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Schöne N, Kemper M, Menck K, Evers G, Krekeler C, Schulze AB, Lenz G, Wardelmann E, Binder C, Bleckmann A. PD-L1 on large extracellular vesicles is a predictive biomarker for therapy response in tissue PD-L1-low and -negative patients with non-small cell lung cancer. J Extracell Vesicles 2024; 13:e12418. [PMID: 38453684 PMCID: PMC10920108 DOI: 10.1002/jev2.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/24/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
Immunotherapy has revolutionized the treatment of patients with non-small cell lung cancer (NSCLC). High expression of tissue PD-L1 (tPD-L1) is currently the only approved biomarker for predicting treatment response. However, even tPD-L1 low (1-49%) and absent (<1%) patients might benefit from immunotherapy but, to date, there is no reliable biomarker, that can predict response in this particular patient subgroup. This study aimed to test whether tumour-associated extracellular vesicles (EVs) could fill this gap. Using NSCLC cell lines, we identified a panel of tumour-related antigens that were enriched on large EVs (lEVs) compared to smaller EVs. The levels of lEVs carrying these antigens were significantly elevated in plasma of NSCLC patients (n = 108) and discriminated them from controls (n = 77). Among the tested antigens, we focused on programmed cell death ligand 1 (PD-L1), which is a well-known direct target for immunotherapy. In plasma lEVs, PD-L1 was mainly found on a population of CD45- /CD62P+ lEVs and thus seemed to be associated with platelet-derived vesicles. Patients with high baseline levels of PD-L1+ lEVs in blood showed a significantly better response to immunotherapy and prolonged survival. This was particularly true in the subgroup of NSCLC patients with low or absent tPD-L1 expression, thus identifying PD-L1-positive lEVs in plasma as a novel predictive and prognostic marker for immunotherapy.
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Affiliation(s)
- Nadja Schöne
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
- University Hospital Münster, West German Cancer CenterMünsterGermany
| | - Marcel Kemper
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
- University Hospital Münster, West German Cancer CenterMünsterGermany
| | - Kerstin Menck
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
- University Hospital Münster, West German Cancer CenterMünsterGermany
| | - Georg Evers
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
- University Hospital Münster, West German Cancer CenterMünsterGermany
| | - Carolin Krekeler
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
- University Hospital Münster, West German Cancer CenterMünsterGermany
| | - Arik Bernard Schulze
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
- University Hospital Münster, West German Cancer CenterMünsterGermany
| | - Georg Lenz
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
| | - Eva Wardelmann
- University of Münster, Gerhard‐Domagk‐Institute of PathologyMünsterGermany
| | - Claudia Binder
- University Medicine Göttingen, Clinic for Hematology/Medical OncologyGöttingenGermany
| | - Annalen Bleckmann
- University of Münster, Department of Medicine A, Hematology, Oncology, and PneumologyMünsterGermany
- University Hospital Münster, West German Cancer CenterMünsterGermany
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Evers G, Mohr M, Sprakel L, Galonska J, Görlich D, Schulze AB. Bronchoscopist-Directed Continuous Flow Propofol Based Analgosedation during Flexible Interventional Bronchoscopy and EBUS. J Clin Med 2023; 12:4223. [PMID: 37445256 DOI: 10.3390/jcm12134223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Sedation techniques in interventional flexible bronchoscopy and endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) are inconsistent and the evidence for required general anesthesia under full anesthesiologic involvement is scarce. Moreover, we faced the challenge of providing bronchoscopic care with limited personnel. Hence, we retrospectively identified 513 patients that underwent flexible interventional bronchoscopy and/or EBUS-TBNA out of our institution between January 2020 and August 2022 to evaluate our deep analgosedation approach based on pethidine/meperidine bolus plus continuous flow adjusted propofol, the bronchoscopist-directed continuous flow propofol based analgosedation (BDcfP) in a two-personnel setting. Consequently, 502 out of 513 patients received BDcfP for analgosedation. We identified cardiovascular comorbidities, chronic obstructive pulmonary disease, and arterial hypertension as risk factors for periprocedural hypotension. Propofol flow rate did not correlate with hypotension. Theodrenaline and cafedrine might be used to treat periprocedural hypotension. Moreover, midazolam might be used to support the sedative effect. In conclusion, BDcfP is a safe and feasible sedative approach during interventional flexible bronchoscopy and EBUS-TBNA. In general, after the implementation of safety measures, EBUS-TBNA and interventional flexible bronchoscopy via BDcfP might safely be performed even with limited personnel.
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Affiliation(s)
- Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Lena Sprakel
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Jule Galonska
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-University Münster, 48149 Münster, Germany
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
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Schulze AB, Mohr M, Sackarnd J, Schmidt LH, Tepasse PR, Rosenow F, Evers G. Risk Factors in HIV-1 Positive Patients on the Intensive Care Unit: A Single Center Experience from a Tertiary Care Hospital. Viruses 2023; 15:v15051164. [PMID: 37243250 DOI: 10.3390/v15051164] [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: 04/29/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
HIV-positive patients with acquired immunodeficiency syndrome (AIDS) often require treatment on intensive care units (ICUs). We aimed to present data from a German, low-incidence region cohort, and subsequently evaluate factors measured during the first 24 h of ICU stay to predict short- and long-term survival, and compare with data from high-incidence regions. We documented 62 patient courses between 2009 and 2019, treated on a non-operative ICU of a tertiary care hospital, mostly due to respiratory deterioration and co-infections. Of these, 54 patients required ventilatory support within the first 24 h with either nasal cannula/mask (n = 12), non-invasive ventilation (n = 16), or invasive ventilation (n = 26). Overall survival at day 30 was 77.4%. While ventilatory parameters (all p < 0.05), pH level (c/o 7.31, p = 0.001), and platelet count (c/o 164,000/µL, p = 0.002) were significant univariate predictors of 30-day and 60-day survival, different ICU scoring systems, such as SOFA score, APACHE II, and SAPS 2 predicted overall survival (all p < 0.001). Next to the presence or history of solid neoplasia (p = 0.026), platelet count (HR 6.7 for <164,000/µL, p = 0.020) and pH level (HR 5.8 for <7.31, p = 0.009) remained independently associated with 30-day and 60-day survival in multivariable Cox regression. However, ventilation parameters did not predict survival multivariably.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Lars Henning Schmidt
- Medical Department IV, Pneumology, Respiratory Medicine and Thoracic Oncology, Klinikum Ingolstadt, 85049 Ingolstadt, Germany
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
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Kemper M, Krekeler C, Menck K, Lenz G, Evers G, Schulze AB, Bleckmann A. Liquid Biopsies in Lung Cancer. Cancers (Basel) 2023; 15:1430. [PMID: 36900221 PMCID: PMC10000706 DOI: 10.3390/cancers15051430] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
As lung cancer has the highest cancer-specific mortality rates worldwide, there is an urgent need for new therapeutic and diagnostic approaches to detect early-stage tumors and to monitor their response to the therapy. In addition to the well-established tissue biopsy analysis, liquid-biopsy-based assays may evolve as an important diagnostic tool. The analysis of circulating tumor DNA (ctDNA) is the most established method, followed by other methods such as the analysis of circulating tumor cells (CTCs), microRNAs (miRNAs), and extracellular vesicles (EVs). Both PCR- and NGS-based assays are used for the mutational assessment of lung cancer, including the most frequent driver mutations. However, ctDNA analysis might also play a role in monitoring the efficacy of immunotherapy and its recent accomplishments in the landscape of state-of-the-art lung cancer therapy. Despite the promising aspects of liquid-biopsy-based assays, there are some limitations regarding their sensitivity (risk of false-negative results) and specificity (interpretation of false-positive results). Hence, further studies are needed to evaluate the usefulness of liquid biopsies for lung cancer. Liquid-biopsy-based assays might be integrated into the diagnostic guidelines for lung cancer as a tool to complement conventional tissue sampling.
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Affiliation(s)
- Marcel Kemper
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center, University Hospital Muenster, 48149 Muenster, Germany
| | - Carolin Krekeler
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center, University Hospital Muenster, 48149 Muenster, Germany
| | - Kerstin Menck
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center, University Hospital Muenster, 48149 Muenster, Germany
| | - Georg Lenz
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center, University Hospital Muenster, 48149 Muenster, Germany
| | - Georg Evers
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center, University Hospital Muenster, 48149 Muenster, Germany
| | - Arik Bernard Schulze
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center, University Hospital Muenster, 48149 Muenster, Germany
| | - Annalen Bleckmann
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center, University Hospital Muenster, 48149 Muenster, Germany
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Schulze AB, Wenge DV, Evers G, Heitkötter B, Bleckmann A, Schmidt LH, Mohr M, Hartmann W, Arteaga MF, Mikesch JH. High expression of transcription factor POU2F1 confers improved survival on smokers with lung adenocarcinoma: a retrospective study of two cohorts. Transl Lung Cancer Res 2023; 12:727-741. [PMID: 37197633 PMCID: PMC10183409 DOI: 10.21037/tlcr-22-714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/08/2023] [Indexed: 03/28/2023]
Abstract
Background Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide and its most important risk factor is tobacco smoking. While smoking is associated with inferior outcome in NSCLC patients, smoking also correlates with a higher tumor mutational burden. In contrast to adenocarcinomas (ADC) of non-smokers, that frequently harbor targetable gain-of-function mutations, NSCLC smokers largely present with non-targetable loss-of-function mutations of genes associated with DNA-damage repair. The transcription factor Pit-1, Oct1/2, Unc-86 (POU) domain class 2 transcription factor 1 (POU2F1) is a widely expressed bipotential stabilizer of repressed and inducible transcriptional states and frequently deregulated in cancer. Methods Via immunohistochemistry, we evaluated POU2F1 protein expression on a tissue micro array of 217 operable stage I-III NSCLC patients. Findings were reproduced in a gene expression database of 1144 NSCLC patients, filtered for POU2F1 mRNA expression. After retroviral overexpression of POU2F1 in A549 cells, we evaluated for clonogenic growth and proliferation. Additionally, CRISPR-Cas9 mediated POU2F1 knockdown in A549 cells was likewise analyzed. Results High protein expression of POU2F1 in 217 NSCLC patients resulted in improved outcome of smokers with ADC [hazard ratio (HR) 0.30 (0.09-0.99), P=0.035]. Moreover, gene expression analysis confirmed favorable outcome of high POU2F1 mRNA expression in smokers with ADC [HR 0.41 (0.24-0.69), P<0.001]. Other than that, retrovirally induced overexpression of POU2F1 in A549 cells significantly reduced both, clonogenic growth as well as proliferation of NSCLC cells, whereas CRISPR-Cas9 mediated knockdown of the protein did not have any impact. Conclusions Our data suggest that high expression of POU2F1 mediates a less aggressive cancer phenotype in smokers with ADC NSCLC. Pharmacological induction of genes and signaling pathways controlled by POU2F1 may provide novel avenues for future targeted NSCLC therapies in smokers.
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Kemper M, Evers G, Schulze AB, Sperveslage J, Schülke C, Lenz G, Herold T, Hartmann W, Schildhaus HU, Bleckmann A. Addendum: Polyclonal on- and off-target resistance mutations in an EML4-ALK positive non-small cell lung cancer patient under ALK inhibition. Oncotarget 2022; 13:1216. [PMID: 36342457 PMCID: PMC9629813 DOI: 10.18632/oncotarget.28293] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marcel Kemper
- 1Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, 48149 Muenster, Germany,2West German Cancer Center, Sites Muenster & Essen, 45147 Essen, Germany,*Authors share first authorship
| | - Georg Evers
- 1Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, 48149 Muenster, Germany,2West German Cancer Center, Sites Muenster & Essen, 45147 Essen, Germany,*Authors share first authorship
| | - Arik Bernard Schulze
- 1Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, 48149 Muenster, Germany,2West German Cancer Center, Sites Muenster & Essen, 45147 Essen, Germany
| | - Jan Sperveslage
- 3Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, 48149 Muenster, Germany
| | - Christoph Schülke
- 4Institute of Clinical Radiology, University Hospital Muenster, 48149 Muenster, Germany
| | - Georg Lenz
- 1Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, 48149 Muenster, Germany,2West German Cancer Center, Sites Muenster & Essen, 45147 Essen, Germany
| | - Thomas Herold
- 5Institute of Pathology, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Hartmann
- 3Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, 48149 Muenster, Germany
| | - Hans-Ulrich Schildhaus
- 2West German Cancer Center, Sites Muenster & Essen, 45147 Essen, Germany,5Institute of Pathology, University Hospital Essen, 45147 Essen, Germany,#Authors share last authorship
| | - Annalen Bleckmann
- 1Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, 48149 Muenster, Germany,2West German Cancer Center, Sites Muenster & Essen, 45147 Essen, Germany,6Department of Hematology/Medical Oncology, University Medical Center Goettingen, 37075 Goettingen, Germany,#Authors share last authorship,Correspondence to:Annalen Bleckmann, email:
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Schulze AB, Evers G, Tenk FS, Schliemann C, Schmidt LH, Görlich D, Mohr M. Central airway obstruction treatment with self-expanding covered Y-carina nitinol stents: A single center retrospective analysis. Thorac Cancer 2022; 13:1040-1049. [PMID: 35199949 PMCID: PMC8977163 DOI: 10.1111/1759-7714.14359] [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: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 12/01/2022] Open
Abstract
Background Central airway obstruction (CAO) is one of the most challenging, potentially lethal complications in malignant and benign respiratory diseases. Worsening dyspnea is also a relevant cause for reduced quality of life in such patients. Here, we present our data on the application of covered, self‐expanding Y‐carina nitinol stents due to benign and malignant diseases. Methods We retrospectively identified 27 patients who had undergone 31 rigid bronchoscopies with implantation of covered Y‐carina nitinol stents over a period of 10 years in order to evaluate indication, clinical course, and outcome. Results Short‐term survival of successfully stented patients with palliative and curative treatment goal did not differ, allowing for diagnosis independent indication. With respect to overall survival, patients with endoluminal obstruction benefited most compared to patients with fistula and/or external compression. Granulation tissue formation (61.3%) and mucus plugging (80.6%) were the most frequent complications. Material defect (6.5%) and migration (3.2%) were rare complications that could be handled by revisional rigid bronchoscopy and stent exchange in some cases. Conclusions Implantation of self‐expanding covered Y‐carina nitinol stents via rigid bronchoscopy is a feasible and safe treatment option for benign and malignant central airway obstruction. Especially in palliative, malignant airway stenosis, stenting might facilitate additional treatment options and optimize dyspnea and eventually quality of life.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Friederike Sophia Tenk
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Lars Henning Schmidt
- Medical Department IV, Pulmonary Medicine and Thoracic Oncology, Klinikum Ingolstadt, Ingolstadt, Germany.,Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische-Wilhelms University Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
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Schulze AB, Evers G, Mohr M. Effect of Training on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction. JAMA 2021; 326:771-772. [PMID: 34427610 DOI: 10.1001/jama.2021.10049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Arik Bernard Schulze
- Department of Hematology, Oncology, and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Hematology, Oncology, and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Hematology, Oncology, and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
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Wilmes D, McCormick-Smith I, Lempp C, Mayer U, Schulze AB, Theegarten D, Hartmann S, Rickerts V. Detection of Histoplasma DNA from Tissue Blocks by a Specific and a Broad-Range Real-Time PCR: Tools to Elucidate the Epidemiology of Histoplasmosis. J Fungi (Basel) 2020; 6:jof6040319. [PMID: 33261008 PMCID: PMC7711923 DOI: 10.3390/jof6040319] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022] Open
Abstract
Lack of sensitive diagnostic tests impairs the understanding of the epidemiology of histoplasmosis, a disease whose burden is estimated to be largely underrated. Broad-range PCRs have been applied to identify fungal agents from pathology blocks, but sensitivity is variable. In this study, we compared the results of a specific Histoplasma qPCR (H. qPCR) with the results of a broad-range qPCR (28S qPCR) on formalin-fixed, paraffin-embedded (FFPE) tissue specimens from patients with proven fungal infections (n = 67), histologically suggestive of histoplasmosis (n = 36) and other mycoses (n = 31). The clinical sensitivity for histoplasmosis of the H. qPCR and the 28S qPCR was 94% and 48.5%, respectively. Samples suggestive for other fungal infections were negative with the H. qPCR. The 28S qPCR did not amplify DNA of Histoplasma in FFPE in these samples, but could amplify DNA of Emergomyces (n = 1) and Paracoccidioides (n = 2) in three samples suggestive for histoplasmosis but negative in the H. qPCR. In conclusion, amplification of Histoplasma DNA from FFPE samples is more sensitive with the H. qPCR than with the 28S qPCR. However, the 28S qPCR identified DNA of other fungi in H. qPCR-negative samples presenting like histoplasmosis, suggesting that the combination of both assays may improve the diagnosis.
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Affiliation(s)
- Dunja Wilmes
- Reference Laboratory for Cryptococcosis and Uncommon Invasive Fungal Infections, Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, 13353 Berlin, Germany; (I.M.-S.); (V.R.)
- Correspondence: ; Tel.: +49-30-187-542-862
| | - Ilka McCormick-Smith
- Reference Laboratory for Cryptococcosis and Uncommon Invasive Fungal Infections, Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, 13353 Berlin, Germany; (I.M.-S.); (V.R.)
| | - Charlotte Lempp
- Vet Med Labor GmbH, Division of IDEXX Laboratories, 71636 Ludwigsburg, Germany; (C.L.); (U.M.)
| | - Ursula Mayer
- Vet Med Labor GmbH, Division of IDEXX Laboratories, 71636 Ludwigsburg, Germany; (C.L.); (U.M.)
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany;
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Sylvia Hartmann
- Senckenberg Institute for Pathology, Johann Wolfgang Goethe University Frankfurt, 60323 Frankfurt am Main, Germany;
| | - Volker Rickerts
- Reference Laboratory for Cryptococcosis and Uncommon Invasive Fungal Infections, Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, 13353 Berlin, Germany; (I.M.-S.); (V.R.)
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Schulze AB, Evers G, Görlich D, Mohr M, Marra A, Hillejan L, Rehkämper J, Schmidt LH, Heitkötter B. Tumor infiltrating T cells influence prognosis in stage I-III non-small cell lung cancer. J Thorac Dis 2020; 12:1824-1842. [PMID: 32642087 PMCID: PMC7330340 DOI: 10.21037/jtd-19-3414a] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Indexed: 12/24/2022]
Abstract
Background T cell infiltration in non-small cell lung cancer (NSCLC) is essential for the immunological response to malignant tissue, especially in the era of immune-checkpoint inhibition. To investigate the prognostic impact of CD4+ T helper cells (Th), CD8+ cytotoxic (Tc) and FOXP3+ regulatory T (Treg) cells in NSCLC, we performed this analysis. Methods By counterstaining of CD4, CD8 and FOXP3 we used immunohistochemistry on tissue microarrays (TMA) to evaluate peritumoral Th cells, Treg cells and Tc cells in n=294 NSCLC patients with pTNM stage I–III disease. Results Strong CD4+ infiltration was associated with higher tumor stages and lymphonodal spread. However, strong CD4+ infiltration yielded improved overall survival (OS) (P=0.014) in adenocarcinoma (ADC) and large cell carcinoma (LCC) but not in squamous cell carcinoma (SCC). A CD4/CD8 ratio <1 was associated with high grade NSCLC tumors (P=0.020). High CD8+ T cell infiltration was an independent prognostic factor for OS (P=0.040) and progression-free survival (PFS) (P=0.012) in the entire study collective. The OS benefit of high CD8+ infiltration was especially prominent in PD-L1 negative NSCLC (P=0.001) but not in PD-L1 positive tissue (P=0.335). Moreover, positive FOXP3+ expression in tumor infiltrating lymphocytes was associated with increased OS (P=0.007) and PFS (P=0.014) in SCC but not in ADC and LCC (all P>0.05). Here, prognostic effects were prominent in PD-L1 positive SCC (P=0.023) but not in PD-L1 negative SCC (P=0.236). Conclusions High proportion of CD8+ Tc cells correlated with improved prognostic outcome in stage I–III NSCLC. Th cells and Treg cells have implications on outcome with respect to tumor histology and biology.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische-Wilhelms University Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Alessandro Marra
- Department of Thoracic Surgery, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Ludger Hillejan
- Department of Thoracic Surgery, Niels-Stensen-Kliniken, Ostercappeln, Germany
| | - Jan Rehkämper
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany.,IV. Medical Department, Pulmonary Medicine and Thoracic Oncology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Birthe Heitkötter
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
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11
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Schulze AB, Schmidt LH, Heitkötter B, Huss S, Mohr M, Marra A, Hillejan L, Görlich D, Barth PJ, Rehkämper J, Evers G. Prognostic impact of CD34 and SMA in cancer-associated fibroblasts in stage I-III NSCLC. Thorac Cancer 2019; 11:120-129. [PMID: 31760702 PMCID: PMC6938745 DOI: 10.1111/1759-7714.13248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Epithelial‐to‐mesenchymal transition (EMT) is a crucial step in lung cancer pathogenesis. Among others, cancer‐associated fibroblasts (CAFs) are reported to regulate this process. Objectives To investigate the prognostic and clinical impact, we analyzed CD34+ and SMA+ CAFs in non‐small cell lung cancer (NSCLC). Methods Retrospectively, immunohistochemistry was performed to study stromal protein expression of both CD34 and SMA in 304 NSCLC patients with pTNM stage I‐III disease. All tissue samples were embedded on tissue microarrays (TMAs). Results Our analysis revealed an association for CD34+ CAFs with G1/2 tumors and adenocarcinoma histology. Moreover CD34+ CAFs were identified as an independent prognostic factor (both for progression free survival [PFS] and overall survival [OS] in stage I‐III NSCLC). Besides, SMA+ expression correlated with higher pTNM‐tumor stages and lymphatic spread (pN stage). In turn, SMA‐negativity was associated with improved PFS, but no prognostic impact was found on OS. Of interest, neither CD34+ CAFs nor SMA+ CAFs were associated with the primary tumor size, localization and depth of infiltration (pT stage). Conclusions CD34 was identified as an independent prognostic marker in pTNM stage I‐III NSCLC. Moreover, loss of CD34+ CAFs might influence the dedifferentiation of the NSCLC tumor from its cell origin. Finally, SMA+ CAFs are more prevalent in NSCLC tumors of higher stages and lymphonodal positive NSCLC. Key points Expression of CD34 on cancer associated fibroblasts (CAFs) is an independent prognostic factor in stage I‐III NSCLC. SMA+ cancer associated fibroblasts are associated with higher tumor stages in NSCLC and might contribute to tumor progression in NSCLC.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Birthe Heitkötter
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Sebastian Huss
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Alessandro Marra
- Department of Thoracic Surgery, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Ludger Hillejan
- Department of Thoracic Surgery, Niels-Stensen-Kliniken Ostercappeln, Ostercappeln, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-University Muenster, Muenster, Germany
| | - Peter J Barth
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Jan Rehkämper
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
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12
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Schmidt LH, Schulze AB, Goerlich D, Schliemann C, Kessler T, Rottmann V, den Toom D, Rosenow F, Sackarnd J, Evers G, Mohr M. Blood clot removal by cryoextraction in critically ill patients with pulmonary hemorrhage. J Thorac Dis 2019; 11:4319-4327. [PMID: 31737317 DOI: 10.21037/jtd.2019.09.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/12/2022]
Abstract
Background Severe pulmonary hemorrhage is a life-threatening complication in critically ill patients. Due to tracheobronchial obstruction, ventilation is often impaired. Traditionally, rigid bronchoscopy is an option for recanalization. However, in comparison to flexible bronchoscopy, the application of rigid bronchoscopy is more complex. Against this background we evaluated the use of flexible cryo-probes for blood clot removal in critically ill patients. Methods Retrospectively, we identified 16 patients (median age: 60 years, 69% male patients), who suffered from severe airway obstruction due to blood clots. All patients required invasive ventilation and 11 patients depended on extracorporeal membrane oxygenation (ECMO). To remove blood clots, flexible bronchoscopic cryoextraction was performed in n=27 cases, whereas rigid bronchoscopy was only needed in two cases. Results Whereas in 9 cases single flexible cryoextraction was successful immediately, the procedure had to be repeated again in 7 patients. In all cases, tracheobronchial obstruction was treated with success and conditions of invasive ventilation were improved. In no case severe complications were observed. Conclusions In consideration of the underlying evaluation, we highly recommend flexible cryoextraction as both a safe and less complex technique for blood clot removal in critically ill patients.
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Affiliation(s)
- Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Dennis Goerlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Veronika Rottmann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Daniel den Toom
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
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13
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Schulze AB, Evers G, Kerkhoff A, Mohr M, Schliemann C, Berdel WE, Schmidt LH. Future Options of Molecular-Targeted Therapy in Small Cell Lung Cancer. Cancers (Basel) 2019; 11:E690. [PMID: 31108964 PMCID: PMC6562929 DOI: 10.3390/cancers11050690] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 03/29/2019] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide. With a focus on histology, there are two major subtypes: Non-small cell lung cancer (NSCLC) (the more frequent subtype), and small cell lung cancer (SCLC) (the more aggressive one). Even though SCLC, in general, is a chemosensitive malignancy, relapses following induction therapy are frequent. The standard of care treatment of SCLC consists of platinum-based chemotherapy in combination with etoposide that is subsequently enhanced by PD-L1-inhibiting atezolizumab in the extensive-stage disease, as the addition of immune-checkpoint inhibition yielded improved overall survival. Although there are promising molecular pathways with potential therapeutic impacts, targeted therapies are still not an integral part of routine treatment. Against this background, we evaluated current literature for potential new molecular candidates such as surface markers (e.g., DLL3, TROP-2 or CD56), apoptotic factors (e.g., BCL-2, BET), genetic alterations (e.g., CREBBP, NOTCH or PTEN) or vascular markers (e.g., VEGF, FGFR1 or CD13). Apart from these factors, the application of so-called 'poly-(ADP)-ribose polymerases' (PARP) inhibitors can influence tumor repair mechanisms and thus offer new perspectives for future treatment. Another promising therapeutic concept is the inhibition of 'enhancer of zeste homolog 2' (EZH2) in the loss of function of tumor suppressors or amplification of (proto-) oncogenes. Considering the poor prognosis of SCLC patients, new molecular pathways require further investigation to augment our therapeutic armamentarium in the future.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany.
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany.
| | - Andrea Kerkhoff
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany.
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany.
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany.
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany.
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany.
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14
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Schulze AB, Evers G, Kümmel A, Rosenow F, Sackarnd J, Hering JP, Schülke C, Engelbertz JA, Görlich D, Barth PJ, Lenz G, Becker H, Mohr M, Schmidt LH. Cyclophosphamide pulse therapy as treatment for severe interstitial lung diseases. Sarcoidosis Vasc Diffuse Lung Dis 2019; 36:157-166. [PMID: 32476949 DOI: 10.36141/svdld.v36i2.7636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/24/2019] [Indexed: 11/02/2022]
Abstract
Introduction Besides invasive or non-invasive ventilation, treatment of severe forms of interstitial lung diseases (ILD) includes immunosuppressive medication. In case of refractory organ- or life-threatening courses of disease, cyclophosphamide pulse therapy can serve as a rescue treatment option. Objectives To investigate therapeutic and prognostic effects of cyclophosphamide for the treatment of severe forms of ILD on intensive care unit (ICU) we performed this analysis. Methods Between 2009 and 2017 we identified 14 patients, who were treated on intensive care unit (ICU) with severe forms of ILD. Retrospectively, clinical, radiologic and prognostic data were collected and evaluated. Results Our analysis demonstrated a prognostic impact of cyclophosphamide on the ILD in general. Whereas pulmonary manifestations of both systemic sclerosis (SSc) and ANCA-associated vasculitis had an improved outcome, a reduced overall survival was found for Goodpasture syndrome (GPS), dermatomyositis (DM), cryptogenic organizing pneumonia (COP) and drug reaction with eosinophilia and systemic symptoms (DRESS; p=0.040, logrank test). Besides, additional plasmapheresis and initiation of cyclophosphamide within ten days following initial diagnosis of ILD were associated with improved prognosis. Conclusion Positive prognostic effects of cyclophosphamide pulse therapy in ICU treated patients suffering from severe respiratory failure due to pulmonary manifestations of both SSc and ANCA-associated-vasculitis were observed. Further prognostic and therapeutic data are needed for cyclophosphamide for this indication in order to prevent patients from its toxic side-effects, who most likely will not benefit from its application.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as first authors
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as first authors
| | - Andreas Kümmel
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Philipp Hering
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schülke
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Jonas Andreas Engelbertz
- Unit of Cytostatic Reconstitution, Hospital pharmacy, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Peter J Barth
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, Muenster, Germany
| | - Heidemarie Becker
- Department of Medicine D, Nephrology, Rheumatology and Hypertensiology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as senior authors
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as senior authors
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15
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Kuemmel A, Alflen A, Schmidt LH, Sebastian M, Wiewrodt R, Schulze AB, Buhl R, Radsak M. Soluble Triggering Receptor Expressed on Myeloid Cells 1 in lung cancer. Sci Rep 2018; 8:10766. [PMID: 30018308 PMCID: PMC6050254 DOI: 10.1038/s41598-018-28971-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/02/2018] [Indexed: 01/18/2023] Open
Abstract
Soluble Triggering Receptor Expressed on Myeloid Cells 1 (sTREM-1) can be found in the sera of patients with infectious, autoimmune and malignant diseases. The primary objective of this study was to investigate the prognostic significance of sTREM-1 in lung cancer patients. We analyzed the sera of 164 patients with lung cancer of all histologies and all stages at the time of diagnosis. We employed an ELISA using the anti-TREM-1 clone 6B1.1G12 mAb and recombinant human TREM-1. Patient data was collected retrospectively by chart review. In ROC-analysis, a sTREM-1 serum level of 163.1 pg/ml showed the highest Youden-Index. At this cut-off value sTREM-1 was a marker of short survival in patients with NSCLC (median survival 8.5 vs. 13.3 months, p = 0.04). A Cox regression model showed stage (p < 0.001) and sTREM-1 (p = 0.011) to indicate short survival. There were no differences in sTREM-1 serum values among patients with or without infection, pleural effusion or COPD. sTREM-1 was not associated with metastasis at the time of diagnosis and was not a predictor of subsequent metastasis. In SCLC patients sTREM-1 levels were lower than in NSCLC patients (p = 0.001) and did not predict survival. sTREM-1 did not correlate with CRP or the number of neutrophils. In non-small cell lung cancer patients, sTREM-1 in serum has prognostic significance.
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Affiliation(s)
- Andreas Kuemmel
- Department of Hematology, Medical Oncology & Pneumology, University Medical Center Mainz, 55131, Mainz, Germany.
| | - Astrid Alflen
- Department of Hematology, Medical Oncology & Pneumology, University Medical Center Mainz, 55131, Mainz, Germany
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Medical Center Muenster, 48149, Muenster, Germany
| | - Martin Sebastian
- Medical Clinic II, University Hospital Frankfurt, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Rainer Wiewrodt
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Medical Center Muenster, 48149, Muenster, Germany
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Medical Center Muenster, 48149, Muenster, Germany
| | - Roland Buhl
- Department of Hematology, Medical Oncology & Pneumology, University Medical Center Mainz, 55131, Mainz, Germany
| | - Markus Radsak
- Department of Hematology, Medical Oncology & Pneumology, University Medical Center Mainz, 55131, Mainz, Germany
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16
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Tenk F, Schmidt LH, Hansmeier A, Schulze AB, Wiewrodt R, Evers G, Görlich D, Lenz G, Mohr M. Retrospektive Analyse von 27 Fallverläufen nach Implantation selbstexandierender gecoverter Nitinol Y-Carina-Stents. Pneumologie 2018. [DOI: 10.1055/s-0037-1619279] [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]
Affiliation(s)
- F Tenk
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - LH Schmidt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - A Hansmeier
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - AB Schulze
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - R Wiewrodt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - G Evers
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - D Görlich
- Institut für Statistik und Biometrie, Universitätsklinikum Münster
| | - G Lenz
- Medizinische Klinik A, Hämatologie und Onkologie, Universitätsklinikum Münster
| | - M Mohr
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
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17
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Schmidt LH, Heitkoetter B, Schulze AB, Schliemann C, Konrad S, Trautmann M, Marra A, Hillejan L, Mohr M, Evers G, Wardelmann E, Rahbar K, Görlich D, Lenz G, Berdel W, Hartmann W, Wiewrodt R, Huss S. Die Bedeutung des Prostata-spezifischen Membranantigens (PSMA) im nicht-kleinzelligen Lungenkarzinom. Pneumologie 2018. [DOI: 10.1055/s-0037-1619220] [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]
Affiliation(s)
- LH Schmidt
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - B Heitkoetter
- Gerhard Domagk Institut für Pathologie, Universitätsklinikum Münster
| | - AB Schulze
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - C Schliemann
- Hämatologie und Onkologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - S Konrad
- Gerhard Domagk Institut für Pathologie, Universitätsklinikum Münster
| | - M Trautmann
- Gerhard Domagk Institut für Pathologie, Universitätsklinikum Münster
| | - A Marra
- Thoraxchirurgie, Klinikum Bremen Ost
| | - L Hillejan
- Klinik für Thoraxchirurgie Im Krankenhaus St. Raphael Ostercappeln
| | - M Mohr
- Medizinische Klinik A, Uniklinik Münster
| | - G Evers
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - E Wardelmann
- Gerhard Domagk Institut für Pathologie, Universitätsklinikum Münster
| | - K Rahbar
- Klinik für Nuklearmedizin, Universitätsklinikum Münster
| | - D Görlich
- Institut für Statistik und Biometrie, Universitätsklinikum Münster
| | - G Lenz
- Hämatologie und Onkologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - W Berdel
- Hämatologie und Onkologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - W Hartmann
- Gerhard Domagk Institut für Pathologie, Universitätsklinikum Münster
| | - R Wiewrodt
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - S Huss
- Gerhard Domagk Institut für Pathologie, Universitätsklinikum Münster
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18
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Wiewrodt R, Höpfner B, Aries C, Schmidt LH, Schulze AB, Blackert K, Wencker M, Herth FJF. Abhängigkeit der Lungenfunktion von Rauchstatus, Umweltbedingungen und Lebensstil. Pneumologie 2018. [DOI: 10.1055/s-0037-1619349] [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]
Affiliation(s)
- R Wiewrodt
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | | | - C Aries
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - LH Schmidt
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - AB Schulze
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | | | | | - FJF Herth
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
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19
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Schmidt LH, den Toom D, Wiewrodt R, Tenk F, Rosenow F, Sackarnd J, Schulze AB, Evers G, Görlich D, Lenz G, Mohr M. Extraktion von Ausgussthromben aus dem Tracheobronchialsystem mit der Kryosonde – Eine retrospektive Analyse von 15 Fällen. Pneumologie 2018. [DOI: 10.1055/s-0037-1619199] [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]
Affiliation(s)
- LH Schmidt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - D den Toom
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - R Wiewrodt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - F Tenk
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - F Rosenow
- Department für Kardiologie und Angiologie, Klinik für Kardiologie – Internistische Intensivmedizin, Universitätsklinikum Münster
| | - J Sackarnd
- Department für Kardiologie und Angiologie, Klinik für Kardiologie – Internistische Intensivmedizin, Universitätsklinikum Münster
| | - AB Schulze
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - G Evers
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - D Görlich
- Institut für Statistik und Biometrie, Universitätsklinikum Münster
| | - G Lenz
- Medizinische Klinik A, Hämatologie und Onkologie, Universitätsklinikum Münster
| | - M Mohr
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
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20
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Pferdmenges N, Krieg V, Schulze AB, Kajueter H, Evers G, Schmidt LH, Mohr M, Hense HW, Heidinger O, Wiewrodt R. Klinische und histologische Charakteristika des malignen Mesothelioms auf der Grundlage der landesweiten, vollständigen Erfassung durch das Krebsregister NRW. Pneumologie 2018. [DOI: 10.1055/s-0037-1619222] [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]
Affiliation(s)
- N Pferdmenges
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - V Krieg
- Landeskrebsregister Nordrhein-Westfalen gGmbH, Münster
| | - AB Schulze
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - H Kajueter
- Landeskrebsregister Nordrhein-Westfalen gGmbH, Münster
| | - G Evers
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - LH Schmidt
- Pneumologische Ambulanz, Innere Medizin, Medizinische Klinik A, Universitätsklinikum Münster
| | - M Mohr
- Pneumologische Ambulanz, Innere Medizin, Medizinische Klinik A, Universitätsklinikum Münster
| | - HW Hense
- Institut für Epidemiologie; Klinische Epidemiologie; Universitätsklinikum Münster
| | - O Heidinger
- Landeskrebsregister Nordrhein-Westfalen gGmbH, Münster
| | - R Wiewrodt
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
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21
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Schulze AB, Heptner B, Kessler T, Baumgarten B, Stoica V, Mohr M, Wiewrodt R, Warneke VS, Hartmann W, Wüllenweber J, Schülke C, Schäfers M, Wilmes D, Becker K, Schmidt LH, Groll AH, Berdel WE. Progressive histoplasmosis with hemophagocytic lymphohistiocytosis and epithelioid cell granulomatosis: A case report and review of the literature. Eur J Haematol 2017; 99:91-100. [DOI: 10.1111/ejh.12886] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
| | - Britta Heptner
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Torsten Kessler
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Birgit Baumgarten
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Viorelia Stoica
- Department of Medicine B; University Hospital Muenster; Muenster Germany
| | - Michael Mohr
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | - Rainer Wiewrodt
- Department of Medicine A; University Hospital Muenster; Muenster Germany
| | | | - Wolfgang Hartmann
- Gerhard Domagk Institute of Pathology; University Hospital Muenster; Muenster Germany
| | - Jörg Wüllenweber
- Institute of Medical Microbiology; University Hospital Muenster; Muenster Germany
| | - Christoph Schülke
- Department of Clinical Radiology; University Hospital Muenster; Muenster Germany
| | - Michael Schäfers
- Department of Nuclear Medicine; University Hospital Muenster; Muenster Germany
| | - Dunja Wilmes
- National Reference Center for Cryptococcosis, Scedosporiosis, and Endemic Mycoses; Robert Koch Institute; Berlin Germany
| | - Karsten Becker
- Institute of Medical Microbiology; University Hospital Muenster; Muenster Germany
| | | | - Andreas H. Groll
- Infectious Disease Research Program; Department of Pediatric Hematology/Oncology; Center for Bone Marrow Transplantation; University Hospital Muenster; Muenster Germany
| | - Wolfgang E. Berdel
- Department of Medicine A; University Hospital Muenster; Muenster Germany
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23
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Schulze AB, Schmidt LH, Baie L, Heitkötter B, Kuemmel A, Mohr M, Buhl R, Hillmann H, Geißler G, Kelsch R, Görlich D, Berdel WE, Hartmann W, Wiewrodt R. Rhesus CE expression on patient red blood cells is an independent prognostic factor for adenocarcinoma of the lung. Clin Respir J 2017; 12:1106-1117. [PMID: 28398662 DOI: 10.1111/crj.12638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/27/2017] [Accepted: 03/20/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The influence of blood group antigens on cancerogenesis is shown for distinct tumor types, yet the impact of Rhesus blood group antigens in lung cancer is not clarified. MATERIALS AND METHODS To investigate the impact of Rhesus blood groups a non-small cell lung cancer (NSCLC) collective (n = 1047) was analyzed retrospectively. Using a second cohort of n = 340 primarily operated stage I-III NSCLC patients, we evaluated immunohistochemistry of CD47-antibody stained tissue samples in correlation to histopathologic subtype and Rhesus blood group. RESULTS AND CONCLUSION In 516 of 1047 patients blood group data were available. Seven different RhCE phenotypes were grouped as "··ee," "ccE·," and "C·E·." Adenocarcinoma patients with Rh "··ee" revealed improved overall survival (29 (21.2-36.8) m; HR 1.00 [index]) compared with Rh "ccE·" (19 (1.9-36.1) m; HR 1.76 [1.15-2.70]) and Rh "C·E·" (10 (7.4-12.6) m; HR 2.65 [1.70-4.12]) univariately (P < .001) and multivariately (P < .001). Rh "··ee" showed reduced incidence of CNS-metastasis (P = .014) and metastasis count (P = .032) in stage IV adenocarcinoma. Immunohistochemistry associated CD47-positivity with adenocarcinomas (n = 340, P = .048). In n = 51 cases blood group data were available. The prognostic effect of Rh "··ee" compared with Rh "ccE·" and Rh "C·E·" was stated (P = .001), foremost in CD47-positive adenocarcinomas (Rh "··ee" vs. Rh "ccE·" and Rh "C·E·," P = .008). Inversely Rh "ccE·" or Rh "C·E·" was found beneficial in CD47-negative non-adenocarcinomas (P = .046). Phenotypic RhCE expression may be an independent prognostic factor for overall survival in adeno-NSCLC. We hypothesize an erythrocytic-immunologic interaction with tumor tissue, possibly altered by RhCE and CD47, resulting in a metastatic prone condition.
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Affiliation(s)
- A B Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - L H Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - L Baie
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - B Heitkötter
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - A Kuemmel
- III. Medical Department, Hematology, Oncology and Pneumology, University Hospital Mainz, Mainz, Germany
| | - M Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - R Buhl
- III. Medical Department, Hematology, Oncology and Pneumology, University Hospital Mainz, Mainz, Germany
| | - H Hillmann
- Institute of Transfusion Medicine and Transplantation Immunology, University Hospital Muenster, Muenster, Germany
| | - G Geißler
- Institute of Transfusion Medicine and Transplantation Immunology, University Hospital Muenster, Muenster, Germany
| | - R Kelsch
- Institute of Transfusion Medicine and Transplantation Immunology, University Hospital Muenster, Muenster, Germany
| | - D Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - W E Berdel
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - W Hartmann
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - R Wiewrodt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
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24
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
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25
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Wiewrodt R, Höpfner B, Aries C, Schulze AB, Schmidt LH, Blackert K, Wencker M, Herth FJF. Hohe Prävalenz obstruktiver Ventilationsstörungen bei jungen Erwachsenen in Deutschland. Pneumologie 2017. [DOI: 10.1055/s-0037-1598554] [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: 10/20/2022]
Affiliation(s)
- R Wiewrodt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | | | - C Aries
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - AB Schulze
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - LH Schmidt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | | | | | - FJF Herth
- Thoraxklinik, University of Heidelberg, Department of Pneumology and Critical Care Medicine; Translational Lung Research Center (Tlrc), Member of the German Center for Lung Research (Dzl), Germany
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26
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Schmidt LH, Lauterbach B, Hansmeier A, Schliemann C, Schulze AB, Wardelmann E, Pühse G, Berdel W, Wiewrodt R, Mohr M. „Sarcoid-like lesions“ und Sarkoidose bei Keimzelltumorpatienten mit hilärer oder mediastinaler Lymphadenopathie. Pneumologie 2017. [DOI: 10.1055/s-0037-1598384] [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: 10/20/2022]
Affiliation(s)
- LH Schmidt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - B Lauterbach
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | | | - C Schliemann
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - AB Schulze
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - E Wardelmann
- Institut für Pathologie, Universitätsklinikum Münster
| | - G Pühse
- Klinik für Urologie, Universitätsklinikum Münster
| | - W Berdel
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - R Wiewrodt
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
| | - M Mohr
- Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinikum Münster
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27
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Schulze AB, Schmidt LH, Baie L, Kümmel A, Mohr M, Görlich D, Hillmann H, Berdel W, Hartmann W, Wiewrodt R. Die Rhesus CE-Expression auf Erythrozyten ist unabhängiger Prognosefaktor beim Adenokarzinom der Lunge. Pneumologie 2017. [DOI: 10.1055/s-0037-1598461] [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: 10/20/2022]
Affiliation(s)
- AB Schulze
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - LH Schmidt
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - L Baie
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - A Kümmel
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Mainz
| | - M Mohr
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - D Görlich
- Institut für Statistik und Biometrie, Universitätsklinikum Münster
| | - H Hillmann
- Transfusionsmedizin, Universitätsklinikum Münster
| | - W Berdel
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
| | - W Hartmann
- Institut für Pathologie, Universitätsklinikum Münster
| | - R Wiewrodt
- Schwerpunkt Pneumologie, Medizinische Klinik A, Universitätsklinikum Münster
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28
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Schulze AB, Schmidt LH, Kümmel A, Baie L, Albers C, Faldum A, Görlich D, Wiewrodt R. Prognostischer Einfluss von Zweitmalignomen auf NSCLC Tumoren. Pneumologie 2016. [DOI: 10.1055/s-0036-1572287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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