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Hartlapp I, Valta-Seufzer D, Siveke JT, Algül H, Goekkurt E, Siegler G, Martens UM, Waldschmidt D, Pelzer U, Fuchs M, Kullmann F, Boeck S, Ettrich TJ, Held S, Keller R, Anger F, Germer CT, Stang A, Kimmel B, Heinemann V, Kunzmann V. Corrigendum to "Prognostic and predictive value of CA 19-9 in locally advanced pancreatic cancer treated with multiagent induction chemotherapy: results from a prospective, multicenter phase II trial (NEOLAP-AIO-PAK-0113)": [ESMO Open 7 (2024) 100552]. ESMO Open 2024; 9:103463. [PMID: 38703429 DOI: 10.1016/j.esmoop.2024.103463] [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: 05/06/2024] Open
Affiliation(s)
- I Hartlapp
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg
| | - D Valta-Seufzer
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg
| | - J T Siveke
- Department of Medical Oncology, Bridge Institute of Experimental Tumor Therapy, University Medicine Essen, Essen; Division of Solid Tumor Translational Oncology (DKTK Partner Site Essen, DKFZ Heidelberg), West German Cancer Center, University Medicine Essen, Essen
| | - H Algül
- Comprehensive Cancer Center München, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Bavaria, Germany
| | - E Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), Hamburg and University Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - G Siegler
- Department of Internal Medicine 5, Hematology and Medical Oncology, Paracelsus Medical University, Nürnberg
| | - U M Martens
- Department of Internal Medicine III, SLK-Clinics Heilbronn GmbH, Heilbronn
| | - D Waldschmidt
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne
| | - U Pelzer
- Division of Oncology and Hematology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin
| | - M Fuchs
- Clinic for Gastroenterology, Hepatology and GI-Oncology, München Klinik Bogenhausen, Munich
| | - F Kullmann
- Department of Internal Medicine I, Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden
| | - S Boeck
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich
| | - T J Ettrich
- Department of Internal Medicine I, Ulm University Hospital, Ulm
| | - S Held
- Department of Biometrics, ClinAssess GmbH, Leverkusen
| | - R Keller
- Clinical Research, AIO Studien gGmbH, Berlin
| | - F Anger
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg
| | - A Stang
- Department of Haematology, Oncology and Palliative Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
| | - B Kimmel
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich
| | - V Kunzmann
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg.
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More TH, Hiller K, Seifert M, Illig T, Schmidt R, Gronauer R, von Hahn T, Weilert H, Stang A. Metabolomics analysis reveals novel serum metabolite alterations in cancer cachexia. Front Oncol 2024; 14:1286896. [PMID: 38450189 PMCID: PMC10915872 DOI: 10.3389/fonc.2024.1286896] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background Cachexia is a body wasting syndrome that significantly affects well-being and prognosis of cancer patients, without effective treatment. Serum metabolites take part in pathophysiological processes of cancer cachexia, but apart from altered levels of select serum metabolites, little is known on the global changes of the overall serum metabolome, which represents a functional readout of the whole-body metabolic state. Here, we aimed to comprehensively characterize serum metabolite alterations and analyze associated pathways in cachectic cancer patients to gain new insights that could help instruct strategies for novel interventions of greater clinical benefit. Methods Serum was sampled from 120 metastatic cancer patients (stage UICC IV). Patients were grouped as cachectic or non-cachectic according to the criteria for cancer cachexia agreed upon international consensus (main criterium: weight loss adjusted to body mass index). Samples were pooled by cachexia phenotype and assayed using non-targeted gas chromatography-mass spectrometry (GC-MS). Normalized metabolite levels were compared using t-test (p < 0.05, adjusted for false discovery rate) and partial least squares discriminant analysis (PLS-DA). Machine-learning models were applied to identify metabolite signatures for separating cachexia states. Significant metabolites underwent MetaboAnalyst 5.0 pathway analysis. Results Comparative analyses included 78 cachectic and 42 non-cachectic patients. Cachectic patients exhibited 19 annotable, significantly elevated (including glucose and fructose) or decreased (mostly amino acids) metabolites associating with aminoacyl-tRNA, glutathione and amino acid metabolism pathways. PLS-DA showed distinct clusters (accuracy: 85.6%), and machine-learning models identified metabolic signatures for separating cachectic states (accuracy: 83.2%; area under ROC: 88.0%). We newly identified altered blood levels of erythronic acid and glucuronic acid in human cancer cachexia, potentially linked to pentose-phosphate and detoxification pathways. Conclusion We found both known and yet unknown serum metabolite and metabolic pathway alterations in cachectic cancer patients that collectively support a whole-body metabolic state with impaired detoxification capability, altered glucose and fructose metabolism, and substrate supply for increased and/or distinct metabolic needs of cachexia-associated tumors. These findings together imply vulnerabilities, dependencies and targets for novel interventions that have potential to make a significant impact on future research in an important field of cancer patient care.
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Affiliation(s)
- Tushar H. More
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany
| | - Karsten Hiller
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany
| | - Martin Seifert
- Asklepios Precision Medicine, Asklepios Hospitals GmbH & Co KgaA, Königstein (Taunus), Germany
- Connexome GmbH, Fischen, Germany
| | - Thomas Illig
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
- Hannover Unified Biobank (HUB), Hannover, Germany
| | - Rudi Schmidt
- Asklepios Precision Medicine, Asklepios Hospitals GmbH & Co KgaA, Königstein (Taunus), Germany
- Immunetrue, Cologne, Germany
| | - Raphael Gronauer
- Asklepios Precision Medicine, Asklepios Hospitals GmbH & Co KgaA, Königstein (Taunus), Germany
- Connexome GmbH, Fischen, Germany
| | - Thomas von Hahn
- Asklepios Hospital Barmbek, Department of Gastroenterology, Hepatology and Endoscopy, Hamburg, Germany
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Semmelweis University, Asklepios Campus Hamburg, Budapest, Hungary
| | - Hauke Weilert
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Semmelweis University, Asklepios Campus Hamburg, Budapest, Hungary
- Asklepios Hospital Barmbek, Department of Hematology, Oncology and Palliative Care Medicine, Hamburg, Germany
| | - Axel Stang
- Asklepios Tumorzentrum Hamburg, Hamburg, Germany
- Semmelweis University, Asklepios Campus Hamburg, Budapest, Hungary
- Asklepios Hospital Barmbek, Department of Hematology, Oncology and Palliative Care Medicine, Hamburg, Germany
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3
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Konermann FM, Gessler N, Wohlmuth P, Behr J, Feldhege J, Glöckner C, Gunawardene MA, Herrlinger KR, Hölting T, Pape UF, Reinmuth N, Stang A, Sheikhzadeh S, Arnold D, Wesseler C. High in-hospital mortality in SARS-CoV-2 infected patients with active cancer disease during Omicron phase of the pandemic - Insights from the CORONA Germany Study. Oncol Res Treat 2023; 46:201-210. [PMID: 36822167 DOI: 10.1159/000529788] [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: 12/13/2022] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION SARS-CoV-2 infected patients with cancer have a worse outcome including a significant higher mortality, compared to non-cancer patients. However, limited data are available regarding in-hospital mortality during the Omicron phase of the pandemic. Therefore, the aim of the study was the comparison of mortality in patients with history of cancer and patients with active cancer disease during the different phases of the COVID-19 pandemic, focusing on the current Omicron variant of concern. METHODS We conducted a multicenter, observational, epidemiological cohort study at 45 hospitals in Germany. Until July 20, 2022, all adult hospitalized SARS-CoV-2 positive patients were included. The primary endpoint was in-hospital mortality regarding cancer status (history of cancer and active cancer disease) and SARS-CoV-2 virus type. RESULTS From March 11 2020 to July 20 2022, a total of 27,490 adult SARS-CoV-2 positive patients were included into the study. 2,578 patients (9.4%) had diagnosis of cancer, of whom 1,065 (41.3%) had history of cancer, whereas 1,513 (58.7%) had active cancer disease. Overall 3,749 out of the total of 27,490 patients (13.6%) died during the hospital stay. Patients with active cancer disease had a significantly higher mortality compared to patients without cancer diagnosis, in both phases of the pandemic (wild-type to Delta: OR 1.940 [1.646-2.285]); Omicron: 2.864 [2.354-3.486]). After adjustment to co-variables, SARS-CoV-2 infected patients with active cancer disease had the highest risk for in-hospital mortality compared to the other groups, in both phases of the pandemic. CONCLUSION The CORONA Germany study indicates that hospitalized patients with active cancer disease are at high risk of death during a SARS-CoV-2 infection. Mortality of patients with history of cancer improved to nearly the level of non-cancer patients during Omicron phase.
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Weilert H, Sadeghi D, Lipp M, Oldhafer KJ, Donati M, Stang A. Potential for cure and predictors of long-term survival after radiofrequency ablation for colorectal liver metastases: A 20-years single-center experience. Eur J Surg Oncol 2022; 48:2487-2494. [PMID: 35718675 DOI: 10.1016/j.ejso.2022.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Additional radiofrequency ablation (RFA) of liver-limited colorectal liver metastases (CRLM) improves overall (OS) and recurrence-free survival (RFS) over systemic therapy alone. We aimed to assess the potential and predictive factors of long-term survival and cure to optimize patient selection for RFA application. METHODS Retrospective review of a prospectively maintained single-center database of consecutive patients undergoing RFA for liver-limited CRLM after systemic therapy between 2002 and 2020. Clinicopathologic characteristics and KRAS/BRAF-genotype data (tested routinely since 2010) were correlated to RFS and OS. Cure was defined as ≥10-years RFS (long-term survival as ≥5-years OS) following RFA. RESULTS For the entire cohort of 158 patients (median follow-up 13.6 years), co-occurrence of three factors, RECIST-defined response, number of ≤3 CRLM, and ≤3 cm maximum size determined a survival plateau that distinguished cured from non-cured patients (10-years RFS: 15.5% vs 0%, p < 0.0001). Among 59 patients (37.3%) being tested, 4(6.8%) were BRAF-mt, 15(25.4%) KRAS-mt, and 40(67.8%) KRAS/BRAF-wt. OS (median follow-up 8.3 years) was estimated to be higher with KRAS/BRAF-wt compared to a mutant KRAS or BRAF status (5-years OS: 22.8% vs 3.4%, p = 0.0018). CONCLUSION This study indicates about 15% chance of cure following RFA of low-volume liver-limited CRLM after downsizing by systemic therapy and a negative effect of KRAS or BRAF mutation on long-term survival after CRLM ablation. These findings may improve clinical decision-making in patients potentially candidate to RFA of CRLM and encourage further investigations on molecular factors determining an oligometastatic state of CRLM curable with focal ablative therapy.
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Affiliation(s)
- Hauke Weilert
- Department of Hematology and Oncology, Asklepios Hospital Barmbek, Hamburg, Germany; Asklepios Campus Hamburg, Semmelweis University, Budapest, Hungary
| | - Darja Sadeghi
- Asklepios Campus Hamburg, Semmelweis University, Budapest, Hungary
| | - Michael Lipp
- Asklepios Campus Hamburg, Semmelweis University, Budapest, Hungary; Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl Jürgen Oldhafer
- Asklepios Campus Hamburg, Semmelweis University, Budapest, Hungary; Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Marcello Donati
- Surgical Clinic Unit, Department of Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Axel Stang
- Department of Hematology and Oncology, Asklepios Hospital Barmbek, Hamburg, Germany; Asklepios Campus Hamburg, Semmelweis University, Budapest, Hungary.
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Sievering AW, Wohlmuth P, Geßler N, Gunawardene MA, Herrlinger K, Bein B, Arnold D, Bergmann M, Nowak L, Gloeckner C, Koch I, Bachmann M, Herborn CU, Stang A. Comparison of machine learning methods with logistic regression analysis in creating predictive models for risk of critical in-hospital events in COVID-19 patients on hospital admission. BMC Med Inform Decis Mak 2022; 22:309. [PMID: 36437469 PMCID: PMC9702742 DOI: 10.1186/s12911-022-02057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Machine learning (ML) algorithms have been trained to early predict critical in-hospital events from COVID-19 using patient data at admission, but little is known on how their performance compares with each other and/or with statistical logistic regression (LR). This prospective multicentre cohort study compares the performance of a LR and five ML models on the contribution of influencing predictors and predictor-to-event relationships on prediction model´s performance. METHODS We used 25 baseline variables of 490 COVID-19 patients admitted to 8 hospitals in Germany (March-November 2020) to develop and validate (75/25 random-split) 3 linear (L1 and L2 penalty, elastic net [EN]) and 2 non-linear (support vector machine [SVM] with radial kernel, random forest [RF]) ML approaches for predicting critical events defined by intensive care unit transfer, invasive ventilation and/or death (composite end-point: 181 patients). Models were compared for performance (area-under-the-receiver-operating characteristic-curve [AUC], Brier score) and predictor importance (performance-loss metrics, partial-dependence profiles). RESULTS Models performed close with a small benefit for LR (utilizing restricted cubic splines for non-linearity) and RF (AUC means: 0.763-0.731 [RF-L1]); Brier scores: 0.184-0.197 [LR-L1]). Top ranked predictor variables (consistently highest importance: C-reactive protein) were largely identical across models, except creatinine, which exhibited marginal (L1, L2, EN, SVM) or high/non-linear effects (LR, RF) on events. CONCLUSIONS Although the LR and ML models analysed showed no strong differences in performance and the most influencing predictors for COVID-19-related event prediction, our results indicate a predictive benefit from taking account for non-linear predictor-to-event relationships and effects. Future efforts should focus on leveraging data-driven ML technologies from static towards dynamic modelling solutions that continuously learn and adapt to changes in data environments during the evolving pandemic. TRIAL REGISTRATION NUMBER NCT04659187.
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Affiliation(s)
| | - Peter Wohlmuth
- Semmelweis University, Asklepios Campus Hamburg, Budapest, Hungary.,Asklepios Proresearch, Research Institute, Hamburg, Germany
| | - Nele Geßler
- Semmelweis University, Asklepios Campus Hamburg, Budapest, Hungary.,Asklepios Proresearch, Research Institute, Hamburg, Germany.,Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Klaus Herrlinger
- Department of Internal Medicine, Asklepios Hospital Nord-Heidberg, Hamburg, Germany.,Asklepios Tumorzentrum, Hamburg, Germany
| | - Berthold Bein
- Department of Anesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Dirk Arnold
- Asklepios Tumorzentrum, Hamburg, Germany.,Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Hospital Altona, Hamburg, Germany
| | - Martin Bergmann
- Department of Internal Medicine, Cardiology, and Pneumology, Asklepios Hospital Wandsbek, Hamburg, Germany
| | - Lorenz Nowak
- Department of Intensive Care and Ventilation Medicine, Asklepios Hospital München-Gauting, Gauting, Germany
| | - Christian Gloeckner
- Department of Internal Medicine, Asklepios Hospital Oberviechtach, Oberviechtach, Germany
| | - Ina Koch
- Biobank for Pulmonary Diseases, Asklepios Hospital München-Gauting, Gauting, Germany
| | - Martin Bachmann
- Department of Intensive Care and Ventilatory Medicine, Asklepios Hospital Harburg, Hamburg, Germany
| | - Christoph U Herborn
- Semmelweis University, Asklepios Campus Hamburg, Budapest, Hungary.,Asklepios Hospitals GmbH & Co. KGaA, Hamburg, Germany
| | - Axel Stang
- Semmelweis University, Asklepios Campus Hamburg, Budapest, Hungary. .,Asklepios Tumorzentrum, Hamburg, Germany. .,Department of Hematology, Oncology and Palliative Care Medicine, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
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Schramm S, Wilk L, Kowall B, Jöckel KH, Stang A, Schmidt B. Willingness to participate in a COVID-19 follow-up study and symptoms 1.5 years after infection. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.051] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Data on willingness to participate in population-based long-COVID studies are sparse. We invited all citizens of Essen aged 18-74 years with a positive SARS-CoV-2 PCR test between Mar-Aug 2020 and assessed COVID-related symptoms in responders ∼1.5 years after infection.
Methods
The invited population included 1282 infected citizens (48% women). At the time of testing 64% reported symptoms. We asked responders about past and current symptoms, hospitalization, smoking, sport, pre-existing conditions (heart attack, stroke, diabetes), subjective health status as compared to before infection, assessed BMI, and performed descriptive statistics.
Results
We investigated 255 participants (50% women, 19-73 years, response rate 20%) ∼20 month (median) after the PCR test. 95% reported symptoms at the time of testing: 67% fatigue, 58% taste disorders, 56% limb pain, 55% odor disorders, 54% headache, 50% cough, 43% fever; 10% needed hospitalization, 3% intensive care, 1.6% artificial ventilation. Compared to the non-hospitalized the formerly inpatients were more often male (62% vs 49%), older (56±13 vs 49±14 years), less often never smokers (42% vs 53%), had a higher BMI (31±7 vs 28±5 kg/m2), and more pre-existing conditions (23% vs 10%). Compared to before infection, 53% rated their current health worse, with a higher rate among inpatients (81%). After ∼1.5 years, 55% still reported symptoms: 25% fatigue, 20% concentration disorder, 18% breathing problems, 13% odor and 11% taste disorders. Persistent symptoms were more common in inpatients than in non-hospitalized (69% vs 53%).
Conclusions
Symptomatic individuals are more likely to participate in a COVID19 follow-up study than asymptomatic ones. This may overestimate the number of individuals with long-term symptoms in population-based long-COVID study populations. However, persistent symptoms seem to be more likely in formerly inpatients compared to non-hospitalized individuals with former SARS-CoV-2 infection.
Key messages
• Symptomatic individuals are more likely to participate in a COVID19 follow-up study than asymptomatic ones.
• Persistent symptoms seem to be more likely in formerly inpatients compared to non-hospitalized individuals with former SARS-CoV-2 infection.
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Affiliation(s)
- S Schramm
- IMIBE, University Hospital Essen , Essen, Germany
| | - L Wilk
- IMIBE, University Hospital Essen , Essen, Germany
| | - B Kowall
- IMIBE, University Hospital Essen , Essen, Germany
| | - KH Jöckel
- IMIBE, University Hospital Essen , Essen, Germany
| | - A Stang
- IMIBE, University Hospital Essen , Essen, Germany
| | - B Schmidt
- IMIBE, University Hospital Essen , Essen, Germany
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7
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Hageman SHJ, Lu W, Kaptoge S, Lall K, Bobak M, Pikhart H, Kubinova R, Pajak A, Tamosiunas A, Stang A, Schmidt B, Schramm S, Di Angelantonio E, Visseren FLJ, Dorresteijn JAN. Prediction of lifetime cardiovascular risk and individual lifetime treatment benefit in four European risk regions: geographic recalibration of the LIFE-CVD model. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2276] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The life expectancy free of cardiovascular disease (CVD) in individuals without previous CVD can be estimated with the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model, as recommended by the 2021 ESC CVD prevention guidelines. Our aim was to systematically recalibrate the LIFE-CVD model to four European risk regions using contemporary and representative registry data.
Methods and results
The LIFE-CVD model was systematically recalibrated to four distinct risk regions within Europe, using representative aggregate data on age- and sex-specific expected CVD and non-CVD mortality incidences and risk factor distributions. For external validation, 1,451,077 individuals without previous CVD were included from seven European cohorts, with 53,721 CVD events and 62,902 non-CVD deaths during follow up. After applying the recalibrated risk prediction models to external validation cohorts, C-indices (figure 1) ranged from 0.670 (95% CI 0.650–0.690) to 0.787 (95% CI 0.785–0.789). Predicted risks matched the observed risks in the CPRD data. With the recalibrated LIFE-CVD model, the estimated gain in CVD-free life expectancy from preventive therapy differed per region, for example a 50-year-old smoking women with a systolic blood pressure of 140mm Hg was estimated to gain 0.4 years of CVD-free life from 10 mm Hg SBP reduction in the low risk region, whereas this would be 1.5 years in the very high risk region (figure 2).
Interpretation
By taking into account geographical differences in CVD incidence, the recalibrated LIFE-CVD model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making in cardiovascular prevention options as recommended by the 2021 European Prevention Guidelines.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S H J Hageman
- University Medical Center Utrecht, Department of vascular medicine , Utrecht , The Netherlands
| | - W Lu
- University College London, Department of Epidemiology and Public Health , London , United Kingdom
| | - S Kaptoge
- University of Cambridge, Department of Public Health and Primary Care , Cambridge , United Kingdom
| | - K Lall
- University of Tartu, Estonian Genome Centre , Tartu , Estonia
| | - M Bobak
- University College London, Department of Epidemiology and Public Health , London , United Kingdom
| | - H Pikhart
- University College London, Department of Epidemiology and Public Health , London , United Kingdom
| | - R Kubinova
- National Institute of Public Health , Prague , Czechia
| | - A Pajak
- Institute of Public Health, Department of Epidemiology and Population Studies , Krakow , Poland
| | - A Tamosiunas
- Lithuanian University of Health Sciences, Institute of Cardiology , Kaunas , Lithuania
| | - A Stang
- Institute for Medical Informatics, Biometry and Epidemiology , Essen , Germany
| | - B Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology , Essen , Germany
| | - S Schramm
- Institute for Medical Informatics, Biometry and Epidemiology , Essen , Germany
| | - E Di Angelantonio
- University of Cambridge, Department of Public Health and Primary Care , Cambridge , United Kingdom
| | - F L J Visseren
- University Medical Center Utrecht, Department of vascular medicine , Utrecht , The Netherlands
| | - J A N Dorresteijn
- University Medical Center Utrecht, Department of vascular medicine , Utrecht , The Netherlands
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8
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Hartlapp I, Valta-Seufzer D, Siveke JT, Algül H, Goekkurt E, Siegler G, Martens UM, Waldschmidt D, Pelzer U, Fuchs M, Kullmann F, Boeck S, Ettrich TJ, Held S, Keller R, Anger F, Germer CT, Stang A, Kimmel B, Heinemann V, Kunzmann V. Prognostic and predictive value of CA 19-9 in locally advanced pancreatic cancer treated with multiagent induction chemotherapy: results from a prospective, multicenter phase II trial (NEOLAP-AIO-PAK-0113). ESMO Open 2022; 7:100552. [PMID: 35970013 PMCID: PMC9434418 DOI: 10.1016/j.esmoop.2022.100552] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prognostic and predictive value of carbohydrate antigen 19-9 (CA 19-9) in locally advanced pancreatic cancer (LAPC) has not yet been defined from prospective randomized controlled trials (RCTs). PATIENTS AND METHODS A total of 165 LAPC patients were treated within the NEOLAP RCT for 16 weeks with multiagent induction chemotherapy [ICT; either nab-paclitaxel/gemcitabine alone or nab-paclitaxel/gemcitabine followed by FOLFIRINOX (combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin)] followed by surgical exploration of all patients without evidence of disease progression. CA 19-9 was determined at baseline and after ICT and correlated with overall survival (OS) and secondary R0 resection rate. RESULTS From the NEOLAP study population (N = 165) 133 patients (81%) were evaluable for CA 19-9 at baseline and 81/88 patients (92%) for post-ICT CA 19-9 response. Median OS (mOS) in the CA 19-9 cohort (n = 133) was 16.2 months [95% confidence interval (CI) 13.0-19.4] and R0 resection (n = 31; 23%) was associated with a significant survival benefit [40.8 months (95% CI 21.7-59.8)], while R1 resected patients (n = 14; 11%) had no survival benefit [14.0 (95% CI 11.7-16.3) months, hazard ratio (HR) 0.27; P = 0.001]. After ICT most patients showed a CA 19-9 response (median change from baseline: -82%; relative decrease ≥55%: 83%; absolute decrease to ≤50 U/ml: 43%). Robust CA 19-9 response (decrease to ≤50U/ml) was significantly associated with mOS [27.8 (95% CI 18.4-37.2) versus 16.5 (95% CI 11.7-21.2) months, HR 0.49; P = 0.013], whereas CA 19-9 baseline levels were not prognostic for OS. Multivariate analysis demonstrated that a robust CA 19-9 response was an independent predictive factor for R0 resection. Using a CA 19-9 decrease to ≤61 U/ml as optimal cut-off (by receiver operating characteristic analysis) yielded 72% sensitivity and 62% specificity for successful R0 resection, whereas CA 19-9 nonresponders (<20% decrease or increase) had no chance for successful R0 resection. CONCLUSIONS CA 19-9 response after multiagent ICT provides relevant prognostic and predictive information and is useful in selecting LAPC patients for explorative surgery. CLINICAL TRIAL NUMBER ClinicalTrials.govNCT02125136; https://clinicaltrials.gov/ct2/show/NCT02125136; EudraCT 2013-004796-12; https://www.clinicaltrialsregister.eu/ctr-search/trial/2013-004796-12/results.
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Affiliation(s)
- I Hartlapp
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - D Valta-Seufzer
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - J T Siveke
- Department of Medical Oncology, Bridge Institute of Experimental Tumor Therapy, University Medicine Essen, Essen, Germany; Division of Solid Tumor Translational Oncology (DKTK Partner Site Essen, DKFZ Heidelberg), West German Cancer Center, University Medicine Essen, Essen, Germany
| | - H Algül
- Comprehensive Cancer Center Munich (CCCM(TUM)) at the Klinikum rechts der Isar, Department of Internal Medicine II, Technical University Munich, Munich, Germany
| | - E Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), Hamburg and University Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - G Siegler
- Department of Internal Medicine 5, Hematology and Medical Oncology, Paracelsus Medical University, Nürnberg, Germany
| | - U M Martens
- Department of Internal Medicine III, SLK-Clinics Heilbronn GmbH, Heilbronn, Germany
| | - D Waldschmidt
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - U Pelzer
- Division of Oncology and Hematology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Fuchs
- Clinic for Gastroenterology, Hepatology and GI-Oncology, München Klinik Bogenhausen, Munich, Germany
| | - F Kullmann
- Department of Internal Medicine I, Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden, Germany
| | - S Boeck
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich, Germany
| | - T J Ettrich
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | - S Held
- Department of Biometrics, ClinAssess GmbH, Leverkusen, Germany
| | - R Keller
- Clinical Research, AIO Studien gGmbH, Berlin, Germany
| | - F Anger
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - A Stang
- Department of Haematology, Oncology and Palliative Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
| | - B Kimmel
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich, Germany
| | - V Kunzmann
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.
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9
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Stavrou GA, Stang A, Raptis DA, Schadde E, Zeile M, Brüning R, Wagner KC, Huber TM, Oldhafer KJ. Intraoperative (Contrast-Enhanced) Ultrasound Has the Highest Diagnostic Accuracy of Any Imaging Modality in Resection of Colorectal Liver Metastases. J Gastrointest Surg 2021; 25:3160-3169. [PMID: 34159555 DOI: 10.1007/s11605-021-04925-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
AIM Defining sensitivity, specificity, diagnostic accuracy for detection of colorectal liver metastases in imaging compared to intraoperative assessment. Defining a cutoff, where accuracy of detection is impaired. METHODS Prospective single-institution clinical trial (clinicaltrials.gov: NCT01522209). Patients underwent CEUS, MDCT, and 3 Tesla EOB-MRI within 2 weeks preoperatively. Intraoperative palpation, IOUS, and CEIOUS were performed. A patient and lesion-based database was analyzed for accuracy of detection of CEUS, CT, MRI, and Palp/IOUS/CEIOUS combined read. Histology was standard of reference. RESULTS Forty-seven high tumor load (mean 5, 4 lesions) patients were analyzed. Histopathology confirmed 264 lesions (245 malignant: 19 benign). Accuracy for detection of all lesions: CEUS 63%, CT 71%, MRI 92%, and PALP/IOUS/CEIOUS 98%. ROC analysis for lesion size showed severe impairment of accuracy in lesion detection smaller than 5mm. Intraoperative imaging was not impaired by lesion size. Patient-based analysis revealed a change of resection plan after IOUS/CEIOUS in 35% of patients. CONCLUSION At 5-mm lesion size, preoperative imaging shows a drop in accuracy of detection. In patients with multiple lesions, addition of MRI to MDCT seems useful. Accuracy of intraoperative ultrasound is not impacted by lesion size and should be mandatory. CEIOUS can improve intraoperative decision-making. TRIAL REGISTRATION Study registered with clinicaltrials.gov : NCT01522209.
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Affiliation(s)
- Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken General Hospital, Saarbruecken, Germany. .,Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.
| | - Axel Stang
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of Medical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Dimitri A Raptis
- Department of Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Erik Schadde
- Department of Surgery, Division of Surgical Oncology and Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA.,Institute of Physiology, University of Zürich Campus Irchel, Zürich, Switzerland.,Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Zeile
- Department of Radiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Roland Brüning
- Department of Radiology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Kim C Wagner
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Tessa M Huber
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl J Oldhafer
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
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10
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Stang A, Weilert H, Lipp MJ, Oldhafer KJ, Hoheisel JD, Zhang C, Bauer AS. MicroRNAs in blood act as biomarkers of colorectal cancer and indicate potential therapeutic targets. Mol Oncol 2021; 15:2480-2490. [PMID: 34288395 PMCID: PMC8410571 DOI: 10.1002/1878-0261.13065] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022] Open
Abstract
Association studies have linked alterations of blood-derived microRNAs (miRNAs) with colorectal cancer (CRC). Here, we performed a microarray-based comparison of the profiles of 2549 miRNAs in 80 blood samples from healthy donors and patients with colorectal adenomas, colorectal diverticulitis and CRC at different stages. Confirmation by quantitative real-time PCR (RT-PCR) was complemented by validation of identified molecules in another 36 blood samples. No variations in miRNA levels were observed in samples from patients with colorectal adenomas and diverticulitis or from healthy donors. However, there were 179 CRC-associated miRNAs of differential abundance compared to healthy controls. Only three - miR-1225-5p, miR-1207-5p and miR-4459 - exhibited increased levels at all CRC stages. Most deregulated miRNAs (128/179, 71%) specifically predicted metastatic CRC. Pathway analysis found several cancer-related pathways to which the miRNAs contribute in various ways. In conclusion, miRNA levels in blood vary throughout CRC progression and affect cellular functions relevant to haematogenous CRC progression and dissemination. The identified biomarker and therapeutic candidates require further confirmation of their clinical relevance.
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Affiliation(s)
- Axel Stang
- Department of Haematology, Oncology & Palliative CareAsklepios Hospital BarmbekHamburgGermany
- Faculty of MedicineSemmelweis UniversityHamburgGermany
| | - Hauke Weilert
- Department of Haematology, Oncology & Palliative CareAsklepios Hospital BarmbekHamburgGermany
- Faculty of MedicineSemmelweis UniversityHamburgGermany
| | - Michael J. Lipp
- Faculty of MedicineSemmelweis UniversityHamburgGermany
- Department of Abdominal & Visceral SurgeryAsklepios Hospital BarmbekHamburgGermany
| | - Karl J. Oldhafer
- Faculty of MedicineSemmelweis UniversityHamburgGermany
- Department of Abdominal & Visceral SurgeryAsklepios Hospital BarmbekHamburgGermany
| | - Jörg D. Hoheisel
- Division of Functional Genome AnalysisGerman Cancer Research CenterHeidelbergGermany
| | - Chaoyang Zhang
- Division of Functional Genome AnalysisGerman Cancer Research CenterHeidelbergGermany
| | - Andrea S. Bauer
- Division of Functional Genome AnalysisGerman Cancer Research CenterHeidelbergGermany
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11
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Gessler N, Gunawardene MA, Wohlmuth P, Arnold D, Behr J, Gloeckner C, Herrlinger K, Hoelting T, Pape UF, Schreiber R, Stang A, Wesseler C, Willems S, Arms C, Herborn CU. Clinical outcome, risk assessment, and seasonal variation in hospitalized COVID-19 patients-Results from the CORONA Germany study. PLoS One 2021; 16:e0252867. [PMID: 34138888 PMCID: PMC8211271 DOI: 10.1371/journal.pone.0252867] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/24/2021] [Indexed: 01/21/2023] Open
Abstract
Background After one year of the pandemic and hints of seasonal patterns, temporal variations of in-hospital mortality in COVID-19 are widely unknown. Additionally, heterogeneous data regarding clinical indicators predicting disease severity has been published. However, there is a need for a risk stratification model integrating the effects on disease severity and mortality to support clinical decision-making. Methods We conducted a multicenter, observational, prospective, epidemiological cohort study at 45 hospitals in Germany. Until 1 January 2021, all hospitalized SARS CoV-2 positive patients were included. A comprehensive data set was collected in a cohort of seven hospitals. The primary objective was disease severity and prediction of mild, severe, and fatal cases. Ancillary analyses included a temporal analysis of all hospitalized COVID-19 patients for the entire year 2020. Findings A total of 4704 COVID-19 patients were hospitalized with a mortality rate of 19% (890/4704). Rates of mortality, need for ventilation, pneumonia, and respiratory insufficiency showed temporal variations, whereas age had a strong influence on the course of mortality. In cohort conducting analyses, prognostic factors for fatal/severe disease were: age (odds ratio (OR) 1.704, CI:[1.221–2.377]), respiratory rate (OR 1.688, CI:[1.222–2.333]), lactate dehydrogenase (LDH) (OR 1.312, CI:[1.015–1.695]), C-reactive protein (CRP) (OR 2.132, CI:[1.533–2.965]), and creatinine values (OR 2.573, CI:[1.593–4.154]. Conclusions Age, respiratory rate, LDH, CRP, and creatinine at baseline are associated with all cause death, and need for ventilation/ICU treatment in a nationwide series of COVID 19 hospitalized patients. Especially age plays an important prognostic role. In-hospital mortality showed temporal variation during the year 2020, influenced by age. Trial registration number NCT04659187.
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Affiliation(s)
- Nele Gessler
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Asklepios Proresearch, Research Institute, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Melanie A. Gunawardene
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Peter Wohlmuth
- Asklepios Proresearch, Research Institute, Hamburg, Germany
| | - Dirk Arnold
- Department of Hematology, Oncology, Palliative Care Medicine and Rheumatology, Asklepios Hospital Altona, Hamburg, Germany
| | - Juergen Behr
- Department of Pneumology, Member of the German Center for Lung Research, Asklepios Hospital Munich-Gauting, Gauting, Germany
| | - Christian Gloeckner
- Department of Internal Medicine, Asklepios Hospital Oberviechtach, Oberviechtach, Germany
| | - Klaus Herrlinger
- Department of Internal Medicine—Gastroenterology, Asklepios Hospital Nord-Heidberg, Hamburg, Germany
| | - Thomas Hoelting
- Department of Internal Medicine—Cardiology and Pneumology, Asklepios Hospital Wandsbek, Hamburg, Germany
| | - Ulrich-Frank Pape
- Department of Internal Medicine—Gastroenterology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Ruediger Schreiber
- Department Anesthesiology and Intensive Care Medicine, Asklepios Hospital West, Hamburg, Germany
| | - Axel Stang
- Semmelweis University, Budapest, Hungary
- Department of Oncology and Palliative Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Claas Wesseler
- Department of Pneumology, Asklepios Hospital Harburg, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | | | - Christoph U. Herborn
- Semmelweis University, Budapest, Hungary
- Asklepios Hospitals GmbH & Co. KGaA, Hamburg, Germany
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12
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Brüning R, Schneider M, Tiede M, Wohlmuth P, Stavrou G, von Hahn T, Ehrenfeld A, Reese T, Makridis G, Stang A, Oldhafer KJ. Ipsilateral access portal venous embolization (PVE) for preoperative hypertrophy exhibits low complication rates in Clavien-Dindo and CIRSE scales. CVIR Endovasc 2021; 4:41. [PMID: 33999299 PMCID: PMC8128945 DOI: 10.1186/s42155-021-00227-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Portal venous embolization (PVE) is a minimal invasive preoperative strategy that aims to increase future liver remnant (FLR) in order to facilitate extended hemihepatectomy. We analyzed our data retrospectively regarding complications and degree of hypertrophy (DH). Methods: 88 patients received PVE either by particles / coils (n = 77) or by glue / oil (n = 11), supported by 7 right hepatic vein embolizations (HVE) by coils or occluders. All complications were categorized by the Clavien- Dindo (CD) and the CIRSE classification. Results In 88 patients (median age 68 years) there was one intervention with a biliary leak and subsequent drainage (complication grade 3 CD, CIRSE 3), two with prolonged hospital stay (grade 2 CD, grade 3 CIRSE) and 13 complications grade 1 CD, but no complications of grade 4 or higher neither in Clavien- Dindo nor in CIRSE classification. The median relative increase in FLR was 47% (SD 35%). The mean pre-intervention standardized FLR rose from 23% (SD 10%) to a post-intervention standardized FLR of 32% (SD 12%). The degree of hypertrophy (DH) was 9,3% (SD 5,2%) and the kinetic growth rate (KGR) per week was 2,06 (SD 1,84). Conclusion PVE and, if necessary, additional sequential HVE were safe procedures with a low rate of complications and facilitated sufficient preoperative hypertrophy of the future liver remnant.
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Affiliation(s)
- Roland Brüning
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany. .,Faculty of medicine, Bavariaring 19, 80336, München, Germany.
| | - Martin Schneider
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Michel Tiede
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Peter Wohlmuth
- Biostatistics, ProResearch, Lohmuehlenstrasse 5, 20099, Hamburg, Germany
| | - Gregor Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken, Winterberg 1, 66199, Saarbrücken, Germany
| | - Thomas von Hahn
- Gastroenterology, Hepatology and interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany.,Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary
| | - Andrea Ehrenfeld
- Gastroenterology, Hepatology and interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Tim Reese
- Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary.,Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Georgios Makridis
- Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Axel Stang
- Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary.,Oncology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Karl J Oldhafer
- Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary.,Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
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13
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Kowall B, Nonnemacher M, Brune B, Brinkmann M, Dudda M, Böttcher J, Schmidt B, Standl F, Stolpe S, Dittmer U, Jöckel KH, Stang A. A model to identify individuals with a high probability of a SARS-CoV-2 infection. J Infect 2020; 82:e32-e34. [PMID: 33245942 PMCID: PMC7686708 DOI: 10.1016/j.jinf.2020.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 01/22/2023]
Affiliation(s)
- B Kowall
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.
| | - M Nonnemacher
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - B Brune
- Medical Emergency Service of the City of Essen, Germany; Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Germany
| | - M Brinkmann
- Center for Clinical Trials, University Hospital Essen, Germany
| | - M Dudda
- Medical Emergency Service of the City of Essen, Germany; Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Germany
| | - J Böttcher
- Public Health Office of the City of Essen, Germany
| | - B Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - F Standl
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - S Stolpe
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - U Dittmer
- Institute for Virology, University Hospital Essen, Germany
| | - K H Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - A Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, Boston, United States
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14
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Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, Heinrich F, Mushumba H, Kniep I, Schröder AS, Burdelski C, de Heer G, Nierhaus A, Frings D, Pfefferle S, Becker H, Bredereke-Wiedling H, de Weerth A, Paschen HR, Sheikhzadeh-Eggers S, Stang A, Schmiedel S, Bokemeyer C, Addo MM, Aepfelbacher M, Püschel K, Kluge S. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann Intern Med 2020; 173:268-277. [PMID: 32374815 PMCID: PMC7240772 DOI: 10.7326/m20-2003] [Citation(s) in RCA: 1657] [Impact Index Per Article: 414.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features. OBJECTIVE To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests. DESIGN Prospective cohort study. SETTING Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction-confirmed diagnosis of COVID-19. PATIENTS The first 12 consecutive COVID-19-positive deaths. MEASUREMENTS Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. RESULTS Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem computed tomography revealed reticular infiltration of the lungs with severe bilateral, dense consolidation, whereas histomorphologically diffuse alveolar damage was seen in 8 patients. In all patients, SARS-CoV-2 RNA was detected in the lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart. LIMITATION Limited sample size. CONCLUSION The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19-related death, as well as possible therapeutic interventions to reduce it. PRIMARY FUNDING SOURCE University Medical Center Hamburg-Eppendorf.
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Affiliation(s)
- Dominic Wichmann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Jan-Peter Sperhake
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Marc Lütgehetmann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Stefan Steurer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Carolin Edler
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Axel Heinemann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Fabian Heinrich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Herbert Mushumba
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Inga Kniep
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Ann Sophie Schröder
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Christoph Burdelski
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Geraldine de Heer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Axel Nierhaus
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Daniel Frings
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Susanne Pfefferle
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | | | | | | | | | | | - Axel Stang
- Asklepios Hospital Barmbek, Hamburg, Germany (H.B., A.S.)
| | - Stefan Schmiedel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Carsten Bokemeyer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Marylyn M Addo
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Martin Aepfelbacher
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Klaus Püschel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany (D.W., J.S., M.L., S.S., C.E., A.H., F.H., H.M., I.K., A.S.S., C.B., G.D., A.N., D.F., S.P., S.S., C.B., M.M.A., M.A., K.P., S.K.)
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Stang A, Khil L, Kajüter H, Pandeya N, Schmults CD, Ruiz ES, Karia PS, Green AC. Incidence and mortality for cutaneous squamous cell carcinoma: comparison across three continents. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:6-10. [PMID: 31833607 DOI: 10.1111/jdv.15967] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/02/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Population-based incidence and mortality studies of cutaneous squamous cell carcinoma (SCC) have been few owing to the commonness of the disease, and rare deaths making accurate mortality statistics difficult. OBJECTIVES Our aim was to summarize SCC incidence and mortality in populations across three continents, exemplified by Australia, the United States (US) and Germany. METHODS We estimated age-specific and age-standardized (Australian Standard 2001 Population) incidence and mortality rates per 100 000 person-years. RESULTS Squamous cell carcinoma incidence is plateauing or falling in Australia, stable in the United States (2013-2015) and rising in Germany (2007-2015). Current incidence estimates in men and women are 341 and 209, 497 and 296, and 54 and 26, respectively, for the three countries. Incidence increases strongly with age in all countries. Mortality of non-melanoma skin cancer appears to be increasing in Germany and stable in Australia (unavailable for the US population). CONCLUSIONS Squamous cell carcinoma is an important health issue, particularly among older men, with incidence exceeding most other cancers. More precise and uniform population-based studies of incidence and mortality are needed to better quantify the impact of SCC on healthcare systems worldwide and to gauge the effect of new treatments such as anti-PD1 therapy on mortality.
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Affiliation(s)
- A Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.,Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - L Khil
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - H Kajüter
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - N Pandeya
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - C D Schmults
- Population Health Department, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - E S Ruiz
- Population Health Department, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - P S Karia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A C Green
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,CRUK Manchester Institute and Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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16
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Stang A, Schwärzler P, Schmidtke S, Tolosa E, Kobbe R. Successful Immunochemotherapy for Burkitt Lymphoma During Pregnancy as a Bridge to Postpartum High-Dose Methotrexate Therapy: A Case Report and Review of the Literature. Clinical Lymphoma Myeloma and Leukemia 2020; 20:e284-e290. [DOI: 10.1016/j.clml.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/09/2019] [Accepted: 12/14/2019] [Indexed: 01/10/2023]
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17
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Kowall B, Lehmann N, Mahabadi AA, Moebus S, Erbel R, Jöckel KH, Stang A. Associations of metabolically healthy obesity with prevalence and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall Cohort Study. Nutr Metab Cardiovasc Dis 2019; 29:228-235. [PMID: 30648599 DOI: 10.1016/j.numecd.2018.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population. METHODS AND RESULTS In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. For cross-sectional and longitudinal analyses, we included 1585 participants free of coronary heart disease at baseline, with CAC measurements at baseline and at follow-up, and with either normal weight (BMI 18.5-24.9 kg/m2) or obesity (BMI ≥30.0 kg/m2) at baseline. We used four definitions of MHO. In our main analysis, we defined obese persons as metabolically healthy if they met ≤1 of the NCEP ATP III criteria for the definition of the metabolic syndrome - waist circumference was not taken into account because of collinearity with BMI. Persons with MHO had a higher prevalence of CAC than metabolically healthy normal weight (MHNW) persons (prevalence ratio = 1.59 (95% confidence interval 1.38-1.84) for the main analysis). Persons with MHO had slightly larger odds of CAC progression than persons with MHNW (odds ratios ranged from 1.17 (0.69-1.99) to 1.48 (1.02-2.13) depending on MHO definition and statistical approach). CONCLUSION Our analyses on MHO CAC associations add to the evidence that MHO is not a purely benign health condition.
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Affiliation(s)
- B Kowall
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - N Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - A A Mahabadi
- West-German Heart and Vascular Center Essen, Department of Cardiology, University Clinic Essen, Essen, Germany
| | - S Moebus
- Center for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany
| | - R Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - K H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - A Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, 715 Albany, Street, Talbot Building, Boston, MA 02118, USA
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18
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Stang A, Rusner C, Trabert B, Oosterhuis JW, McGlynn KA, Heidinger O. Incidence of testicular tumor subtypes according to the updated WHO classification, North Rhine-Westphalia, Germany, 2008-2013. Andrology 2018; 7:402-407. [PMID: 30578617 DOI: 10.1111/andr.12565] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/18/2018] [Accepted: 10/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2016, the WHO introduced an updated classification for testicular tumors. The application of this updated classification to cancer registry data requires some recoding of tumors. OBJECTIVES The aim of this study was to provide up-to-date population-based incidence estimates of subtypes of testicular germ cell tumors (TGCT) according to the updated classification. MATERIAL AND METHODS We reviewed 2251 pathology reports (42.9%) out of 5252 testicular tumors at the cancer registry of North Rhine-Westphalia for the years 2008-2013. We used population counts to estimate age-standardized incidence rates per million person-years (EUROSTAT revised European Standard Population). RESULTS The application of the updated WHO classification resulted in a recoding of 8.9% of all testicular tumors. While the recodings have no influence on the incidence of seminomatous and non-seminomatous TGCTs that include mixed TGCTs, they influence the incidence of individual histological types of seminomatous and non-seminomatous TGCTs. Among the 4935 testicular germ cell tumors (TGCT), 23.7% were mixed TGCTs. Overall, 46.9% of all mixed TGCTs included seminoma and age-standardized incidence rates were highest for the combination seminoma plus embryonal carcinoma (5.9 per million person-years) and embryonal carcinoma plus teratoma (4.9 per million person-years). The median age at diagnosis was higher for mixed TGCTs including seminoma (31 years) than those that did not include seminoma (28 years). DISCUSSION AND CONCLUSIONS Population-based incidence time trends for seminomatous and non-seminomatous TGCTs that include mixed TGCTs are not distorted by the introduction of the WHO update. Trend distortions can only be expected if time trends of individual histological subtypes of the seminomatous and non-seminomatous TGCTs are examined.
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Affiliation(s)
- A Stang
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany.,Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - C Rusner
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
| | - B Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - J W Oosterhuis
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands
| | - K A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - O Heidinger
- Cancer Registry of North Rhine-Westphalia, Muenster, Germany
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Stolpe S, Bock E, Scholz C, Stang A, Blume C. Unknown insufficiency of renal function – an almost unnoticed public health issue. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Stolpe
- University Hospital Essen, Essen, Germany
| | - E Bock
- University Hospital Essen, Essen, Germany
| | - C Scholz
- University Hospital Cologne, Cologne, Germany
| | - A Stang
- University Hospital Essen, Essen, Germany
| | - C Blume
- Leibniz-University Hannover, Hannover, Germany
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20
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Donati M, Stang A, Stavrou GA, Basile F, Oldhafer KJ. Extending resectability of hilar cholangiocarcinomas: how can it be assessed and improved? Future Oncol 2018; 15:193-205. [PMID: 30378439 DOI: 10.2217/fon-2018-0413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Until the 1980's, Klatskin tumors were considered 'desperate cases' and most of them were not resected; almost no oncologic concept was available. After many improvements, today, extended hepatectomy, including caudate lobe resection and lymphoadenectomy, have become a standard of care for oncologicaly radical resection of Klatskin tumors. Portal vein en bloc resection, if necessary, is a diffused standard assuring R0-resection without any improvement of survival in most series. Arterial resection remains episodical and controversial in its oncologic impact. Arterial resection-reconstruction was demonstrated to be feasible with many different technical possibilities. Neoadjuvant chemotherapy, refinement of associating liver partition and portal vein ligation for staged hepatectomy and liver transplantations are some possible future resources for treatment of those aggressive tumors that could be able to expand the pool of treatable patients.
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Affiliation(s)
- Marcello Donati
- Department of Surgery & Medical-Surgical Specialties, Surgical Clinic Unit, University Hospital of Catania (CAST), University of Catania, 95122 Catania, Italy.,Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany
| | - Axel Stang
- Oncology Unit, Asklepios Barmbek Hospital, Hamburg, Germany
| | - Gregor A Stavrou
- Department of General, Visceral, Thoracic & Pediatric Surgery, Saarbrucken Hospital, Saarbrucken-Saarland, Germany
| | - Francesco Basile
- Department of Surgery & Medical-Surgical Specialties, Surgical Clinic Unit, University Hospital of Catania (CAST), University of Catania, 95122 Catania, Italy
| | - Karl J Oldhafer
- Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany.,Department of General & Abdominal Surgery, Asklepios Barmbek Hospital, Hamburg, Germany
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21
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Samsen A, von der Heyde S, Bokemeyer C, David KA, Flath B, Graap M, Grebenstein B, Heflik L, Hollburg W, Layer P, von Leitner E, Overkamp F, Saeger W, Schneider S, von Seydewitz CU, Stang A, Stein A, Zornig C, Juhl H. Multi-omic based molecular profiling of advanced cancer identifies treatable targets and improves survival in individual patients. Oncotarget 2018; 9:34794-34809. [PMID: 30410678 PMCID: PMC6205171 DOI: 10.18632/oncotarget.26198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/10/2018] [Indexed: 01/22/2023] Open
Abstract
A proof-of-concept study was conducted to assess whether patients with advanced stage IV cancer for whom predominantly no standard therapy was available could benefit from comprehensive molecular profiling of their tumor tissue to provide targeted therapy. Tumor samples of 83 patients were collected under highly standardized conditions and analyzed using immunohistochemistry, next-generation sequencing and phosphoprotein profiling. Expression and phosphorylation of key oncogenic pathways were measured to identify targets at the (phospho-) proteomic level. At genomic level, 50 oncogenes and tumor suppressor genes were analyzed. Based on molecular profiling, targeted therapies were decided by the attending oncologist. Accordingly, 28 patients who met the defined criteria fell in two equal-sized groups. One group received targeted therapies while the other did not. Following six months of treatment, disease control was achieved by 49% of patients receiving targeted therapy (complete remission, 14%; partial remission, 21%; stable disease, 14%; disease progression, 36%; death, 14%) and 21% of patients receiving non-targeted therapy (stable disease, 21%; disease progression, 64%; death, 14%). Individual patients experienced dramatic responses to a therapy which otherwise would not have been applied. This approach clarifies the value of multi-omic molecular profiling for cancer diagnostics.
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Affiliation(s)
| | | | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, Department of Oncology, Hematology, Bone Marrow Transplantation and Pneumology, University Cancer Center Hamburg, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Bernd Flath
- HOPA-Hämatologisch-Onkologische Praxis Altona, Hamburg, Germany
| | | | | | - Ludger Heflik
- Praxis Und Tagesklinik Für Internistische Onkologie und Hämatologie, Recklinghausen, Germany
| | - Wiebke Hollburg
- HOPA-Hämatologisch-Onkologische Praxis Altona, Hamburg, Germany
| | - Peter Layer
- Israelitisches Krankenhaus, Hamburg, Germany
| | | | | | | | | | - Cay-Uwe von Seydewitz
- Medizinische Klinik, Onkologie/Hämatologie Und Palliativmedizin, Krankenhaus Reinbek St Adolf-Stift, Reinbek, Germany
| | - Axel Stang
- Department of Hematology, Oncology and Palliative Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Alexander Stein
- II. Medical Clinic and Polyclinic, Department of Oncology, Hematology, Bone Marrow Transplantation and Pneumology, University Cancer Center Hamburg, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Engel M, Pundt N, Stang A, Erbel R, Moebus S. Intra-individual fluctuation patterns of depressive symptoms assessed over 12 years. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667809] [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)
- M Engel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
| | - N Pundt
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
| | - A Stang
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
- Zentrum für Klinische Epidemiologie, Essen, Deutschland
| | - R Erbel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
| | - S Moebus
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
- Zentrum für Urbane Epidemiologie, Essen, Deutschland
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23
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Pannier-Fischer F, Bromen K, Schuldt K, Stang A, Poncar C, Wittenhorst M, Bock E, Weber S, Jöckel KH, Rabe E. Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie. Phlebologie 2018. [DOI: 10.1055/s-0037-1617353] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungZiel: Die Bonner Venenstudie zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen deutschen Wohnbevölkerung im Alter von 18-79 Jahren fand zwischen dem 13. 11. 2000 und 15. 3. 2002 statt. Es nahmen insgesamt 3072 Probanden teil, die Response-Proportion lag insgesamt bei 59%. Ergebnisse: Eine Beinschwellung in der Anamnese trat bei jedem 6. Mann (16,2%) und bei nahezu jeder 2. Frau (42,1%) auf. Eine kurz zurückliegende ein- oder beidseitige Beinschwellung in den letzten vier Wochen gab jeder 6. Teilnehmer an. Dies entspricht 14,8% (7,9% der Männer, 20,2% der Frauen). Für Gefäßerkrankungen typische Beinbeschwerden innerhalb der letzten vier Wochen gab insgesamt jeder 2. der Probanden (56,4%) an. Bei der Beurteilung der klinischen Ausprägung gemäß der CEAP-Klassifikation fällt auf, dass lediglich 9,6% der Probanden keinerlei Venenveränderungen aufweisen. Bei 59% bestehen isoliert Teleangiektasien oder retikuläre Venen, bei 14,3% Krampfadern (C2) ohne weitere Zeichen einer chronischen venösen Insuffizienz. Auffällig ist, dass bei 13,4% ein prätibiales Ödem im Rahmen von Venenveränderungen zum Untersuchungszeitpunkt vorlag. Demgegenüber liegt die Zahl der fortgeschrittenen Zeichen der chronischen venösen Insuffizienz bei 3,3%. Die Häufigkeit des floriden oder abgeheilten Ulcus cruris lag bei 0,7%. Schlussfolgerungen: Jeder 6. Mann und jede 5. Frau hat somit chronische Veneninsuffizienz (C3–C6). Die Zahlen zeigen, dass Venenkrankheiten insgesamt nach wie vor eine hohe Prävalenz aufweisen, dass aber die schweren Ausprägungen der chronischen venösen Insuffizienz in den vergangenen 20 Jahren zurückgegangen sind.
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Abstract
SummaryLymphoedema is a disease frequently diagnosed in vascular departments, its origin being primary or secondary after cellulitis or cancer treatment. The prevalence of lower extremity lymphoedema in the general population is largely unknown. The aim of this article is to describe the prevalence of Stemmer's sign as a diagnostic criterium for lymphoedema in an unselected adult German population. Methods: The population for this cross-sectional study was recruited from November 2000 through March 2002 from the general population of the city of Bonn and two surrounding rural communities. 3072 individuals (1145 rural and 1927 urban) could be enrolled in the study. The results of the clinical examination were categorized in four groups: grade 0 normal skin fold at the dorsum of the second toe, grade 1 skin fold enlarged measuring 0.5–1 cm, grade 2 the skin fold >1 cm and grade 3 >1 cm with severe induration or papillomatosis. Results: Among 3055 out of 3072 subjects information on all variables were available. In 15.9% of the population a positive Stemmer sign was found with a slightly higher overall prevalence in women. Most of this group presented as grade 1 Stemmer's sign (14.1%). The more severe grades 2 and 3 were present in 1.8 % of the study population with no clear difference between sexes. We observed a considerably higher prevalence of Stemmer's sign of all grades in the urban population. The prevalence of Stemmer's sign increased with age from 3.2% up to 35.9% in the 70–79 year old population. Prevalence of positive Stemmer's sign was also higher in higher C-stages of the CEAP classification (5.8% in C0 to 100% in C6). Conclusions: The prevalence of lymphoedema in the general population represented by grade 2–3 Stemmer's sign in 1.8% and grade 1 Stemmer's sign in 14% is high. Women have a slightly higher prevalence of positive Stemmer's sign than men. The prevalence of positive Stemmer's sign is associated with age and chronic venous insufficiency.
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Abstract
SummaryThe aim of this study was to assess the prevalence of use of medical compression stockings (MCS) in the general adult population in Germany, to comment the indications for which MCS therapy has been described and the patients’ experience with it. Methods: The survey is based on the Bonn Vein Study. The population of this cross-sectional study was randomly recruited between November 2000 and March 2002 from the registers of residents of the city of Bonn and two rural townships in the area. In total, 3.072 men and women were included in the trial. In addition to clinical examination and duplex-ultrasound, participants were asked whether any phlebological treatment had been carried out due to a leg disorder or disease.. If compression stockings had been worn, we asked for details such as compression class and length of stockings, wearing time, effectiveness, and recognition. Results: In total, 22.9% of people providing information (12.7% of male, 31.0% of female) mentioned having received a specific phlebological treatment in the past. Therapy with compression stockings had the highest prevalence with 14.6% in the general population (7.5% of males, 20.3% of females). The mean age at the first prescription was 45.5 years (SD = 14.3 years). With increasing severity of venous disease, as rated according to the CEAP classification, the prevalence increased from 1% in C0 patients to 82% in C5/C6 patients. Of 450 participants who had used compression stockings in the past, 309 (68.6%) did not wear CS at the time of the survey. The remainder had generally been wearing them on five or more days per week (73.0%) for 8 or more hours per day (89.4%). On average, 71.3% of the participants said that the disease for which MCS were prescribed, had improved as a result of MCS therapy. Improvement concerned a reduction of sensations of swelling (84.2%), of heaviness (89.4%), leg pain after long periods of standing (60.9), and tension in the legs (78.9).
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Stavrou GA, Donati M, Fard-Aghaie MH, Zeile M, Huber TM, Stang A, Oldhafer KJ. Did the International ALPPS Meeting 2015 Have an Impact on Daily Practice? The Hamburg Barmbek Experience of 58 Cases. Visc Med 2017; 33:456-461. [PMID: 29344520 DOI: 10.1159/000479476] [Citation(s) in RCA: 12] [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] [Indexed: 12/14/2022] Open
Abstract
Background ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced only 10 years ago and has gained wide acceptance as a variation of staged procedures in liver surgery. It has been criticized for its high morbidity and mortality, which all centers reported in their initial series. Methods After a world expert meeting in Hamburg in 2015 where all experts in the field met to discuss this method, caveats were extracted and formulated. We researched our complete prospective ALPPS database to see if the recommendations had any impact on outcome. Results In total, we performed 58 ALPPS procedures in our center. 33 patients were operated on before, 25 after the meeting. Results in terms of morbidity and mortality were significantly better after the meeting, as were patient selection and strategy. Conclusion In our own center's experience, the implementation of the meetings' recommendations and the information gathered through this valuable exchange had a dramatic impact on results. Having performed 58 ALPPS procedures in total, we can now conclude that ALPPS has become much safer in our hands since the 2015 meeting and that morbidity and mortality are no longer the issue to be discussed. Future research must focus on oncologic outcomes in these patients.
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Affiliation(s)
- Gregor A Stavrou
- General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany.,Semmelweis Medical Faculty, Campus Hamburg, Hamburg, Germany
| | - Marcello Donati
- General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany.,Department of Surgery, Vittorio-Emanuele University Hospital Catania, Catania, Italy
| | - Mohammad H Fard-Aghaie
- General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Martin Zeile
- Semmelweis Medical Faculty, Campus Hamburg, Hamburg, Germany.,Diagnostic and Interventional Radiology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Tessa M Huber
- General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Axel Stang
- Semmelweis Medical Faculty, Campus Hamburg, Hamburg, Germany.,Medical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl J Oldhafer
- General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany.,Semmelweis Medical Faculty, Campus Hamburg, Hamburg, Germany
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Lehnich AT, Kowall B, Moebus S, Jöckel KH, Stang A. Einnahme von schlafstörenden und schlafinduzierenden Medikamenten – eine Interaktionsanalyse auf der additiven Skala. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1606013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- AT Lehnich
- Universitätsklinikum Essen, IMIBE, Essen
| | - B Kowall
- Universitätsklinikum Essen, IMIBE, Essen
| | - S Moebus
- Universitätsklinikum Essen, IMIBE, Essen
| | - KH Jöckel
- Universitätsklinikum Essen, IMIBE, Essen
| | - A Stang
- Universitätsklinikum Essen, IMIBE, Essen
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Lehnich AT, Rusner C, Bock E, Katz R, Chodick G, Stang A. CT Scans in der Nachsorge von Hodenkrebs – Fluch oder Segen? Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- AT Lehnich
- Universitätsklinikum Essen, IMIBE, Essen
| | - C Rusner
- Radiologisches Zentrum Bärenkaree, Altenburg
| | - E Bock
- Universitätsklinikum Essen, IMIBE, Essen
| | - R Katz
- Maccabi Health Services, Tel Aviv
| | | | - A Stang
- Universitätsklinikum Essen, IMIBE, Essen
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Kowall B, Lehmann N, Moebus S, Erbel R, Jöckel KH, Stang A. Schlafmerkmale und die Progression des koronararteriellen Verkalkung: Ergebnisse der Heinz Nixdorf Recall Studie. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B Kowall
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - N Lehmann
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - S Moebus
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - R Erbel
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - KH Jöckel
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - A Stang
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
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Dragano N, Gerhardus A, Kurth BM, Kurth T, Razum O, Stang A, Teichert U, Wieler LH, Wildner M, Zeeb H. [Public Health: Setting Goals, Establishing Structures and Improving Health for All]. Gesundheitswesen 2016; 78:686-688. [PMID: 27756087 DOI: 10.1055/s-0042-116192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Public health is a population- and system-based approach that is needed to improve the health of societies and to decrease health inequalities. In the face of global challenges, the public health approach is essential. In Germany, the importance of public health is only partly reflected by its institutions and institutional arrangements. This applies equally to research, teaching and training, as well as to the public health service. Furthermore, the public health perspective is not sufficiently considered in cross-sectional topics that are relevant for health.There have been several initiatives to overcome structural deficits which can partly be traced back to historical circumstances. The White Paper presented here should encourage discussions about future policy options in public health. The authors represent public health in practice, research, and teaching in Germany.
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Affiliation(s)
- N Dragano
- Institut für Medizinische Soziologie, Weiterbildungsstudiengang MSc Public Health, Heinrich-Heine-Universität Düsseldorf
| | - A Gerhardus
- Institut für Public Health und Pflegeforschung, Universität Bremen
| | - B-M Kurth
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin
| | - T Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin
| | - O Razum
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - A Stang
- Zentrum für Klinische Epidemiologie, Universitätsklinikum Essen
| | - U Teichert
- Bundesverband der Ärztinnen und Ärzte des Öffentlichen Gesundheitsdienstes, Düsseldorf
| | - L H Wieler
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin
| | - M Wildner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen/Oberschleißheim
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
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Zeile M, Bakal A, Volkmer JE, Stavrou GA, Dautel P, Hoeltje J, Stang A, Oldhafer KJ, Brüning R. Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization-the effect of collaterals on embolized liver volume. Br J Radiol 2016; 89:20160306. [PMID: 27730840 DOI: 10.1259/bjr.20160306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy. METHODS 28 patients with primary or secondary liver tumours, mean age 64.1 ± 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 ± 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated. RESULTS Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 ± 84.7 cm3 and the median relative increase was 46.6 ± 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p = 0.004) as well as low plasma total protein (p = 0.019). Successful embolization of Segment IV showed only a trend to significance (p = 0.098). CONCLUSION Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge: Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.
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Affiliation(s)
- Martin Zeile
- 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany.,2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany
| | - Artur Bakal
- 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany
| | - Jan E Volkmer
- 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Gregor A Stavrou
- 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.,3 Department of Abdominal Surgery and Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Philip Dautel
- 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.,4 Department of Gastroenterology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Jan Hoeltje
- 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany.,2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany
| | - Axel Stang
- 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.,5 Department of Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl J Oldhafer
- 2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany.,3 Department of Abdominal Surgery and Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Roland Brüning
- 1 Institute of Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany.,2 Semmelweis University, Medical Faculty, Campus Hamburg, Hamburg, Germany
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Stang A, Donati M, Weilert H, Oldhafer KJ. Impact of Systemic Therapy and Recurrence Pattern on Survival Outcome after Radiofrequency Ablation for Colorectal Liver Metastases. J Cancer 2016; 7:1939-1949. [PMID: 27877209 PMCID: PMC5118657 DOI: 10.7150/jca.15656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/26/2016] [Accepted: 07/09/2016] [Indexed: 12/21/2022] Open
Abstract
Background: Most patients undergoing radiofrequency ablation (RFA) of colorectal liver metastasases (CLM) develop disease recurrence, but little is known about the effect of recurrence patterns and/or systemic therapy on outcome. In this study, we examined the recurrence patterns and survival after systemic therapy plus RFA in patients with unresectable CLM without extrahepatic disease. The aims were to analyze the effect of recurrence patterns on survival and to assess the relative benefit contributed by systemic therapy and local ablation to disease control and patient outcome. Methods: From January 2002 to December 2012, 113 patients underwent RFA of liver-limited CLM after systemic therapy. Univariate and multivariate analyses for associations between clinical and/or treatment-related variables, recurrence-free survival (RFS), recurrence patterns, and overall survival (OS) were carried out. Results: Of 113 patients, 105 (92.8%) had disease recurrence (median RFS: 6.1 months). Lower post-recurrence OS was observed after early (≤6 months) than after late recurrence (8.5 versus 24.0 months, p < 0.001). Recurrence sites were RFA-sites only (4.8%), liver-only (57.1%), lung-only (10.5%), or multiple (27.6%); the corresponding post-recurrence OS was 21, 19, 39, and 7 months (p < 0.001), respectively. Response to pre-RFA systemic therapy was the strongest predictor for OS (hazard ratio [HR] 5.28), RFS (HR 3.30), early (odds ratio [OR] 6.34) and multiple-site recurrence (OR 3.83) (p < 0.01), respectively; only responders achieved 5-year OS and RFS (29% and 12% versus 0% and 0% for non-responders, p < 0.001, respectively). Conclusions: Survival after RFA for liver-limited CLM is strongly linked to the timing and pattern of non-local disease recurrence. Local ablation efficacy is necessary but not sufficient to obtain long-term disease control. Effective pre-RFA systemic therapy does favourably affect the incidence, timing and patterns of recurrence and long-term survival and appears essential for the tailoring of RFA application to maximize patient benefit.
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Affiliation(s)
- Axel Stang
- Department of Hematology, Oncology, & Palliative Care, Asklepios Hospital Barmbek, Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany
| | - Marcello Donati
- Department of Surgery & Medical-Surgical Specialities, General & Oncologic Surgery Unit, Vittorio-Emanuele University Hospital, University of Catania, Italy
| | - Hauke Weilert
- Department of Hematology & Oncology, Asklepios Hospital Altona, Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany
| | - Karl Jürgen Oldhafer
- Department of General & Abdominal Surgery, Asklepios Hospital Barmbek, Semmelweis University of Medicine, Asklepios Campus, Germany
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Weber T, Wassertheurer S, Hametner B, Parragh S, Moebus S, Pundt N, Mahabadi A, Roggenbuck U, Lehmann N, Stang A, Jöckel K, Erbel R. [OP.5B.03] POPULATION-BASED REFERENCE VALUES FOR PULSATILE HEMODYNAMICS IN MIDDLE-AGED AND ELDERLY INDIVIDUALS – RESULTS OF THE HEINZ NIXDORF RECALL STUDY. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000491484.36380.82] [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: 11/25/2022]
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Trottier ED, Gravel J, Ali S, Meckler G, Blanchet M, Stang A, Porter R, Lemay S, Dubrovsky AS, Chan M, Jain R, Principi T, Joubert G, Kam A, Thull-Freedman J, Neto G, Lagacé M. Treating and Reducing Anxiety and Pain in the Paediatric Emergency Department (The Trapped 2 Survey): Time for Action – A Pediatric Emergency Research Canada (Perc) Project. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e70b] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Multiples barriers to appropriate analgesia provision are reported in the paediatric emergency department (PED), including limited accessibility to effective strategies.
OBJECTIVES: To evaluate the improvement in the accessibility of pain and anxiety management strategies in PEDs in Canada, after the creation of a national pediatric pain quality improvement collaborative, through Pediatric Emergency Research Canada.
DESIGN/METHODS: In 2013, the TRAPPED 1 survey was administered across Canadian PEDs, in order to evaluate the resources in place for pain and anxiety management. Subsequent to the TRAPPED 1, a pain Quality Improvement Collaborative was created to stimulate the implementation of new pain and anxiety management strategies through the sharing of information between PEDs. The TRAPPED 2 survey involved a cross sectional survey similar to TRAPPED 1, after a two year interval. Its main focus was to evaluate the improvement in the accessibility of specific, preferred strategies reported by each centre, after participating in this collaborative between December 2014 to November 2015, and then working to implement change within their own PEDs.
RESULTS: All 15/15 Canadian PEDs responded to TRAPPED 1 in 2013. In 2014, 11/15 agreed to participate in the national pain Quality Improvement Collaborative, with a goal of introducing new pain and anxiety management strategies within their own PEDs. An in-person meeting, email communication, and telephone meetings were employed for information sharing regarding experiences/challenges within each of the participating centres. Newly introduced strategies included education, distraction, nurse-initiated protocols, and policies/education to encourage the use of intranasal (IN) medications. 11/11 centres have responded to the interim follow up surveys in 2015. At the end of the project (Fall 2105), 15/15 Canadian PEDs agreed to complete the final TRAPPED 2 survey. When comparing the results of 2015 with 2013, an increased number of PEDs used face-based pain scales (14/15 vs 6/15) and behavioural scales (5/15 vs 1/15) for pain assessment of school-aged children and infants, respectively. Use of assessment room wall decoration for distraction increased from 7/15 to 11/15. Reminder posters for pain management at triage increased from 4/15 to 6/15. Availability of electronic distraction strategies (e.g. using tablets) increased from 4/15 to 10/15 centres. For skin-piercing procedure, nurses initiated protocols to use topical anesthetic creams and oral sucrose was available in 12/15 centres (compared to 10/15 in 2013), and 14/15 (compared to 12/15 in 2013) respectively. Availability of IN medications increased in the last two years: fentanyl 14/15 (9/15 in 2013) and midazolam in at least 10/15 (8/15 in 2013). 10/11 PEDS involved in the QI strategy reported the implementation of at least one of their strategies identified.
CONCLUSION: This study suggests that the use of a pain Quality Improvement Collaborative may improve the introduction of new strategies in multiple PEDs. It can help guide other centres when introducing new strategies to reduce pain and anxiety for children in community EDs. Future research can focus on the sustainability of the strategies, and as well the effect of the collaborative on the introduction of other pain treatment strategies.
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Todorovich S, Poonai C, Wright B, Ali S, Bhatt C, Todorovich S, Canton K, Mishra A, Speechley K, Stang A, Thompson G, Poonai N. Family Perceptions and Provision of Analgesia for Acutely Painful Conditions in Children: A Multi-Centred Prospective Survey. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e70] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: More than two-thirds of children who present to the emergency department (ED) complain of pain. It is well known that children’s pain is poorly managed in the ED compared to their adult counterparts. With respect to analgesic administration in the ED, discrepancies exist between physician self-report and institutional audit. Patient refusal of analgesia is a likely explanation. There is good evidence that misconceptions and fears about analgesia in children are common among caregivers and may contribute to withholding pain medication. To date, no study has surveyed caregivers presenting the the ED to assess frequency of analgesic administration and reasons for withholding analgesia. We hypothesize that there will be a significant proportion of care-givers and patients that refuse pain medication in the ED. We also hypothesize that there will be a wide range of reasons for refusal. The insight we gain from this study will help nurses, clinical educators, and physicians provide the appropriate information to parents in an effort to target misconceptions and allay fears.
OBJECTIVES: Our objectives were to characterize the degree of care-giver and patient provision of analgesia prior to arrival, refusal of analgesia in the ED, and reasons behind their decision-making process. We hope to identify specific misconceptions, attitudes, or beliefs that impair the optimal provision of analgesia to children in the ED.
DESIGN/METHODS: A novel survey was designed by a focus group using an iterative approach and implemented over a 16-week period across two Canadian tertiary care paediatric EDs. We included a consecutive sample of caregivers of children aged 4-17 years with an acutely painful condition (headache, abdominal pain, injury, otitis, pharyngitis). Caregivers were asked to answer questions covering five domains: (i) demographics, (ii) analgesia prior to arrival (iii) analgesia offered in the ED and reasons for refusal, (iv) perceptions of analgesia, and (v) caregiver satisfaction at discharge. Children were asked to rate their pain on arrival and at discharge. The primary outcome was the frequency of caregiver provision of analgesia prior to arrival and the proportion of caregivers who accept the offer of analgesia offered in the ED.
RESULTS: Three hundred forty-four caregivers completed the survey. The majority were female (269/339, 79%), aged 36 years or older (256/340, 75%) with a post-secondary education (237/336, 71%). Most (309/339, 91%) reported being able to “tell when their child was in pain”. All respondents rated their child’s maximal pain related to the presenting condition as at least a 6/10. With regards to the primary outcome, 229/338 (68%) of caregivers reported that they did not treat their child’s pain prior to arrival in the ED. Of those who did treat their child’s pain, ibuprofen was the most commonly used analgesic (77/112, 69%). The most common reasons for withholding analgesia was a lack of time (80/210, 38%), fear of masking seriousness of child’s condition (49/210, 23%), fear of masking signs and symptoms (48/210, 23%), and a lack of analgesia at home (47/210, 22%). Analgesia was offered to 186/344 (45%) of children in the ED and the majority of caregivers 157/186 (84%) accepted the offer. The most common reason for not accepting analgesia in the ED was child refusal (15/20, 75%). Most, 231/338 (68%) of caregivers felt that their child’s pain was managed well in the ED.
CONCLUSION: This survey of caregiver perceptions surrounding analgesia for children with acutely painful conditions presenting to the pae-diatric ED suggests that most do not treat their child’s pain prior to arrival, despite high levels of pain. Misconceptions surrounding analgesia prior to arrival are common. Despite this, most caregivers accepted analgesia in the ED. Our results suggest that educational strategies should be directed at caregiver awareness of the impact of pain on children and the need for prompt analgesic therapy, even when an ED visit is planned.
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Donati M, Stavrou GA, Stang A, Basile F, Oldhafer KJ. "Liver-first" approach with ALPPS: The natural combination of two new concepts in liver surgery. Surg Oncol 2016; 25:278-80. [PMID: 27566034 DOI: 10.1016/j.suronc.2016.05.007] [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] [Received: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Marcello Donati
- Department of Surgery and Medical-Surgical Specialties, General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital of Catania, Italy; Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany.
| | - Gregor A Stavrou
- Department of General and Abdominal Surgery, Asklepios Barmbek Hospital, Germany.
| | - Axel Stang
- Department of Oncology, Asklepios Barmbek Hospital, Hamburg, Germany.
| | - Francesco Basile
- Department of Surgery and Medical-Surgical Specialties, General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital of Catania, Italy.
| | - Karl J Oldhafer
- Department of General and Abdominal Surgery, Asklepios Barmbek Hospital, Germany; Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany.
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Abstract
Population attributable risks (PARs) are often used in health sciences because they offer an apparently easy answer to the question as to the proportion of disease cases that could be prevented in a population if one or more risk factors were eliminated. We discuss some problems in the interpretation of PARs that result from the fact that diseases have more than one cause. Moreover, requirements are discussed which have to be met before PARs can give a realistic idea of the proportion of cases of illness that can be avoided.
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Affiliation(s)
- B Kowall
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen
| | - A Stang
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen
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Abstract
The liver-first approach was proposed for the first time in 2006 to obtain resectability of stage IV colorectal cancer patients and complete the therapeutic plan. From then some groups have used this new revolutionary approach reporting promising results. Other alternative strategies have been proposed for metastatic patients. The authors reviewed the literature weighing the pros and cons of each strategy proposed to manage these advanced tumor stages. The therapeutic options are analyzed in the light of oncologic problems and evidence. Also problems, questions and perspectives are given. Even if the 'liver-first' approach seems to be a promising strategy, the ideal diagnostic-therapeutic flowchart for metastatic colorectal cancer is still difficult to standardize. The great heterogeneity of this population of patients is one of the main problems. A 'tailored approach' philosophy is necessary to calibrate, in a multidisciplinary setting, a case-by-case choice of therapeutic options.
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Affiliation(s)
- Marcello Donati
- Department of Surgery & Medical-Surgical Specialties, General & Oncologic Surgery Unit, Vittorio-Emanuele University Hospital, University of Catania, 95122 Catania, Italy
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Betzen C, Alhamdani MSS, Lueong S, Schröder C, Stang A, Hoheisel JD. Clinical proteomics: promises, challenges and limitations of affinity arrays. Proteomics Clin Appl 2015; 9:342-7. [PMID: 25594918 PMCID: PMC5024047 DOI: 10.1002/prca.201400156] [Citation(s) in RCA: 23] [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: 10/13/2014] [Revised: 12/16/2014] [Accepted: 01/13/2015] [Indexed: 12/14/2022]
Abstract
After the establishment of DNA/RNA sequencing as a means of clinical diagnosis, the analysis of the proteome is next in line. As a matter of fact, proteome‐based diagnostics is bound to be even more informative, since proteins are directly involved in the actual cellular processes that are responsible for disease. However, the structural variation and the biochemical differences between proteins, the much wider range in concentration and their spatial distribution as well as the fact that protein activity frequently relies on interaction increase the methodological complexity enormously, particularly if an accuracy and robustness is required that is sufficient for clinical utility. Here, we discuss the contribution that protein microarray formats could play towards proteome‐based diagnostics.
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Affiliation(s)
- Christian Betzen
- Division of Functional Genome Analysis, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany; Department of Pediatric Medicine I, University Children's Hospital Heidelberg, Heidelberg, Germany
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Oldhafer KJ, Donati M, Jenner RM, Stang A, Stavrou GA. ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence. World J Surg 2015; 38:1504-9. [PMID: 24326456 DOI: 10.1007/s00268-013-2401-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a promising method to increase resectability rates of liver tumors. Little has been published about oncological results so far. This report describes clinical evidence regarding a possible effect of ALPPS on tumor recurrence. METHODS Ten ALPPS procedures were performed for otherwise non-resectable colorectal liver metastases. Seven of these ten patients had a follow-up of at least 3 months and were analyzed for tumor recurrence. RESULTS Six of these seven patients had tumor recurrence to the liver. Three of seven patients presented with lung metastases, occurring earlier than liver metastases in two of three cases. One patient with a follow-up of 3 months had no visible recurrent disease, but increasing carcinoembryonic antigen levels. CONCLUSIONS The patient group operable only through ALPPS is at high risk for recurrence and early tumor progression. Still, this new method is the only chance for an oncological treatment strategy including a surgical approach and possibly better outcome.
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Affiliation(s)
- Karl J Oldhafer
- Division of General and Abdominal Surgery, Department of Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, 22291, Hamburg, Germany,
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Stang A, Trabert B, Rusner C, Poole C, Almstrup K, Rajpert-De Meyts E, McGlynn KA. A survey of etiologic hypotheses among testicular cancer researchers. Andrology 2014; 3:19-26. [PMID: 25538016 DOI: 10.1111/andr.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/11/2022]
Abstract
Basic research results can provide new ideas and hypotheses to be examined in epidemiological studies. We conducted a survey among testicular cancer researchers on hypotheses concerning the etiology of this malignancy. All researchers on the mailing list of Copenhagen Testis Cancer Workshops and corresponding authors of PubMed-indexed articles identified by the search term 'testicular cancer' and published within 10 years (in total 2750 recipients) were invited to respond to an e-mail-based survey. Participants of the 8th Copenhagen Testis Cancer Workshop in May 2014 were subsequently asked to rate the plausibility of the suggested etiologic hypotheses on a scale of 1 (very implausible) to 10 (very plausible). This report describes the methodology of the survey, the score distributions by individual hypotheses, hypothesis group, and the participants' major research fields, and discuss the hypotheses that scored as most plausible. We also present plans for improving the survey that may be repeated at a next international meeting of experts in testicular cancer. Overall 52 of 99 (53%) registered participants of the 8th Copenhagen Testis Cancer Workshop submitted the plausibility rating form. Fourteen of 27 hypotheses were related to exposures during pregnancy. Hypotheses with the highest mean plausibility ratings were either related to pre-natal exposures or exposures that might have an effect during pregnancy and in post-natal life. The results of the survey may be helpful for triggering more specific etiologic hypotheses that include factors related to endocrine disruption, DNA damage, inflammation, and nutrition during pregnancy. The survey results may stimulate a multidisciplinary discussion about new etiologic hypotheses of testicular cancer.
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Affiliation(s)
- A Stang
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
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Stang A. [An introduction to causality principles in biomedical research]. Gesundheitswesen 2014; 76:874-82; quiz 883-4. [PMID: 25525680 DOI: 10.1055/s-0034-1387509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Stang
- Universitätsklinikum Essen - Institut für Medizinische Informatik, Biometrie und Epidemiologie
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Kontautiene S, Stang A, Gollnick H, Valiukeviciene S. The role of phenotype, body mass index, parental and sun exposure factors in the prevalence of melanocytic nevi among schoolchildren in Lithuania. J Eur Acad Dermatol Venereol 2014; 29:1506-16. [DOI: 10.1111/jdv.12905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/04/2014] [Indexed: 02/03/2023]
Affiliation(s)
- S. Kontautiene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - A. Stang
- Institute for Medical Informatics, Biometry, and Epidemiology; University Hospital of Essen; University Duisburg-Essen; Essen Germany
| | - H. Gollnick
- Department of Dermatology and Venereology; Otto-von-Guericke-University; Magdeburg Germany
| | - S. Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
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Höbel S, Baumbach R, Dautel P, Oldhafer KJ, Stang A, Feyerabend B, Yahagi N, Faiss S. Single-Center Erfahrung mit der Endoskopischen Submukosa Dissektion (ESD) bei prämalignen und malignen gastrointestinalen Neoplasien. Z Gastroenterol 2014. [DOI: 10.1055/s-0034-1386273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Stang A, Oldhafer KJ, Weilert H, Keles H, Donati M. Selection criteria for radiofrequency ablation for colorectal liver metastases in the era of effective systemic therapy: a clinical score based proposal. BMC Cancer 2014; 14:500. [PMID: 25016394 PMCID: PMC4099490 DOI: 10.1186/1471-2407-14-500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/27/2014] [Indexed: 12/28/2022] Open
Abstract
Background At present, there are no widely accepted criteria for the use of radiofrequency ablation (RFA) for the treatment of colorectal liver metastases (CLM) in the context of effective modern-agent therapies. We aimed to define selection criteria for patients with liver-limited CLM who may benefit from adding RFA to systemic therapy with respect to long-term disease control. Methods Between 2002 and 2007, 88 consecutive patients received RFA for liver-only CLM during partial remission (PR), stable disease (SD), or progressive disease (PD) after systemic therapy. At a median follow-up of 8.2 years (range 5.2-11.1 years), clinical data were correlated to overall survival (OS) and recurrence-free survival (RFS). Results Poor OS and RFS correlated significantly with PD to systemic therapy before RFA (HR 5.46; p < 0.0001; and HR 6.46; p < 0.0001), number of ≥4 CLM (HR 3.13; p = 0.0005; and HR 1.77; p = 0.0389), and carcinoembryonic antigen (CEA) level of ≥100 ng/ml (HR 1.67; p = 0.032; and HR 1.67; p = 0.044). The presence of four criteria (PR, ≤3 CLM, ≤3 cm maximum size, and CEA ≤100 ng/ml) selected a subgroup (n = 23) with significantly higher probabilities for OS and RFS at 5 years (39% and 22%,respectively) compared to those without any or up 3 of these criteria (0-27% and 0-9%, p < 0.001, respectively). Conclusions A score based on four criteria (response to systemic therapy, ≤3 CLM, ≤3 cm size, low CEA value) may allow to select patients with liver-only CLM for whom additional use of RFA most likely adds benefit in an attempt to achieve long-term disease control. Almost one-fourth of patients fulfilling these four criteria may achieve 5-year survival without disease recurrence following effective systemic plus local RFA treatment.
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Affiliation(s)
- Axel Stang
- Department of Hematology and Oncology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291 Hamburg, Germany.
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Höbel S, Baumbach R, Dautel P, Oldhafer KJ, Stang A, Feyerabend B, Yahagi N, Faiss S. [Single centre experience of endoscopic submucosal dissection (ESD) in premalignant and malignant gastrointestinal neoplasia]. Z Gastroenterol 2014; 52:193-9. [PMID: 24526404 DOI: 10.1055/s-0033-1356065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Worldwide endoscopic submucosal dissection (ESD) of early GI cancers or premalignant neoplasia is becoming increasingly important. In Germany ESD is restricted to larger endoscopic institutions and only a few literature reports are available. The aim of the present study is to describe the results of 46 ESDs conducted in a German endoscopic centre. MATERIAL AND METHODS Between June 2007 and May 2012 46 ESDs in 45 patients (33 men, 12 women, mean age 66.1 years) were performed in the oesophagus (n = 17), stomach (n = 23) and rectum (n = 6). Data were collected for the en-bloc, R0 and R0 en-bloc resection rates as well as for complications, the curative resection and the local recurrence rates. In order to demonstrate a learning curve, results were evaluated for two periods (June 2007 to November 2010 vs. December 2010 to May 2012). RESULTS ESD was technically possible in 93.5%. En-bloc, R0, R0 en-bloc and curative resection rates were 90.7%, 74.4%, 67.4% and 65.1%, respectively. The complication rate was 13%. In the second period en-bloc and R0 en-bloc resection rates increased from 81% to 100% and, respectively, from 52.4% to 81.8%. After a medium follow-up of 11.4 months, local tumour recurrence occurred in 10%. In cases of curative R0 en bloc resection of malignant tumours no tumour recurrence occurred. DISCUSSION Despite the small number of patients, the present data underline the value of ESD, especially in cases of R0 en-bloc resections in the therapy for premalignant and early malignant GI tumours. Due to the required learning curve, ESD should be restricted to larger endoscopic centres in Germany.
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Affiliation(s)
- S Höbel
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
| | - R Baumbach
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
| | - P Dautel
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
| | - K J Oldhafer
- Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg
| | - A Stang
- Onkologie & Palliativmedizin, Asklepios Klinik Barmbek, Hamburg
| | | | - N Yahagi
- Division of Research and Development for Minor Invasive Treatment, Tumor Center, Keio University School of Medicine, Tokyo
| | - S Faiss
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
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Kantelhardt EJ, Zerche P, Mathewos A, Trocchi P, Addissie A, Aynalem A, Wondemagegnehu T, Ersumo T, Reeler A, Yonas B, Tinsae M, Gemechu T, Jemal A, Thomssen C, Stang A, Bogale S. Breast cancer survival in Ethiopia: a cohort study of 1,070 women. Int J Cancer 2014; 135:702-9. [PMID: 24375396 DOI: 10.1002/ijc.28691] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [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: 07/17/2013] [Accepted: 12/11/2013] [Indexed: 11/07/2022]
Abstract
There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in 2005-2010. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Cohort Studies
- Combined Modality Therapy
- Ethiopia/epidemiology
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasm Metastasis
- Neoplasm Staging
- Prognosis
- Survival Rate
- Young Adult
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Affiliation(s)
- E J Kantelhardt
- Department of Gynaecology, Martin Luther University, Halle an der Saale, Germany; Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany
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Rusner C, Dieckmann KP, Friedel H, Spielmann RP, Stang A. Häufigkeit der Computertomografie in der Nachsorge von Hodentumorpatienten - eine Einschätzung der Versorgungslage in Deutschland. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346416] [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: 10/26/2022]
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Stang A, Jansen L, Trabert B, Rusner C, Eberle A, Katalinic A, Emrich K, Holleczek B, Brenner H. Survival after a diagnosis of testicular germ cell cancers in Germany and the United States, 2002-2006: a high resolution study by histology and age. Cancer Epidemiol 2013; 37:492-7. [PMID: 23623488 DOI: 10.1016/j.canep.2013.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to provide detailed age-specific (5-year age groups) and histology-specific (histologic subtypes of seminoma and nonseminoma) relative survival estimates of testicular germ cell cancer patients in Germany and the United States (U.S.) for the years 2002-2006 and to compare these estimates between countries. METHODS We pooled data from 11 cancer registries of Germany and used data from the U.S. (SEER-13 database) including 11,508 and 10,774 newly diagnosed cases (1997-2006) in Germany and the U.S., respectively. We estimated 5-year relative survival (5-year-RS) by histology and age based on period analysis. RESULTS 5-year-RS for testicular germ cell tumors was 96.7% and 96.3% in Germany and the U.S., respectively. 5-Year-RS for spermatocytic seminoma was close to 100% in both countries. 5-Year-RS for nonseminoma was lower than for classical seminoma in Germany (93.3% versus 97.6%) and the U.S. (91.0% versus 98.2%). Among nonseminomas, choriocarcinomas provided the lowest 5-year-RS in both countries (Germany 80.1%, U.S. 79.6%). Age-specific 5-year-RS for seminoma showed only little variation by age. 5-Year-RS for nonseminomas tended to be lower at higher ages, especially for malignant teratoma. DISCUSSION This is the first study that provides up-to-date survival estimates for testicular cancer by histology and age in Germany and the U.S. Survival after a diagnosis of testicular cancer is very comparable between Germany and the U.S. 5-Year-RS for spermatocytic seminoma was close to 100% and the lowest 5-year-RS occurred among choriocarcinoma. Higher age at diagnosis is associated with a poorer prognosis among nonseminoma patients.
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Affiliation(s)
- A Stang
- Institute of Clinical Epidemiology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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Karciauskiene J, Valiukeviciene S, Gollnick H, Stang A. The prevalence and risk factors of adolescent acne among schoolchildren in Lithuania: a cross-sectional study. J Eur Acad Dermatol Venereol 2013; 28:733-40. [DOI: 10.1111/jdv.12160] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J. Karciauskiene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - S. Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - H. Gollnick
- Department of Dermatology and Venereology; Otto-von-Guericke-University; Magdeburg Germany
| | - A. Stang
- Institute of Clinical Epidemiology; Martin-Luther-University; Halle Germany
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