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Bizzarri N, Imterat M, Fruscio R, Giannarelli D, Perrone AM, Mancari R, Traut A, Rosati A, du Bois A, Ferrari D, De Iaco P, Ergasti R, Ataseven B, Bianchi T, Di Stanislao M, Perri MT, Heitz F, Concin N, Fanfani F, Vizza E, Scambia G, Harter P, Fagotti A. Lymph node staging in grade 1-2 endometrioid ovarian carcinoma apparently confined to the ovary: Is it worth? Eur J Cancer 2023; 195:113398. [PMID: 37890354 DOI: 10.1016/j.ejca.2023.113398] [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: 06/29/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE The aim of this study was to assess the disease-free survival (DFS) and overall survival (OS) of patients with grade 1-2 endometrioid ovarian carcinoma apparently confined to the ovary, according to surgical staging. METHODS Multicenter, retrospective, observational cohort study. Patients with endometrioid ovarian carcinoma, surgical procedure performed between May 1985 and December 2019, stage pT1 N0/N1/Nx, grade 1-2 were included. Patients were stratified according to lymphadenectomy (defined as removal of any lymph node versus no lymph node assessment), and subgroup analyses according to tumor grade were performed. Kaplan-Meier curves and cox regression analyses were used to perform survival analyses. RESULTS 298 patients were included. 199 (66.8 %) patients underwent lymph node assessment. Of these, 166 (83.4 %) had unilateral/bilateral pelvic and para-aortic/caval lymphadenectomy. Eleven (5.5 %) patients of those who underwent lymph node assessment showed pathologic metastatic lymph nodes (FIGO stage IIIA1). Twenty-seven patients (9.1 %) had synchronous endometrioid endometrial cancer. After a median follow up of 45 months (95 %CI:37.5-52.5), 5-year DFS and OS of the entire cohort were 89.8 % and 96.2 %, respectively. Age ≤ 51 years (HR=0.24, 95 %CI:0.06-0.91; p = 0.036) and performance of lymphadenectomy (HR=0.25, 95 %CI: 0.07-0.82; p = 0.022) represented independent protective factors toward risk of death. Patients undergoing lymphadenectomy had better 5-year DFS and OS compared to those not receiving lymphadenectomy, 92.0 % versus 85.6 % (p = 0.016) and 97.7 % versus 92.8 % (p = 0.013), respectively. This result was confirmed after exclusion of node-positive patients. When stratifying according to tumor grade (node-positive excluded), patients with grade 2 who underwent lymphadenectomy had better 5-year DFS and OS than those without lymphadenectomy (93.0 % versus 83.1 %, p = 0.040 % and 96.5 % versus 90.6 %, p = 0.037, respectively). CONCLUSION Staging lymphadenectomy in grade 2 endometrioid ovarian carcinoma patients was associated with improved DFS and OS. Grade 1 and grade 2 might be considered as two different entities, which could benefit from different approach in terms of surgical staging. Prospective studies, including molecular profiles are needed to confirm the survival drivers in this rare setting.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Majdi Imterat
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynaecologic Oncology, Hadassah Medical Centers, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Robert Fruscio
- Fondazione IRCCS San Gerardo dei Tintori, UOC Ginecologia, Università di Milano-Bicocca, Milano, Italy
| | - Diana Giannarelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Facility of Epidemiology and Biostatistics, Rome, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rosanna Mancari
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andrea Rosati
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Debora Ferrari
- Fondazione IRCCS San Gerardo dei Tintori, UOC Ginecologia, Università di Milano-Bicocca, Milano, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Raffaella Ergasti
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Beyhan Ataseven
- Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Klinikum Lippe, Academic Department of Gynecology, Gynecologic Oncology and Obstetrics, Detmold, Germany
| | - Tommaso Bianchi
- Fondazione IRCCS San Gerardo dei Tintori, UOC Ginecologia, Università di Milano-Bicocca, Milano, Italy
| | - Marco Di Stanislao
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Teresa Perri
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nicole Concin
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Imterat M, Gebers G, Heitz F, Schneider S, Ehmann S, Welz J, du Bois A, Traut A, Walz MK, Concin N, Harter P, Ataseven B. Low anterior resection syndrome and its impact on quality of life of ovarian carcinoma patients: A prospective longitudinal study. Gynecol Oncol 2023; 178:96-101. [PMID: 37839314 DOI: 10.1016/j.ygyno.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Bowel dysfunction is frequently reported in patients with ovarian carcinoma (OC). Our aim was to evaluate the incidence of low anterior resection syndrome (LARS) like symptoms in patients with primary OC and its impact on quality of life (QoL). METHODS A prospective longitudinal observational cohort study was performed, including patients with newly diagnosed OC treated by primary or interval surgery with residual tumor <1 cm, from 2018 until 2021. Patients with a stoma or recurrence of disease were excluded. Intestinal dysfunction was assessed using the validated LARS score questionnaire pre- and postoperatively. There are 3 subgroups based on the results: no, minor, or major LARS. The impact on QoL was evaluated by an additional question to demonstrate the severity of patient's life impairment. RESULTS The questionnaire was answered by 78 patients pre- and post-operatively. LARS like symptoms were reported preoperatively in 34.6% (24.4% minor/10.2% major) and significantly increased postoperatively to 47.4% (28.2% minor/19.2% major; p = 0.011). Moderate to severe impairment of QoL correlated with LARS scores pre- (80%) and post-operatively (90%). Patients with two bowel anastomoses (mean score 18.6 pre- and 24.9 post-operatively, p = 0.041) showed a significant increase of the questionnaire score. CONCLUSIONS Major LARS like symptoms appear in 10% of OC patients preoperatively and significantly increase to almost two-fold postoperatively. Multiple bowel anastomoses had a significant risk for higher postoperative LARS score. QoL impairment correlates linearly with LARS positive scoring, independent on the timing of the complaints.
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Affiliation(s)
- Majdi Imterat
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynaecologic Oncology, Hadassah Medical Centers, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Gudrun Gebers
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Sarah Ehmann
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Julia Welz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Martin K Walz
- Department of Surgery, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Nicole Concin
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Klinikum Lippe, Academic Department of Gynecology, Gynecologic Oncology and Obstetrics, Detmold, Germany
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Reinisch M, Bruzas S, Spoenlein J, Shenoy S, Traut A, Harrach H, Chiari O, Cremer E, Ataseven B, Gubelt L, Kuemmel S. Safety and effectiveness of sacituzumab govitecan in patients with metastatic triple-negative breast cancer in real-world settings: first observations from an interdisciplinary breast cancer centre in Germany. Ther Adv Med Oncol 2023; 15:17588359231200454. [PMID: 37789989 PMCID: PMC10542232 DOI: 10.1177/17588359231200454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Background Sacituzumab govitecan has been recently approved by the USFDA and EMA for the treatment of patients with metastatic triple-negative breast cancer (mTNBC). We report real-world safety and effectiveness in patients with mTNBC receiving sacituzumab govitecan treatment at a breast cancer centre in Germany. Methods Data from patients who had received sacituzumab govitecan as treatment for mTNBC, in both de novo and relapsed disease, at the Kliniken Essen-Mitte, Essen, Germany, were collected through institutional records. Data were analysed for safety parameters and survival outcomes and reported using descriptive statistics. Results Patients (N = 43) received a median (range) of 5 (1-28) cycles of sacituzumab govitecan and were followed up for a median of 12.9 months. The most reported adverse events (AEs) of any grade were alopecia (n = 39; 90.7%), diarrhoea (n = 16; 37.2%), fatigue (n = 15, 34.9%), anaemia (n = 15, 34.9%) and neutropenia (n = 14, 32.6%). AEs ⩾ Grade 3 with the highest incidence were neutropenia (n = 12; 27.9%) and diarrhoea (n = 8; 18.6%). In eight (18.6%) patients, dose of sacituzumab govitecan dose was reduced due to patients' clinical condition prior to commencing treatment; in further 17 (39.5%) patients, sacituzumab govitecan dose had to be reduced or treatment interrupted on account of AEs associated with the drug after treatment had commenced. Median progression-free survival and median overall survival were calculated to be 5.0and 13.1 months, respectively. Conclusion The real-world safety and effectiveness profile of sacituzumab govitecan in patients with mTNBC are in line with clinical trial data. Further studies are required to guide optimal use of sacituzumab govitecan against mTNBC, especially in context of management of accompanying AEs.
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Affiliation(s)
- Mattea Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Henricistrasse 92, Essen 45136, Germany
| | - Simona Bruzas
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | | | - Satyendra Shenoy
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Hakima Harrach
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Ouafaa Chiari
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Efsthatia Cremer
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lars Gubelt
- Zentralapotheke, Kliniken Essen-Mitte, Essen, Germany
| | - Sherko Kuemmel
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Kuemmel S, Heil J, Bruzas S, Breit E, Schindowski D, Harrach H, Chiari O, Hellerhoff K, Bensmann E, Hanf V, Graßhoff ST, Deuschle P, Belke K, Polata S, Paepke S, Warm M, Meiler J, Schindlbeck C, Ruhwedel W, Beckmann U, Groh U, Dall P, Blohmer JU, Traut A, Reinisch M. Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer. JAMA Surg 2023; 158:807-815. [PMID: 37285140 PMCID: PMC10248815 DOI: 10.1001/jamasurg.2023.1772] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/19/2023] [Indexed: 06/08/2023]
Abstract
IMPORTANCE The increasing use of neoadjuvant systemic therapy (NST) has led to substantial pathological complete response rates in patients with initially node-positive, early breast cancer, thereby questioning the need for axillary lymph node dissection (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce. OBJECTIVE To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND. DESIGN, SETTING, AND PARTICIPANTS The SenTa study is a prospective registry study and was conducted between January 2017 and October 2018. The registry includes 50 study centers in Germany. Patients with clinically node-positive breast cancer underwent clipping of the most suspicious lymph node (LN) before NST. After NST, the marked LNs and sentinel LNs were excised (TAD) followed by ALND according to the clinician's choice. Patients who did not undergo TAD were excluded. Data analysis was performed in April 2022 after 43 months of follow-up. EXPOSURE TAD alone vs TAD with ALND. MAIN OUTCOMES AND MEASURES Three-year clinical outcomes were evaluated. RESULTS Of 199 female patients, the median (IQR) age was 52 (45-60) years. A total of 182 patients (91.5%) had 1 to 3 suspicious LNs; 119 received TAD alone and 80 received TAD with ALND. Unadjusted invasive disease-free survival was 82.4% (95% CI, 71.5-89.4) in the TAD with ALND group and 91.2% (95% CI, 84.2-95.1) in the TAD alone group (P = .04); axillary recurrence rates were 1.4% (95% CI, 0-54.8) and 1.8% (95% CI, 0-36.4), respectively (P = .56). Adjusted multivariate Cox regression indicated that TAD alone was not associated with an increased risk of recurrence (hazard ratio [HR], 0.83; 95% CI, 0.34-2.05; P = .69) or death (HR, 1.07; 95% CI, 0.31-3.70; P = .91). Similar results were obtained for 152 patients with clinically node-negative breast cancer after NST (invasive disease-free survival: HR, 1.26; 95% CI, 0.27-5.87; P = .77; overall survival: HR, 0.81; 95% CI, 0.15-3.83; P = .74). CONCLUSIONS AND RELEVANCE These results suggest that TAD alone in patients with mostly good clinical response to NST and at least 3 TAD LNs may confer survival outcomes and recurrence rates similar to TAD with ALND.
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Affiliation(s)
- Sherko Kuemmel
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology With Breast Center Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Simona Bruzas
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Elisabeth Breit
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | | | - Hakima Harrach
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - Ouafaa Chiari
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Volker Hanf
- Breast Unit Klinikum Fürth, Frauenklinik Nathanstift, Fürth, Germany
| | | | - Petra Deuschle
- Breast Unit, Marienhaus Klinikum Hetzelstift Neustadt/Weinstraße, Neustadt, Germany
| | - Kerstin Belke
- Klinik für Gynäkologie und Geburtshilfe, Robert-Koch-Krankenhaus Apolda, Apolda, Germany
| | - Silke Polata
- Klinik für Innere Medizin/Onkologisches Zentrum, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - Stefan Paepke
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Mathias Warm
- Brustzentrum Holweide, Kliniken der Stadt Köln, Cologne, Germany
| | | | | | - Wencke Ruhwedel
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Gütersloh, Gütersloh, Germany
| | - Ulrike Beckmann
- Brustzentrum der Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Ulrich Groh
- Klinik für Gynäkologie, Geburtshilfe und Senologie, Hochwaldkrankenhaus Bad Nauheim, Bad Nauheim, Germany
| | - Peter Dall
- Brustzentrum und Gynäkologisches Krebszentrum, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Mattea Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology With Breast Center Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Imterat M, Harter P, Rhiem K, Heitz F, Schneider S, Concin N, Moubarak M, Welz J, Vrentas V, Traut A, Hahnen E, Schmutzler R, du Bois A, Ataseven B. Incidence and Prognostic Impact of Deleterious Germline Mutations in Primary Advanced Ovarian Carcinoma Patients. Cancers (Basel) 2023; 15:cancers15092534. [PMID: 37174000 PMCID: PMC10177155 DOI: 10.3390/cancers15092534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Data on deleterious variants in genes other than BRCA1/2 remain limited. A retrospective cohort study was performed, including primary OC cases with TruRisk® germline gene panel testing between 2011 and 2020. Patients with testing after relapse were excluded. The cohort was divided into three groups: (A) no mutations, (B) deleterious BRCA1/2 mutations, and (C) deleterious mutations in other genes. A total of 702 patients met the inclusion criteria. Of these 17.4% (n = 122) showed BRCA1/2 mutations and a further 6.0% (n = 42) in other genes. Three-year overall survival (OS) of the entire cohort was significantly longer in patients with germline mutations (85%/82.8% for cohort B/C vs. 70.2% for cohort A, p < 0.001) and 3-year progression-free survival (PFS) only for cohort B (58.1% vs. 36.9%/41.6% in cohort A/C, p = 0.002). In multivariate analysis for the subgroup of advanced-stages of high-grade serous OC, both cohorts B/C were found to be independent factors for significantly better outcome, cohort C for OS (HR 0.46; 95% CI 0.25-0.84), and cohort B for both OS and PFS (HR 0.40; 95% CI 0.27-0.61 and HR 0.49; 95% CI 0.37-0.66, respectively). Germline mutations were detected in a quarter of OC patients, and a quarter of those in genes other than BRCA1/2. Germline mutations demonstrate in our cohort a prognostic factor and predict better prognosis for OC patients.
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Affiliation(s)
- Majdi Imterat
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
- Department of Gynaecologic Oncology, Hadassah Medical Centers, Faculty of Medicine, Hebrew University of Jerusalem, Kalman Ya'Akov Man St., Jerusalem 91905, Israel
| | - Philipp Harter
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50931 Cologne, Germany
| | - Florian Heitz
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Stephanie Schneider
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Nicole Concin
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Malak Moubarak
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Julia Welz
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Vasileios Vrentas
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Alexander Traut
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50931 Cologne, Germany
| | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50931 Cologne, Germany
| | - Andreas du Bois
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
| | - Beyhan Ataseven
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte (KEM), 45136 Essen, Germany
- Academic Department of Gynecology, Gynecologic Oncology and Obstetrics, Klinikum Lippe, Medical School, University Medical Center East Westphalia-Lippe, Bielefeld University, 33615 Bielefeld, Germany
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Reinisch M, Bruzas S, Gluz O, Ataseven B, Schmid P, Cortés J, Blohmer JU, Shenoy S, Dyson MH, Dittmer-Grabowski C, Chiari O, Harrach H, Gebauer D, Traut A, Kuemmel S. Prognostic and predictive impact of gene expression in node-positive early breast cancer patients receiving dose-dense versus standard-dose adjuvant chemotherapy. Mol Oncol 2023. [PMID: 37057719 DOI: 10.1002/1878-0261.13435] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/16/2022] [Accepted: 04/13/2023] [Indexed: 04/15/2023] Open
Abstract
The utility of multigene expression assays in advanced (≥4 positive lymph nodes) early breast cancer (EBC) is limited. We conducted exploratory transcriptomic analysis of 758 genes (Breast Cancer 360 panel, nCounter® platform; NanoString) in primary tumor samples collected during a phase 3 trial comparing adjuvant taxane-containing dose-dense chemotherapy (ddCTX) versus standard-dosed chemotherapy (stCTX) in resected EBC with ≥4 positive lymph nodes. Prognostic and predictive associations with disease-free survival (DFS) and overall survival (OS) were evaluated by Cox regression with false discovery rate (FDR) adjustment. Data were available from tumor samples of 141/226 patients (median follow-up: 14 years). Several genes/signatures, including immune markers, showed prognostic relevance in unadjusted analyses. Of these, two remained significant after multiplicity adjustment: a positive effect on DFS of programmed cell death 1 ligand-2 (PD-L2) in the ddCTX arm (univariate HR: 0.53, FDR-adjusted P = 0.036) and a negative effect on OS of HER2-enriched (HER2-E) signature in the stCTX arm (univariate HR: 5.40, FDR-adjusted P = 0.036). Predictive analyses showed greater DFS benefit of ddCTX in tumors with high antigen processing machinery (APM) expression (multivariate interaction P = 0.024). Multigene expression assays have a prognostic and predictive potential in advanced EBC and further investigation is warranted in order to identify candidates for de-escalated treatment. In addition, intrinsic subtype and immune gene expression have predictive potential.
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Affiliation(s)
| | | | - Oleg Gluz
- Bethesda Hospital, Breast Center Niederrhein, Mönchengladbach, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Javier Cortés
- International Breast Cancer Centre (IBCC), Quiron Group, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jens-Uwe Blohmer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | | | - Mark H Dyson
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | | | | | | | | | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
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7
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Plett H, Ricciardi E, Vacaru V, Ramspott JP, Colombo N, Sehouli J, du Bois A, Garbi A, Richter R, Ataseven B, Aletti G, Braicu E, Heitz F, Portuesi R, Muallem MZ, Dagres T, Parma G, Roser E, Traut A, Multinu F, Harter P. Adult ovarian granulosa cell tumors: analysis of outcomes and risk factors for recurrence. Int J Gynecol Cancer 2023; 33:734-740. [PMID: 36759002 DOI: 10.1136/ijgc-2022-003854] [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: 02/11/2023] Open
Abstract
OBJECTIVE Adult granulosa cell tumors represent less than 5% of all ovarian malignancies. The aim of this study was to analyze the clinicopathological parameters and their impact on progression-free and overall survival. METHODS Patients with primary adult granulosa cell tumors treated in three international referral centers between July 1999 and December 2018 were included. The following data were anonymously exported from the prospective database: age at diagnosis, International Federation of Gynecology and Obstetrics (FIGO) stage, adjuvant therapy, surgical procedures, progression-free survival, and overall survival. Descriptive statistical analysis regarding tumor and treatment characteristics was performed. Survival analyses included Kaplan-Meier functions and Cox proportional hazard ratios (HR). RESULTS A total of 168 patients with primary adult granulosa cell tumors were included. Median age was 50 years (range 13-82). With regard to stage distribution, 54.2% (n=91) of patients were FIGO stage IA, 1.2% (n=2) were stage IB, 26.8% (n=45) were stage IC, and 17.9% (n=30) were FIGO stage II-IV. 66.7% (n=112) of patients underwent surgical restaging, of whom 17.9% (n=20) were moved to a higher stage. In addition, 36 (21.4%) patients underwent fertility-sparing surgery. After a median follow-up of 61 months (range 0-209), 10.7% of patients (n=18) had recurrent disease and 4.8% (n=8) died of disease. Five-year progression-free survival was 86.1% and estimated overall survival was 95.7%. Five-year progression-free survival was worse for patients with advanced stages (FIGO stage IA/B vs IC: HR 5.09 (95% CI 1.53 to 16.9); FIGO stage IA/B vs II-IV: HR 5.62 (95% CI 1.58 to 19.9)). Nineteen patients receiving adjuvant chemotherapy had lower estimated 5-year progression-free survival compared with patients not receiving chemotherapy (49.7% vs 91.1%, p<0.001; HR 9.15 (95% CI 3.62 to 23.1)). CONCLUSION The prognosis of patients with primary adult granulosa cell tumors is mainly determined by FIGO stage. The outcome of patients with FIGO stage IC is comparable to those with advanced stages. Fertility-sparing surgery seems to be a safe procedure in stage IA. Our data do not support the use of adjuvant chemotherapy in early and advanced stages of adult granulosa cell tumors.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany .,Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Enzo Ricciardi
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Ospedale Sandro Pertini, Rome, Italy.,Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Vlad Vacaru
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany.,Division of Gynecology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Jan Philipp Ramspott
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Nicoletta Colombo
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,Faculty of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Annalisa Garbi
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Giovanni Aletti
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Elena Braicu
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Rosalba Portuesi
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mustafa-Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Timoleon Dagres
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Gabriella Parma
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Eva Roser
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Francesco Multinu
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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8
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Imterat M, Bizzarri N, Fruscio R, Perrone AM, Traut A, du Bois A, Rosati A, Ferrari D, De Iaco P, Ataseven B, Ergasti R, Volontè S, Tesei M, Heitz F, Perri MT, Concin N, Fanfani F, Scambia G, Fagotti A, Harter P. Impact of substage and histologic type in stage I ovarian carcinoma survival: a multicenter retrospective observational study. Int J Gynecol Cancer 2023; 33:42-49. [PMID: 36104079 DOI: 10.1136/ijgc-2022-003745] [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: 01/10/2023] Open
Abstract
OBJECTIVE This international study aimed to investigate the impact of substage, histological type and other prognostic factors on long-term survival for stage I ovarian carcinoma. METHODS Our study was a retrospective multicenter cohort study that included patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I (IA-IC3) ovarian carcinoma treated at four European referral centers in Germany and Italy. Using Kaplan-Meier survival curves we compared overall and disease-free survival between the different stage I groups. RESULTS A total of 1115 patients were included. Of these, 48.4% (n=540) were in stage IA, 6.6% (n=73) stage IB, and 45% (n=502) stage IC, of the latter substage IC1, 54% (n=271), substage IC2, 31.5% (n=158), and substage IC3, 14.5% (n=73). Five-year overall and disease-free survival rates for the entire cohort were 94% and 86%, respectively, with no difference between stage IA and IB. However, there was a significantly better overall and disease-free survival for stage IA as compared with stage IC (p=0.007 and p<0.001, respectively). Multivariate analysis revealed incomplete/fertility-sparing staging (HR 1.95; 95% CI 1.27 to 2.99, and HR 3.54; 95% CI 1.83 to 6.86, respectively), and stage IC (HR 2.47; 95% CI 1.63 to 3.75) as independent risk factors for inferior disease-free survival, while low-grade endometrioid (HR 0.42; 95% CI 0.25 to 0.72) and low-grade mucinous (HR 0.17; 95% CI 0.06 to 0.44) histology had superior disease-free survival. Considering overall survival, stage IC (HR 2.41; 95% CI 1.45 to 4.01) and older age (HR 2.41; 95% CI 1.46 to 3.95) were independent risk factors. CONCLUSION Although stage I ovarian carcinoma exhibited excellent outcomes, the prognosis of patients with stage IA differs significantly compared with stage IC. Sub-optimal staging as an indicator for quality of care, and tumor biology defined by histology (low-grade endometrioid/mucinous) independently impact disease-free survival.
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Affiliation(s)
- Majdi Imterat
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany
| | - Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany
| | - Andrea Rosati
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Debora Ferrari
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Raffaella Ergasti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Silvia Volontè
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - Marco Tesei
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany.,Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maria Teresa Perri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Nicole Concin
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, Nordrhein-Westfalen, Germany
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9
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Imterat M, Bizzarri N, Fruscio R, Perrone AM, du Bois A, Rosati A, Ferrari D, De Iaco P, Ataseven B, Ergasti R, Volonté S, Tesei M, Heitz F, Perri MT, Bommert M, Fanfani F, Scambia G, Fagotti A, Traut A, Harter P. Long-term survival of early stage I epithelial ovarian cancer: A multicenter retrospective observational study (321). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Imterat M, Bois AD, Heitz F, Traut A, Harter P, Ataseven B. Low anterior resection syndrome and their impact on life quality in ovarian cancer patient: A prospective longitudinal study (498). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Moubarak M, Harter P, Ataseven B, Traut A, Welz J, Baert T, Heitz F. Re-treatment with PARPi in patients with recurrent epithelial ovarian cancer: A single institutional experience. Gynecol Oncol Rep 2022; 40:100939. [PMID: 35169607 PMCID: PMC8829558 DOI: 10.1016/j.gore.2022.100939] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Real-life data support prospective evidence that 2nd PARPi therapy can be beneficial. Patients who do not meet OREO criteria might also benefit from a PARPi rechallenge. Patients should be well informed about the limitations and risks of this option. Further trials are needed to understand the mechanisms of PARP resistance.
Introduction We aimed to evaluate real-life experiences with the re-challenge of poly(ADP-Ribose)Polymerase (PARP) inhibitors (PARPi) after a prior PARPi therapy in patients with recurrent EOC. Methods A retrospective descriptive study was conducted at a tertiary care center of excellence for ovarian cancer. Demographic, pathological, and therapeutic data were collected for patients with recurrent epithelial ovarian cancer who were re-treated with PARPi in their therapy course. Results Twenty-nine patients were included in the study. Twenty-six patients received the second PARPi as maintenance therapy after two different lines of therapy and three patients received the second PARPi as upfront therapy after progression. Most of the patients (57.7%) were exposed to first PARPi after a second-line therapy. The median progression-free survival under the first and second PARPi therapy was estimated at 15 and 7 months respectively. PFS under the second PARPi after platinum-based chemotherapy was better after a complete remission with a median PFS of 8.5 months, compared to patients with partial remission (5.5 months). A better PFS was noted in case of negative BRCA status under the second PARPi therapy (median PFS of 7.4 vs. 4.5 months, p = 0.11). The second PARPi therapy was mainly discontinued due to disease progression (84.6% of the cases). Discontinuation of treatment with the second PARP due to toxicity was needed in one case who developed a myelodysplastic syndrome. Conclusion Real-life data support prospective evidence that patients with recurrent EOC may derive benefit of the re-treatment with PARPi in case of clear response to the last platinum-based therapy.
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Affiliation(s)
- Malak Moubarak
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Traut
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Julia Welz
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Thais Baert
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - Florian Heitz
- Department of Gynecology & Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Corresponding author at: Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte; Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
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12
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Yazdian M, Groeben H, Ataseven B, Schneider S, Baert T, Bommert M, Traut A, Elfers-Wassenhoven A, Brüß U, Schwameis R, du Bois A, Wagner U, Harter P. The role of factor XIII in surgery for advanced stage of epithelial ovarian cancer. Arch Gynecol Obstet 2021; 305:1311-1318. [PMID: 34724570 DOI: 10.1007/s00404-021-06308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hereditary factor (F) XIII-deficiency is a known risk factor for postoperative complications, but data of acquired FXIII-deficiency in malignancies are limited. Therefore, we evaluated the role of acquired FXIII-deficiency in surgery for advanced epithelial ovarian cancer (EOC). MATERIALS AND METHODS We performed a retrospective analysis of patients with known serum FXIII status and treatment between 2011 and 2018 at our center. We defined cohorts according to FXIII with values > 75% as normal (group A), 55-75% as reduced (group B) and < 55% as low (group C). Complications were classified according to the Clavien-Dindo Classification, class III-V complications were defined as severe. RESULTS 347 patients with EOC were identified. 180 patients (51.2%) were in group A, 82 patients (23.6%) in group B, and 85 patients (24.4%) in group C. Lower levels of FXIII were associated with higher amount of ascites, FIGO IV, high grade serous histology, low albumin, and higher CA-125 levels. Regarding intraoperative variables, low FXIII was associated with longer duration of surgery, higher blood loss, higher surgical complexity score/number of bowel anastomosis and a higher probability for macroscopic residual disease. The risk of severe complications in group A was 12.2%, 24.4% in group B, and 31.8% in group C. In a multivariate model, low FXIII (OR 2.8), > 1 bowel anastomosis (OR 2.7), age-adjusted Charlson comorbidity index ≥ 4 (OR 3.6) and a longer duration of surgery (> 285 min.) were significant predictive factors for severe complications. CONCLUSION FXIII is associated with tumor and treatment burden. A low level of FXIII is associated with postoperative complications. The knowledge about the presurgical serum FXIII-level might be helpful to plan the treatment strategy.
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Affiliation(s)
- Mahtab Yazdian
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Harald Groeben
- Department of Anesthesiology, Ev. Kliniken-Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Thais Baert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | | | - Ulrich Brüß
- Department of Anesthesiology, Ev. Kliniken-Essen-Mitte, Essen, Germany
| | - Richard Schwameis
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany.
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany.
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13
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Ataseven B, Tripon D, Schwameis R, Harter P, Rhiem K, Schneider S, Heikaus S, Baert T, Francesco AP, Heitz F, Traut A, Groeben HT, Schmutzler R, du Bois A. Clinical outcome in patients with primary epithelial ovarian cancer and germline BRCA1/2-mutation - real life data. Gynecol Oncol 2021; 163:569-577. [PMID: 34565600 DOI: 10.1016/j.ygyno.2021.09.004] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND We evaluated the clinical impact of germline (g)BRCA1/2-mutation on initial disease presentation, surgical implications, surgical morbidity and survival in patients with advanced epithelial ovarian cancer (EOC) undergoing debulking surgery (DS). METHODS Data of all consecutive EOC patients with stage III/IV, high-grade serous disease and known gBRCA1/2 status (gBRCA; non-gBRCA), who underwent DS at our department between 01/2011 and 06/2019 were analyzed. Associations between gBRCA-status and severe postoperative complications and survival were analyzed. RESULTS gBRCA-status was determined in 50.1% (612/1221) of all patients. gBRCA was present in 21.9% (134/612). Significant differences were observed in terms of median age (p = 0.001) and histology (high-grade serous histology gBRCA: 98.5%, non-gBRCA 76.2%; p < 0.001). gBRCA-status had no impact on intraoperative disease presentation, surgical complexity or complete resection rate (gBRCA: 74.4%, non-gBRCA: 69.0%; p = 0.274). gBRCA-status was not predictive for severe postoperative complication (gBRCA: 12.0%, non-gBRCA: 19.1%; p = 0.082). Median PFS and OS was 31/22 and 71/53 months in patients with/without gBRCA-mutation, respectively. gBRCA was a significant prognostic factor for PFS (HR 0.57 p < 0.001) and for OS (HR 0.64, p = 0.048) after adjusting for established prognostic factors. CONCLUSIONS gBRCA-status had no impact on initial disease presentation, surgical results or postoperative complications. gBRCA patients have a significantly longer PFS but the impact on the long term prognosis is unclear. Complete resection remains the most important prognostic factor in patients with EOC independent of gBRCA-status.
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Affiliation(s)
- Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany.
| | - Denise Tripon
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Richard Schwameis
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | | | - Thaïs Baert
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | | | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | - Harald-Thomas Groeben
- Department of Anesthesiology and Intensive Care, Kliniken Essen-Mitte, Essen, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
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14
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Bruzas S, Kuemmel S, Harrach H, Breit E, Ataseven B, Traut A, Rüland A, Kostara A, Chiari O, Dittmer-Grabowski C, Reinisch M. Next-Generation Sequencing-Directed Therapy in Patients with Metastatic Breast Cancer in Routine Clinical Practice. Cancers (Basel) 2021; 13:4564. [PMID: 34572791 PMCID: PMC8468801 DOI: 10.3390/cancers13184564] [Citation(s) in RCA: 5] [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: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Next-generation sequencing (NGS) followed by matched therapy has opened up new therapeutic options to patients with metastatic breast cancer (mBC). Here we report our experience with this approach in everyday clinical practice. This retrospective study included 95 patients with mBC who were genotyped with the FoundationOne® (CDx) assay in a commercial molecular pathology laboratory. Genetic alterations were identified in all tumor specimens, and 83 patients (87.4%) had a median of 2 (range, 1-6) potentially actionable alterations. A multidisciplinary tumor board recommended genomically guided therapy to 63 patients, 30 of whom received such treatment. Everolimus (n = 15) and anti-human epidermal growth factor receptor 2 (HER2) therapy (n = 6) were most frequently administered. The ratio of progression-free survival (PFS) under NGS-based therapy to PFS under the last line of standard therapy prior to NGS was >1.3 in 13 (43.3%) patients, indicative of a clinical benefit to NGS-directed therapy. One-year overall survival rates were 22.7% (95% CI, 6.5-44.4) in 65 patients allocated to the standard therapy versus 62.9% (95% CI, 41.6-78.2) in 30 patients receiving the matched therapy. In conclusion, NGS-matched treatment improved the clinical outcomes in a subgroup of mBC patients.
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Affiliation(s)
- Simona Bruzas
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
| | - Sherko Kuemmel
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Hakima Harrach
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
| | - Elisabeth Breit
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, 45136 Essen, Germany; (B.A.); (A.T.)
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, 45136 Essen, Germany; (B.A.); (A.T.)
| | - Anna Rüland
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
- Brustzentrum, St. Marienhospital, 52353 Düren, Germany
| | - Athina Kostara
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
| | - Ouafaa Chiari
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
| | - Christine Dittmer-Grabowski
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
| | - Mattea Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany; (S.B.); (S.K.); (H.H.); (E.B.); (A.R.); (A.K.); (O.C.); (C.D.-G.)
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15
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Pauly N, Baert T, Schmutzler R, du Bois A, Schneider S, Rhiem K, Schömig-Markiefka B, Siemanowski J, Heikaus S, Traut A, Heitz F, Prader S, Ehmann S, Harter P, Ataseven B. Modern day screening for Lynch syndrome in endometrial cancer: the KEM experience. Arch Gynecol Obstet 2021; 304:975-984. [PMID: 33710393 DOI: 10.1007/s00404-021-06006-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/11/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Current guidelines for Lynch syndrome detection in endometrial cancer (EC) patients rely either on risk evaluation, based on personal/family history, or detection of mismatch repair (MMR) deficiency on tumor tissue. We present a combined screening algorithm for Lynch syndrome. METHODS In this study, 213 consecutive patients treated for EC at Kliniken Essen-Mitte between 2014 and 2018 were included. Personal/family history was evaluated by the Amsterdam II, revised Bethesda/German-DKG criteria and prediction model PREMM5. MMR testing was performed by immunohistochemistry (IHC) and/or polymerase chain reaction (PCR) based microsatellite analysis on tumor tissue. MLH1 promoter methylation analysis was performed in case of MLH1 loss or microsatellite instability. RESULTS Based on personal/family history 2/213 (Amsterdam II), 31/213 (revised Bethesda/German-DKG) and 149/213 (PREMM5) patients were identified as at risk for Lynch syndrome. MMR analysis was performed by IHC in 51.2%, by PCR in 32.4%, and in 16.4% of patients both methods were used. MMR deficiency was detected in 20.6% (44/213). Methylation analysis was performed in 27 patients of whom, 22 (81.4%) showed MLH1 promoter hypermethylation. Only 9% of MMR deficient patients were identified as at risk for Lynch syndrome by the revised Bethesda/German-DKG criteria. A pathogenic germline mutation was discovered in 3 out of 20 patients that underwent genetic testing. None of these patients were younger than 50 years or had a family history of Lynch syndrome-associated malignancies. CONCLUSION General MMR assessment is a feasible strategy to improve the detection of Lynch Syndrome in patients with EC.
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Affiliation(s)
- Nina Pauly
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany.
| | - Thaïs Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
- Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | | | - Janna Siemanowski
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | | | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
- Department for Gynecology With the Center for Oncologic Surgery, Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sonia Prader
- Department of Gynecology, Hospital Brixen, Brixen, Südtirol, Italy
| | - Sarah Ehmann
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte (KEM), Henricistrasse 92, 45136, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
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16
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Ramspott JP, Baert T, MacKintosh ML, Traut A, Ataseven B, Bommert M, Heitz F, Plett H, Schneider S, Waltering KU, Heikaus S, Harter P, du Bois A. Response evaluation after neoadjuvant therapy: evaluation of chemotherapy response score and serological and/or radiological assessment of response in ovarian cancer patients. Arch Gynecol Obstet 2021; 304:1021-1032. [PMID: 33661392 DOI: 10.1007/s00404-021-06020-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The chemotherapy response score (CRS) is a histopathological tool to evaluate response to neoadjuvant chemotherapy (NACT) in high-grade serous ovarian cancer (OC). We critically evaluated the clinical value of CRS and compared its predictive power to standard serological (CA125) and radiological response. METHODS A retrospective analysis of 277 OC patients, who received primary chemotherapy, was performed. CRS, serological, and radiological findings were correlated with progression-free (PFS) and overall survival (OS). RESULTS CRS could be determined in 172 of 277 patients (62.1%). In patients with CRS3, a longer median PFS and OS was observed compared with CRS1/2 patients (31.2 vs. 18.9, P < 0.001; 55.0 vs. 36.1 months, P = 0.050). CA125 and radiological response evaluation were also predictive for PFS and OS. Patients with serological and radiological complete response showed longer PFS (23.0 vs. 14.4, P = 0.011; 21.4 vs. 9.6 months, P < 0.001) and OS (49.5 vs. 29.0, P = 0.003; 45.0 vs. 12.9 months, P < 0.001). Patients with pathological complete response (pCR) had the best median PFS (52.8 months), even compared with non-pCR CRS3 (27.8 months). In the total study cohort, serological, and radiological complete response was better at predicting PFS (hazard ratio 2.23 and 2.77). CONCLUSION In this study, evaluation of response to chemotherapy by CRS was not superior to conventional methods (CA125 or radiology). Independent of the evaluation method, response to NACT was predictive of PFS and OS. We observed no added value for CRS as a prognostic marker. The clinical relevance of CRS should be discussed, as no therapeutic consequences result from CRS evaluation.
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Affiliation(s)
- Jan Philipp Ramspott
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany. .,Department of Gynecology and Obstetrics, Münster University Hospital, Münster, Germany.
| | - Thaïs Baert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - Michelle Louise MacKintosh
- Department of Gynaecological Oncology, St Mary's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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17
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Tripon D, Harter P, Rhiem K, Schneider S, du Bois A, Heitz F, Baert T, Traut A, Pauly N, Ehmann S, Schmutzler R, Ataseven B. Prävalenz von BRCA1 and BRCA2 Mutationen bei Patientinnen mit primärem Ovarialkarzinom – Bildet die deutsche Checkliste zur Erfassung des Risikos für familiären Brust-/und Eierstockkrebs den Beratungsbedarf ausreichend ab? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717207] [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)
- D Tripon
- Kliniken Essen-Mitte
- LMU Klinik für Frauenheilkunde und Geburtshilfe
| | | | - K Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs
| | | | | | - F Heitz
- Kliniken Essen-Mitte
- Charite Berlin, Gynäkologie
| | - T Baert
- Kliniken Essen-Mitte
- Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, ImmunOvar Research Group
| | | | | | | | | | - B Ataseven
- Kliniken Essen-Mitte
- LMU Klinik für Frauenheilkunde und Geburtshilfe
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18
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Pauly N, du Bois A, Harter P, Baert T, Heitz F, Schneider S, Heikaus S, Traut A, Ehmann S, Ataseven B. Welchen Mehrwert bringt eine zusätzliche Bestimmung molekularpathologischer, immunhistochemischer Parameter zusätzlich zur konventionellen histopathologischen Evaluation des frühen Endometriumkarzinoms? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718169] [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)
| | | | | | - T Baert
- Kliniken Essen-Mitte
- Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven
| | - F Heitz
- Kliniken Essen-Mitte
- Charité – Universitätsmedizin Berlin
| | | | | | | | | | - B Ataseven
- Kliniken Essen-Mitte
- LMU Klinik für Frauenheilkunde und Geburtshilfe
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19
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Ehmann S, Ramspott J, du Bois A, Harter P, Heitz F, Schneider S, Baert T, Pauly N, Traut A, Heikaus S, Ataseven B. Histopathologisches Resultat nach prophylaktischer bilateraler Salpingo-Oophorektomie bei Frauen mit BRCA1/2-Mutation – single center Erfahrung. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718131] [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)
| | | | | | | | | | | | - T Baert
- Kliniken Essen-Mitte
- ImmunOvar Research Group, Laboratory of Tumor Immunology and Immunotherapy, Department of Oncology, KU Leuven
| | | | | | | | - B Ataseven
- Kliniken Essen-Mitte
- LMU Klinik für Frauenheilkunde und Geburtshilfe
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20
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JP R, ML M, AK L, Traut A, Ataseven B, Bommert M, Heitz F, Prader S, Schneider S, KU W, Heikaus S, Harter P, du Bois A, Baert T. Chemotherapy Response Score: Correlation with preoperative assessment of serological response and clinical implications in ovarian cancer patients. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718173] [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)
- Ramspott JP
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | - MacKintosh ML
- St Mary’s Hospital, Manchester University Hospitals NHS Trust, Gynaecological Oncology
| | | | - A Traut
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | - B Ataseven
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
- LMU Klinik für Frauenheilkunde und Geburtshilfe
| | - M Bommert
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | - F Heitz
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | - S Prader
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | - S Schneider
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | | | | | - P Harter
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | - A du Bois
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
| | - T Baert
- Kliniken Essen-Mitte, Department of Gynecology and Gynecologic Oncology
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven
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21
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Yazdian M, Ataseven B, Schneider S, Baert T, Bommert M, Traut A, du Bois A, Harter P. The role of factor (f) XIII in patients with advanced epithelial ovarian cancer (EOC) FIGO III/IV. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718201] [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)
- M Yazdian
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologische Onkologie
- Frauenklinik Universität Marburg, Gynäkologie
| | - B Ataseven
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologie & Gynäkologische Onkologie
| | - S Schneider
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologie & Gynäkologische Onkologie
| | - T Baert
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologie & Gynäkologische Onkologie
| | - M Bommert
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologie & Gynäkologische Onkologie
| | - A Traut
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologie & Gynäkologische Onkologie
| | - A du Bois
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologische Onkologie
| | - P Harter
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Gynäkologie & Gynäkologische Onkologie
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22
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Ataseven B, Tripon D, Rhiem K, Harter P, Schneider S, Heitz F, Baert T, Traut A, Pauly N, Ehmann S, Plett H, Schmutzler RK, du Bois A. Prevalence of BRCA1 and BRCA2 Mutations in Patients with Primary Ovarian Cancer - Does the German Checklist for Detecting the Risk of Hereditary Breast and Ovarian Cancer Adequately Depict the Need for Consultation? Geburtshilfe Frauenheilkd 2020; 80:932-940. [PMID: 32905297 PMCID: PMC7467803 DOI: 10.1055/a-1222-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023] Open
Abstract
BackgroundBRCA1/2
mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the
BRCA1/2
mutation(s) based on the checklist score (CLS).
Methods
A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 – 5/2019 at the Central Essen Clinics, where a
BRCA1/2
genetic analysis result and a CLS was available. Out of 545 cases with a
BRCA1/2
result (cohort A), 453 cases additionally had an extended gene panel result (cohort B).
Results
A
BRCA1/2
mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non-
BRCA1/2
genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a
BRCA1
(n = 92) or
BRCA2
(n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a
BRCA1/2
mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively.
Conclusions
The
BRCA1/2
mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a
BRCA1/2
mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.
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Affiliation(s)
- Beyhan Ataseven
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der LMU München, München
| | - Denise Tripon
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinik Köln, Köln
| | - Philipp Harter
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Stephanie Schneider
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Florian Heitz
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité - Universitätsmedizin Berlin, Berlin
| | - Thais Baert
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Abteilung für Onkologie und Tumorimmunologie, KU Leuven, Leuven, Belgien
| | - Alexander Traut
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Nina Pauly
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Sarah Ehmann
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Helmut Plett
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité - Universitätsmedizin Berlin, Berlin
| | - Rita K Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinik Köln, Köln
| | - Andreas du Bois
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
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Plett H, Ricciardi E, Harter P, Ataseven B, Heitz F, Prader S, Schneider S, Heikaus S, Fisseler-Eckhoff A, Kommoss F, Lax SF, Staebler A, Traut A, du Bois A. Dataset on patients with Recurrent Borderline Ovarian Tumors and Table with Review of Literature on Fertility and Oncologic Outcomes of patients with Borderline Ovarian Tumors. Data Brief 2020; 30:105653. [PMID: 32395597 PMCID: PMC7206201 DOI: 10.1016/j.dib.2020.105653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
The data presented here is related to the research article entitled "FERTILITY-SPARING SURGERY AND REPRODUCTIVE-OUTCOMES IN PATIENTS WITH BORDERLINE OVARIAN TUMORS" by Plett et al. in Journal of Gynecologic Oncology [1] and is analysed and discussed in detail. 18 Patients with Recurrent Borderline Ovarian Tumors (BOT) were identified and listed in Table 1. All patients underwent treatment for primary BOT either per radical surgery (RS) or fertility sparing surgery (FSS) by the same team in Horst Schmidt Klinik (HSK) in Wiesbaden and the Department of Gynecology and Gynecologic Oncology at Kliniken Essen-Mitte between January 2000 and December 2018 and were followed up closely. Details on patients` and surgical characteristics are given as well as management of character of recurrent disease. In Table 2 important publications from the last 20 years are listed in order to visualize better the oncologic outcomes (invasive and non-invasive relapses) and calculated risks of recurrence with the purpose to understand better the important findings of the related article cited above.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Enzo Ricciardi
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Sigurd F. Lax
- Department of Pathology, LKH Graz II, Graz and Johannes Kepler University, Linz, Austria
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University of Tuebingen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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Plett H, Harter P, Ataseven B, Heitz F, Prader S, Schneider S, Heikaus S, Fisseler-Eckhoff A, Kommoss F, Lax SF, Staebler A, Traut A, du Bois A. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors. Gynecol Oncol 2020; 157:411-417. [PMID: 32115229 DOI: 10.1016/j.ygyno.2020.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Borderline ovarian tumors (BOT) are considered a biological category with increased epithelial proliferation and cellular atypia in the absence of invasive growth. Since BOT occur often in young patients fertility sparing surgery (FSS) is an important issue. With this study we aimed to evaluate risk factors for relapses and fertility of patients after FSS. METHODS Patients diagnosed with BOT and treated between 2000 and 2018 were included. External pathological review was done in all patients. FSS was performed after individual discussion and a complete surgical staging according to FIGO, without lymphadenectomy and with a waiver for preservation of uterus and one ovary. RESULTS Among 352 Patients 80.2% had FIGO I and 63.9% had a serous BOT. Eighteen patients (5.1%) relapsed and 4 cases of malignant transformation were reported (1.1%). One patient of the latter died, all others have no evidence of disease. The overall recurrence-rate was 1.1% in FIGO-Stage I and 25.5% in FIGO III-IV (HR = 27; 95%-CI 7.7-95; p ≤.001). 95 patients underwent FSS. Thirteen (13.7%) of these patients relapsed, all as BOT. In multivariate analysis FIGO stages II-IV (HR = 27; 95%-CI: 8.1-102; p ≤.001) and FSS (HR = 12; 95%-CI: 2.9-47; p = .001) remained significant risk factors for recurrent disease. Pregnancy rate among forty-one patients attempting to conceive was 82.9%. 29 patients experienced at least one life-birth, in total 38 life-births were reported. CONCLUSION FSS in stage I is a safe procedure and life-birth-rates after FSS are high. More advanced FIGO stages have to be discussed individually and relapse rates have to be weighed against FSS. A central review of pathology, as we performed routinely, is mandatory and may have contributed to our low rate of invasive relapses.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Charité University Hospital, Berlin, Germany.
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Sigurd F Lax
- Department of Pathology, LKH Graz II, Graz and Johannes Kepler University, Linz, Austria
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University of Tuebingen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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Reinisch M, Gluz O, Ataseven B, Schmid P, Blohmer JU, Dittmer-Grabwoski C, Rueland A, Bruzas S, Seiberling C, Harrach H, Gebauer D, Traut A, Kuemmel S. Abstract PD5-09: Prognostic and predictive impact of genes and signatures measured with the BC360 panel (Nanostring) in node positive (≥pN2a) high risk patients (pts) receiving dose dense (dd) versus standard dosed chemotherapy in an adjuvant randomized trial with a long term follow-up (FU). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd5-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) patients with ≥ 4 positive lymph nodes have a particularly poor prognosis with shorter disease free survival (DFS) and overall survival (OS) than pts with pN1a. However this is a highly heterogeneous group. The implementation of genomic signatures and/or Ki-67 status for hormone receptor positive BC pts with node negative or positive (≤ pN1a) disease enables identification of a subgroup of pts with favourable outcome and no survival benefit from chemotherapy (CTX). However, here is lack of information regarding pts with ≥ 4 positive lymph nodes, and so far all patients receive a recommendation for CTX. In addition, there are no predictive factors for use of dd CTX in this group so far.
Methods: Between 1996–2000, 231 BC pts ≥ pN2a (median positive lymph nodes n= 6) with no evidence of distant metastases, were randomized to either adjuvant dd treatment with dd 3 × epirubicin (E, 90 mg/m2) + paclitaxel (P, 175 mg/m2) every 2 weeks (q2w) followed by 3 × cyclophosphamide (C)/methotrexate/5-fluorouracil (CMF, 600/40/600 mg/m2, q2w), or standard (st) treatment : 4 × E + C (C, 600 mg/m2) q3w followed by 3 × CMF q3w. Pts in the dd arm had a significantly better DFS (adjusted p = 0.027) with a non-significant trend to better OS (adjusted p = 0.058). Due to the recruitment period, there is no information on the HER2 status of the included pts (Reinisch et al, 2018).
The BC360 panel analysis was performed on 147 tumor specimens (dd arm n= 75; st arm n= 72). Samples were run on the 770 gene BC360 panel with additional 6 spike-in genes. Genes related to adhesion and migration, immune activation, ER signaling, DNA damage and repair, apoptosis, and proliferation were analyzed. The survival analysis was used to create the forest plot incorporating a Cox proportional hazards model with the survival outcome as a dependent variable, the observed normalized gene expression or signature score data as a continuous covariate, and any grouping variable included as a strata variable in the model.
Results: After quality control, 144/147 tumor specimens were available for the analysis (dd arm: 72; st arm; 72). The intrinsic subtype was equivalently distributed between the arms. The expression of PD-L1 (p = 0.025), PD-L2 (p = 0.007) and the presence of macrophages (p = 0.019) were positively correlated with an improved DFS in pts receiving dd but not st CTX. An improved OS was also associated with the presence of macrophages (p = 0.018) and the expression of TGF-β (p = 0.035) only in pts receiving dd CTX.
Pts with a HER2 enriched subtype benefited from the use of dd CTX. Dd CTX does not influence the outcome in BRCAness and HRD positive pts regardless the applied CTX. Further prognostic and predictive factors correlated to a median FU of 20 years will be presented at the meeting.
Conclusions: To our best knowledge, this is the first time the BC360 panel was run on samples of a cohort of high risk pts with ≥ pN2a with a median long term FU of 20 years. Our data may indicate that markers associated with immune activation are predictive factors for the use of dd therapies. High risk pts with different benefit from CTX may be identified. In pts with a HER2 enriched subtype not having received anti-HER2 therapy, the application of dd therapy may correlate with a better outcome. This analysis highlights the prognostic and predictive value of gene signatures to provide treatment guidance.
Citation Format: Mattea Reinisch, Oleg Gluz, Beyhan Ataseven, Peter Schmid, Jens-Uwe Blohmer, Christine Dittmer-Grabwoski, Anna Rueland, Simona Bruzas, Christine Seiberling, Hakima Harrach, Daniel Gebauer, Alexander Traut, Sherko Kuemmel. Prognostic and predictive impact of genes and signatures measured with the BC360 panel (Nanostring) in node positive (≥pN2a) high risk patients (pts) receiving dose dense (dd) versus standard dosed chemotherapy in an adjuvant randomized trial with a long term follow-up (FU) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD5-09.
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Affiliation(s)
| | - Oleg Gluz
- 2Bethesda Hospital, Mönchengladbach, Germany
| | | | - Peter Schmid
- 3Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Ataseven B, Frindte J, Harter P, Gebers G, Vogt C, Traut A, Breit E, Bluni V, Reinisch M, Heitz F, Kostara A, Kuemmel S, Prader S, Bommert M, Schneider S, du Bois A. Perception of side effects associated with anticancer treatment in women with breast or ovarian cancer (KEM-GO-1): a prospective trial. Support Care Cancer 2019; 28:3605-3615. [PMID: 31828488 DOI: 10.1007/s00520-019-05216-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Due to advances in anticancer treatment and supportive care, patients increasingly complained about nonphysical side effects of chemotherapy and targeted therapy in recent years. Therefore, continuous assessment of side effects and patients' perceptions is important. The aim of this study was to evaluate the identification and severity of side effects perceived by ovarian cancer (OC) and breast cancer (BC) patients undergoing contemporary anticancer therapy. METHODS Between 2015 and 2017, consecutive chemo-naïve OC and BC patients were enrolled in this prospective cohort study. Interviews were performed 12 ± 3 weeks after start of anticancer therapy, and patients were asked to select and rank, according to severity, 72 physical or nonphysical symptoms potentially related to their treatment. Data were analyzed with descriptive statistics. RESULTS Forty-five OC patients and 98 BC patients completed the interview. Sleeping difficulties were ranked as the most troublesome symptom, followed by concerns about family or partner, and loss of hair. Alopecia was the most predominant side effect for BC patients, whereas OC patients were highly afflicted by numbness in limbs. Chemotherapy alone or in combination with targeted therapy caused pronounced sleep disturbances. Prolonged taxane treatment led to shortness of breath and numbness in limbs. Vomiting was ranked by one and nausea by eight women among the five most bothersome symptoms. CONCLUSIONS Sleep disturbances have lately emerged as the most severe problem in women with OC or BC receiving anticancer therapy. Concerns about family and partner were ranked second in the current study and first in previous investigations.
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Affiliation(s)
- Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany. .,Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany.
| | - Johanna Frindte
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Gudrun Gebers
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Caroline Vogt
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Elisabeth Breit
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany.,Interdisciplinary Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Vincenzo Bluni
- Interdisciplinary Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Mattea Reinisch
- Interdisciplinary Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany.,Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Athina Kostara
- Interdisciplinary Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Sherko Kuemmel
- Interdisciplinary Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Henricistrasse 92, 45136, Essen, Germany
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Reinisch M, Gluz O, Ataseven B, Blohmer JU, Budner M, Dittmer-Grabowski C, Kohls A, Krocker J, Kümmel A, Hagemann F, Rüland A, Traut A, Kümmel S. Updated Survival Analysis after a Median Follow-up of 12 Years of an Anthracycline-Containing Adjuvant Prospective Multicentre, Randomised Phase III Trial on Dose-Dense Chemotherapy in Primary Node-Positive, High-Risk Breast Cancer Patients. Breast Care (Basel) 2019; 14:159-164. [PMID: 31316314 DOI: 10.1159/000491792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose Although dose-dense (dd) chemotherapy plays a fundamental role in the treatment of breast cancer (BC), a variety of trials have presented divergent survival results. Here, we present data of patients with more than 3 positive axillary lymph nodes (+aLN) receiving dd chemotherapy after a median follow-up period of 12.3 years. Methods In the years 1996-2000, 231 patients with invasive BC, ≥pN2a and no evidence of distant metastases were recruited to receive treatment A, i.e. dd 3 × epirubicin (E, 90 mg/m<sup>2</sup>) + paclitaxel (P, 175 mg/m<sup>2</sup>) every 2 weeks (q2w) followed by 3 × cyclophosphamide (C)/methotrexate/5-fluorouracil (CMF, 600/40/600 mg/m<sup>2</sup>, q2w), or treatment B, i.e. 4 × E + C (C, 600 mg/m<sup>2</sup>) q3w followed by 3 × CMF q3w. Results 113 patients in arm A and 113 patients in arm B were analysed after an updated median follow-up of 12.3 years. The median age was 55 years, with a median number of 6 +aLN, 50.4% had a T2 and 79.2% hormone receptor-positive BC. The disease-free survival (DFS) rate was 53.1% in arm A and 42.5% in arm B (adjusted p = 0.027). The overall survival (OS) rate was 54.9% in arm A and 48.7% in arm B (adjusted p = 0.058). In the multivariable analysis, the tumour burden was a significant predictor for DFS and OS. Conclusion The adjuvant use of dd chemotherapy led to a statistically significant improvement of DFS after a follow-up of 12.3 years.
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Affiliation(s)
- Mattea Reinisch
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Essen, Germany
| | - Oleg Gluz
- Bethesda Hospital, Breast Center Niederrhein, Mönchengladbach, Germany; West German Study Group, Mönchengladbach, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | | | - Marek Budner
- Breast Unit, Helios Klinikum, Bad Saarow, Germany
| | | | - Andreas Kohls
- Breast Unit, Evangelisches Krankenhaus Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - Jutta Krocker
- Breast Unit, Sana Klinikum Berlin-Lichtenberg, Berlin, Germany
| | - Aylin Kümmel
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Essen, Germany
| | - Friederike Hagemann
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Essen, Germany
| | - Anna Rüland
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Essen, Germany
| | | | - Sherko Kümmel
- Breast Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Essen, Germany
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Harter P, Heitz F, Ataseven B, Prader S, Schneider S, Baert T, Alesina P, Groeben H, Traut A, Du Bois A. Impact of a structured quality management program on survival of patients with advanced (AOC) and relapsed ovarian cancer (ROC) treated in a dedicated tertiary gynecologic-oncology (GO) center. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17048 Background: Treatment of AOC needs interdisciplinary and specialized skills and structures. We report the impact of a dedicated quality management program over 2 decades from learning curve and specialization process started in 1998-2004 when the surgical department was separated from a general clinic of obstetrics and gynecology. The next period from 2005-2010 covers the data after implementation of the first step of our ovarian cancer quality assurance program. In 2011, a dedicated department of GO was founded. Additionally, we investigated the role of subsequent centralized versus decentralized treatment when patients relapsed after they had primary therapy at our institution. Methods: Descriptive analysis of our prospective tumor registry including all consecutive patients with primary diagnosis of AOC FIGO IIB-IV treated from 1998-2004, 2005-2010 and 2011-2017. All patients having started any therapy outside of our center were excluded. Results: The number of patients with untreated AOC increased from 10 to 147 per year from 1998 to 2017. In total, 1,663 pts were analyzed. The annual percentage of FIGO IV increased from 14% in 1998 to 54-61% in recent years (2013-2017). The complete resection rate of upfront surgery was 50%, 67%, and 69% in the periods 1997-2004, 2005-2010, and 2011-2017, respectively. Correspondingly, median PFS increased from 19 to 21 and 26 months (p < 0.001) and median OS increased from 33 to 42 and 56 months, respectively (p < 0.001). Altogether, 893 pts (53.7%) experienced a relapse. 490/893 pts (54.9% of all ROC pts) were treated again in our center, the remaining 45.1% were treated somewhere else. Median OS calculated from first relapse was 43 months for patients re-treated in our institution versus 32 months for others (p < 0.001). Conclusions: We demonstrate a correlation between specialization and improved outcome in AOC. Focusing and implementing a quality assurance program including structural evolution from a department of general obstetrics/gynecology to a department of GO led to an improvement although systemic primary treatment standards did not change during this period.
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Affiliation(s)
- Philipp Harter
- Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
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Ehmann S, du Bois A, Harter P, Heitz F, Prader S, Traut A, Pauly N, Heikaus S, Ataseven B. Altersabhängiger Vergleich von histologischem Tumortyp und Stadienverteilung bei Patientinnen mit primärem epithelialem Ovarialkarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671012] [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: 10/28/2022] Open
Affiliation(s)
- S Ehmann
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - A du Bois
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - P Harter
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - F Heitz
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - S Prader
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - A Traut
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - N Pauly
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - S Heikaus
- Zentrum für Pathologie Essen-Mitte, Essen, Deutschland
| | - B Ataseven
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
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Harter P, Prader S, Ataseven B, Heitz F, Alesina P, Gröben H, Traut A, du Bois A. Survival of patients with advanced ovarian cancer in a specialized center from 1998 – 2016. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671030] [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: 10/28/2022] Open
Affiliation(s)
- P Harter
- Kliniken Essen-Mitte, Gynecology & Gynecologic Oncology, Essen, Deutschland
| | - S Prader
- Kliniken Essen-Mitte, Gynecology & Gynecologic Oncology, Essen, Deutschland
| | - B Ataseven
- Kliniken Essen-Mitte, Gynecology & Gynecologic Oncology, Essen, Deutschland
| | - F Heitz
- Kliniken Essen-Mitte, Gynecology & Gynecologic Oncology, Essen, Deutschland
| | - P Alesina
- Kliniken Essen-Mitte, Visceral Surgery, Essen, Deutschland
| | - H Gröben
- Kliniken Essen-Mitte, Anesthesiology, Essen, Deutschland
| | - A Traut
- Kliniken Essen-Mitte, Gynecology & Gynecologic Oncology, Essen, Deutschland
| | - A du Bois
- Kliniken Essen-Mitte, Gynecology & Gynecologic Oncology, Essen, Deutschland
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Plett H, Harter P, Prader S, Ataseven B, Heitz F, Bommert M, Schneider S, Alesina PF, Traut A, du Bois A. Role of primary surgery for persistent residual disease after more than 5 cycles of chemotherapy for primary advanced ovarian cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671315] [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: 10/28/2022] Open
Affiliation(s)
- H Plett
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - P Harter
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - S Prader
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - B Ataseven
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - F Heitz
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - M Bommert
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - S Schneider
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - PF Alesina
- Kliniken-Essen-Mitte, Chirurgie, Essen, Deutschland
| | - A Traut
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - A du Bois
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
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Frindte J, Ataseven B, Harter P, Göke G, Podkowinkski J, Vogt C, Bluni V, Vincent M, Traut A, Heitz F, Kümmel S, Prader S, Bommert M, Schneider S, du Bois A. Change of patient perceptions of chemotherapy side effects in breast and ovarian cancer patients. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671017] [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: 10/28/2022] Open
Affiliation(s)
- J Frindte
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - B Ataseven
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - P Harter
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - G Göke
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - J Podkowinkski
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - C Vogt
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - V Bluni
- Kliniken Essen Mitte, Senologie/Interdisziplinäres Brustzentrum, Essen, Deutschland
| | - M Vincent
- Kliniken Essen Mitte, Senologie/Interdisziplinäres Brustzentrum, Essen, Deutschland
| | - A Traut
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - F Heitz
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - S Kümmel
- Kliniken Essen Mitte, Senologie/Interdisziplinäres Brustzentrum, Essen, Deutschland
| | - S Prader
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - M Bommert
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - S Schneider
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
| | - A du Bois
- Kliniken Essen Mitte, Gynäkologie und gynäkologische Onkologie, Essen, Deutschland
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Pauly N, du Bois A, Harter P, Baert T, Heitz F, Heikaus S, Prader S, Traut A, Ehmann S, Ataseven B. Mismatch-Repair-Defekt-Analyse bei 191 konsekutiven Endometriumkarzinom-Patientinnen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671314] [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: 10/28/2022] Open
Affiliation(s)
- N Pauly
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - A du Bois
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - P Harter
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - T Baert
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - F Heitz
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - S Heikaus
- Zentrum für Pathologie Essen-Mitte, Essen, Deutschland
| | - S Prader
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - A Traut
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - S Ehmann
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
| | - B Ataseven
- Kliniken Essen-Mitte (KEM), Gynäkologie und Gynäkologische Onkologie, Essen, Deutschland
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Ehmann S, Ataseven B, Prader S, Harter P, Baert T, Heitz F, Traut A, Pauly N, Heikaus S, du Bois A. Die Etablierung der Indocyanin-Grün-Fluoreszenz-Markierung zur Darstellung des Sentinel-Lymphknotens beim Endometriumkarzinom in einem Zentrum für Gynäko-Onkologie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671013] [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: 10/28/2022] Open
Affiliation(s)
- S Ehmann
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - B Ataseven
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - S Prader
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - P Harter
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - T Baert
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - F Heitz
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - A Traut
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - N Pauly
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
| | - S Heikaus
- Zentrum für Pathologie Essen-Mitte, Essen, Deutschland
| | - A du Bois
- Klinik für Gynäkologie und gynäkologische Onkologie, Kliniken-Essen-Mitte, DKG zertifiziertes und ESGO akkreditiertes gynäko-onkologisches Krebszentrum, Essen, Deutschland
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Ataseven B, González Luengo T, Harter P, Waltering K, Heitz F, Koch JA, Prader S, Traut A, Alesina PF, Heikaus S, du Bois A. Impact of quantitative body composition on survival in patients with epithelial ovarian cancer undergoing primary debulking surgery. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1670995] [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: 10/28/2022] Open
Affiliation(s)
- B Ataseven
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
| | | | - P Harter
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
| | - K Waltering
- Kliniken Essen-Mitte (KEM), Radiologie, Essen, Deutschland
| | - F Heitz
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
| | - JA Koch
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
| | - S Prader
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
| | - A Traut
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
| | - PF Alesina
- Kliniken Essen-Mitte (KEM), Chirurgie, Essen, Deutschland
| | - S Heikaus
- Kliniken Essen-Mitte (KEM), Pathologie, Essen, Deutschland
| | - A du Bois
- Kliniken Essen-Mitte (KEM), Essen, Deutschland
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Ataseven B, Luengo TG, du Bois A, Waltering KU, Traut A, Heitz F, Alesina PF, Prader S, Meier B, Schneider S, Koch JA, Walz M, Groeben HT, Nina P, Brunkhorst V, Heikaus S, Harter P. Skeletal Muscle Attenuation (Sarcopenia) Predicts Reduced Overall Survival in Patients with Advanced Epithelial Ovarian Cancer Undergoing Primary Debulking Surgery. Ann Surg Oncol 2018; 25:3372-3379. [DOI: 10.1245/s10434-018-6683-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Indexed: 12/27/2022]
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Harter P, Plett H, Prader S, Ataseven B, Heitz F, Bommert M, Schneider S, Alesina P, Traut A, Du Bois A. Role of primary surgery for persistent residual disease after more than 5 cycles of chemotherapy for primary advanced ovarian cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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
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Heitz F, Harter P, Ataseven B, Heikaus S, Schneider S, Prader S, Bommert M, Fisseler-Eckhoff A, Traut A, du Bois A. Stage- and Histologic Subtype-Dependent Frequency of Lymph Node Metastases in Patients with Epithelial Ovarian Cancer Undergoing Systematic Pelvic and Paraaortic Lymphadenectomy. Ann Surg Oncol 2018; 25:2053-2059. [DOI: 10.1245/s10434-018-6412-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Indexed: 11/18/2022]
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Kahl A, du Bois A, Harter P, Prader S, Schneider S, Heitz F, Traut A, Alesina PF, Meier B, Walz M, Brueckner A, Groeben HT, Brunkhorst V, Heikaus S, Ataseven B. Prognostic Value of the Age-Adjusted Charlson Comorbidity Index (ACCI) on Short- and Long-Term Outcome in Patients with Advanced Primary Epithelial Ovarian Cancer. Ann Surg Oncol 2017; 24:3692-3699. [DOI: 10.1245/s10434-017-6079-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 12/12/2022]
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Grimm C, Harter P, Alesina PF, Prader S, Schneider S, Ataseven B, Meier B, Brunkhorst V, Hinrichs J, Kurzeder C, Heitz F, Kahl A, Traut A, Groeben HT, Walz M, du Bois A. The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery. Gynecol Oncol 2017; 146:498-503. [DOI: 10.1016/j.ygyno.2017.06.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/03/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023]
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Groeben H, Nottebaum B, Alesina P, Traut A, Neumann H, Walz M. Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series † †This Article is accompanied by Editorial Aew414. Br J Anaesth 2017; 118:182-189. [DOI: 10.1093/bja/aew392] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/27/2022] Open
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Heitz F, Hengsbach A, Harter P, Traut A, Ataseven B, Schneider S, Prader S, Kurzeder C, Sporkmann M, du Bois A. Intake of selective beta blockers has no impact on survival in patients with epithelial ovarian cancer. Gynecol Oncol 2016; 144:181-186. [PMID: 27863705 DOI: 10.1016/j.ygyno.2016.11.012] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Some authors have claimed a significant impact of β-blocking agents on outcome in epithelial ovarian cancer (EOC). This study investigated the impact of concurrent medication with selective beta blockers (SBB) in patients undergoing primary treatment for EOC. METHODS The study included all consecutive patients with primary EOC treated in two tertiary gynecological-oncologic units between 1999 and 2014. Medication was retrospectively analyzed by chart review. RESULTS The study cohort comprised 801 patients, of whom 141 (17.6%) had received SBB. Median age of patients without SBB medication was 56years (range: 19-90years) and 64years (range: 41-84years) in patients taking SBB (p<0.001). The main prognostic factor FIGO stage did not differ between both cohorts. 63.8% of patients taking SBB underwent complete tumor resection compared to 74.2% of patients without SBB (p=0.012). Patients without SBB experienced less severe post-operative complications according to the Clavien-Dindo classification (18.8% vs 29.0%; p=0.003). Between the both groups without and with SBB intake, PFS and OS did not differ significantly (PFS: 27months and 24months, p=0.40; OS: 56months and 44, p=0.15). Multivariate analyses did not yield any association between SBB intake and prognosis but confirmed well-known prognostic factors. CONCLUSIONS Intake of selective β-blockers did not influence the prognosis of patients with EOC.
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Affiliation(s)
- Florian Heitz
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany.
| | - Alexandra Hengsbach
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Christian Kurzeder
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Mareike Sporkmann
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology; Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
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Kahl A, Ataseven B, Harter P, Heitz FH, Kurzeder C, Schneider S, Prader S, Traut A, du Bois A. Die prognostische Wertigkeit altersadjustierten Charlson Komorbiditätsindex bei Frauen mit primärem epithelialem Ovarialkarzinom auf die peri-/postoperative Morbidität und Mortalität. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593298] [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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Ataseven B, Kahl A, Harter P, Heitz F, Kurzeder C, Schneider S, Prader S, Traut A, du Bois A. Der prognostische Stellenwert des altersadjustierten Charlson Komorbiditätsindex auf das Gesamtüberleben bei 1038 Frauen mit primärem epithelialem Ovarialkarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592697] [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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Ataseven B, Harter P, Heitz F, Heikaus S, Grimm C, Traut A, Kurzeder C, Prader S, du Bois A. The revised 2014 FIGO staging system for epithelial ovarian cancer: is a subclassification of FIGO stage IV justified? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592990] [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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Ataseven B, du Bois A, Harter P, Prader S, Grimm C, Kurzeder C, Schneider S, Heikaus S, Traut A, Heitz F. Impact of abdominal wall metastases on prognosis in FIGO IV epithelial ovarian cancer. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593289] [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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Kurzeder C, Harter P, Prader S, Heitz F, Ataseven B, Schneider S, Traut A, du Bois A. Roboterassistierte radikale Hysterektomie nach neoadjuvanter Chemotherapie bei lokal fortgeschrittenem Zervixkarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592722] [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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Ataseven B, Grimm C, Harter P, Heikaus S, Heitz F, Traut A, Prader S, Kahl A, Schneider S, Kurzeder C, du Bois A. Prognostic Impact of Port-Site Metastasis After Diagnostic Laparoscopy for Epithelial Ovarian Cancer. Ann Surg Oncol 2016; 23:834-840. [PMID: 27406097 DOI: 10.1245/s10434-016-5415-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study was designed to evaluate the prevalence, morbidity, and prognostic impact of port-site metastasis (PSM) in patients with epithelial ovarian cancer (EOC) undergoing laparoscopy before subsequent primary debulking surgery (PDS). METHODS All consecutive patients treated between 2000 and 2014, who had a laparoscopy followed by PDS, were extracted from our prospectively maintained database. All patients with histological examination of port-sites were included in this unicentric exploratory analysis. RESULTS A total of 250 (25.5 %) of 982 patients with EOC underwent laparoscopy before PDS. Port-site resection was performed in those 214 (85.6 %) patients in whom a complete or almost complete resection with residuals ≤1 cm was achieved. Median interval between laparoscopy and PDS was 25 days. PSM was detected in 100 of 214 patients (46.7 %). Risk factors for PSM were higher tumor stage (odds ratio [OR] 13.5, 95 % confidence interval [CI] 2.9-62.0, p = 0.04), positive lymph node status (OR 3.0, 95 % CI 1.3-6.7, p = 0.009), and ascites >500 mL (OR 3.9, 95 % CI 1.5-10.0, p = 0.005). Wound healing disorders and postoperative morbidity were significantly higher in patients with PSM (Clavien-Dindo Classification grade 3-5: 41.0 vs. 14.9 %, p < 0.001). However, multivariate Cox-regression models did not identify PSM as independent prognostic factor. CONCLUSIONS The prevalence of PSM after laparoscopy in EOC patients is considerably high. PSM had no impact on survival; however, PSM were associated with more postoperative complications and a higher surgical treatment burden. This should be balanced with the expected benefit when laparoscopy is considered for the management of EOC.
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Affiliation(s)
- Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany.
| | - Christoph Grimm
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany.,Department of General Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna - Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | | | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Annett Kahl
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Stefanie Schneider
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Christian Kurzeder
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
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Ataseven B, Harter P, Grimm C, Heitz F, Heikaus S, Traut A, Kahl A, Kurzeder C, Prader S, du Bois A. The revised 2014 FIGO staging system for epithelial ovarian cancer: Is a subclassification into FIGO stage IVA and IVB justified? Gynecol Oncol 2016; 142:243-7. [PMID: 27208538 DOI: 10.1016/j.ygyno.2016.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 04/22/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The revised 2014 FIGO staging system for epithelial ovarian cancer (EOC) included many changes of the previous system, particularly dividing FIGO stage IV in two subgroups. We evaluated if classifying patients with EOC in FIGO stage IVA and IVB has any prognostic implication.
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Affiliation(s)
- Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany.
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | - Christoph Grimm
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | - Sebastian Heikaus
- Center for Pathology, Kliniken Essen-Mitte, Am Deimelsberg 34, 45276 Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | - Annett Kahl
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | - Christian Kurzeder
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany
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Haller H, Voiss P, Choi KE, Lange S, Felber S, Traut A, Paul A, Dobos G, Kümmel S. Request for complementary and alternative medicine (CAM) in German patients with breast cancer: A cross-sectional survey. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Petra Voiss
- Department of Senology / Breast Care Center, Kliniken Essen-Mitte, Essen, Germany
| | - Kyung-Eun Choi
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Silke Lange
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Sabine Felber
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Anna Paul
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Sherko Kümmel
- Department of Senology / Breast Care Center, Kliniken Essen Mitte, Essen, Germany
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