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Seifert F, Eisenblätter R, Beckmann J, Schürmann P, Hanel P, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Fasching P, Luyten A, Häfner N, Dürst M, Runnebaum IB, Hillemanns P, Dörk T, Ramachandran D. Association of two genomic variants with HPV type-specific risk of cervical cancer. Tumour Virus Res 2023; 16:200269. [PMID: 37499979 PMCID: PMC10415783 DOI: 10.1016/j.tvr.2023.200269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
PROBLEM Human papillomavirus infection is integral to developing invasive cervical cancer in the majority of patients. In a recent genome-wide association study, rs9357152 and rs4243652 have been associated with seropositivity for HPV16 or HPV18, respectively. It is unknown whether these variants also associate with cervical cancer triggered by either HPV16 or HPV18. METHODS We investigate whether the two HPV susceptibility variants show association with type-specific cervical cancer in a genetic case-control study with cases stratified by HPV16 or HPV18, respectively. We further tested whether rs9357152 modulates gene expression of any of 36 genes at the human leukocyte antigen locus in 256 cervical tissues. RESULTS rs9357152 was associated with invasive HPV16-positive cervical cancer (OR 1.33, 95%CI 1.03-1.70, p = 0.03), and rs4243652 was associated with HPV18-positive adenocarcinomas (OR 2.96, 95%CI 1.18-7.41, p = 0.02). These associations remained borderline significant after testing against different sets of controls. rs9357152 was found to be an eQTL for HLA-DRB1 in HPV-positive cervical tissues (pANOVA = 0.0009), with the risk allele lowering mRNA levels. CONCLUSIONS We find evidence that HPV seropositivity variants at chromosome 6 and 14 may modulate type-specific cervical cancer risk. rs9357152 may exert its effect through regulating HLA-DRB1 induction in the presence of HPV. In regard of multiple testing, these results need to be confirmed in larger studies.
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Affiliation(s)
- Finja Seifert
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Rieke Eisenblätter
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Julia Beckmann
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Peter Schürmann
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Patricia Hanel
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Matthias Jentschke
- Clinics of Gynaecology and Obstetrics, Hannover Medical School, D-30625, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Peter Fasching
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynaecology and Obstetrics, Mare Klinikum, Kronshagen, Germany; Department of Gynaecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Norman Häfner
- Department of Gynaecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Matthias Dürst
- Department of Gynaecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynaecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Peter Hillemanns
- Clinics of Gynaecology and Obstetrics, Hannover Medical School, D-30625, Hannover, Germany
| | - Thilo Dörk
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany
| | - Dhanya Ramachandran
- Gynaecology Research Unit, Comprehensive Cancer Center, Hannover Medical School, D-30625, Hannover, Germany.
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2
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Ramachandran D, Dennis J, Fachal L, Schürmann P, Bousset K, Hülse F, Mao Q, Wang Y, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Runnebaum I, Hein A, Stübs F, Koch M, Ruebner M, Beckmann MW, Fasching PA, Luyten A, Dürst M, Hillemanns P, Easton DF, Dörk T. OUP accepted manuscript. Hum Mol Genet 2022; 31:2483-2497. [PMID: 35157032 PMCID: PMC9396939 DOI: 10.1093/hmg/ddac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Laura Fachal
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Kristine Bousset
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Ingo Runnebaum
- Department of Gynaecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena 07747, Germany
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Frederik Stübs
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Martin Koch
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Matthias Ruebner
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Matthias W Beckmann
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Peter A Fasching
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynaecology and Obstetrics, Mare Klinikum, Kronshagen, Germany
- Department of Gynaecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Matthias Dürst
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Thilo Dörk
- To whom correspondence should be addressed at: Gynaecology Research Unit (OE6411), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Tel: +49 5115326075; Fax: +49 5115326081;
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Denecke A, Iftner T, Iftner A, Riedle S, Ocak M, Luyten A, Üye I, Tunc K, Petry KU. Significant decline of HPV 6 infection and genital warts despite low HPV vaccination coverage in young women in Germany: a long-term prospective, cohort data analysis. BMC Infect Dis 2021; 21:634. [PMID: 34215215 PMCID: PMC8252220 DOI: 10.1186/s12879-021-06139-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of human papillomavirus (HPV) vaccination has resulted in a remarkable decline of genital warts in women and men, but in Germany historical rates of vaccination are relatively low. We report long-term surveillance data on changes in HPV 6 and HPV 11 infection and the prevalence of genital warts in young women in the Wolfsburg HPV epidemiological study (WOLVES). METHODS Women born in 1983/84, 1988/89, and 1993/94 participated in four cohorts between 2009/10 and 2014/15. Quadrivalent vaccination coverage and prevalence of HPV 6/11 infection and genital warts are reported for participants aged 19-22 years and 24-27 years at the time of sample collection. Statistical analyses were done to compare similarly aged participants using 2 × 2 contingency tables (Röhmel-Mansmann unconditional exact test; two-side alpha of 0.05). RESULTS A total of 2456 women were recruited. Between 2010 and 2015, there was a statistically significant decrease in the prevalence of HPV 6 infection among women aged 24-27 years (2.1% versus 0.0%; P < 0.0001) and women aged 19-22 years (2.0% versus 0.0%; P = 0.0056). There was no significant decline in HPV 11 infection. In total, 52 of 2341 participants were diagnosed with genital warts. There was a statistically significant drop in the risk of developing genital warts in women aged 24-27 years between 2010 and 2015 (4.7% versus 1.7%, respectively; P = 0.0018). The overall risk of developing genital warts in women aged 19-27 years decreased from 3.1% in 2010 to 1.2% in 2015 (P = 0.0022). CONCLUSIONS An increase in vaccination coverage was associated with a decreased prevalence of genital warts in young women. A protective effect greater than herd immunity alone was seen despite low vaccination rates. Quadrivalent vaccine had a protective effect on genital HPV 6 infection and an almost fully protective effect on the development of genital warts in the youngest population.
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Affiliation(s)
- Agnieszka Denecke
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany. .,Department of Obstetrics, Gynecology and Reproductive Medicine, Medical Hannover School, Hannover, Germany.
| | - Thomas Iftner
- Institute of Medical Virology, University of Tübingen, Tübingen, Germany
| | - Angelika Iftner
- Institute of Medical Virology, University of Tübingen, Tübingen, Germany
| | - Sebastian Riedle
- MD research, Statistics in clinical research, Pullach i, Isartal, Germany
| | - Marion Ocak
- MD research, Statistics in clinical research, Pullach i, Isartal, Germany
| | | | - Isak Üye
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Kübra Tunc
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Karl Ulrich Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
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4
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Ramachandran D, Wang Y, Schürmann P, Hülse F, Mao Q, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Runnebaum I, Hein A, Koch M, Ruebner M, Beckmann MW, Fasching PA, Luyten A, Dürst M, Hillemanns P, Dörk T. Association of genomic variants at PAX8 and PBX2 with cervical cancer risk. Int J Cancer 2021; 149:893-900. [PMID: 33905146 DOI: 10.1002/ijc.33614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
Cervical malignancy is triggered by human papillomavirus infection but the risk for cervical cancer has a hereditary component. From a recent Genome Wide Association Study meta-analysis, 2q14.1 (PAX8) and 6p21.32 (PBX2) have been proposed as novel cervical cancer susceptibility loci. We investigated the two main signals at these loci in an independent case-control series of 2578 cases with cervical dysplasia or carcinoma and 1483 healthy females. We find significant associations for both variants, rs10175462 at PAX8 and rs2856437 at PBX2, with overall cervical disease (rs10175462: odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74-0.91, P = 2.4 × 10-4 ; rs2856437: OR 1.52, 95% CI 1.14-2.02, P = .004). Both variants showed evidence of association with invasive squamous cervical cancer (rs10175462: OR 0.80, 95% CI 0.68-0.94, P = .006; rs2856437: OR 1.56, 95% CI 1.03-2.36, P = .036) and with high-grade dysplasia (rs10175462: OR 0.79, 95%CI 0.70-0.90, P = 1.9 × 10-4 ; rs2856437: OR 1.58, 95% CI 1.15-2.17, P = .005). A combined analysis of high-grade dysplasia and invasive cervical cancer also showed significant associations for both variants (rs10175462: OR 0.81, 95% CI 0.73-0.91, P = 2.4 × 10-4 ; rs2856437: OR 1.57, 95% CI 1.18-2.10, P = .002). No association was detected for rs2856437 with low-grade dysplasia, while rs10175462 showed weak evidence of association (P = .05). RNA analyses in cervical samples revealed that PAX8 transcripts were upregulated in HPV-positive lesions (P = .008) but this was not observed in the presence of the protective minor allele of rs10175462. The rs10175462 genotype also correlated with reduced levels of the lncRNA PAX8-AS1 (P < .001). Taken together, our results extend the evidence for a link between genomic risk variants at the HLA region (PBX2) with cervical disease and support PAX8 as the first consistent non-HLA cervical cancer susceptibility locus.
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Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Ingo Runnebaum
- Department of Gynecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Martin Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynecology and Obstetrics, Mare Klinikum, Kronshagen, Germany
- Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Matthias Dürst
- Department of Gynecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
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Woelber L, Bommert M, Prieske K, Fischer I, zu Eulenburg C, Vettorazzi E, Harter P, Jueckstock J, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann K, Beckmann M, Mustea A, Meier W, Wimberger P, Hanker L, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Mahner S, Schmalfeldt B, Jaeger A. Pelvic Lymphadenectomy in Vulvar Cancer - Does it make sense? Geburtshilfe Frauenheilkd 2020; 80:1221-1228. [PMID: 33293730 PMCID: PMC7714620 DOI: 10.1055/a-1120-0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/12/2020] [Indexed: 01/18/2023] Open
Abstract
Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 - 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 - 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 - 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inger Fischer
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
| | - Julia Jueckstock
- Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
| | - Felix Hilpert
- Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Niko de Gregorio
- Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany
| | - Severine Iborra
- Gynecology and Gynecologic Oncology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Sophie Fuerst
- Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
| | | | - Klaus Baumann
- Department of Gynecology, Medical Center Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, Bonn, Germany
| | - Werner Meier
- Department of Obstetrics and Gynecology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Lars Hanker
- Department of Gynecology and Gynecologic Oncology, University Medical Center Lübeck, Lübeck, Germany
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alexander Luyten
- Department of Gynecology and Obstetrics, Medical Center Wolfsburg, Wolfsburg, Germany
| | - Martin Hellriegel
- Department of Gynecology and Gynecologic Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Kosse
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany
| | - Christoph Heiss
- Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert, Göppingen, Germany
| | - Peer Hantschmann
- Department of Gynecology and Obstetrics, Medical Center Altötting, Altötting, Germany
| | - Peter Mallmann
- Department of Gynecology and Gynecologic Oncology, University Medical Center Köln, Köln, Germany
| | - Berno Tanner
- Department of Gynecology and Obstetrics, Medical Center Oranienburg, Oranienburg, Germany
| | | | - Sven Mahner
- Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Woelber L, Bommert M, Harter P, Prieske K, zu Eulenburg C, Jueckstock J, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann K, Thiel F, Mustea A, Meier W, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Mahner S, Jaeger A. Role of pelvic lymph node resection in vulvar cancer – a subset analysis of the AGO-CaRE-1 study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
| | | | | | - K Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
| | - C zu Eulenburg
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf
| | - J Jueckstock
- Department of Gynecology and Obstetrics, University of Munich
| | - F Hilpert
- Oncologic Medical Center at the Jerusalem Hospital Hamburg
| | - N de Gregorio
- Department of Obstetrics and Gynecology, University of Ulm Medical Center
| | - S Iborra
- Gynecology and Gynecologic Oncology, University Hospital Freiburg
| | - J Sehouli
- Department of Gynecology, Charité University Medicine Berlin, Campus Virchow
| | - A Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg
| | - P Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School
| | - S Fuerst
- Department of Gynecology and Obstetrics, University of Munich
| | - HG Strauss
- Department of Gynecology, University Hospital Halle
| | - K Baumann
- Department of Gynecology, Medical Center Ludwigshafen
| | - F Thiel
- Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert
| | - A Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn
| | - W Meier
- Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf
| | - P Wimberger
- Department of Gynecology and Gynecologic Oncology, Technical University Medical Center Dresden
| | - L Hanker
- Department of Gynecology and Gynecologic Oncology, University Medical Center Luebeck
| | - B Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
| | - U Canzler
- Department of Gynecology and Gynecologic Oncology, Technical University Medical Center Dresden
| | - T Fehm
- Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf
| | - A Luyten
- Department of Gynecology and Obstetrics, Medical Center Wolfsburg
| | - M Hellriegel
- Department of Gynecology and Gynecologic Oncology, University Medical Center Goettingen
| | - J Kosse
- Department of Gynecology and Obstetrics, Medical Center Offenbach
| | - C Heiss
- Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert
| | - P Hantschmann
- Department of Gynecology and Obstetrics, Medical Center Altoetting
| | - P Mallmann
- Department of Gynecology and Gynecologic Oncology, University Medical Center Koeln
| | - B Tanner
- Department of Gynecology and Obstetrics, Medical Center Oranienburg
| | - J Pfisterer
- Department of Gynecology and Gynecologic Oncology, University Medical Center Kiel
| | - S Mahner
- Department of Gynecology and Obstetrics, University of Munich
| | - A Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
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7
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Prieske K, Woelber L, Muallem M, Eulenburg C, Jückstock J, Hilpert F, de Gregorio N, Iborra S, Ignatov A, Hillemanns P, Fuerst S, Strauss H, Baumann K, Thiel F, Mustea A, Meier W, Harter P, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Sehouli J, Mahner S. The influence of age on treatment and prognosis of patients with squamous cell vulvar cancer (VSCC)- a subset analysis of the AGO-CaRE-1 study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- K Prieske
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - L Woelber
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - M.Z Muallem
- Charité, Campus Virchow Klinikum, Frauenklinik
| | - C Eulenburg
- Universitätklinikum Hamburg-Eppendorf, Institut für medizinische Biometrie und Epidemiologie
| | - J Jückstock
- Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern& Campus Innenstadt, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - F Hilpert
- Onkologisches Therapiezentrum am Jerusalem Krankenhaus
| | | | - S Iborra
- Uniklinik RWTH Aachen, Klinik für Gynäkologie und Geburtsmedizin
- Universitätsklinikum Freiburg, Universitäts- Frauenklinik
| | - A Ignatov
- Universitätsklinikum Magdeburg, Frauenklinik
| | | | - S.T Fuerst
- Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern& Campus Innenstadt, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - H.G Strauss
- Universitätsklinikum Martin-Luther-Universität Halle-Wittenberg
| | | | - F Thiel
- Alb Fils Kliniken, Klinik am Eichert, Frauenklinik
| | - A Mustea
- Universitätsklinikum Bonn, Klinik für Gynäkologie und Gynäkologische Onkologie
| | - W Meier
- Evangelisches Krankenhaus, Frauenklinik
| | - P Harter
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Klinik für Gynäkologie und gynäkologische Onkologie
| | - P Wimberger
- Technische Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - L Hanker
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Frauenheilkunde und Geburtshilfe
| | - B Schmalfeldt
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - U Canzler
- Technische Universität Dresden, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - T Fehm
- Universitätsklinikum Düsseldorf, Universitätsfrauenklinik
| | - A Luyten
- Klinikum Wolfsburg, Frauenklinik
- Dysplasie-Einheit an der Park-Klinik Kiel
| | - M Hellriegel
- Georg-August-Universitätsklinikum Göttingen, Universitäts-Frauenklinik
| | - J Kosse
- Sana Klinikum Offenbach, Frauenklinik
| | - C Heiss
- Alb Fils Kliniken, Klinik am Eichert, Frauenklinik
| | | | - P Mallmann
- Klinikum der Universität zu Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
| | - B Tanner
- Oberhavel Kliniken, Klinik Oranienburg, Frauenklinik
| | | | - J Sehouli
- Charité, Campus Virchow Klinikum, Frauenklinik
| | - S Mahner
- Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern& Campus Innenstadt, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe
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8
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Ramachandran D, Schürmann P, Mao Q, Wang Y, Bretschneider LM, Speith LM, Hülse F, Enßen J, Bousset K, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Tarbiat J, Runnebaum I, Dürst M, Hein A, Koch M, Ruebner M, Ekici A, Beckmann MW, Fasching PA, Luyten A, Petry KU, Hillemanns P, Dörk T. Association of genomic variants at the human leukocyte antigen locus with cervical cancer risk, HPV status and gene expression levels. Int J Cancer 2020; 147:2458-2468. [PMID: 32580243 DOI: 10.1002/ijc.33171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
The human leukocyte antigen (HLA) locus on chromosome 6 has been reported to be associated with cervical cancer. We investigated two independent single-nucleotide polymorphisms in a large case-control series of cervical dysplasia and carcinoma that has been newly established by the German Cervigen Consortium, comprising a total of 2481 cases and 1556 healthy females. We find significant associations for both variants, rs9272117 at HLA-DQA1 and rs2844511 at MICA and HCP5, with cervical disease. Both variants showed evidence of association with invasive cervical cancer (rs9272117: OR 0.89, 95% CI 0.79-0.99, P = .036; rs2844511: OR 1.17, 95% CI 1.04-1.31, P = .008) and with high-grade dysplasia (rs9272117: OR 0.78, 95% CI 0.70-0.87, P = 7.1 × 10-6 ; rs2844511: OR 1.13, 95% CI 1.01-1.26, P = .035), as well as in a combined analysis of both groups (rs9272117: OR 0.83, 95% CI 0.75-0.91, P = 6.9 × 10-5 ; rs2844511: OR 1.14, 95% CI 1.04-1.26, P = .005). Variant rs2844511, but not rs9272117, also showed modest evidence of association with low-grade dysplasia (OR 1.26, 95% CI 1.04-1.54, P = .019). In case-only analyses, rs2844511 tended to predict HPV status (P = .044) and rs9272117 tended to associate with HPV16 (P = .022). RNA studies in cervical samples showed a significant correlation in the transcript levels of MICA, HCP5 and HLA-DQA1, suggesting extensive co-regulation. All three genes were upregulated in HPV16-positive samples. In stratified analyses, rs9272117 was associated with HLA-DQA1 levels, specifically in HPV-positive samples, while rs2844511 was associated with MICA and HCP5 levels. The risk allele of rs2844511 was required for correlations between MICA or HCP5 with HLA-DQA1. Altogether, our results support 6p21.32-33 as the first consistent cervical cancer susceptibility locus and provide evidence for a link between genetic risk variants, HPV16 status and transcript levels of HLA-DQA1, HCP5 and MICA, which may contribute to tumor immune evasion.
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Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Bretschneider
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Speith
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Julia Enßen
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Kristine Bousset
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | | | - Ingo Runnebaum
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Dürst
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Martin Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arif Ekici
- Institute of Human Genetics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynecology and Obstetrics, Mare Klinikum, Kronshagen, Germany.,Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | | | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
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9
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Jueckstock J, Fuerst S, Bommert M, Harter P, Prieske K, Eulenburg C, Hilpert F, deGregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Jaeger A, Strauss HG, Baumann K, Thiel F, Mustea A, Meier W, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Woelber L, Mahner S. Bedeutung der pelvinen Lymphonodektomie beim Plattenepithelkarzinom der Vulva (VSCC) – Subgruppenanalyse der AGO-CaRE-1 Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Jueckstock
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München
| | - S Fuerst
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München
| | - M Bommert
- Klinik für Gynäkologie & Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - P Harter
- Klinik für Gynäkologie & Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - K Prieske
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - C Eulenburg
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - F Hilpert
- Onkologisches Kompetenzzentrum, Krankenhaus Jerusalem, Hamburg
| | - N deGregorio
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm
| | - S Iborra
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen
| | - J Sehouli
- Klinik für Gynäkologie, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin
| | - A Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Magdeburg
| | - P Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover
| | - A Jaeger
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H-G Strauss
- Universitätsklinik und Poliklinik für Gynäkologie, Halle
| | - K Baumann
- Frauenklinik am Klinikum Ludwigshafen
| | - F Thiel
- Frauenklinik mit Gynäkologie und Geburtshilfe, Alb Fils Kliniken, Klinik am Eichert, Göppingen
| | - A Mustea
- Zentrum für Geburtshilfe und Frauenheilkunde, Universitätsklinikum Bonn
| | - W Meier
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf
| | - P Wimberger
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Technische Universität Dresden
| | - L Hanker
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - B Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - U Canzler
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Technische Universität Dresden
| | - T Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf
| | - A Luyten
- Frauenklinik, Klinikum Wolfsburg
| | - M Hellriegel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen
| | - J Kosse
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach
| | - C Heiss
- Frauenklinik mit Gynäkologie und Geburtshilfe, Alb Fils Kliniken, Klinik am Eichert, Göppingen
| | - P Hantschmann
- Klinik für Gynäkologie und Geburtshilfe, Kreiskliniken Altötting-Burghausen, Altötting
| | - P Mallmann
- Klinik für Frauenheilkunde und Geburtshilfe, Uniklinik Köln
| | - B Tanner
- Klinik für Gynäkologie und Geburtshilfe, Oberhavel Klinik Oranienburg
| | | | - L Woelber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - S Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München
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10
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Klapdor R, Wölber L, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Jückstock J, Hilpert F, de Gregorio N, Hillemanns P, Fürst ST, Mahner S. Predictive factors for lymph node metastases in vulvar cancer. An analysis of the AGO-CaRE-1 multicenter study. Gynecol Oncol 2019; 154:565-570. [DOI: 10.1016/j.ygyno.2019.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/29/2022]
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11
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Horn J, Denecke A, Luyten A, Rothe B, Reinecke-Lüthge A, Mikolajczyk R, Petry KU. Reduction of cervical cancer incidence within a primary HPV screening pilot project (WOLPHSCREEN) in Wolfsburg, Germany. Br J Cancer 2019; 120:1015-1022. [PMID: 30988395 PMCID: PMC6734660 DOI: 10.1038/s41416-019-0453-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Randomised controlled trials showed human papillomavirus (HPV)-based screening leads to a significant reduction in cervical cancer incidence compared with cytology-based screening only. Methods Non-hysterectomised participants ≥30 years underwent co-testing with Papanicolaou (Pap) smear and HR-HPV testing (Hybrid Capture 2; HC2). Women with normal findings had their next screening round after 5 years, and HC2+ and Pap abnormal cases were immediately referred for colposcopy, while cases with discordant findings had repeat testing after 12 months with referral to colposcopy in cases with persistent positive findings. Results Twenty-six thousand six hundred and twenty-four women were recruited between February 2006 and December 2016. Two hundred and seventy-four CIN3+ cases were diagnosed (270 HPV+, 4 HPV−), including 31 invasive cervical cancers (29 HPV+, 2 HPV−). No CIN3+ was detected in HPV− women with abnormal cytology. We observed a significant decline in the 5-year incidence of CIN3+ (from 0.96% [95% CI 0.85–1.09%] to 0.16% [95% CI 0.10–0.25%]; p < 0.0001) and cervical cancer (from 0.10% [95% CI 0.07%–0.15%] to 0.025% [95% CI 0.01–0.08%]; p = 0.01) between the first and subsequent rounds. Approximately 90% (246/274) of CIN3+ cases were diagnosed at first colposcopy. Conclusions The decline in disease rates with 5-yearly co-testing seems mainly attributable to HPV testing since no CIN3+ occurred in HPV−/Pap+ women.
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Affiliation(s)
- Johannes Horn
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Agnieszka Denecke
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | - Beate Rothe
- Central Laboratory, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.,German Centre for Infection Research, Site Braunschweig-Hannover, Germany
| | - Karl Ulrich Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.
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12
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Petry KU, Horn J, Luyten A, Mikolajczyk RT. Punch biopsies shorten time to clearance of high-risk human papillomavirus infections of the uterine cervix. BMC Cancer 2018; 18:318. [PMID: 29566658 PMCID: PMC5865384 DOI: 10.1186/s12885-018-4225-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background The primary objective was to determine human papilloma virus (HPV) clearance rate after cervical biopsy among women with persistent high-risk HPV infection compared with spontaneous HPV clearance rate in the absence of biopsy. Methods We collected data from a dedicated screening program of women aged 30–70 years old. Inclusion criteria for the baseline non-interventional cohort were a positive HPV test (hybrid capture 2, HC2) and normal cytology. In the baseline cohort women were followed with approximately yearly HPV-tests and cytology until HPV regressed (one negative HPV test) or interventions in the form of diagnostic biopsies or therapy. Women who had a diagnostic biopsy were included in the biopsy cohort and followed until HPV regression or therapy. Observed HPV regression rates and time to HPV regression were compared between baseline and biopsy cohorts. For the comparison, we used Fisher’s exact test for the HPV regression rates and interval-censored, accelerated failure time model for time to HPV regression. Results Among the 1079 women included in the baseline cohort, 499 (46.3%) had HPV clearance and 475 were referred for colposcopy with biopsy. The biopsy cohort comprised all women who were not treated and had at least one HC2 test after biopsy (201/475; 42.3%). Of those, 138 (68.7%) experienced HPV regression. In the biopsy cohort, time to clearance of HPV infection was approximately halved (0.46, 95% CI 0.38–0.56) compared with the baseline cohort. This result was robust in a wide range of sensitivity analyses. Conclusions A higher proportion of women cleared their HPV infection, and time to HPV clearance was shorter in the biopsy cohort than in the baseline cohort. It is reassuring for clinicians to know that conservative management of patients with HPV persistency is successful when colposcopy with biopsies excludes high-grade disease.
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Affiliation(s)
- K U Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.
| | - J Horn
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - A Luyten
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - R T Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.,Hannover Medical School, Hannover, Germany.,German Centre for Infection Research/ Site Braunschweig-Hannover, Braunschweig, Germany
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13
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Petry KU, Liebrich C, Luyten A, Zander M, Iftner T. Surgical staging identified false HPV-negative cases in a large series of invasive cervical cancers. Papillomavirus Res 2017; 4:85-89. [PMID: 29179875 PMCID: PMC5883200 DOI: 10.1016/j.pvr.2017.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We examined a large series of biopsy-proven invasive cervical cancers with surgical staging and HPV re-testing to estimate the relevance of HPV-negative cervical cancers in a Caucasian population. METHODS We prospectively collected smears from 371 patients with a biopsy-proven diagnosis of cervical cancer for HC2 testing of high-risk HPV (HR-HPV). In HC2-negative cases, smears and paraffin embedded tissue blocks underwent additional HPV genotyping. RESULTS HC2 tests showed 31/371 cases (8.8%) had negative findings. Surgical staging showed that 21/31 HC2-negative cases (68%) were not cervical cancer. Overall, 340/350 cases of primary cervical cancer confirmed by surgical staging tested HC2 positive (97.2%). Non-high-risk HPV subtypes were detected in five cases (one HPV-53, one HPV-70, and three HPV-73) and high-risk subtypes in four patients with HC2-negative cervical cancer (two HPV 16 and two HPV-18). The remaining case, a primary undifferentiated carcinoma of the uterine cervix, tested negative for HPV-DNA with all tests. CONCLUSIONS The main explanation for HPV-negative cervical cancer was a false diagnosis, followed by cancers associated with non-HR-HPV types, and false-negative HR-HPV results. Truly HPV negative seem to be very rare in Caucasian populations. Retrospective analyses without surgical staging may overestimate the proportion of HPV negative cervical cancers.
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Affiliation(s)
- Karl Ulrich Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.
| | - Clemens Liebrich
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Alexander Luyten
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Martina Zander
- Institute of Pathology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Thomas Iftner
- Institute of Experimental Virology, University of Tübingen, Germany
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14
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Klapdor R, Hillemanns P, Wölber L, Jückstock J, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Habermann A, Fürst ST, Strauß HG, Baumann K, Thiel F, Mustea A, Meier W, Harter P, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Richter B, Jäger M, Mahner S. Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study. Ann Surg Oncol 2016; 24:1314-1321. [PMID: 27896515 DOI: 10.1245/s10434-016-5687-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Analyzing the large patient cohort of the multicenter AGO-CaRE-1 study, we compared isolated sentinel lymph node dissection (SLND) with radical lymph node dissection (LND) of the groin in relation to recurrence rates and survival. METHODS The AGO-CaRE-1 study retrospectively collected data on treatment patterns and follow-up of vulvar cancer patients [International Federation of Gynecology and Obstetrics (FIGO) stage ≥1B] treated at 29 gynecologic cancer centers between 1998 and 2008. This subgroup analysis evaluated the influence of SLND alone on progression-free survival (PFS) and overall survival (OS). RESULTS In 487 (63.1%) of 772 included patients with tumors smaller than 4 cm, an LND was performed and no metastatic lymph nodes were detected (LN0). Another 69/772 (8.9%) women underwent SLND alone, showing a negative SLN (SLN0). Tumors in the LN0 group were larger and showed a deeper invasion (LN0 vs. SLN0 tumor diameter: 20.0 vs. 13.0 mm, p < 0.001; depth of invasion: 4.0 vs. 3.0 mm, p = 0.002). After a median follow-up of 33 months (0-156), no significant differences in relation to isolated groin recurrence rates (SLN0 3.0% vs. LN0 3.4%, p = 0.845) were detected. Similarly, univariate 3-year PFS analysis showed no significant differences between both groups (SLN0 82.7% vs. LN0 77.6%, p = 0.230). A multivariate Cox regression analysis, including tumor diameter, depth of invasion, age, grading, and lymphovascular space invasion was performed: PFS [hazard ratio (HR) 0.970, 95% confidence interval (CI) 0.517-1.821] and OS (HR 0.695, 95% CI 0.261-1.849) did not differ significantly between both cohorts. CONCLUSION This subgroup analysis of the large AGO-CaRE-1 study showed similar results for groin LND and SLND alone with regard to recurrence rates and survival in node-negative patients with tumors <4 cm.
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Affiliation(s)
- Rüdiger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Linn Wölber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Jückstock
- Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
| | | | | | - Severine Iborra
- Department of Obstetrics and Gynecology, University Medical Center - RWTH, Aachen, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité - University Medicine Berlin, Berlin, Germany
| | - Anika Habermann
- Department of Gynecology, University of Magdeburg, Magdeburg, Germany
| | | | | | - Klaus Baumann
- Department of Gynecology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Falk Thiel
- Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany
| | - Alexander Mustea
- Department of Gynecology, University Medicine of Greifswald, Greifswald, Germany
| | - Werner Meier
- Department of Gynecology, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany
| | - Philipp Harter
- Department of Gynecology, Kliniken Essen Mitte, Essen, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Carl-Gustav-Carus University Dresden, Dresden, Germany
| | - Lars Hanker
- Department of Gynecology, UKSH Campus Lübeck, Lübeck, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, Carl-Gustav-Carus University Dresden, Dresden, Germany
| | - Tanja Fehm
- Department of Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany.,Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany
| | - Alexander Luyten
- Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Martin Hellriegel
- Department of Gynecology, Georg-August-University Goettingen, Goettingen, Germany
| | - Jens Kosse
- Department of Gynecology, SANA Hospital Offenbach, Offenbach, Germany
| | - Christoph Heiss
- Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany
| | - Peer Hantschmann
- Department of Gynecology, Hospital Altoettingen, Altoettignen, Germany
| | - Peter Mallmann
- Department of Gynecology, University Hospital Cologne, Cologne, Germany
| | | | | | | | - Martin Jäger
- Institute for Biometrics, Hannover Medical School, Hannover, Germany
| | - Sven Mahner
- Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
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Woelber L, Griebel LF, Eulenburg C, Sehouli J, Jueckstock J, Hilpert F, de Gregorio N, Hasenburg A, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann KH, Thiel FC, Mustea A, Meier W, Harter P, Wimberger P, Hanker LC, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Richter B, Neuser P, Mahner S. Role of tumour-free margin distance for loco-regional control in vulvar cancer-a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study. Eur J Cancer 2016; 69:180-188. [PMID: 27837710 DOI: 10.1016/j.ejca.2016.09.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY A tumour-free pathological resection margin of ≥8 mm is considered state-of-the-art. Available evidence is based on heterogeneous cohorts. This study was designed to clarify the relevance of the resection margin for loco-regional control in vulvar cancer. METHODS AGO-CaRE-1 is a large retrospective study. Patients (n = 1618) with vulvar cancer ≥ FIGO stage IB treated at 29 German gynecologic-cancer-centres 1998-2008 were included. This subgroup analysis focuses on solely surgically treated node-negative patients with complete tumour resection (n = 289). RESULTS Of the 289 analysed patients, 141 (48.8%) had pT1b, 140 (48.4%) pT2 and 8 (2.8%) pT3 tumours. One hundred twenty-five (43.3%) underwent complete vulvectomy, 127 (43.9%) partial vulvectomy and 37 (12.8%) radical local excision. The median minimal resection margin was 5 mm (1 mm-33 mm); all patients received groin staging, in 86.5% with full dissection. Median follow-up was 35.1 months. 46 (15.9%) patients developed recurrence, thereof 34 (11.8%) at the vulva, after a median of 18.3 months. Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm. When analysed as a continuous variable, the margin distance had no statistically significant impact on local recurrence (HR per mm increase: 0.930, 95% CI: 0.849-1.020; p = 0.125). Multivariate analyses did also not reveal a significant association between the margin and local recurrence neither when analysed as continuous variable nor categorically based on the 8 mm cutoff. Results were consistent when looking at disease-free-survival and time-to-recurrence at any site (HR per mm increase: 0.949, 95% CI: 0.864-1.041; p = 0.267). CONCLUSIONS The need for a minimal margin of 8 mm could not be confirmed in the large and homogeneous node-negative cohort of the AGO-CaRE database.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Lis-Femke Griebel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Eulenburg
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department for Epidemiology, Medical Statistics and Decision Making, University Medical Center Groningen, Groningen, The Netherlands
| | - Jalid Sehouli
- Department of Gynecology, Charité, University Medicine Berlin, Berlin, Germany
| | - Julia Jueckstock
- Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
| | - Felix Hilpert
- University Medical Center Kiel, Kiel, Germany; Jerusalem Hospital, Hamburg, Germany
| | | | - Annette Hasenburg
- Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Gynecology and Obstetrics, University Hospital Mainz, Mainz, Germany
| | - Atanas Ignatov
- Department of Gynecology, University of Magdeburg, Magdeburg, Germany
| | - Peter Hillemanns
- Department of Gynecology, Hannover Medical School, Hannover, Germany
| | - Sophie Fuerst
- Department of Gynecology, University of Munich (LMU), Munich, Germany
| | | | - Klaus H Baumann
- Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany; Department of Gynecology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany; Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany
| | - Alexander Mustea
- Department of Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - Werner Meier
- Department of Gynecology, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany
| | - Philipp Harter
- Department of Gynecology, Kliniken Essen Mitte, Essen, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - Lars Christian Hanker
- Department of Gynecology, University Hospital Frankfurt, Frankfurt, Germany; Department of Gynecology, UKSH Campus Lübeck, Lübeck, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology, University Hospital Technical University of Munich, Germany
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - Tanja Fehm
- Department of Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany; Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - Alexander Luyten
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Martin Hellriegel
- Department of Gynecology, Georg-August-University Goettingen, Goettingen, Germany
| | - Jens Kosse
- Department of Gynecology, Offenbach Hospital, Offenbach, Germany
| | - Christoph Heiss
- Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany
| | - Peer Hantschmann
- Department of Gynecology, Hospital Altoettingen, Altoettignen, Germany
| | - Peter Mallmann
- Department of Gynecology, University Hospital Cologne, Cologne, Germany
| | | | | | | | - Petra Neuser
- KKS Philipps University Marburg, Marburg; Germany
| | - Sven Mahner
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology and Obstetrics, University of Munich, Munich, Germany; Department of Gynecology, University of Munich (LMU), Munich, Germany
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Eulenburg C, Suling A, Neuser P, Reuss A, Canzler U, Fehm T, Luyten A, Hellriegel M, Woelber L, Mahner S. Propensity Scoring after Multiple Imputation in a Retrospective Study on Adjuvant Radiation Therapy in Lymph-Node Positive Vulvar Cancer. PLoS One 2016; 11:e0165705. [PMID: 27802342 PMCID: PMC5089685 DOI: 10.1371/journal.pone.0165705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/17/2016] [Indexed: 11/19/2022] Open
Abstract
Propensity scoring (PS) is an established tool to account for measured confounding in non-randomized studies. These methods are sensitive to missing values, which are a common problem in observational data. The combination of multiple imputation of missing values and different propensity scoring techniques is addressed in this work. For a sample of lymph node-positive vulvar cancer patients, we re-analyze associations between the application of radiotherapy and disease-related and non-related survival. Inverse-probability-of-treatment-weighting (IPTW) and PS stratification are applied after multiple imputation by chained equation (MICE). Methodological issues are described in detail. Interpretation of the results and methodological limitations are discussed.
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Affiliation(s)
- Christine Eulenburg
- Medical Statistics and Decision Making, Department for Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna Suling
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Neuser
- KKS Philipps University Marburg, Marburg, Germany
| | | | - Ulrich Canzler
- Dept. of Gynecology and Obstetrics, University of Dresden, Dresden, Germany
| | - Tanja Fehm
- Dept. of Gynecology University Medical Center Duesseldorf, Duesseldorf, Germany
- Dept. of Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Alexander Luyten
- Dept. of Gynecology, Obstetrics and Gynecologic Oncology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Martin Hellriegel
- Dept. of Gynecology, Georg-August-University Goettingen, Goettingen, Germany
| | - Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Mahner
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany
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Luyten A, Strehlke S, Weiß V, Iftner A, Iftner T, Petry KU. WOLVES – impact of HPV vaccination in Wolfsburg, Germany. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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18
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Luyten A, Mikolajczyk RT, Horn J, Petry KU. Accelerated regression rates of cervical high-risk human papillomavirus infections by punch biopsies of the uterine cervix. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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Luyten A, Strehlke S, Iftner A, Iftner T, Petry KU. HPV clearance and persistency in young women – five years follow of WOLVES- study. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Klapdor R, Wölber L, Jückstock J, Hillemanns P, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Habermann A, Fürst ST, Strauß HG, Baumann K, Thiel F, Mustea A, Meier W, Harter P, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Richter B, Jäger M, Mahner S. Sentinellymphonodektomie beim Vulvakarzinom: Eine Subgruppenanalye der AGO-CaRE-1 Multicenterstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Luyten A, Strehlke S, Rothe B, Petry KU. Comparison of Anyplex II HPV HR- and Hybrid Capture2 testing in a screening population (WOLPHSCREEN). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wölber L, Jückstock J, Neuser P, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Habermann A, Hillemanns P, Fürst S, Strauss HG, Baumann K, Thiel F, Mustea A, Meier W, Harter P, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellrigel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Richter B, Eulenburg C, Mahner S. Prognose nach isoliertem Lokalrezidiv beim Vulvakarzinom – eine Subgruppenanalyse der AGO-CaRE-1 Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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23
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zu Eulenburg C, Woelber LL, Baumann KH, Neuser P, Thiel F, Mustea A, Meier W, Harter P, Wimberger P, Hanker LC, Schmalfeldt B, Canzler U, Fehm TN, Luyten A, Hellriegel M, Reuss A, Suling A, Mahner S. The course of vulvar cancer: The utility of multistate models in the AGO-CaRE-1 study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Klaus H. Baumann
- Dept of Gynecology, Gynecologic Endocrinology and Oncology, University of Gießen and Marburg GmbH, Marburg, Marburg, Germany
| | - Petra Neuser
- Coordinating Center for Clinical Trials, Marburg, Germany
| | - Falk Thiel
- Alb Fils Kliniken, Klinik am Eichert, Göppingen, Germany
| | | | - Werner Meier
- Frauenklinik, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany
| | - Philipp Harter
- Dept Gynecology & Gyn.Oncology, Kliniken Essen Mitte, Essen, Germany
| | | | - Lars Christian Hanker
- Dept of Gynecology & Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Canzler
- Dept. of Gynecology and Obstetrics, University of Dresden, Dresden, Germany
| | | | | | | | | | - Anna Suling
- Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Mahner
- Department for Gynecology, University of Munich, Munich, Germany
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Luyten A, Bettens K, D'haeseleer E, Hodges A, Galiwango G, Vermeersch H, Van Lierde K. Short-term effect of short, intensive speech therapy on articulation and resonance in Ugandan patients with cleft (lip and) palate. J Commun Disord 2016; 61:71-82. [PMID: 27060419 DOI: 10.1016/j.jcomdis.2016.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 11/24/2015] [Accepted: 03/26/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of the current study was to assess the short-term effectiveness of short and intensive speech therapy provided to patients with cleft (lip and) palate (C(L)P) in terms of articulation and resonance. METHODS Five Ugandan patients (age: 7.3-19.6 years) with non-syndromic C(L)P received six hours of individualized speech therapy in three to four days. Speech therapy focused on correct phonetic placement and contrasts between oral and nasal airflow and resonance. Speech evaluations performed before and immediately after speech therapy, including perceptual and instrumental assessment techniques, were compared. RESULTS Post-therapy, improvement of speech was noted for most of the patients, although to varying degrees. Clinically relevant progress of objective nasalance values and/or articulation was obtained in four patients. Overall, two patients showed normal speech intelligibility, while three patients required additional speech therapy. CONCLUSION These preliminary short-term results demonstrate that short and intensive speech therapy can be effective for patients with C(L)P in countries with limited access to speech-language therapy. However, further research is needed on the long-term effectiveness and the advantages of applying this treatment protocol in countries with good access to speech therapy. LEARNING OUTCOMES The reader will be able to (1) list the challenges in resource poor-countries to achieve access to speech-language therapy services, (2) describe when the application of speech therapy is appropriate in patients with C(L)P, (3) describe the speech therapy that can be applied to reduce compensatory articulation and resonance disorders in patients with C(L)P, and (4) list the (possible) advantages of short, intensive speech therapy for both resource-poor and developed countries.
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Affiliation(s)
- A Luyten
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - K Bettens
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - E D'haeseleer
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - A Hodges
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda.
| | - G Galiwango
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda.
| | - H Vermeersch
- Ghent University, Department of Head and Neck Surgery, De Pintelaan 185 2P2, 9000 Gent, Belgium.
| | - K Van Lierde
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
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Luyten A, Petry KU. Relevance of HPV Screening for Triaging Equivocal Cytology Findings in the Pap II-p, Pap III and Pap IIID Groups - Results of Two Long-Term Studies. Geburtshilfe Frauenheilkd 2015; 75:1058-1062. [PMID: 26556908 DOI: 10.1055/s-0035-1557841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction: The use of HPV screening for the triage of ASC-US (atypical squamous cells of undetermined significance) cytology results has been established as a sound standard by international trials whereas the data for other cytology findings are in part contradictory. There is a lack of long-term studies on the use of HPV triage in Germany. Materials and Methods: For the present study data from a primary HPV screening project involving women aged over 30 years, ongoing since 2006, and an epidemiological study on women aged between 20 and 27 years, ongoing since 2009, were used. Upon recruitment, all women underwent a smear test for cytology and screening for "high-risk" HPV using Hybrid Capture 2 (HC2). If both tests were positive or if there were persisting remarkable cytology findings or a positive HPV test, then clarification by colposcopy was performed. Results: Altogether, among 282 women with Pap II-p (ASC-US), Pap III (ASC-H) or Pap IIID (LSIL + CIN2) and negative HPV test there was no case of CIN3+. Among the women under 30 years of age, however, 69 % (ASC-US) to 85 % (LSIL + CIN2) of the remarkable findings were HPV positive, also among the older women with Pap IIID, the 71 % prevalence of HPV was too high for a triage and even without triage there was a 23 % risk for CIN3+. On the other hand, of the women over 30 years old with ASC-US (Pap II-p) findings, only 21 % were positive for HPV and the risk for CIN3+ in this group was high at 29 %. Also for ASC-H (Pap III) findings in the age group of over 30 years with an HPV prevalence of 56 % there was an efficient triage for CIN3+. Discussion: In summary, the HPV triage of ASC-US (Pap II-p) findings in women aged over 30 years was found to be efficient; in contrast, LSIL + CIN2 (Pap IIID) findings in this age group justified an immediate referral to colposcopy whereas cytology control appeared to be sufficient for younger women.
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Affiliation(s)
- A Luyten
- Frauenklinik im Klinikum Wolfsburg, Wolfsburg
| | - K U Petry
- Frauenklinik im Klinikum Wolfsburg, Wolfsburg
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Luyten A, Hagemann I, Scherbring S, Boehmer G, Gieseking F, Woelber L, Glasenapp F, Hampl M, Kuehler-Obbarius C, van den Bergh M, Leeson S, Redman C, Petry KU. Utility of EFC quality indicators for colposcopy in daily practice: results from an independent, prospective multicenter trial. Eur J Obstet Gynecol Reprod Biol 2015; 191:43-7. [DOI: 10.1016/j.ejogrb.2015.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/26/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Buttmann-Schweiger N, Klug SJ, Luyten A, Holleczek B, Heitz F, du Bois A, Kraywinkel K. Incidence patterns and temporal trends of invasive nonmelanotic vulvar tumors in Germany 1999-2011. A population-based cancer registry analysis. PLoS One 2015; 10:e0128073. [PMID: 26020540 PMCID: PMC4447423 DOI: 10.1371/journal.pone.0128073] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 04/23/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Time trends on the incidence and characteristics of invasive vulvar cancer in Germany have so far been studied in few local population- and hospital based tumor registries. We aimed to provide an overview on recent developments of vulvar cancer in Germany, using population-based cancer registry data. METHODS We analyzed the data on vulvar cancer of eight population-based German cancer registries for the period 1999-2011. ICD-10 codes and ICD-O-3 morphology codes were used to select site and histologic types. The annual percentage change was calculated on age-adjusted incidence rates with a joinpoint regression model. RESULTS A total of 12,711 registered cases of invasive carcinoma of the vulva were included in the analyses, hereof were 12,205 of squamous cell origin. Age-standardized incidence rates of vulvar cancer annually increased by 6.7% (95% confidence limits: 5.6-7.9) from 1.7 per 100,000 women in 1999 to 3.6 per 100,000 women in 2011. An increase was observed among women of all ages, and especially between 30 and 69 years of age. CONCLUSION The annual incidence of invasive carcinoma of the vulva nearly doubled in the past decade in Germany, considerably exceeding the rates observed in other Western European countries. A combination of changes in risk factors, and documentation practice might have contributed to the observed substantial increase in vulvar cancer incidence.
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Affiliation(s)
- Nina Buttmann-Schweiger
- Robert Koch-Institute, Department of Epidemiology and Health Monitoring, German Centre for Cancer Registry Data, Berlin, Germany
- Cancer Epidemiology, University Cancer Centre Dresden, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefanie J. Klug
- Cancer Epidemiology, University Cancer Centre Dresden, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander Luyten
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
| | - Klaus Kraywinkel
- Robert Koch-Institute, Department of Epidemiology and Health Monitoring, German Centre for Cancer Registry Data, Berlin, Germany
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Van Lierde KM, Luyten A, D'haeseleer E, Van Maele G, Becue L, Fonteyne E, Corthals P, De Pauw G. Articulation and oromyofunctional behavior in children seeking orthodontic treatment. Oral Dis 2015; 21:483-92. [PMID: 25537125 DOI: 10.1111/odi.12307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/26/2014] [Accepted: 12/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- KM Van Lierde
- Department of Speech, Language and Hearing Sciences; Ghent University; Gent Belgium
| | - A Luyten
- Department of Speech, Language and Hearing Sciences; Ghent University; Gent Belgium
| | - E D'haeseleer
- Department of Speech, Language and Hearing Sciences; Ghent University; Gent Belgium
| | - G Van Maele
- Department of Biostatistics; Ghent University; Gent Belgium
| | - L Becue
- Department of Speech, Language and Hearing Sciences; Ghent University; Gent Belgium
| | - E Fonteyne
- Department of Speech, Language and Hearing Sciences; Ghent University; Gent Belgium
| | - P Corthals
- Department of Speech, Language and Hearing Sciences; University College Ghent; Ghent University & Faculty of Education, Health and Social Work; Gent Belgium
| | - G De Pauw
- Department of Orthodontics; Ghent University; Gent Belgium
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Luyten A, Luyten K, Strehlke S, Mauritz C, Pietralla M, Ulrich Petry K. Prävention / Onkologie. Primäres HPV-Screening in Deutschland – Langzeitergebnisse des Wolfsburger Pilotprojekts. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1382984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Luyten A, Strehlke S, Luyten K, Iftner A, Iftner T, Petry KU. WOLVES – Genotypenspezifisches Modell der HPV-Clearance und -Persistenz bei jungen Frauen in Wolfsburg. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Luyten A, Hastor H, Luyten K, Petry KU. Detektionen nicht-zervikaler Dysplasien und Karzinome im Rahmen eines primären HPV Screenings. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Woelber L, Kosse J, Heiss C, Neuser P, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Richter B, Jückstock J, Hilpert F, De Gregorio N, Iborra S, Sehouli J, Habermann A, Hillemanns P, Fürst S, Strauss HG, Baumann K, Thiel F, Mustea A, Meier W, Harter P, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Mahner S. Lokaler Resektionsrand und Rezidivrisiko beim Plattenepithelkarzinom der Vulva – Ergebnisse einer Subgruppenanalyse der multizentrischen AGO CaRE-1 Studie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Luyten A, Luyten K, Strehlke S, Petry KU. WOLPHSCREEN – Klinischer Verlauf neu erworbener HPV-Infektionen bei Frauen ab 35 Jahren. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Woelber LL, Sehouli J, Habermann A, Hillemanns P, Neuser P, Fuerst S, Strauss HG, Baumann KH, Thiel FC, Mustea A, Meier W, Harter P, Wimberger P, Hanker LC, Schmalfeldt B, Canzler U, Fehm TN, Luyten A, Hellriegel M, Mahner S. Resection margin and locoregional control in vulvar cancer: A subset analysis of the AGO CARE-1 multicenter study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jalid Sehouli
- European Competence Center for Ovarian Cancer, Charité Medical University, Berlin, Germany
| | | | | | - Petra Neuser
- Koordinierungszentrum für Klinische Studien der Philipps-Universität Marburg, Marburg, Germany
| | - Sophie Fuerst
- Universitätsfrauenklinik Muenchen - Grosshadern, München, Germany
| | | | | | | | - Alexander Mustea
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Greifswald, Germany
| | | | | | | | | | - Barbara Schmalfeldt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Muenchen, Germany, Muenchen, Germany
| | | | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | | | | | - Sven Mahner
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hillemanns P, Petry KU, Soergel P, Collinet P, Ardaens K, Gallwas J, Luyten A, Dannecker C. Efficacy and safety of hexaminolevulinate photodynamic therapy in patients with low-grade cervical intraepithelial neoplasia. Lasers Surg Med 2014; 46:456-61. [PMID: 24799181 DOI: 10.1002/lsm.22255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Non-surgical therapies are needed to reduce the rate of progression of low-grade cervical intraepithelial neoplasia (CIN 1) to high grade CIN (CIN 2/3). The aim of this study was to assess the efficacy and safety of hexaminolevulinate (HAL) photodynamic therapy (PDT) in the treatment of patients with CIN 1. STUDY DESIGN This phase IIa prospective double-blind study randomized patients with CIN 1 into three groups: HAL vaginal suppository, placebo vaginal suppository or follow-up only. Patients in the first two groups received HAL or placebo suppositories 5 hours before illumination with 50 J/cm(2) red coherent light (633 nm) using a special light catheter. All patients had a follow up including colposcopy, cytology and human papilloma virus (HPV) testing 3 and 6 months and additional biopsy 6 months after PDT. The main outcome measure was efficacy, defined as complete histologic remission 6 months after PDT. Secondary outcomes were histologic remission 3 months and HPV eradication 6 months after first PDT. RESULTS Seventy patients were randomized: 47 to HAL, 12 to placebo, 11 to follow up only. After 6 months CIN lesions had cleared in 57% of patients in the HAL-PDT group compared to 25% in the combined control group (per protocol population, P = 0.04). Twenty-six patients (37%) reported 44 adverse events (AEs), of which 40 were mild or moderate. Nineteen treatment-related AEs were reported by 15 patients (32%) in the HAL PDT group, one in the placebo PDT group (8%), and none in the follow-up group. The most common adverse events were local discomfort including mild pain/cramping (11) and leucorrhoea (2). CONCLUSION HAL PDT shows a favorable efficacy and safety profile and represents a promising alternative to observation and surgical procedures in patients with CIN 1.
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Affiliation(s)
- Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
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Luyten A, Sörgel P, Clad A, Gieseking F, Maass-Poppenhusen K, Lellé RJ, Harter P, Buttmann N, Petry KU. Treatment of extramammary Paget disease of the vulva with imiquimod: A retrospective, multicenter study by the German Colposcopy Network. J Am Acad Dermatol 2014; 70:644-650. [DOI: 10.1016/j.jaad.2013.12.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/28/2013] [Accepted: 12/03/2013] [Indexed: 01/09/2023]
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Luyten A, Buttmann-Schweiger N, Luyten K, Mauritz C, Reinecke-Lüthge A, Pietralla M, Meijer CJLM, Petry KU. Early detection of CIN3 and cervical cancer during long-term follow-up using HPV/Pap smear co-testing and risk-adapted follow-up in a locally organised screening programme. Int J Cancer 2014; 135:1408-16. [PMID: 24519782 DOI: 10.1002/ijc.28783] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/08/2014] [Indexed: 11/07/2022]
Abstract
We evaluated compliance with human papillomavirus (HPV) testing and risk-adapted patient pathways and monitored changes in high-grade cervical disease during long-term follow-up. Women aged >30 years attending routine screening for cervical cancer were managed according to results from first-round screening tests (cytology and high-risk HPV; Hybrid Capture 2). Between February 2006 and January 2011, 19,795 of 19,947 women agreed to participate, of whom 4,067 proceeded to a second screening round 5 years after recruitment. Predefined endpoints were compliance, grade 3 cervical intraepithelial neoplasia or cancer (CIN3+), new HPV infection, HPV persistence and abnormal smears in round 2. A total of 765 of 19,795 women (3.9%) in round 1 and 41 of 4,067 (1.0%) in round 2 were referred for colposcopy. Compliance rates with colposcopy were 93.1 and 92.7%, respectively, while histological assessment was performed in 680 of 712 (95.5%) and 36 of 38 (94.7%), respectively. CIN3+ rates were 172 of 19,795 (0.87%; 95% confidence intervals: 0.7-1.0) in round 1 and 2 of 4,064 (0.05%; 95% confidence intervals: 0.006-0.2) in round 2; the difference was statistically significant (Fisher's exact test, p<0.001). After 5 years, the incidence of new HPV infection was 124 of 3,906 (3.2%) and HPV persistence was observed in 22 of 161 (13.7%). Locally organised HPV/cytology co-testing is feasible and acceptable to women. Risk-adapted management rapidly detected a high rate of prevalent CIN3+, while the subsequent long-term risk of new high-grade cervical disease was surprisingly low. It remains unclear if this phenomenon is explained by CIN3 mostly occurring early in life or by modifying the natural course of HPV infection with colposcopy and histological assessment.
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Affiliation(s)
- Alexander Luyten
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Germany
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Petry KU, Rinnau F, Böhmer G, Hollwitz B, Luyten A, Buttmann N, Brünger M, Iftner T. Annual Papanicolaou screening for 5 years among human papillomavirus-negative women. BMC Cancer 2013; 13:379. [PMID: 23937771 PMCID: PMC3751119 DOI: 10.1186/1471-2407-13-379] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/01/2013] [Indexed: 11/17/2022] Open
Abstract
Background Primary human papilloma virus (HPV) screening is more effective than cytology in reducing the risk of cervical cancer, but screening intervals should be extended in HPV-negative women. However, some Markov models predicted that long intervals are associated with an excess risk of cervical cancer. The aim of this analysis was to estimate the real-life risks and benefits of annual Papanicolaou (Pap) screening in HPV-negative women with normal cytology. Methods Women with negative Hybrid Capture 2 (HC2) results and normal cytology at the time of inclusion in the Hannover HPV screening trial underwent annual Pap smears for 5 years. A subgroup was randomly selected for retesting with cytology, HC2, and colposcopy 60–68 months after recruitment. Results Of 4236 women included, 3406 had at least one Pap smear, but only 1185 attended all five annual screening visits. The proportion of women with at least one abnormal smear was 14.4% in 60 months. The probability of abnormal smears increased continuously over time. No case of ≥ CIN2+ was observed during 5 years. Of 605 women selected for subgroup analysis, 292 agreed to be retested (48.3%). The rate of high-risk HPV at 60–68 months was 3.0% (9/296). Conclusions The long-term risk of high-grade neoplasia after an initial negative HC2 test and normal cytology result was low, while the rate of false-positive abnormal Pap smears was significant and increased constantly over time. Pap smear screening of HPV-negative women more frequently than every 5 years could be potentially harmful and seems to be of little clinical value.
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Affiliation(s)
- Karl Ulrich Petry
- Zentrum für Frauenheilkunde, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Street 1, 30625 Hannover, Germany.
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Petry KU, Luyten A, Justus A, Iftner A, Strehlke S, Reinecke-Lüthge A, Grunwald E, Schulze-Rath R, Iftner T. Prevalence of high-risk HPV types and associated genital diseases in women born in 1988/89 or 1983/84--results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany. BMC Infect Dis 2013; 13:135. [PMID: 23497108 PMCID: PMC3623770 DOI: 10.1186/1471-2334-13-135] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-risk human papilloma virus (HR-HPV) infection is associated with the development of cervical cancer. HPV vaccination reduces the risk of developing malignant lesions and is expected to change the dynamics of HPV transmission. Data from non-vaccinated women may provide an important benchmark to allow the impact of HPV vaccination programs to be assessed.This study was designed to prospectively determine the changing dynamics of HR-HPV infection and associated genital diseases in young women, most of whom were non-vaccinated. METHODS Data from a population-based cohort study, comprising women of two predefined birth cohorts (women born in 1983/84 or 1988/89), were analyzed between 19 October 2009 and 31 December 2010 to determine risk factors for high-risk HPV infection and the association between specific HR-HPV types and atypical Pap smear test results. HPV status was determined by Hybrid Capture 2 (HC2) assay and genotyping. RESULTS The prevalence of HR-HPV was 22.8% in the 1983/84 cohort (150/659) and 23.7% in the 1988/99 cohort (142/599). Only the number of sexual partners was a significant risk factor for HPV infection (odds ratios 22.687 and 6.124 for more than five versus one partner 84 cohort,/84 and 1988/89 cohorts, respectively) in multivariate analysis. HPV16 positive-women were significantly more likely to have abnormal Pap smears of any degree than HPV16-negative women (22.0% versus 3.61%, p < 0.0001 for the 1983/84 cohort and 9.09% versus 2.52%, p = 0.0482 for the 1988/89 cohort). CIN3 was diagnosed in six women 84 cohort,/84 cohort and two in the 1988/89 cohort. All women with CIN3 tested positive for HC2-HR and all six CIN3 cases 84 cohort,/84 cohort tested positive for HPV16. In the 1988/89 cohort, the rate of HPV16 infection was significantly lower in vaccinated than non-vaccinated women (1.59% versus 8.88%; p = 0.003). CONCLUSIONS HR-HPV infection was highly prevalent in both cohorts and associated with an increased risk of abnormal Pap smears and biopsy proven CIN2+. HPV16 infection was associated with a high risk of clinically relevant lesions. HPV vaccination significantly decreased the risk of HPV16 infection.
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Affiliation(s)
- Karl Ulrich Petry
- Klinikum Wolfsburg, Frauenklinik, Schwerpunkt gynäkologische Onkologie, Sauerbruchstr.7, Wolfsburg 38440, Germany.
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Petry KU, Luyten A, Justus A, Iftner A, Strehlke S, Schulze-Rath R, Iftner T. Prevalence of low-risk HPV types and genital warts in women born 1988/89 or 1983/84 -results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany. BMC Infect Dis 2012; 12:367. [PMID: 23259726 PMCID: PMC3536688 DOI: 10.1186/1471-2334-12-367] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wolfsburg HPV Epidemiological Study (WOLVES) is a population-based cohort study on HPV infections and associated diseases in the pre-vaccination era in young women in Wolfsburg, Germany. METHODS Women born 1983/84 or 1988/89 were invited to participate. Participants were recruited in gynecology practices, and completed a questionnaire with socioeconomic, sexual and medical data including vaccination status. Pelvic examination with Pap smear and HPV testing (HC2 = Hybrid Capture 2) was obligatory. HC2-positive and 10% of HC2-negative samples were tested for specific HPV types with SPF-10-PCR, and in inconclusive cases with DNA sequencing. Women with genital warts (GW) and those with atypical Pap smears were transferred for colposcopy. GWs were classified as typical condylomata acuminata (TCA), flat condyloma (FC) and seborrheic wart-like (SWL). RESULTS In total, 1258 subjects were recruited from the target population of 2850 (44.1%). Overall the prevalence of HC2 low-risk (LR) types was 8.5%. HPV6 was the most frequent LR type (2.1%), followed by HPV42 (1.1%), HPV11 and HPV44 (each 0.4%). LiPA showed a low sensitivity for HPV types 42, 90 and 91, which were detected only by HC2 and HPV sequencing. Nine women (0.7%) were transferred with incident GW: five TCA, two FC and two SWL. All TCA were associated with HPV6 in corresponding cervical swabs and warts. Tissues of SWL contained HPV6 (n = 1) and HPV16 (n = 1). The cumulative life-risk for GW was 1.4% in the 1988/89 and 4.8% in the 1983/84 cohort. Eight of 107 HC2-LR + and five of nine cases of GW had concomitant abnormal Pap smears. All CIN lesions could be linked to high-risk HPV types but borderline and low-grade abnormal smears were explained by vaginal and cervical TCA in four cases. CONCLUSIONS HC2 was a specific test for the detection of established and potential LR types. In this first WOLVES analysis, HPV6 was the most frequent HPV type and the single LR type linked to disease. The observed GW incidence of 715 per 100,000 fits well with estimates of healthcare providers. Although life risks for GW were lower than in Scandinavian analyses, the societal burden within the WOLVES populations was considerable.
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Affiliation(s)
- Karl Ulrich Petry
- Klinikum Wolfsburg, Frauenklinik, Schwerpunkt gynäkologische Onkologie, Sauerbruchstr, 7, 38440, Wolfsburg, Germany.
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Lambaerts K, Van Dyck S, Mortier E, Ivarsson Y, Degeest G, Luyten A, Vermeiren E, Peers B, David G, Zimmermann P. Syntenin, a syndecan adaptor and an Arf6 phosphatidylinositol 4,5-bisphosphate effector, is essential for epiboly and gastrulation cell movements in zebrafish. Development 2012. [DOI: 10.1242/dev.082610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Luyten A, Dhaeseleer E, Hodges A, Galiwango G, Budolfsen T, Vermeersch H, Van Lierde K. Normative Nasalance Data in Ugandan English-Speaking Children. Folia Phoniatr Logop 2012; 64:131-6. [DOI: 10.1159/000338235] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Van Lierde K, Galiwango G, Hodges A, Bettens K, Luyten A, Vermeersch H. Impact of tongue reduction on overall speech intelligibility, articulation and oromyofunctional behavior in 4 children with Beckwith-Wiedemann syndrome. Folia Phoniatr Logop 2011; 64:55-63. [PMID: 22095257 DOI: 10.1159/000329569] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the impact of partial glossectomy (using the keyhole technique) on speech intelligibility, articulation, resonance and oromyofunctional behavior. PATIENTS AND METHODS A partial glossectomy was performed in 4 children with Beckwith- Wiedemann syndrome between the ages of 0.5 and 3.1 years. An ENT assessment, a phonetic inventory, a phonemic and phonological analysis and a consensus perceptual evaluation of speech intelligibility, resonance and oromyofunctional behavior were performed. RESULTS It was not possible in this study to separate the effects of the surgery from the typical developmental progress of speech sound mastery. Improved speech intelligibility, a more complete phonetic inventory, an increase in phonological skills, normal resonance and increased motor-oriented oral behavior were found in the postsurgical condition. The presence of phonetic distortions, lip incompetence and interdental tongue position were still present in the postsurgical condition. CONCLUSION Speech therapy should be focused on correct phonetic placement and a motor-oriented approach to increase lip competence, and on functional tongue exercises and tongue lifting during the production of alveolars. Detailed analyses in a larger number of subjects with and without Beckwith-Wiedemann syndrome may help further illustrate the long-term impact of partial glossectomy.
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Affiliation(s)
- K Van Lierde
- Department of ENT, Head and Neck Surgery and Logopaedics, University Hospital Gent, Gent , Belgium.
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Petry KU, Schmidt D, Scherbring S, Luyten A, Reinecke-Lüthge A, Bergeron C, Kommoss F, Löning T, Ordi J, Regauer S, Ridder R. Triaging Pap cytology negative, HPV positive cervical cancer screening results with p16/Ki-67 Dual-stained cytology. Gynecol Oncol 2011; 121:505-9. [DOI: 10.1016/j.ygyno.2011.02.033] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 02/09/2011] [Accepted: 02/23/2011] [Indexed: 11/29/2022]
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Laksana A, Luyten A, Sogari A, Pietralla M, Petry K. Onkologie. Das Wolfsburger Pilotprojekt zur Risiko-adaptierten Prävention des Zervixkarzinoms. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0030-1271169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Luyten A, Scherbring S, Petry K. Onkologie. Patientinnen befürworten die Durchführung der Schlingenkonisation in Lokalanästhesie zur Behandlung von CIN2/3. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0030-1270879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Van Lierde K, Luyten A, Van Borsel J, Baudonck N, Debusschere T, Vermeersch H, Bonte K. Speech intelligibility of children with unilateral cleft lip and palate (Dutch cleft) following a one-stage Wardill–Kilner palatoplasty, as judged by their parents. Int J Oral Maxillofac Surg 2010; 39:641-6. [DOI: 10.1016/j.ijom.2010.02.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 07/03/2009] [Accepted: 02/01/2010] [Indexed: 11/16/2022]
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48
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Luyten A, Scherbring S, Reinecke-Lüthge A, Braun BE, Pietralla M, Theiler K, Petry KU. Risk-adapted primary HPV cervical cancer screening project in Wolfsburg, Germany – Experience over 3 years. J Clin Virol 2009; 46 Suppl 3:S5-10. [DOI: 10.1016/s1386-6532(09)70294-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Luyten A, Theiler KG, Pietralla M, Braun BE, Reinecke-Lüthge A, Petry K. Risikoadaptierte Prävention des Zervixkarzinoms. Das Wolfsburger Vorsorge-Projekt nach 18 Monaten. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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50
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Luyten A, Brummer O, Kühnle H, Kreipe H, Reinecke-Lüthge A, Petry K. Neue Optionen bei der Therapie des Morbus Paget der Vulva. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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