the patients and from less than 1% to 2% of the patients, respectively. The median survival in the curatively treated subgroups was up to 24 months. SUMMARY The cancer registry data appear to confirm the known increase in the incidence of pancreatic cancer in the western world. Resection rates and the rates of treatment with neoadjuvant and palliative intent also increased. The overall survival of all patients with ductal pancreatic cancer only increased marginally. In the subgroups of patients who were treated with curative intent, however, significantly longer survival times were found.
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Affiliation(s)
- Steffen Deichmann
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Oliver Dworschak
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Birte Kulemann
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Jens Höppner
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Louisa Bolm
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Monika Klinkhammer-Schalke
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Deutschland
| | - Sylke Ruth Zeissig
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Deutschland
| | - Kees Kleihus van Tol
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Deutschland
| | - Ruediger Braun
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Hryhoriy Lapshyn
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Tobias Keck
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Ulrich Friedrich Wellner
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Kim Christin Honselmann
- Klinik für Chirurgie, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck, Deutschland
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Bolm L, Zemskov S, Zeller M, Baba T, Roldan J, Harrison JM, Petruch N, Sato H, Petrova E, Lapshyn H, Braun R, Honselmann KC, Hummel R, Dronov O, Kirichenko AV, Klinkhammer-Schalke M, Kleihues-van Tol K, Zeissig SR, Rades D, Keck T, Fernandez-del Castillo C, Wellner UF, Wegner RE. Concepts and Outcomes of Perioperative Therapy in Stage IA-III Pancreatic Cancer-A Cross-Validation of the National Cancer Database (NCDB) and the German Cancer Registry Group of the Society of German Tumor Centers (GCRG/ADT). Cancers (Basel) 2022; 14:cancers14040868. [PMID: 35205616 PMCID: PMC8870242 DOI: 10.3390/cancers14040868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The aim of this study is to assess perioperative therapy in stage IA-III pancreatic cancer cross-validating the German Cancer Registry Group of the Society of German Tumor Centers-Network for Care, Quality, and Research in Oncology, Berlin (GCRG/ADT) and the National Cancer Database (NCDB). (2) Methods: Patients with clinical stage IA-III PDAC undergoing surgery alone (OP), neoadjuvant therapy (TX) + surgery (neo + OP), surgery+adjuvantTX (OP + adj) and neoadjuvantTX + surgery + adjuvantTX (neo + OP + adj) were identified. Baseline characteristics, histopathological parameters, and overall survival (OS) were evaluated. (3) Results: 1392 patients from the GCRG/ADT and 29,081 patients from the NCDB were included. Patient selection and strategies of perioperative therapy remained consistent across the registries for stage IA-III pancreatic cancer. Combined neo + OP + adj was associated with prolonged OS as compared to neo + OP alone (17.8 m vs. 21.3 m, p = 0.012) across all stages in the GCRG/ADT registry. Similarly, OS with neo + OP + adj was improved as compared to neo + OP in the NCDB registry (26.4 m vs. 35.4 m, p < 0.001). (4) Conclusion: The cross-validation study demonstrated similar concepts and patient selection criteria of perioperative therapy across clinical stages of PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to either therapy alone.
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Affiliation(s)
- Louisa Bolm
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; (T.B.); (J.R.); (J.M.H.); (N.P.); (H.S.); (C.F.-d.C.)
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
- Correspondence:
| | - Sergii Zemskov
- Department of General Surgery, Bogomolets National Medical Unoversity, 01601 Kyiv, Ukraine; (S.Z.); (O.D.)
| | - Maria Zeller
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Taisuke Baba
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; (T.B.); (J.R.); (J.M.H.); (N.P.); (H.S.); (C.F.-d.C.)
| | - Jorge Roldan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; (T.B.); (J.R.); (J.M.H.); (N.P.); (H.S.); (C.F.-d.C.)
| | - Jon M. Harrison
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; (T.B.); (J.R.); (J.M.H.); (N.P.); (H.S.); (C.F.-d.C.)
| | - Natalie Petruch
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; (T.B.); (J.R.); (J.M.H.); (N.P.); (H.S.); (C.F.-d.C.)
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Hiroki Sato
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; (T.B.); (J.R.); (J.M.H.); (N.P.); (H.S.); (C.F.-d.C.)
| | - Ekaterina Petrova
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Ruediger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Kim C. Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Oleksii Dronov
- Department of General Surgery, Bogomolets National Medical Unoversity, 01601 Kyiv, Ukraine; (S.Z.); (O.D.)
| | - Alexander V. Kirichenko
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA; (A.V.K.); (R.E.W.)
| | - Monika Klinkhammer-Schalke
- German Cancer Registry Group, Society of German Tumor Centers—Network for Care, Quality and Research in Oncology, 14057 Berlin, Germany; (M.K.-S.); (K.K.-v.T.)
| | - Kees Kleihues-van Tol
- German Cancer Registry Group, Society of German Tumor Centers—Network for Care, Quality and Research in Oncology, 14057 Berlin, Germany; (M.K.-S.); (K.K.-v.T.)
| | - Sylke R. Zeissig
- Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, 97070 Wuerzburg, Germany;
| | - Dirk Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany;
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Carlos Fernandez-del Castillo
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; (T.B.); (J.R.); (J.M.H.); (N.P.); (H.S.); (C.F.-d.C.)
| | - Ulrich F. Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany; (M.Z.); (E.P.); (H.L.); (R.B.); (K.C.H.); (R.H.); (T.K.); (U.F.W.)
| | - Rodney E. Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA; (A.V.K.); (R.E.W.)
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Teufel A, Li M, Gerken M, Ebert MP, Schlitt HJ, Evert M, Herr W, Klinkhammer-Schalke M. Second cancer after adjuvant chemotherapy in patients with colon cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
86 Background: Adjuvant chemotherapeutic treatment of UICC-stage III/IV colon cancer with fluorouracil, leucovorin and oxaliplatin (FOLFOX) is widely accepted as the current standard after R0-resection. However, with continuous improvement of patients´ survival and life expectancy, long-term side effects of chemotherapy such as second cancer development are becoming increasingly important. Methods: We performed a retrospective analysis of clinical data derived from the population-based cancer registry at the Regensburg Tumor Center, Germany. Patients who were diagnosed with colon cancer UICC stage III and IV between 2002 and 2018 and underwent R0 surgical resection of primary tumor were included for the study. Second cancer was as defined new tumor occurrence at least 6 months after beginning of chemotherapy and in another localization compared to primary tumor. Second cancer rate was compared between patients with and patients without adjuvant chemotherapy. Results: Data of totally 2,856 Patients with UICC-stage III/IV colon cancer were analyzed, 1,520 (53.2%) of whom received adjuvant chemotherapy. Overall, 223 (7.8%) patients developed a subsequent second cancer. Most frequent second cancers were prostate cancer (18.4%), colon cancer (16.1%), breast cancers (8.1%), lung cancer (8.1%), rectal cancer (4.9%) and uterine cancer (4.9%). However, patients treated with adjuvant chemotherapy did not have a significantly increased risk for second cancer development compared to patients without adjuvant chemotherapy (Table). Interestingly, our data suggest a significantly decreased second cancer rate in patients treated with FOLFOX compared to FUFOL for adjuvant treatment. Conclusions: Second cancer development was not increased after adjuvant chemotherapy for UICC-stage III/IV colon cancer, which is a novel aspect in the ongoing discussions on reduction of adjuvant treatment to 3 months or treatment of lymph node negative patients. Primary tumor (N) Second tumor (N) Second tumor (%) Cumulative rate 60 months (%) Log-Rank p Chemotherapy Yes 1520 145 9.5% 8.8% No 1336 78 5.8% 9.0% 0.685 Total 2856 223 7.8% 8.9%
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Affiliation(s)
- Andreas Teufel
- Universitätsmedizin Mannheim, II. Medizinische Klinik, Mannheim, Germany
| | - Moying Li
- Department of Medicine II, Mannheim University Hospital, Mannheim, Germany
| | - Michael Gerken
- Tumor Center Regensburg e. V., University of Regensburg, Regensburg, Germany
| | - Matthias Philip Ebert
- Department of Medicine II, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans J. Schlitt
- University of Regensburg Medical Center, Regensburg, Germany
| | - Matthias Evert
- Department of Pathology, University of Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Universitaetsklinikum Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg, Institute of Quality Management and Health Services Research of the University of Regensburg, Regensburg, Germany
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Völkel V, Schatz S, Draeger T, Gerken M, Klinkhammer-Schalke M, Fürst A. Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany. Surg Endosc 2022; 36:1172-1180. [PMID: 33650009 PMCID: PMC8758606 DOI: 10.1007/s00464-021-08384-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center. PATIENTS AND METHODS Data were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan-Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis. RESULTS During the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien-Dindo 3-4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%. CONCLUSION TaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.
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Affiliation(s)
- Vinzenz Völkel
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany.
- Caritas Krankenhaus St. Josef Regensburg, Klinik für Allgemeine Innere Medizin, Gastroenterologie und Kardiologie, Landshuter Str. 65, 93053, Regensburg, Germany.
| | - Sabine Schatz
- Caritas Krankenhaus St. Josef Regensburg, Klinik für Allgemein-, Viszeral, Thoraxchirurgie und Adipositasmedizin, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Teresa Draeger
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany
- Caritas Krankenhaus St. Josef Regensburg, Klinik für Allgemeine Innere Medizin, Gastroenterologie und Kardiologie, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Michael Gerken
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany
| | - Alois Fürst
- Caritas Krankenhaus St. Josef Regensburg, Klinik für Allgemein-, Viszeral, Thoraxchirurgie und Adipositasmedizin, Landshuter Str. 65, 93053, Regensburg, Germany
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Inwald EC, Klinkhammer-Schalke M, Müller-Nordhorn J, Voigtländer S, Gerken M, Ortmann O. Auswirkungen der COVID-19-Pandemie auf die Inzidenz und Therapie von Krebserkrankungen. Forum 2022; 37:198-203. [PMCID: PMC8972628 DOI: 10.1007/s12312-022-01068-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Die COVID-19-Pandemie hat weltweit gravierende Auswirkungen auf die Gesundheitsversorgung. Vorerkrankte Personen, insbesondere Krebspatient*innen, stellen dabei eine besonders vulnerable Gruppe dar. Die COVID-19-Pandemie hatte und hat sowohl national als auch international erhebliche Auswirkungen auf die Diagnostik und Therapie bei Krebspatient*innen. Bereits zu Beginn der Pandemie wurde über gravierende Einschränkungen bei der Abklärung von Krebserkrankungen sowie den Früherkennungsuntersuchungen berichtet. Es zeigten sich Verzögerungen bei der Krebsdiagnostik sowie ein erheblicher Rückgang der Zahl der diagnostizierten Krebsfälle. Patient*innen vermieden aus Sorge vor einer Ansteckung, medizinische Versorgung in Anspruch zu nehmen. Diese Faktoren können zu einer erhöhten Rate von Diagnosestellungen in fortgeschrittenen Tumorstadien führen. Eingeschränkte Versorgungskapazitäten haben Verzögerungen von Krebstherapien zur Folge. Therapiemodifikationen können den Verlauf und das Überleben von Patient*innen mit Tumorerkrankungen beeinflussen.
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Affiliation(s)
- Elisabeth C. Inwald
- Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Landshuter Str. 65, 93053 Regensburg, Deutschland
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Deutschland
| | - Jacqueline Müller-Nordhorn
- Bayerisches Krebsregister, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Deutschland
| | - Sven Voigtländer
- Bayerisches Krebsregister, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Deutschland
| | - Michael Gerken
- Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Deutschland
| | - Olaf Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Landshuter Str. 65, 93053 Regensburg, Deutschland
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Spoerl S, Spanier G, Reiter E, Gerken M, Haferkamp S, Grosse J, Drexler K, Ettl T, Klinkhammer-Schalke M, Fischer R, Spoerl S, Reichert TE, Klingelhöffer C. Head and neck melanoma: outcome and predictors in a population-based cohort study. Head Face Med 2021; 17:45. [PMID: 34686191 PMCID: PMC8532308 DOI: 10.1186/s13005-021-00295-x] [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: 09/10/2020] [Accepted: 10/05/2021] [Indexed: 02/09/2023] Open
Abstract
Background To evaluate predictive clinico-pathological characteristics on outcome in head and neck melanoma (HNM) in a population-based study with particular emphasis on the prognostic effect of sentinel lymph node biopsy (SLNB), Charlson comorbidity index (CCI) and distinct tumor localisations. Methods Here we primarily describe a retrospective multicenter population-based cohort study with 402 patients having undergone resection with curative intent of HNM between 2010 and 2017. SLNB was used in the diagnosis of 79 HNM patients. Outcome was analyzed, focusing on SLNB, CCI as well as tumor localisation. Overall survival (OAS) und recurrence free survival (RFS) was examined by uni- and multivariate analysis. Results Histopathologically verified lymph node metastasis according to SLNB was associated with impaired RFS in HNM patients (p = 0.004). Especially in higher tumor stages, the sole implementation of SLNB improved survival significantly in the present cohort (p = 0.042). With most of the HNM being located in the face, melanoma of the scalp and neck could be linked to deteriorated patient’s outcome in uni- as well as multivariate analysis (p = 0.021, p = 0.004). Conclusions SLNB is a useful tool in predicting development of distant metastasis after HNM resection with curative intent. Especially in higher tumor stages, performing a SLNB ameliorated survival of HNM patients. Additionally, CCI as well as a distinct tumor localisations in HNM were identified as important risk factors in our population-based cohort study.
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Affiliation(s)
- Steffen Spoerl
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - Gerrit Spanier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany.
| | - Elena Reiter
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Michael Gerken
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - René Fischer
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Silvia Spoerl
- Department of Internal Medicine 5 - Hematology/Oncology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Torsten E Reichert
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - Christoph Klingelhöffer
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
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Völkel V, Klinkhammer-Schalke M, Fürst A. Falling Mortality Thanks to Improved Treatment for Colorectal Cancer. Dtsch Arztebl Int 2021; 118:664. [PMID: 34919049 DOI: 10.3238/arztebl.m2021.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Voigtländer S, Hakimhashemi A, Inwald EC, Ortmann O, Gerken M, Klug SJ, Klinkhammer-Schalke M, Meyer M, Müller-Nordhorn J. The Impact of the COVID-19 Pandemic on Cancer Incidence and Treatment by Cancer Stage in Bavaria, Germany. Dtsch Arztebl Int 2021; 118:660-661. [PMID: 34919047 DOI: 10.3238/arztebl.m2021.0329] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/05/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
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Scharl S, Sprötge T, Gerken M, Scharl A, Ignatov A, Inwald EC, Ortmann O, Kölbl O, Klinkhammer-Schalke M, Papathemelis T. Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study. Arch Gynecol Obstet 2021; 305:203-213. [PMID: 34223974 DOI: 10.1007/s00404-021-06140-5] [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: 01/10/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient's preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age. METHODS The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology. RESULTS Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (p = 0.015) or higher age (p < 0.01). Guideline adherence was not affected by comorbidities (p = 0.563), but was significantly reduced with higher age (p < 0.01). In a multivariable model, higher age (p < 0.01), obesity (p = 0.011), higher FIGO Stage (p < 0.01) and histologic subtype (p < 0.01) significantly decreased OS. Surgery (p < 0.001), chemotherapy (p < 0.01) and systematic LNE (p = 0.011) were associated with higher OS. CONCLUSION Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.
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Affiliation(s)
- Sophia Scharl
- Department of Radiation Oncology and Nuclear Medicine, Medizinisches Versorgungszentrum am Klinikum Rosenheim, Rosenheim, Germany.
| | - Tim Sprötge
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Michael Gerken
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Anton Scharl
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Regensburg, Germany
| | - Elisabeth C Inwald
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiation Oncology, University Medical Center, Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Thomas Papathemelis
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany
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Scharl S, Gerken M, Sprötge T, Kronberger K, Scharl A, Ignatov A, Ortmann O, Kölbl O, Klinkhammer-Schalke M, Papathemelis T. Comparison of survival outcomes and effects of therapy between subtypes of high-grade endometrial cancer - a population-based study. Acta Oncol 2021; 60:897-903. [PMID: 33905297 DOI: 10.1080/0284186x.2021.1914347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Similarities in outcome between grade 3 endometrioid cancer and non-endometrioid histologies have been reported by a number of studies. Other reports, however, stated a significantly better prognosis for G3 endometrioid compared to type II histology. In this population-based study, we compared the outcome and treatment approaches of high-grade endometrial cancer patients with FIGO stages I-III depending on their histology. MATERIAL AND METHODS 284 high-grade endometrial cancer patients diagnosed between 1998 and 2015 were retrospectively analyzed. Overall survival (OS), recurrence-free survival (RFS), and recurrence rates were compared depending on histology. RESULTS Type I G3 patients had a statistically significant OS advantage over women suffering from type II carcinoma (HR 1.527, 95%-CI 1.024-2.276; p = 0.038) and carcinosarcoma (HR 2.106, 95%-CI 1.270-3.493; p = 0.004) in univariable and multivariable Cox-regression analysis. RFS in Type I G3 was significantly superior compared to patients with carcinosarcoma (HR 1.719, 95%-CI 1.018-2.901; p = 0.043) and not significantly superior to type II patients (HR 1.368, 95%-CI 0.920-2.036; p = 0.122). Cumulative recurrence rates were significantly higher in carcinosarcoma compared to type I G3 (HR 2.217, 95%-CI 1.096-4.485; p = 0.027) in univariable analysis, but not after risk adjustment (HR of 1.472, 95%-CI 0.654-3.311; p = 0.350). CONCLUSION The prognosis of patients with type I G3 endometrial cancer patients seems to be significantly superior to patients with type II cancer and particularly carcinosarcoma. Systematic LND seemed to be beneficial in all of the three subtypes. The benefit of adjuvant treatment methods may differ between histologies.
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Affiliation(s)
- Sophia Scharl
- Department of Radiation Oncology and Nuclear Medicine, Medizinisches Versorgungszentrum am Klinikum Rosenheim, Rosenheim, Germany
| | - Michael Gerken
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Tim Sprötge
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Karin Kronberger
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Anton Scharl
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany
| | - Atanas Ignatov
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiation Oncology, University Medical Center, Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Thomas Papathemelis
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany
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Lindberg-Scharf P, Steinger B, Koller M, Hofstädter A, Ortmann O, Kurz J, Sasse J, Klinkhammer-Schalke M. Long-term improvement of quality of life in patients with breast cancer: supporting patient-physician communication by an electronic tool for inpatient and outpatient care. Support Care Cancer 2021; 29:7865-7875. [PMID: 34176020 PMCID: PMC8550515 DOI: 10.1007/s00520-021-06270-1] [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: 11/30/2020] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
Purpose The effectiveness of a pathway with quality of life (QoL) diagnosis and therapy has been already demonstrated in an earlier randomized trial (RCT) in patients with breast cancer. We refined the pathway by developing and evaluating an electronic tool for QoL assessment in routine inpatient and outpatient care. Methods In a single-arm study, patients with breast cancer with surgical treatment in two German hospitals were enrolled. QoL (EORTC QLQ-C30, QLQ-BR23) was measured with an electronic tool after surgery and during aftercare in outpatient medical practices (3, 6, 9, 12, 18, and 24 months) so that results (QoL-profile) were available immediately. Feedback by patients and physicians was analyzed to evaluate feasibility and impact on patient-physician communication. Results Between May 2016 and July 2018, 56 patients were enrolled. Physicians evaluated the QoL pathway as feasible. Patients whose physician regularly discussed QoL-profiles with them reported significantly more often that their specific needs were cared for (p < .001) and that their physician had found the right treatment strategy for these needs (p < .001) compared with patients whose doctor never/rarely discussed QoL-profiles. The latter significantly more often had no benefit from QoL assessments (p < .001). Conclusion The QoL pathway with electronic QoL assessments is feasible for inpatient and outpatient care. QoL results should be discussed directly with the patient. Clinical trial information NCT04334096, date of registration 06.04.2020 Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06270-1.
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Affiliation(s)
- Patricia Lindberg-Scharf
- Tumor Center Regensburg, Institute of Quality Management and Health Services Research of the University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany.
| | - Brunhilde Steinger
- Tumor Center Regensburg, Institute of Quality Management and Health Services Research of the University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andrea Hofstädter
- Department of Obstetrics and Gynecology, University Hospital Regensburg, St. Hedwig Clinic, Steinmetzstraße 1-3, 93049, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, RegensburgRegensburg, Germany
| | - Jan Kurz
- Tumor Center Regensburg, Institute of Quality Management and Health Services Research of the University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Jonathan Sasse
- Tumor Center Regensburg, Institute of Quality Management and Health Services Research of the University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg, Institute of Quality Management and Health Services Research of the University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
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48
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Hoffmann F, Kaiser T, Apfelbacher C, Benz S, Bierbaum T, Dreinhöfer K, Hauptmann M, Heidecke CD, Koller M, Kostuj T, Ortmann O, Schmitt J, Schünemann H, Veit C, Hoffmann W, Klinkhammer-Schalke M. [Routine Practice Data for Evaluating Intervention Effects: Part 2 of the Manual]. Gesundheitswesen 2021; 83:e40. [PMID: 34077984 DOI: 10.1055/a-1516-8823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg
| | - Thomas Kaiser
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Köln
| | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto von Guericke Universität Magdeburg, Magdeburg
| | - Stefan Benz
- Kliniken Böblingen, Klinikverbund Südwest GmbH, Sindelfingen.,Arbeitsgemeinschaft Deutscher Tumorzentren, Berlin
| | | | - Karsten Dreinhöfer
- Klinik für Orthopädie und Unfallchirurgie, Medical Park Berlin Humboldtmühle.,Centrum für Muskuloskeletale Chirurgie (CMSC), Charité Universitätsmedizin Berlin
| | - Michael Hauptmann
- Institut für Biometrie und Registerforschung, Fakultät für Gesundheitswissenschaften, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
| | | | - Michael Koller
- Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg
| | - Tanja Kostuj
- Orthopädisch-Traumatologische Zentrum, St. Marien-Hospitals Hamm, Hamm
| | - Olaf Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Regensburg Fakultät für Medizin, Regensburg
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Holger Schünemann
- Cochrane Canada and Mc Master GRADE Centre, WHO Collaborating Centre for Infectious Diseases, Research and Methods, Hamilton, Canada
| | - Christof Veit
- BQS Institut für Qualität & Patientensicherheit GmbH, Hamburg
| | | | - Monika Klinkhammer-Schalke
- Deutsches Netzwerk Versorgungsforschung e.V., Berlin.,Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg
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49
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Hoffmann F, Kaiser T, Apfelbacher C, Benz S, Bierbaum T, Dreinhöfer K, Hauptmann M, Heidecke CD, Koller M, Kostuj T, Ortmann O, Schmitt J, Schünemann H, Veit C, Hoffmann W, Klinkhammer-Schalke M. [Routine Practice Data for Evaluating Intervention Effects: Part 2 of the Manual]. Gesundheitswesen 2021; 83:470-480. [PMID: 34020493 DOI: 10.1055/a-1484-7235] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The evaluation of intervention effects is an important domain of health services research. The ad hoc commission for the use of routine practice data of the German Network for Health Services Research (DNVF) therefore provides this second part of its manual focusing on the use of routine practice data for the evaluation of intervention effects. First, we discuss definition issues and the importance of contextual factors. Subsequently, general requirements for planning, data collection and analysis as well as concrete examples for the evaluation of intervention effects for the 3 fields of application regarding pharmacotherapy, nonpharmaceutical interventions as well as complex interventions are elaborated. We consider scenarios in which no information from randomized controlled trials (RCTs) comparing the two groups directly is yet available or in which RCTs are already available but an extension of the research question is required. In all examples either with or without randomization, the first and foremost question is always whether the data source is suitable for the specific research question. Most of the examples chosen are from oncology trials, because the necessary data are already available for Germany, at least in some form. Finally, the manual discusses possible challenges for future use of these data.
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Affiliation(s)
- Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg
| | - Thomas Kaiser
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Köln
| | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto von Guericke Universität Magdeburg, Magdeburg
| | - Stefan Benz
- Kliniken Böblingen, Klinikverbund Südwest GmbH, Sindelfingen.,Arbeitsgemeinschaft Deutscher Tumorzentren, Berlin
| | | | - Karsten Dreinhöfer
- Klinik für Orthopädie und Unfallchirurgie, Medical Park Berlin Humboldtmühle.,Centrum für Muskuloskeletale Chirurgie (CMSC), Charité Universitätsmedizin Berlin
| | - Michael Hauptmann
- Institut für Biometrie und Registerforschung, Fakultät für Gesundheitswissenschaften, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
| | | | - Michael Koller
- Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg
| | - Tanja Kostuj
- Orthopädisch-Traumatologische Zentrum, St. Marien-Hospitals Hamm, Hamm
| | - Olaf Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Regensburg Fakultät für Medizin, Regensburg
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Holger Schünemann
- Cochrane Canada and Mc Master GRADE Centre, WHO Collaborating Centre for Infectious Diseases, Research and Methods, Hamilton, Canada
| | - Christof Veit
- BQS Institut für Qualität & Patientensicherheit GmbH, Hamburg
| | | | - Monika Klinkhammer-Schalke
- Deutsches Netzwerk Versorgungsforschung e.V., Berlin.,Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg
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Markowiak T, Dakkak B, Loch E, Großer C, Klinkhammer-Schalke M, Hofmann HS, Ried M. Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival. J Cardiothorac Surg 2021; 16:84. [PMID: 33858453 PMCID: PMC8048191 DOI: 10.1186/s13019-021-01460-8] [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: 07/18/2020] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Surgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent. Methods In this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively. Results A total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9–14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1–75.9), and there was no significant difference with regard to the surgical method used (p = 0.34). Conclusions VATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Beshir Dakkak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Großer
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, University Institute of Quality Assurance and Health Services Research, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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