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Bongkodmas P, Vacharathit V, Lerttiendamrong B, Manasnayakorn S, Tantiphlachiva K, Vongwattanakit P, Treeratanapun N, Vongsaisuwon M. New concept in selecting blue dye injection site effect on clinical outcome of early-stage breast cancer patients: a retrospective cohort. World J Surg Oncol 2024; 22:207. [PMID: 39095792 PMCID: PMC11297735 DOI: 10.1186/s12957-024-03493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Clinico-anatomical review and pilot studies demonstrated that intraparenchymal injection at any site, even those not containing the index lesion, or periareolar injections should provide concordant outcomes to peritumoral injections. METHOD This was a single-center retrospective cohort at King Chulalongkorn Memorial Hospital. The electronic medical records of patients were characterized into conventional and new injection concept groups. The inclusion criteria were patients who had either a mastectomy or BCS along with SLNB. We excluded patients who underwent ALND, received neoadjuvant therapy, or had non-invasive breast cancer. The primary outcome was the 5-year rate of breast cancer regional recurrence. Additionally, we reported on the re-operation rate, disease-free period, distant disease-free period, mortality rate, and recurrence rates both locoregional and systemic. Recurrences were identified through clinical assessments and imaging. SURGICAL TECHNIQUE 3 ml of 1%isosulfan blue dye was injected, with the injection site varying according to the specific concept being applied. In cases of SSM and NSM following the new concept, the blue dye was injected at non-periareolar and non-peritumoral sites. After the injection, a 10-minute interval was observed without massaging the injection site. Following this interval, an incision was made to access the SLNs, which were subsequently identified, excised, and sent for either frozen section analysis or permanent section examination. RESULT There were no significant differences in DFS, DDFS or BCSS between the two groups (p = 0.832, 0.712, 0.157). Although the re-operation rate in the NI group was approximately half that of the CI group, this difference was not statistically significant (p = 0.355). CONCLUSION Our study suggests that tailoring isosulfan blue dye injection site based on operation type rather than tumor location is safe and effective approach for SLN localization in early-stage breast cancer. However, this study has limitations, including being a single-center study with low recurrence and death cases. Future studies should aim to increase the sample size and follow-up period.
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Affiliation(s)
- Pattanan Bongkodmas
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Sopark Manasnayakorn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kasaya Tantiphlachiva
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Mawin Vongsaisuwon
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Salmerón-Ruiz A, Luengo Gómez D, Medina Benítez A, Láinez Ramos-Bossini AJ. Primary staging of rectal cancer on MRI: an updated pictorial review with focus on common pitfalls and current controversies. Eur J Radiol 2024; 175:111417. [PMID: 38484688 DOI: 10.1016/j.ejrad.2024.111417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 10/04/2024]
Abstract
Magnetic resonance imaging (MRI) plays a pivotal role in primary staging of rectal cancer, enabling the determination of appropriate management strategies and prediction of patient outcomes. However, inconsistencies and pitfalls exist in various aspects, including rectal anatomy, MRI protocols and strategies for artifact resolution, as well as in T- and N-staging, all of which limit the diagnostic value of MRI. This narrative and pictorial review offers a comprehensive overview of factors influencing primary staging of rectal cancer and the role of MRI in assessing them. It highlights the significance of the circumferential resection margin and its relationship with the mesorectal fascia, as well as the prognostic role of extramural venous invasion and tumor deposits. Special attention is given to tumors of the lower rectum due to their complex anatomy and the challenges they pose in MRI staging. The review also addresses current controversies in rectal cancer staging and the need for personalized risk stratification. In summary, this review provides valuable insights into the role of MRI in the primary staging of rectal cancer, emphasizing key aspects for accurate assessment to enhance patient outcomes.
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Affiliation(s)
- A Salmerón-Ruiz
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain
| | - D Luengo Gómez
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain
| | - A Medina Benítez
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain
| | - A J Láinez Ramos-Bossini
- Abdominal Radiology Section. Department of Radiology, Hospital Universitario Virgen de las Nieves, 18014. Granada, Spain; Advanced Medical Imaging Group (TeCe22), Instituto Biosanitario de Granada (ibs.GRANADA). 18016 Granada, Spain.
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Wei T, Liu J, Ma S, Wang M, Yuan Q, Huang A, Wu Z, Shang D, Yin P. A Nucleotide Metabolism-Related Gene Signature for Risk Stratification and Prognosis Prediction in Hepatocellular Carcinoma Based on an Integrated Transcriptomics and Metabolomics Approach. Metabolites 2023; 13:1116. [PMID: 37999212 PMCID: PMC10673507 DOI: 10.3390/metabo13111116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/25/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. The in-depth study of genes and metabolites related to nucleotide metabolism will provide new ideas for predicting the prognosis of HCC patients. This study integrated the transcriptome data of different cancer types to explore the characteristics and significance of nucleotide metabolism-related genes (NMGRs) in different cancer types. Then, we constructed a new HCC classifier and prognosis model based on HCC samples from TCGA and GEO, and detected the gene expression level in the model through molecular biology experiments. Finally, nucleotide metabolism-related products in serum of HCC patients were examined using untargeted metabolomics. A total of 97 NMRGs were obtained based on bioinformatics techniques. In addition, a clinical model that could accurately predict the prognostic outcome of HCC was constructed, which contained 11 NMRGs. The results of PCR experiments showed that the expression levels of these genes were basically consistent with the predicted trends. Meanwhile, the results of untargeted metabolomics also proved that there was a significant nucleotide metabolism disorder in the development of HCC. Our results provide a promising insight into nucleotide metabolism in HCC, as well as a tailored prognostic and chemotherapy sensitivity prediction tool for patients.
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Affiliation(s)
- Tianfu Wei
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China; (T.W.)
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Jifeng Liu
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China; (T.W.)
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Shurong Ma
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China; (T.W.)
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Mimi Wang
- Institute of Integrative Medicine, Dalian Medical University, Dalian 116000, China
| | - Qihang Yuan
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China; (T.W.)
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Anliang Huang
- Institute of Integrative Medicine, Dalian Medical University, Dalian 116000, China
| | - Zeming Wu
- iPhenome Biotechnology (Yun Pu Kang) Inc., Dalian 116000, China
| | - Dong Shang
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China; (T.W.)
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian 116000, China
| | - Peiyuan Yin
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China; (T.W.)
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian 116000, China
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Engel J, Eckel R, Halfter K, Schubert-Fritschle G, Hölzel D. Breast cancer: emerging principles of metastasis, adjuvant and neoadjuvant treatment from cancer registry data. J Cancer Res Clin Oncol 2023; 149:721-735. [PMID: 36538148 PMCID: PMC9931789 DOI: 10.1007/s00432-022-04369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/17/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Growing primary breast cancers (PT) can initiate local recurrences (LR), regional lymph nodes (pLN) and distant metastases (MET). Components of these progressions are initiation, frequency, growth duration, and survival. These characteristics describe principles which proposed molecular concepts and hypotheses must align with. METHODS In a population-based retrospective modeling approach using data from the Munich Cancer Registry key steps and factors associated with metastasis were identified and quantified. Analysis of 66.800 patient datasets over four time periods since 1978, reliable evidence is obtained even in small subgroups. Together with results of clinical trials on prevention and adjuvant treatment (AT) principles for the MET process and AT are derived. RESULTS The median growth periods for PT/MET/LR/pLN comes to 12.5/8.8/5/3.5 years, respectively. Even if 30% of METs only appear after 10 years, a pre-diagnosis MET initiation principle not a delayed one should be true. The growth times of PTs and METs vary by a factor of 10 or more but their ratio is robust at about 1.4. Principles of AT are 50% PT eradication, the selective and partial eradication of bone and lung METs. This cannot be improved by extending the duration of the previously known ATs. CONCLUSION A paradigm of ten principles for the MET process and ATs is derived from real world data and clinical trials indicates that there is no rationale for the long-term application of endocrine ATs, risk of PTs by hormone replacement therapies, or cascading initiation of METs. The principles show limits and opportunities for innovation also through alternative interpretations of well-known studies. The outlined MET process should be generalizable to all solid tumors.
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Affiliation(s)
- Jutta Engel
- Munich Cancer Registry (MCR), Ludwig-Maximilians-University (LMU), 81377, Munich, Germany
| | - Renate Eckel
- Munich Cancer Registry (MCR), Ludwig-Maximilians-University (LMU), 81377, Munich, Germany
| | - Kathrin Halfter
- Munich Cancer Registry (MCR), Ludwig-Maximilians-University (LMU), 81377, Munich, Germany
| | | | - Dieter Hölzel
- Munich Cancer Registry (MCR), Ludwig-Maximilians-University (LMU), 81377, Munich, Germany.
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Microbeam Radiation Therapy controls local growth of radioresistant melanoma and treats out-of-field locoregional metastasis. Int J Radiat Oncol Biol Phys 2022; 114:478-493. [DOI: 10.1016/j.ijrobp.2022.06.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022]
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Identification and Validation of Prognosis-Related Necroptosis Genes for Prognostic Prediction in Hepatocellular Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:3172099. [PMID: 35813858 PMCID: PMC9259286 DOI: 10.1155/2022/3172099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/25/2022]
Abstract
Background The prediction of hepatocellular carcinoma (HCC) survival is challenging because of its rapid progression. In recent years, necroptosis was found to be involved in the progression of multiple cancer types. However, the role of necroptosis in HCC remains unclear. Methods Clinicopathological parameters and transcriptomic data of 370 HCC patients were obtained from TCGA-LIHC dataset. Prognosis-related necroptosis genes (PRNGs) were identified and utilized to construct a LASSO risk model. The GEO cohorts (GSE54236 and GSE14520) were used for external validation. We evaluated the distribution of HCC patients, the difference in prognosis, and the accuracy of the prognostic prediction of the LASSO risk model. The immune microenvironment and functional enrichment of different risk groups were further clarified. Finally, we performed a drug sensitivity analysis on the PRNGs that constructed the LASSO model and verified their mRNA expression levels in vitro. Results: A total of 48 differentially expressed genes were identified, 23 of which were PRNGs. We constructed the LASSO risk model using nine genes: SQSTM1, FLT3, HAT1, PLK1, MYCN, KLF9, HSP90AA1, TARDBP, and TNFRSF21. The outcomes of low-risk patients were considerably better than those of high-risk patients in both the training and validation cohorts. In addition, stronger bile acid metabolism, xenobiotic metabolism, and more active immune cells and immune functions were observed in low-risk patients, and high expressions of TARDBP, PLK1, and FLT3 were associated with greater drug sensitivity. With the exception of FLT3, the mRNA expression of the other eight genes was verified in Huh7 and 97H cells. Conclusions. The PRNG signature provides a novel and effective method for predicting the outcome of HCC as well as potential targets for further research.
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Vandyck HHLD, Hillen LM, Bosisio FM, van den Oord J, zur Hausen A, Winnepenninckx V. Rethinking the biology of metastatic melanoma: a holistic approach. Cancer Metastasis Rev 2021; 40:603-624. [PMID: 33870460 PMCID: PMC8213587 DOI: 10.1007/s10555-021-09960-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
Over the past decades, melanoma-related mortality has remained nearly stable. The main reason is treatment failure of metastatic disease and the inherently linked knowledge gap regarding metastasis formation. In order to elicit invasion, melanoma cells manipulate the tumor microenvironment, gain motility, and adhere to the extracellular matrix and cancer-associated fibroblasts. Melanoma cells thereby express different cell adhesion molecules like laminins, integrins, N-cadherin, and others. Epithelial-mesenchymal transition (EMT) is physiological during embryologic development, but reactivated during malignancy. Despite not being truly epithelial, neural crest-derived malignancies like melanoma share similar biological programs that enable tumorigenesis, invasion, and metastasis. This complex phenomenon is termed phenotype switching and is intertwined with oncometabolism as well as dormancy escape. Additionally, it has been shown that primary melanoma shed exosomes that create a favorable premetastatic niche in the microenvironment of secondary organs and lymph nodes. Although the growing body of literature describes the aforementioned concepts separately, an integrative holistic approach is missing. Using melanoma as a tumor model, this review will shed light on these complex biological principles in an attempt to clarify the mechanistic metastatic pathways that dictate tumor and patient fate.
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Affiliation(s)
- Hendrik HLD Vandyck
- Department of Pathology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Center, MUMC+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Lisa M Hillen
- Department of Pathology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Center, MUMC+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Francesca M Bosisio
- Laboratory of Translational Cell and Tissue Research (TCTR), Department of Pathology, KU Leuven and UZ Leuven, Leuven, Belgium
| | - Joost van den Oord
- Laboratory of Translational Cell and Tissue Research (TCTR), Department of Pathology, KU Leuven and UZ Leuven, Leuven, Belgium
| | - Axel zur Hausen
- Department of Pathology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Center, MUMC+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Véronique Winnepenninckx
- Department of Pathology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Center, MUMC+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Chen MY, Gillanders WE. Staging of the Axilla in Breast Cancer and the Evolving Role of Axillary Ultrasound. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:311-323. [PMID: 34040436 PMCID: PMC8139849 DOI: 10.2147/bctt.s273039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Abstract
Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically. As a result, staging of the axilla has always played a central role in the treatment of breast cancer. Anatomic staging was believed to be important for two reasons: 1) it predicts prognosis and guides medical therapy, and 2) it is a potential therapy for removal of disease in the axilla. This paradigm has now been called into question. Prognostic information is driven increasingly by tumor biology, and trials such as the ACOSOG Z0011 demonstrates removal of axillary disease is not therapeutic. Staging of the axilla has undergone a dramatic de-escalation; however, sentinel lymph node biopsy (SLNB) is still an invasive surgery and represents a large economic burden on the healthcare system. In this review, we outline the changing paradigms of axillary staging in breast cancer from emphasis on anatomic staging to tumor biology, and the evolving role of axillary ultrasound, bringing patients less invasive and more personalized therapy.
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Affiliation(s)
- Michael Y Chen
- Department of Surgery, Washington University, St Louis, MS, USA
| | - William E Gillanders
- Department of Surgery, Washington University, St Louis, MS, USA
- Siteman Cancer Center in St. Louis, St Louis, MS, USA
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Weißbach L, Roloff C. [It is unclear whether pelvic lymphadenectomy is of oncological benefit in prostate cancer]. Aktuelle Urol 2021; 52:161-167. [PMID: 32731262 DOI: 10.1055/a-1140-5574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fossati's 2017 review questions the value of pelvic lymphadenectomy (pLA) in radical prostatectomy (RP) because available studies fail to show any oncological benefit. Our finding that no spread of metastatic lymph nodes (LN) has been demonstrated is based on registry data, clinical trials without evidence of pLA benefit and considerations of the genetic link between LN metastasis and distant metastases. The improved imaging with 68GaPSMA-PET-CT facilitates the detection of metastases and thus the omission of pLA as diagnostic intervention, thereby avoiding typical complications. The question whether pLA, or a multimodal treatment concept, might benefit intermediate and high-risk patients can only be answered by an RCT which, above all, must consider the incompletely removed primary as a source of metastatic spread.
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Kolberg HC, Kühn T, Krajewska M, Bauerfeind I, Fehm TN, Fleige B, Helms G, Lebeau A, Stäbler A, Schmatloch S, Hausschild M, Schwentner L, Schrenk P, Loibl S, Untch M, Kolberg-Liedtke C. Residual Axillary Burden After Neoadjuvant Chemotherapy (NACT) in Early Breast Cancer in Patients with a priori Clinically Occult Nodal Metastases - a transSENTINA Analysis. Geburtshilfe Frauenheilkd 2020; 80:1229-1236. [PMID: 33293731 PMCID: PMC7714621 DOI: 10.1055/a-1298-3453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background
Among patients with breast cancer undergoing neoadjuvant chemotherapy (NACT), the association between pathological complete remission (pCR) in the breast and clinical/pathological parameters is well established, whereas the association between these parameters and residual axillary involvement after NACT remains unclear.
Methods
Patients with clinically occult nodal metastases (i.e. negative by clinical assessment but positive by SLNB prior to NACT, i.e. Arm B of the SENTINA trial) were included in the presented analysis. All patients received a second sentinel lymph node biopsy (SLNB) and axillary dissection after NACT. Univariate and multivariate analyses were carried out to evaluate the association between clinical/pathological parameters and axillary involvement after NACT.
Results
Arm B of the SENTINA study contained 360 patients, 318 of which were evaluable for this analysis. After NACT, 71/318 (22.3%) patients had involved SLNs or non-SLNs after NACT. Overall, 71/318 (22.3%) patients achieved a pCR in the breast. Associations of extranodal spread, lack of multifocality and pCR in the breast with residual axillary burden were statistically significant. In a descriptive analysis including all patients with clinically negative axilla before NACT in the SENTINA trial 1.2% of triple negative (TN) patients and 0.5% of HER/2 positive patients had residual axillary disease in case of a breast pCR.
Conclusions
Patients in the SENTINA trial with clinically negative axilla and involved SLNs still carried a significant risk of nodal metastases after NACT. However, the risk of residual axillary burden was particularly low in TN and HER/2 positive tumors in case of a breast pCR.
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Affiliation(s)
| | - Thorsten Kühn
- Interdisciplinary Breast Centre, Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Maja Krajewska
- Institute of Biometry and Clinical Epidemiology, Charité - University Hospital Berlin, Berlin, Germany
| | - Ingo Bauerfeind
- Department of Gynecology and Obstetrics, Klinikum Landshut, Landshut, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Barbara Fleige
- Department of Pathology, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Gisela Helms
- Department of Gynecology and Obstetrics, University Medical Centre Tübingen, Tübingen, Germany
| | - Annette Lebeau
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annette Stäbler
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | | | - Maik Hausschild
- Department of Gynecology and Obstetrics, Health Center Fricktal, Rheinfelden, Switzerland
| | | | - Peter Schrenk
- Breast Competence Centre, Kepler University Hospital, Linz, Austria
| | | | - Michael Untch
- Department of Gynecology and Obstetrics, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
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Di Micco R, Gentilini OD. Axillary observation alone versus sentinel node biopsy: past, present and future perspectives. MINERVA CHIR 2020; 75:392-399. [PMID: 33345525 DOI: 10.23736/s0026-4733.20.08528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The evolution of axillary surgery in breast cancer has led from complete axillary dissection (AD) to sentinel node biopsy (SNB). It has not stopped yet but continues with a progressive de-escalation of surgical procedures aiming at axillary conservation. In parallel, the meaning of axillary surgery has changed as well. Over time, the dual role of both a therapeutic and a staging procedure has decreased leaving room to other modalities to treat and stage breast cancer. Although, the gold standard for axillary staging in early breast cancer remains SNB, the idea that axillary surgery could be even omitted has been proposed. The concept of abandoning axillary surgery is revolutionary but not new. Historical literature provides interesting data on patients who did not receive any axillary treatment at all with no impact on their survival. Starting from this, several ongoing trials are working to demonstrate that in selected breast cancer cohorts the information deriving from axillary surgery is superfluous and "axillary observation" alone is as effective as SNB. Whilst surgery has been de-escalated to less invasive procedures, systemic treatment, radiotherapy, multigene assays and advanced imaging modalities have gained ground in the management of breast cancer. New research is expected to help select the subgroups of patients for whom axillary surgery is not necessary anymore. This is a qualitative review reporting the most relevant literature data from historical trials on the omission of axillary surgery to the most recent and ongoing ones.
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Affiliation(s)
- Rosa Di Micco
- Breast Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy - .,Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy -
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Karihtala P, Jääskeläinen A, Roininen N, Jukkola A. Prognostic factors in metastatic breast cancer: a prospective single-centre cohort study in a Finnish University Hospital. BMJ Open 2020; 10:e038798. [PMID: 33046470 PMCID: PMC7552835 DOI: 10.1136/bmjopen-2020-038798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Although novel early breast cancer prognostic factors are being continuously discovered, only rare factors predicting survival in metastatic breast cancer have been validated. The prognostic role of early breast cancer prognostic factors in metastatic disease also remains mostly unclear. DESIGN AND SETTING Prospective cohort study in a Finnish University Hospital. PARTICIPANTS AND OUTCOMES 594 women with early breast cancer were originally followed. Sixty-one of these patients developed distant metastases during the follow-up, and their primary breast cancer properties, such as tumour size, nodal status, oestrogen receptor (ER) and progesterone receptor expression, grade, proliferation rate, histopathological subtype and breast cancer subtype were analysed as potential prognostic factors for metastatic disease. RESULTS In multivariate analysis, the presence of lymph node metastases at the time of early breast cancer surgery (HR, 2.17; 95% CI, 1.09-4.31; p=0.027) and ER status (negative vs positive, HR, 2.16; 95% CI, 1.14-4.10; p=0.018) were significant predictors of survival in metastatic disease. CONCLUSIONS These results confirm ER status as a primary prognostic factor in metastatic breast cancer. Furthermore, it also suggests that the presence of initial lymph node metastases could serve as a prognostic factor in recurrent breast cancer.
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Affiliation(s)
- Peeter Karihtala
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Helsinki, Finland
| | - Anniina Jääskeläinen
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Nelli Roininen
- Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arja Jukkola
- Department of Oncology, Tampere University Hospital, Cancer Center, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
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Tyuryumina EY, Neznanov AA, Turumin JL. A Mathematical Model to Predict Diagnostic Periods for Secondary Distant Metastases in Patients with ER/PR/HER2/Ki-67 Subtypes of Breast Cancer. Cancers (Basel) 2020; 12:cancers12092344. [PMID: 32825078 PMCID: PMC7563940 DOI: 10.3390/cancers12092344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023] Open
Abstract
Previously, a consolidated mathematical model of primary tumor (PT) growth and secondary distant metastasis (sdMTS) growth in breast cancer (BC) (CoMPaS) was presented. The aim was to detect the diagnostic periods for visible sdMTS via CoMPaS in patients with different subtypes ER/PR/HER2/Ki-67 (Estrogen Receptor/Progesterone Receptor/Human Epidermal growth factor Receptor 2/Ki-67 marker) of breast cancer. CoMPaS is based on an exponential growth model and complementing formulas, and the model corresponds to the tumor-node-metastasis (TNM) staging system and BC subtypes (ER/PR/HER2/Ki-67). The CoMPaS model reflects (1) the subtypes of BC, such as ER/PR/HER2/Ki-67, and (2) the growth processes of the PT and sdMTSs in BC patients without or with lymph node metastases (MTSs) in accordance with the eighth edition American Joint Committee on Cancer prognostic staging system for breast cancer. CoMPaS correctly describes the growth of the PT in the ER/PR/HER2/Ki-67 subtypes of BC patients and helps to calculate the different diagnostic periods, depending on the tumor volume doubling time of sdMTS, when sdMTSs might appear. CoMPaS and the corresponding software tool can help (1) to start the early treatment of small sdMTSs in BC patients with different tumor subtypes (ER/PR/HER2/Ki-67), and (2) to consider the patient almost healthy if sdMTSs do not appear during the different diagnostic periods.
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Affiliation(s)
- Ella Ya. Tyuryumina
- International Laboratory for Intelligent Systems and Structural Analysis, Faculty of Computer Science, National Research University Higher School of Economics, 109028 Moscow, Russia;
- Correspondence:
| | - Alexey A. Neznanov
- International Laboratory for Intelligent Systems and Structural Analysis, Faculty of Computer Science, National Research University Higher School of Economics, 109028 Moscow, Russia;
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Is the Recommendation of a Pelvic Lymphadenectomy in Conjunction with Radical Prostatectomy in Prostate Cancer Patients Justified? Report from a Multidisciplinary Expert Panel Meeting. Adv Ther 2020; 37:213-224. [PMID: 31679107 DOI: 10.1007/s12325-019-01133-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Pelvic lymphadenectomy (pLA) in prostate cancer (PCa) is one of the most common uro-oncologic surgical procedures. An increased complication rate is accompanied by unproven oncologic benefit. Extent of pLA and mechanisms of metastasis are discussed controversially. We aimed to explore evidence and knowledge gaps in pLA and mechanisms of metastasis in PCa and to develop further steps to clarify oncologic benefits through an expert panel. METHODS A multidisciplinary expert meeting was initiated, compiling available facts on pLA and mechanisms of metastasis in PCa. Questions and hypotheses were formulated. The resulting protocol was modeled on priority and consistency in four anonymized voting rounds using the Delphi method (March 2018-June 2018). RESULTS The oncologic benefit of pLA in PCa is still unclear. Results of randomized trials (RCTs) are pending. Extent and techniques of pLA are differently applied and inconsistently recommended by the guidelines as well as the indication for pLA. Different growth rates for the primaries and metastases and different survival curves for lymph node and organ metastasis at diagnosis argue against metastasis originating from positive nodes. However, results from clinical and basic research support this opportunity in PCa. CONCLUSIONS The RCTs required to clarify the estimated low oncologic benefit of pLA prove to be difficult because of the great effort (e.g., high case number). Establishing a network of treatment centers for implementation of high-quality cohort studies could be an alternative approach. Future studies with larger panels and international participants based on the presented feasibility should be launched to set this process in motion. Until valid data are available, benefits and harms of pLA should be weighted under consideration of low-invasive techniques (e.g., sentinel pLA).
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15
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Engel J, Weichert W, Jung A, Emeny R, Hölzel D. Lymph node infiltration, parallel metastasis and treatment success in breast cancer. Breast 2019; 48:1-6. [DOI: 10.1016/j.breast.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023] Open
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16
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Hennigs A, Riedel F, Feißt M, Köpke M, Rezai M, Nitz U, Moderow M, Golatta M, Sohn C, Heil J. Evolution of the Use of Completion Axillary Lymph Node Dissection in Patients with T1/2N0M0 Breast Cancer and Tumour-Involved Sentinel Lymph Nodes Undergoing Mastectomy: A Cohort Study. Ann Surg Oncol 2019; 26:2435-2443. [PMID: 31049766 DOI: 10.1245/s10434-019-07388-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND In breast cancer, completion axillary lymph node dissection (cALND) was previously recommended for patients with at least one tumour-affected sentinel lymph node (SLN). Several prospective trials predominantly in patients undergoing breast-conserving surgery showed no benefit and increased arm morbidity with this procedure. We report the influence of these trials on clinical practice of patients undergoing mastectomy. METHODS We analysed prospectively collected data from patients with primary invasive breast cancer treated at German breast cancer units between January 2008 and December 2015. Time trends of cALND rates were analysed in patients undergoing mastectomy for T1/2N0M0 breast cancer with one or two tumour-involved SLNs. Multivariable logistic regression was used to determine factors influencing the decision not to perform cALND. RESULTS Among the entire study cohort of 166,074 patients treated at 179 breast cancer units, 4093 patients (2%) had T1/2N0M0 breast cancer with one or two tumour-involved SLNs and underwent mastectomy. cALND rates decreased from 89.9% in 2010 to 55.5% in 2015 (p < 0.001). Rates decreased from 82% to 8% in patients with micrometastatic SLN disease and from 93% to 63% in those with macrometastasis (p < 0.001). In multivariable analysis, factors associated with omission of cALND were treatment at a general, nonacademic hospital, pT1 status, older age, higher number of removed SLNs, fewer tumour-affected SLNs, and SLN micrometastasis (all p < 0.001). CONCLUSIONS Despite limited evidence from prospective trials relating to the omission of cALND specifically in patients undergoing mastectomy, our nationwide data show that use of cALND decreased in these patients in routine clinical practice.
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Affiliation(s)
- André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Melitta Köpke
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Mahdi Rezai
- European Breast Center, Luisen Hospital, Düsseldorf, Germany
| | - Ulrike Nitz
- Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda, Mönchengladbach, Germany
| | | | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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17
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Sukhbaatar A, Mori S, Saiki Y, Takahashi T, Horii A, Kodama T. Lymph node resection induces the activation of tumor cells in the lungs. Cancer Sci 2019; 110:509-518. [PMID: 30499190 PMCID: PMC6361607 DOI: 10.1111/cas.13898] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 01/14/2023] Open
Abstract
Lymph node (LN) dissection is a crucial procedure for cancer staging, diagnosis and treatment, and for predicting patient survival. Activation of lung metastatic lesions after LN dissection has been described for head and neck cancer and breast cancer. Preclinical studies have reported that dissection of a tumor‐bearing LN is involved in the activation and rapid growth of latent tumor metastases in distant organs, but it is also important to understand how normal (non‐tumor‐bearing) LN resection influences secondary cancer formation. Here, we describe how the resection of tumor‐bearing and non‐tumor‐bearing LN affects distant metastases in MXH10/Mo‐lpr/lpr mice. Tumor cells were administered intravenously and/or intranodally into the right subiliac lymph node (SiLN) to create a mouse model of lung metastasis. Luciferase imaging revealed that tumor cells in the lung were activated after resection of the SiLN, irrespective of whether it contained tumor cells. No luciferase activity was detected in the lungs of mice that did not undergo LN resection (excluding the intravenous inoculation group). Our results indicate that resection of an LN can activate distant metastases regardless of whether the LN contains tumor cells. Hence, lung metastatic lesions are suppressed while metastatic LN are present but activated after LN resection. If this phenomenon occurs in patients with cancer, it is likely that lung metastatic lesions may be activated by elective LN dissection in clinical N0 cases. The development of minimally invasive cancer therapy without surgery would help to minimize the risk of activation of distant metastatic lesions by LN resection.
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Affiliation(s)
- Ariunbuyan Sukhbaatar
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Shiro Mori
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Department of Oral and Maxillofacial Surgery, Tohoku University Hospital, Sendai, Japan
| | - Yuriko Saiki
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Tetsu Takahashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Akira Horii
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Tetsuya Kodama
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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18
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Reimer T, Engel J, Schmidt M, Offersen BV, Smidt ML, Gentilini OD. Is Axillary Sentinel Lymph Node Biopsy Required in Patients Who Undergo Primary Breast Surgery? Breast Care (Basel) 2018; 13:324-330. [PMID: 30498416 PMCID: PMC6257084 DOI: 10.1159/000491703] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Local treatment of the axilla in clinically node-negative (cN0) early breast cancer patients with routine sentinel lymph node biopsy (SLNB) is debated for various reasons: i) pN staging information may not be necessary for the postoperative treatment decision regarding adjuvant systemic therapy in the great majority of patients; ii) the SLNB-positive rate is declining below 20% in specialized breast centers; iii) albeit being a minimally invasive procedure, SLNB causes a significant reduction in quality of life in 23% of patients; and iv) previous randomized trials from the pre-SLNB era did not show a disadvantage for patients without axillary surgery with regard to overall survival. These data support the hypothesis that avoiding axillary treatment in patients with clinically and sonographically unsuspicious lymph nodes seems to be a safe option, although omitting axillary surgery may increase the risk of locoregional recurrence. Currently, the information regarding node-positive status is essential to guide postoperative treatment such as systemic or radiation therapies in a non-negligible minority of patients. Three ongoing prospective European trials (SOUND, INSEMA, BOOG 2013-08) with axillary observation alone versus SLNB in cN0 patients and primary breast-conserving surgery have the objective to evaluate oncologic safety when omitting SLNB.
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Affiliation(s)
- Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre, Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians-University (LMU), Munich, Germany
| | - Marcus Schmidt
- Division of Molecular Medicine, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, University Medical Center Mainz, Mainz, Germany
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology and Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marjolein L. Smidt
- Division of Surgical Oncology, Maastricht University Medical Centre, Maastricht, Netherlands
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19
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de Boniface J, Schmidt M, Engel J, Smidt ML, Offersen BV, Reimer T. What Is the Best Management of cN0pN1(sn) Breast Cancer Patients? Breast Care (Basel) 2018; 13:331-336. [PMID: 30498417 DOI: 10.1159/000491704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although the majority of breast cancer patients are clinically node-negative (cN0) at diagnosis, 15-20% will have a metastatic sentinel lymph node (SLN, pN1(sn)). While a less radical approach regarding axillary surgery in cN0 patients with a positive SLN biopsy is advocated, the limitations of 5 published trials on axillary management in pN1(sn) are discussed intensely in the literature and support the performance of ongoing validation and extension trials, especially considering the lack of data in the setting of mastectomy. As locoregional radiotherapy has a significant effect on both recurrence and survival, a standardization of locoregional radiotherapy in the situation of SLN biopsy alone in pN1(sn) patients has to be defined in the future, and de-escalation trials should embrace a truly multidisciplinary approach. This is also of utmost importance considering the fact that high-volume nodal disease requires an intensified adjuvant chemotherapy strategy to which patients omitting axillary dissection cannot be stratified. Finally, there is mounting evidence that the therapeutic role of extensive axillary surgery in low-volume nodal disease is negligible, and multidisciplinary and translational efforts must be undertaken to individualize treatment in order to gain a reasonable balance between necessary staging information and unnecessary treatment-related morbidity.
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Affiliation(s)
- Jana de Boniface
- Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Schmidt
- Division of Molecular Medicine, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, University Medical Center Mainz, Mainz, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR), Institute for Medical Information Processing, Biometry and Epidemiology (IBE) at the University Hospital of Munich, Ludwig Maximilians-University (LMU), Munich, Germany
| | - Marjolein L Smidt
- Division of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology & Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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20
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Tyuryumina EY, Neznanov AA. Consolidated mathematical growth model of the primary tumor and secondary distant metastases of breast cancer (CoMPaS). PLoS One 2018; 13:e0200148. [PMID: 29979733 PMCID: PMC6034839 DOI: 10.1371/journal.pone.0200148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/20/2018] [Indexed: 11/28/2022] Open
Abstract
The goal of this research is to improve the accuracy of predicting the breast cancer (BC) process using the original mathematical model referred to as CoMPaS. The CoMPaS is the original mathematical model and the corresponding software built by modelling the natural history of the primary tumor (PT) and secondary distant metastases (MTS), it reflects the relations between the PT and MTS. The CoMPaS is based on an exponential growth model and consists of a system of determinate nonlinear and linear equations and corresponds to the TNM classification. It allows us to calculate the different growth periods of PT and MTS: 1) a non-visible period for PT, 2) a non-visible period for MTS, and 3) a visible period for MTS. The CoMPaS has been validated using 10-year and 15-year survival clinical data considering tumor stage and PT diameter. The following are calculated by CoMPaS: 1) the number of doublings for the non-visible and visible growth periods of MTS and 2) the tumor volume doubling time (days) for the non-visible and visible growth periods of MTS. The diameters of the PT and secondary distant MTS increased simultaneously. In other words, the non-visible growth period of the secondary distant MTS shrinks, leading to a decrease of the survival of patients with breast cancer. The CoMPaS correctly describes the growth of the PT for patients at the T1aN0M0, T1bN0M0, T1cN0M0, T2N0M0 and T3N0M0 stages, who does not have MTS in the lymph nodes (N0). Additionally, the CoMPaS helps to consider the appearance and evolution period of secondary distant MTS (M1). The CoMPaS correctly describes the growth period of PT corresponding to BC classification (parameter T), the growth period of secondary distant MTS and the 10-15-year survival of BC patients considering the BC stage (parameter M).
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Affiliation(s)
- Ella Ya. Tyuryumina
- International Laboratory for Intelligent Systems and Structural Analysis, Faculty of Computer science, National Research University Higher School of Economics, Moscow, Russia
- * E-mail:
| | - Alexey A. Neznanov
- International Laboratory for Intelligent Systems and Structural Analysis, Faculty of Computer science, National Research University Higher School of Economics, Moscow, Russia
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21
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Siddiqui M, Nagtegaal I, Santiago I, Knijn N, Berho M, Mirnezami A, Rao S, Brown G. Session 2: What causes liver metastases - lymph nodes or is it something else? Colorectal Dis 2018; 20 Suppl 1:39-42. [PMID: 29878686 DOI: 10.1111/codi.14077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The traditional view of progression of disease in cancer is the sequential spread of tumour to locoregional lymph nodes and then to distant metastases. However, this view may need to be challenged and modern pathology techniques such as immunohistochemistry and tumour profiling can provide us with a greater insight into the pathways and mechanisms of distant spread. Professor Nagtegaal discusses the evidence for reconsidering the current paradigm and reflects on the need for further investigation into mechanisms of distant metastatic spread.
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Affiliation(s)
- M Siddiqui
- Royal Marsden NHS Foundation Trust, London, UK.,Croydon University Hospital, Croydon, UK
| | - I Nagtegaal
- Radboud University Medical Care Academy, Nijmegen, The Netherlands
| | - I Santiago
- Champalimaud Foundation, Lisbon, Portugal
| | - N Knijn
- Radboud University Medical Care Academy, Nijmegen, The Netherlands
| | - M Berho
- Pathology and Laboratory Medicine, Cleveland Clinic, Weston, Florida, USA
| | | | - S Rao
- Royal Marsden NHS Foundation Trust, London, UK
| | - G Brown
- Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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22
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Ma Q, Dieterich LC, Detmar M. Multiple roles of lymphatic vessels in tumor progression. Curr Opin Immunol 2018; 53:7-12. [PMID: 29605736 DOI: 10.1016/j.coi.2018.03.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
Abstract
Sentinel lymph node metastasis is a prognostic indicator for systemic tumor spread in many types of cancers, and tumor lymphangiogenesis correlates with reduced survival. Consequently, lymphatic vessels have been suggested to promote tumor progression in multiple ways. Tumor lymphangiogenesis occurs both in primary tumors and at distant (pre-) metastatic sites, and facilitates lymphatic invasion and tumor cell dissemination. Lymphatic vessels have also emerged as regulators of tumor immunity, transporting tumor antigens to lymph nodes and directly interacting with immune cells. Furthermore, lymphatic vessels might provide a 'lymphovascular' niche contributing to the maintenance of stem-like tumor cells that are tightly related to tumor recurrence. Thus, targeting tumor lymphangiogenesis or specific lymphatic-associated functions might represent a promising approach to inhibit tumor progression.
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Affiliation(s)
- Qiaoli Ma
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, 8093 Zurich, Switzerland
| | - Lothar C Dieterich
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, 8093 Zurich, Switzerland
| | - Michael Detmar
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, 8093 Zurich, Switzerland.
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23
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Ullah I, Karthik GM, Alkodsi A, Kjällquist U, Stålhammar G, Lövrot J, Martinez NF, Lagergren J, Hautaniemi S, Hartman J, Bergh J. Evolutionary history of metastatic breast cancer reveals minimal seeding from axillary lymph nodes. J Clin Invest 2018; 128:1355-1370. [PMID: 29480816 DOI: 10.1172/jci96149] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/21/2017] [Indexed: 12/26/2022] Open
Abstract
Metastatic breast cancers are still incurable. Characterizing the evolutionary landscape of these cancers, including the role of metastatic axillary lymph nodes (ALNs) in seeding distant organ metastasis, can provide a rational basis for effective treatments. Here, we have described the genomic analyses of the primary tumors and metastatic lesions from 99 samples obtained from 20 patients with breast cancer. Our evolutionary analyses revealed diverse spreading and seeding patterns that govern tumor progression. Although linear evolution to successive metastatic sites was common, parallel evolution from the primary tumor to multiple distant sites was also evident. Metastatic spreading was frequently coupled with polyclonal seeding, in which multiple metastatic subclones originated from the primary tumor and/or other distant metastases. Synchronous ALN metastasis, a well-established prognosticator of breast cancer, was not involved in seeding the distant metastasis, suggesting a hematogenous route for cancer dissemination. Clonal evolution coincided frequently with emerging driver alterations and evolving mutational processes, notably an increase in apolipoprotein B mRNA-editing enzyme, catalytic polypeptide-like-associated (APOBEC-associated) mutagenesis. Our data provide genomic evidence for a role of ALN metastasis in seeding distant organ metastasis and elucidate the evolving mutational landscape during cancer progression.
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Affiliation(s)
- Ikram Ullah
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Amjad Alkodsi
- Genome-Scale Biology Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Una Kjällquist
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Gustav Stålhammar
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - John Lövrot
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Jens Lagergren
- Department of Computational Biology, Royal Institute of Technology, Stockholm, Sweden
| | - Sampsa Hautaniemi
- Genome-Scale Biology Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.,Radiumhemmet - Karolinska Oncology, Karolinska University Hospital, Stockholm, Sweden
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24
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Schubert-Fritschle G, Combs SE, Kirchner T, Nüssler V, Engel J. Use of Multicenter Data in a Large Cancer Registry for Evaluation of Outcome and Implementation of Novel Concepts. Front Oncol 2017; 7:234. [PMID: 29046867 PMCID: PMC5632760 DOI: 10.3389/fonc.2017.00234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/11/2017] [Indexed: 01/22/2023] Open
Abstract
Large clinical cancer registries (CCRs) in Germany shall be strengthened by the German Social Code Book V (SGB V) and implemented until the end of 2017. There are currently several large cancer registries that support clinical data for outcome analysis and knowledge acquisition. The various examples of the Munich Cancer Registry outlined in this paper present many-sided possibilities using and analyzing registry data. The main objective of population-based cancer registration within a defined area and the performance of outcomes research is to provide feedback regarding the results to the broad public, the reporting doctors, and the scientific community. These tasks determine principles of operation and data usage by CCRs. Each clinical department delivers its own findings and applied therapy. The compilation of these data in CCRs provides information on patient progress through the regional network of medical care and delivers meaningful information on the course of oncological diseases. Successful implementation of CCRs allows for presenting the statistical outcomes of health-care delivery, improving the quality of care within the region, accelerating the process of implementing innovative therapies, and generating new hypotheses as a stimulus for research activities.
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Affiliation(s)
- Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Stephanie E. Combs
- Munich Tumour Centre (TZM), Medical Faculties, Ludwig-Maximilians-University (LMU) and the Technical University of Munich (TUM), Munich, Germany
- Department of Radiation Oncology, Technische Universität Munich (TUM), Klinikum rechts der Isar, Munich, Germany
- Department of Radiation Sciences (DRS), Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum Munich, Oberschleißheim, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Thomas Kirchner
- Munich Tumour Centre (TZM), Medical Faculties, Ludwig-Maximilians-University (LMU) and the Technical University of Munich (TUM), Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
- Institute for Pathology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Volkmar Nüssler
- Munich Tumour Centre (TZM), Medical Faculties, Ludwig-Maximilians-University (LMU) and the Technical University of Munich (TUM), Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
- Munich Tumour Centre (TZM), Medical Faculties, Ludwig-Maximilians-University (LMU) and the Technical University of Munich (TUM), Munich, Germany
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25
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Naxerova K, Reiter JG, Brachtel E, Lennerz JK, van de Wetering M, Rowan A, Cai T, Clevers H, Swanton C, Nowak MA, Elledge SJ, Jain RK. Origins of lymphatic and distant metastases in human colorectal cancer. Science 2017; 357:55-60. [PMID: 28684519 PMCID: PMC5536201 DOI: 10.1126/science.aai8515] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/16/2017] [Accepted: 05/08/2017] [Indexed: 12/15/2022]
Abstract
The spread of cancer cells from primary tumors to regional lymph nodes is often associated with reduced survival. One prevailing model to explain this association posits that fatal, distant metastases are seeded by lymph node metastases. This view provides a mechanistic basis for the TNM staging system and is the rationale for surgical resection of tumor-draining lymph nodes. Here we examine the evolutionary relationship between primary tumor, lymph node, and distant metastases in human colorectal cancer. Studying 213 archival biopsy samples from 17 patients, we used somatic variants in hypermutable DNA regions to reconstruct high-confidence phylogenetic trees. We found that in 65% of cases, lymphatic and distant metastases arose from independent subclones in the primary tumor, whereas in 35% of cases they shared common subclonal origin. Therefore, two different lineage relationships between lymphatic and distant metastases exist in colorectal cancer.
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Affiliation(s)
- Kamila Naxerova
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
- Division of Genetics, Department of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Johannes G Reiter
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA 02138, USA
| | - Elena Brachtel
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Marc van de Wetering
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center (UMC) Utrecht, 3584CT Utrecht, Netherlands
- Cancer Genomics Netherlands, UMC Utrecht, 3584CG Utrecht, Netherlands
| | | | - Tianxi Cai
- Department of Biostatistics, Harvard University, Boston, MA 02115, USA
| | - Hans Clevers
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center (UMC) Utrecht, 3584CT Utrecht, Netherlands
- Cancer Genomics Netherlands, UMC Utrecht, 3584CG Utrecht, Netherlands
| | - Charles Swanton
- The Francis Crick Institute, London NW1 1AT, UK
- University College London Cancer Institute, London WC1E 6DD, UK
| | - Martin A Nowak
- Program for Evolutionary Dynamics, Harvard University, Cambridge, MA 02138, USA
- Department of Mathematics and Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Stephen J Elledge
- Division of Genetics, Department of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
- Howard Hughes Medical Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Rakesh K Jain
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Sun X, Liu X. Cancer metastasis: enactment of the script for human reproductive drama. Cancer Cell Int 2017; 17:51. [PMID: 28469531 PMCID: PMC5414196 DOI: 10.1186/s12935-017-0421-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/24/2017] [Indexed: 12/14/2022] Open
Abstract
Based on compelling evidence from many biological disciplines, we put forth a hypothesis for cancer metastasis. In the hypothesis, the metastatic cascade is depicted as human reproduction in miniature. Illustrated in a reproductive light, the staggering resemblance of cancer metastasis to human reproduction becomes evident despite some ostensible dis-similarities. In parallel to the appearance of primordial germ cells during early embryogenesis, the cancer reproductive saga starts with the separation of metastasis initiating cells (MICs) from cancer initiating cells when the primary cancer is still in its infancy. Prime MICs embark on a journey to the host bone marrow where they undergo further development and regulation. Migrating MICs are guided by the same CXCR4/CYCL12 axis as used in the migration of primordial germ cells to the genital ridge. Like the ovary, the host bone marrow features immune privileges, coolness, hypoxia and acidity which are essential for stemness maintenance and regulation. Opportune activation of the MICs via fusion with bone marrow stem cells triggers a frenzy of cellular proliferation and sets them on the move again. This scenario is akin to oocyte fertilization in the Fallopian tube and its subsequent journey towards the decidum. Just as the human reproductive process is plagued with undesirable outcomes so is the cancer metastasis highly inefficient. The climax of the cancer metastatic drama (colonization) is reached when proliferating MIC clusters attempt to settle down on decidum-like premetastatic sites. Successfully colonized clusters blossom into overt macrometastases only after the execution of sophisticated immunomodulation, angiogenesis and vascular remodeling. Similarly, the implanted blastomere needs to orchestrate these feats before flourishing into a new life. What is more, the cancer reproductive drama seems to be directed by a primordial hypothalamus–pituitary–gonad axis. Pursuing this reproductive trail could lead to new frontiers and breakthroughs in cancer research and therapeutics.
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Affiliation(s)
- Xichun Sun
- Department of Pathology and Laboratory Medicine, McGuire Holmes Veteran Affairs Medical Center, School of Medicine, Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA 23249 USA.,Department of Hepatobiliary Surgery, People's Hospital of Hunan Province, Hunan, China
| | - Xiwu Liu
- Department of Pathology and Laboratory Medicine, McGuire Holmes Veteran Affairs Medical Center, School of Medicine, Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA 23249 USA.,Department of Hepatobiliary Surgery, People's Hospital of Hunan Province, Hunan, China
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Ebner F, Wöckel A, Janni W, Kreienberg R, Schwentner L, Wischnewsky M. Personalized axillary dissection: the number of excised lymph nodes of nodal-positive breast cancer patients has no significant impact on relapse-free and overall survival. J Cancer Res Clin Oncol 2017; 143:1823-1831. [DOI: 10.1007/s00432-017-2425-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 12/31/2022]
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Hölzel D, Schubert-Fritschle G, Schmidt M, Eckel R, Engel J. [Clinical and epidemiological cancer registration in Germany]. DER PATHOLOGE 2016; 37:371-87. [PMID: 27384334 DOI: 10.1007/s00292-016-0188-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Function and funding of detailed clinical cancer registries (CCRs) is defined by German Social Code Book V (SGB V) and shall be implemented by the end of 2017. CONTENT Cancer registration according to regionally defined catchment areas, feedback of results and quality assurance are the basis which determines principles of operation and use of data. Each clinical department delivers only its own findings and therapy, while compilation by the clinical cancer registry describes the patients' way through the regional network of medical care. In this way, oncological centers are not burdened by troublesome documentation of data which originate from other clinics. CONCLUSION After successful implementation of CCRs, interested physicians and clinics are able to spend time for analysis and use of meaningful data with the objective of improving quality of care within the region, implementing innovative therapies and presenting their results, and generating new hypotheses to stimulate research.
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Affiliation(s)
- D Hölzel
- Tumorregister München, IBE/Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - G Schubert-Fritschle
- Tumorregister München, IBE/Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - M Schmidt
- Tumorregister München, IBE/Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - R Eckel
- Tumorregister München, IBE/Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - J Engel
- Tumorregister München, IBE/Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland.
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McCreery MQ, Halliwill KD, Chin D, Delrosario R, Hirst G, Vuong P, Jen KY, Hewinson J, Adams DJ, Balmain A. Evolution of metastasis revealed by mutational landscapes of chemically induced skin cancers. Nat Med 2015; 21:1514-20. [PMID: 26523969 PMCID: PMC5094808 DOI: 10.1038/nm.3979] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/23/2015] [Indexed: 12/15/2022]
Abstract
Human tumors show a high level of genetic heterogeneity, but the processes that influence the timing and route of metastatic dissemination of the subclones are unknown. Here we have used whole-exome sequencing of 103 matched benign, malignant and metastatic skin tumors from genetically heterogeneous mice to demonstrate that most metastases disseminate synchronously from the primary tumor, supporting parallel rather than linear evolution as the predominant model of metastasis. Shared mutations between primary carcinomas and their matched metastases have the distinct A-to-T signature of the initiating carcinogen dimethylbenzanthracene, but non-shared mutations are primarily G-to-T, a signature associated with oxidative stress. The existence of carcinomas that either did or did not metastasize in the same host animal suggests that there are tumor-intrinsic factors that influence metastatic seeding. We also demonstrate the importance of germline polymorphisms in determining allele-specific mutations, and we identify somatic genetic alterations that are specifically related to initiation of carcinogenesis by Hras or Kras mutations. Mouse tumors that mimic the genetic heterogeneity of human cancers can aid our understanding of the clonal evolution of metastasis and provide a realistic model for the testing of novel therapies.
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Affiliation(s)
- Melissa Q McCreery
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Kyle D Halliwill
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Douglas Chin
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Reyno Delrosario
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Gillian Hirst
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Peter Vuong
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Kuang-Yu Jen
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - James Hewinson
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - David J Adams
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - Allan Balmain
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, Cancer Research Institute, University of California, San Francisco, San Francisco, California, USA
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Winzer KJ, Bellach J, Kristiansen G. Long-Term Analysis of Ab-2 (Clone SN3b) Immunoreactivity as a Prognostic Factor in Breast Carcinoma. Breast Care (Basel) 2015; 10:273-6. [PMID: 26600764 DOI: 10.1159/000377654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND CD24 expression has been described as a significant prognostic factor in multiple solid tumours. Most of these studies have, however, been undertaken using the Ab-2 antibody (clone SN3b), which detects a CD24-associated carbohydrate, and not the CD24 protein itself. Although its biological identity remains unclear, its prognostic significance means that detection of this carbohydrate may, nonetheless, be clinically relevant. METHODS 133 breast carcinomas were selected (pT1-2 pN0-2 M0, no secondary carcinoma, no contralateral carcinoma) from a previous SN3b expression study on a larger cohort of breast carcinomas. After updating data on follow-up observations, we carried out univariate and multivariate analysis of the prognostic significance of SN3b for total and breast cancer-specific survival. RESULTS A statistically significant correlation between cytoplasmic SN3b immunoreactivity and positive node status was found. Cytoplasmic SN3b also has node status-independent prognostic significance. Total survival exhibits a statistically significant dependency on cytoplasmic SN3b even for pN0 cases. CONCLUSION The independent prognostic value of CD24 as detected by Ab-2/clone SN3b could replace the diagnostic axillary dissection in breast carcinoma patients if this was confirmed in further studies. Also, clarifying the exact epitope of this interesting antibody is more than warranted.
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Affiliation(s)
| | - Joachim Bellach
- Comprehensive Cancer Centre Charité, Charité - Universitätsmedizin Berlin, Germany
| | - Glen Kristiansen
- Institute of Pathology, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
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Schrodi S, Tillack A, Niedostatek A, Werner C, Schubert-Fritschle G, Engel J. No Survival Benefit for Patients with Treatment in Certified Breast Centers-A Population-based Evaluation of German Cancer Registry Data. Breast J 2015; 21:490-500. [DOI: 10.1111/tbj.12444] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Simone Schrodi
- Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC); Department of Medical Informatics, Biometry and Epidemiology (IBE); Großhadern Clinic; Ludwig-Maximilians-University (LMU); Munich Germany
| | - Anett Tillack
- Cancer Centre Brandenburg; Onkologischer Schwerpunkt Frankfurt (Oder); Frankfurt (Oder) Germany
| | | | - Carmen Werner
- Regional Clinical Cancer Register Dresden (RKKRD); Dresden Germany
| | - Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC); Department of Medical Informatics, Biometry and Epidemiology (IBE); Großhadern Clinic; Ludwig-Maximilians-University (LMU); Munich Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC); Department of Medical Informatics, Biometry and Epidemiology (IBE); Großhadern Clinic; Ludwig-Maximilians-University (LMU); Munich Germany
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Janni W, Kühn T, Schwentner L, Kreienberg R, Fehm T, Wöckel A. Sentinel node biopsy and axillary dissection in breast cancer: the evidence and its limits. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:244-9. [PMID: 24766712 DOI: 10.3238/arztebl.2014.0244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increasing evidence suggests that surgical removal of the axillary lymph nodes (axillary dissection, ALD) in early breast cancer yields no advantage in terms of either overall or disease-free survival, even in women with involvement of sentinel nodes. The optimal role of sentinel node biopsy (SNB) in neo-adjuvant therapy is currently under discussion. METHOD This review is based on a selective search in the Medline, EMBASE, Cochrane Library, and G.I.N. (Guidelines International Network) databases for relevant articles on the role of axillary dissection in node-positive breast cancer and the role of SNB in neo-adjuvant chemotherapy. RESULTS Although no single study provides adequate evidence, the available literature increasingly casts doubt on the putative therapeutic benefit of ALD as part of a multimodal treatment strategy for breast cancer. It is currently unclear what group of patients, if any, might benefit from ALD. Nor is any definitive judgment possible, from the available evidence, regarding the optimal role of SNB in neo-adjuvant therapy. The most recent evidence indicates that SNB after neo-adjuvant chemotherapy in ycN0 patients who had suspect lymph nodes before systemic treatment has a low rate of sensitivity. CONCLUSION Current evidence indicates that the radicality of lymph node surgery in the treatment of breast cancer can be reduced, even if the node status is positive.
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Affiliation(s)
- Wolfgang Janni
- Department of Obstetrics and Gynecology, Ulm University Medical Center, Department of Gynecology and Obstetrics, Hospital Esslingen, Department of Gynecology and Obstetrics, Düsseldorf University Hospital
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van Erning FN, Crolla RMPH, Rutten HJT, Beerepoot LV, van Krieken JHJM, Lemmens VEPP. No change in lymph node positivity rate despite increased lymph node yield and improved survival in colon cancer. Eur J Cancer 2015; 50:3221-9. [PMID: 25459398 DOI: 10.1016/j.ejca.2014.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 12/12/2022]
Abstract
AIM To analyse trends over time in the number of lymph nodes evaluated and in the proportion of node positivity and to investigate the impact on survival for patients with colon cancer. PATIENTS AND METHODS 8616 patients resected for M0 colon cancer diagnosed in the southern Netherlands between 2000 and 2011 were included in this study. Trends in nodal evaluation and node positivity were analysed. Multivariable logistic regressions were used to assess the influence of period of diagnosis on adequate nodal evaluation (P12 lymph nodes) and no depositivity after adjusting for patient and tumour characteristics. Crude 5-year relative survival was used as an estimate for disease-specific survival. RESULTS Overall, the proportion adequate nodal evaluation increased from 13% in 2000–2002 to 59% in 2009–2011 (p < 0.0001), whereas the proportion node positivity remained similar across study periods (approximately 35%). Patients diagnosed in later periods were more likely to have received adequate nodal yield (adjusted Odds ratio (OR) 2009–2011 versus 2000–2002 9.8, 95% Confidence interval (CI) 8.3–11.6). However, the adjusted odds of having node positive disease did not differ between periods of diagnosis. Relative excess risk of dying was independently correlated with the number of lymph nodes evaluated (1–8 LNs versus P12 LNs, N0: 2.2, 95% CI 1.7–2.9; N+: 1.7, 95% CI 1.4–2.0) and period of diagnosis (2009–2011 versus 2000–2002, N+ only: 0.8, 95% CI 0.6–1.0). CONCLUSION The reason for improved survival with increased nodal yield is different from simple understaging as the proportion of lymph node positivity remained constant.
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Sautter-Bihl ML, Sedlmayer F, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Piroth MD, Souchon R, Wenz F, Sauer R. How nescience may obscure evidence. Strahlenther Onkol 2014; 190:861-3. [PMID: 25238991 DOI: 10.1007/s00066-014-0755-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M-L Sautter-Bihl
- Klinik für Radioonkologie und Strahlentherapie, Städtisches Klinikum Karlsruhe gGmbH, 76133, Karlsruhe, Moltkestr. 90, Germany,
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Hoch S, Katabi N, Daniel H, Franke N, Wiegand S, Zimmerman AP, Mandapathil M, Ferlito A, Teymoortash A. Prognostic value of level IV metastases from head and neck squamous cell carcinoma. Head Neck 2014; 38:140-6. [PMID: 25224439 DOI: 10.1002/hed.23861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic value of level IV metastases in head and neck squamous cell carcinoma (HNSCC). METHODS The clinical and histopathological data of 111 patients with HNSCC with pN+ neck who underwent a primary tumor resection with unilateral or bilateral neck dissection were analyzed. RESULTS Level IV metastases were histopathologically proven in 33 patients (29.7%). Pulmonary metastases were observed in 12 of 33 patients (36.4%) with level IV metastases, and in 13 of 78 patients (16.7%) without level IV metastases (p = .04). Multivariate analyzes revealed a significant association between level IV metastases and pulmonary metastases (p = .038). However, an influence on overall (p = .65) or disease-free survival (p = .66) was not observed. CONCLUSION Level IV metastases seem to be a predictive factor for pulmonary metastases but not for overall and disease-free survival in patients with HNSCC.
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Affiliation(s)
- Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Nour Katabi
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Hanna Daniel
- Institute of Medical Biometry and Epidemiology, Philipp University, Marburg, Germany
| | - Nora Franke
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Annette P Zimmerman
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Magis Mandapathil
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Alfio Ferlito
- University of Udine School of Medicine, Udine, Italy
| | - Afshin Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
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Budach W, Kammers K, Boelke E, Matuschek C. Adjuvant radiotherapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials. Radiat Oncol 2013; 8:267. [PMID: 24225206 PMCID: PMC3842771 DOI: 10.1186/1748-717x-8-267] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/08/2013] [Indexed: 12/21/2022] Open
Abstract
Background Radiotherapy (RT) improves overall survival (OS) of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved lymph nodes (LN). The contribution of RT to the regional LN to this survival benefit was poorly understood. Recently, the results of three large randomized trials addressing this question have become available. Material and methods The published abstracts (full publication pending) of the MA.20 (n=1832) and the EORTC 22922–10925 (EORTC) (n=4004) trial and the full publication of the French trial (n=1334) were basis of the meta-analysis. Main eligibility criteria were positive axillary LN (all trials), LN negative disease with high risk for recurrence (MA.20), and medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial tested the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS). Results Regional RT of the MS-LN and the IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS (Hazard Ratio (HR) 0.85 (95% CL 0.75 - 0.96)). Adding the results of the French trial and using the random effects model to respect the different design of the French trial, the effect on OS of regional radiotherapy was still significant (HR 0.88 (95% CL 0.80 - 0.97)). The absolute benefits in OS were 1.6% in the MA.20 trial at 5 years, 1.6% in the EORTC trial at 10 years, and 3.3% in the French trial at 10 years (not significant in single trials). Regional radiotherapy of the MS-LN and the IM-LN (MA.20 and EORTC) was associated with a significant improvement of DFS (HR 0.85 (95% CL 0.77 - 0.94)) and DMFS (HR 0.82 (95% CL 0.73 - 0.92)). The effect sizes were not significantly different between trials for any end point. Conclusion Additional regional radiotherapy to the internal mammary and medial supraclavicular lymph nodes statistically significantly improves DFS, DMFS, and overall survival in stage I-III breast cancer.
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Affiliation(s)
- Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University of Düsseldorf, Moorenstraße 5, Düsseldorf, D-40225, Germany.
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Selection and adaptation during metastatic cancer progression. Nature 2013; 501:365-72. [PMID: 24048069 DOI: 10.1038/nature12628] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/12/2013] [Indexed: 02/07/2023]
Abstract
Cancer is often regarded as a process of asexual evolution driven by genomic and genetic instability. Mutation, selection and adaptation are by convention thought to occur primarily within, and to a lesser degree outside, the primary tumour. However, disseminated cancer cells that remain after 'curative' surgery exhibit extreme genomic heterogeneity before the manifestation of metastasis. This heterogeneity is later reduced by selected clonal expansion, suggesting that the disseminated cells had yet to acquire key traits of fully malignant cells. Abrogation of the cells' progression outside the primary tumour implies new challenges and opportunities for diagnosis and adjuvant therapies.
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[Cervical, inguinal and abdominal lymphnode dissection]. Chirurg 2013; 84:551-8. [PMID: 23719728 DOI: 10.1007/s00104-012-2412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Diagnostic lymph node dissections can be defined as a form of oncological service surgery. These procedures aim at clarification of differential diagnoses of local or systemic lymph node pathologies or contribute to tumor staging. Procedure implementation can either involve incisional biopsy, selective lymph node extirpation or regional systematic lymph node dissection. Sentinel lymph node lymphadenectomy is a focused form of selective lymphadenectomy. Both surgeon and oncologist must have a preoperative consensus and mutual understanding about the detailed purpose of the procedure in the individual patient setting. Terminology conventions must be considered in communication. Potential reasons to extend surgery should be strategically reflected prior to surgery. Interventional techniques and minimally invasive forms of surgical lymph node dissection must be technically taken into account in order to reduce procedural morbidity. Clinically indicative scenarios, pathophysiological concepts and technical options of surgical lymph node dissection are described and discussed for various anatomical regions.
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Markiewicz A, Ahrends T, Wełnicka-Jaśkiewicz M, Seroczyńska B, Skokowski J, Jaśkiewicz J, Szade J, Biernat W, Zaczek AJ. Expression of epithelial to mesenchymal transition-related markers in lymph node metastases as a surrogate for primary tumor metastatic potential in breast cancer. J Transl Med 2012; 10:226. [PMID: 23157797 PMCID: PMC3524044 DOI: 10.1186/1479-5876-10-226] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 11/14/2012] [Indexed: 12/22/2022] Open
Abstract
Background Breast cancers are phenotypically and genotypically heterogeneous tumors containing multiple cancer cell populations with various metastatic potential. Aggressive tumor cell subpopulations might more easily be captured in lymph nodes metastases (LNM) than in primary tumors (PT). We evaluated mRNA and protein levels of master EMT regulators: TWIST1, SNAIL and SLUG, protein levels of EMT-related markers: E-cadherin, vimentin, and expression of classical breast cancer receptors: HER2, ER and PgR in PT and corresponding LNM. The results were correlated with clinicopathological data and patients outcomes. Methods Formalin-fixed paraffin-embedded samples from PT and matched LNM from 42 stage II-III breast cancer patients were examined. Expression of TWIST1, SNAIL and SLUG was measured by reverse-transcription quantitative PCR. Protein expression was examined by immunohistochemistry on tissue microarrays. Kaplan-Meier curves for disease-free survival (DFS) and overall survival (OS) were compared using F-Cox test. Hazard ratios (HRs) with 95% confidence intervals (95% CI) were computed using Cox regression analysis. Results On average, mRNA expression of TWIST1, SNAIL and SLUG was significantly higher in LNM compared to PT (P < 0.00001 for all). Gene and protein levels of TWIST1, SNAIL and SLUG were highly discordant between PT and matched LNM. Increased mRNA expression of TWIST1 and SNAIL in LNM was associated with shorter OS (P = 0.04 and P = 0.02, respectively) and DFS (P = 0.02 and P = 0.01, respectively), whereas their expression in PT had no prognostic impact. Negative-to-positive switch of SNAIL protein correlated with decreased OS and DFS (HR = 4.6; 1.1-18.7; P = 0.03 and HR = 3.8; 1.0-48.7; P = 0.05, respectively). Conclusions LNM are enriched in cells with more aggressive phenotype, marked by elevated levels of EMT regulators. High expression of TWIST1 and SNAIL in LNM, as well as negative-to-positive conversion of SNAIL confer worse prognosis, confirming the correlation of EMT with aggressive disease behavior. Thus, molecular profiling of LNM may be used as surrogate marker for aggressiveness and metastatic potential of PT.
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Affiliation(s)
- Aleksandra Markiewicz
- Laboratory of Cell Biology, Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Dębinki 1, Gdańsk, Poland
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