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van den Brand FF, Masrati H, Jordanova ES, Bloemena E, Lissenberg-Witte BI, de Boer YS, Bontkes HJ, Mebius R, Bouma G. MAdCAM-1 does not play a central role in the early pathophysiology of autoimmune hepatitis. Clin Res Hepatol Gastroenterol 2023; 47:102099. [PMID: 36841352 DOI: 10.1016/j.clinre.2023.102099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION CD4+ T cells are thought to have a central role in the pathogenesis of autoimmune hepatitis (AIH). Mucosal addressin cell adhesion molecule-1 (MAdCAM-1) directs homing of CD4+ T cells in the alimentary tract and is a therapeutic target in inflammatory bowel diseases. Here we assessed MAdCAM-1 expression in AIH and viral hepatitis and related its expression with immune infiltrate analysis and histopathological key features. METHODS Hepatic portal areas of pretreatment biopsies (n=10) and follow-up biopsies (n=9) of patients with a confirmed diagnosis of AIH were assessed for MAdCAM-1 expression and infiltrate composition using immunohistochemistry and multispectral imaging (Vectra® Polaris™). Controls consisted of biopsies of patients with untreated chronic viral hepatitis B or C (n=22). RESULTS MAdCAM-1 expression on endothelium was sparsely present in portal fields of two treatment-naïve AIH patients. Three patients showed MAdCAM-1 expression within lymphoid aggregates. No expression of significance (including single-cell expression) was observed in the remaining 6 patients. In contrast, viral hepatitis C biopsies showed endothelial MAdCAM-1 expression in 8 of 13 untreated patients. Densities of both B-cells (CD20+) and CD4+ T-cells (CD3+ CD8-) were increased in AIH and viral hepatitis patients with MAdCAM-1 expression. CONCLUSION MAdCAM-1 was detected in liver biopsies in a minority of patients with AIH at the time of diagnosis suggesting no central role in its pathophysiology. Lymphoid or reticular MAdCAM-1 pattern expression was associated with more dense infiltrates of both B-cells and CD4+ T-cells, and may be related to the formation of secondary lymphoid follicles.
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Affiliation(s)
- F F van den Brand
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands.
| | - H Masrati
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands
| | - E S Jordanova
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E Bloemena
- Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands; Department of Pathology, Amsterdam UMC, location VU University Medical Center, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, location VU University Medical Center, The Netherlands
| | - Y S de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands
| | - H J Bontkes
- Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam UMC, location VU University Medical Center, The Netherlands; Department of Molecular Cell Biology and Immunology, Amsterdam UMC, location VU University Medical Center, The Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - R Mebius
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, location VU University Medical Center, The Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands; Cancer Center Amsterdam Research Institute, Amsterdam, location VU University medical center, The Netherlands
| | - G Bouma
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands
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2
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Lange MM, Roos E, Bloemena E. [Pathologist reporting to the patient]. Ned Tijdschr Geneeskd 2022; 166:D6534. [PMID: 35899713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
For many patients the pathology report plays a key role in diagnosis and treatment planning. The report is traditionally addressed to the clinician and not to the patient. Although nowadays the patient can read the report, the complex content most often is incomprehensible to him/her. In an era of shared decision-making in which the patient must be fully informed, direct communication between patient and pathologist could be of added value for successful therapeutic management. Some successful initiatives have been reported. However, in the Netherlands direct interaction between the pathologist and the patient is still rare. This article is a plea to view the pathology report from a patient's perspective and to investigate how the communication of the content can be optimized. This article discusses possibilities for practical implementation, potential benefits and bottlenecks, as a basis for starting a discussion with practitioners, pathologists and patients in the Netherlands.
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Affiliation(s)
- M M Lange
- Amsterdam UMC, locatie VUmc, afd. Pathologie, Amsterdam
| | - E Roos
- Amsterdam UMC, locatie VUmc, afd. Pathologie, Amsterdam
| | - E Bloemena
- Amsterdam UMC, locatie VUmc, afd. Pathologie, Amsterdam
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Engel MSD, van der Lans RJL, Jansen JC, Leemans CR, Bloemena E, Lissenberg-Witte BI, Rijken JA, Smit CF, Hensen EF. Management and outcome of middle ear adenomatous neuroendocrine tumours: A systematic review. Oral Oncol 2021; 121:105465. [PMID: 34352556 DOI: 10.1016/j.oraloncology.2021.105465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
Middle ear adenomatous neuroendocrine tumours (MEANTs) are rare, unpredictable tumours. Although most MEANTs are characterized by a benign biological behaviour and indolent growth pattern, some studies have reported locally invasive and metastastic disease. Currently, the optimal management strategy for MEANTs remains subject of debate. The aim of this study is to review the literature on MEANTs with focus on its clinical characteristics, treatment strategies and outcome. A systematic review was conducted using PubMed, Embase and Cochrane databases. A total of 111 studies comprising 198 patients with MEANT were included. Treatment modalities comprised surgery (90%), surgery with adjuvant radiotherapy (9%) and palliative (chemo)radiotherapy in (1%). Local recurrence was observed in 25% of the patients and 7% of the patients developed metastasis, over a median period of 5.7 years (range 7 months - 32 years). Twelve of 13 patients (92%) who developed metastases had a local recurrence. Four patients (2%) died of MEANT: three due to distant metastases and one due to extensive local recurrence. Reliable histopathologic predictors of outcome could not be identified. These findings indicate that the clinical presentations of MEANT vary substantially, the overall recurrence rate is considerable and initial local tumour control is paramount. Because of the unpredictable clinical course, prolonged follow-up is warranted.
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Affiliation(s)
- M S D Engel
- Department of Otolaryngology & Head and Neck Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R J L van der Lans
- Department of Otolaryngology & Head and Neck Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J C Jansen
- Department of Otorhinolaryngology & Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - C R Leemans
- Department of Otolaryngology & Head and Neck Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - E Bloemena
- Department of Pathology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - B I Lissenberg-Witte
- Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J A Rijken
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C F Smit
- Department of Otolaryngology & Head and Neck Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - E F Hensen
- Department of Otorhinolaryngology & Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Dekker H, Schulten EAJM, van Ruijven L, van Essen HW, Blom GJ, Bloemena E, Ten Bruggenkate CM, Kullaa AM, Bravenboer N. Bone microarchitecture and turnover in the irradiated human mandible. J Craniomaxillofac Surg 2020; 48:733-740. [PMID: 32591131 DOI: 10.1016/j.jcms.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/13/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the microarchitecture and turnover in irradiated cancellous mandibular bone and the relation with radiation dose, to elucidate the effects of radiotherapy on the mandible. PATIENTS AND METHODS Mandibular cancellous bone biopsies were taken from irradiated patients and controls. Micro-CT scanning was performed to analyze microstructural bone parameters. Bone turnover was assessed by histomorphometry. Local radiation dose at the biopsy site (Dmax) was estimated from radiotherapy plans. RESULTS Twenty-seven irradiated patients and 35 controls were included. Osteoid volume (Osteoid Volume/Bone Volume, OV/BV) [0.066/0.168 (median/interquartile range (IQR), OV/BV; %), P < 0.001], osteoid surface (Osteoid Surface/Bone Surface, OS/BS) [0.772/2.17 (median/IQR, OS/BS; %), P < 0.001] and osteoclasts number (Osteoclasts per millimetre bone surface, Ocl/mmBS; mm2) [0.026/0.123 (median/IQR, Ocl/mmBS; mm2), P < 0.001] were decreased; trabecular number (Tb.N) was lower [1.63/0.63 (median/IQR, Tb.N; 1/mm-1), P = 0.012] and trabecular separation (Tb.Sp) [0.626/0.24 (median/IQR, Tb.Sp; μm), P = 0.038] was higher in irradiated mandibular bone. With higher Dmax, trabecular number increases (Spearman's correlation R = 0.470, P = 0.018) and trabecular separation decreases (Spearman's correlation R = -0.526, P = 0.007). Bone mineral density (BMD, milligrams hydroxyappetite per cubic centimetre, mgHA/cm3) [1016/99 (median/IQR, BMD; mgHA/cm3), P = 0.03] and trabecular separation [0.739/0.21 (median/IQR, Tb.Sp; μm), P = 0.005] are higher whereas connectivity density (Conn Dens) [3.94/6.71 (median/IQR, Conn Dens), P = 0.047] and trabecular number [1.48/0.44 (median/IQR, Tb.N; 1/mm-1), P = 0.002] are lower in Dmax ≤50 Gy compared to controls. CONCLUSIONS Radiotherapy dramatically impairs bone turnover in the mandible. Deterioration in microarchitecture only affects bone irradiated with a Dmax of <50 Gy. The 50 Gy value seems to be a critical threshold to where the effects of the radiation is more detrimental.
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Affiliation(s)
- H Dekker
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands.
| | - E A J M Schulten
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands.
| | - L van Ruijven
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.
| | - H W van Essen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Chemistry, the Netherlands.
| | - G J Blom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiotherapy, Amsterdam, the Netherlands.
| | - E Bloemena
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands.
| | - Chr M Ten Bruggenkate
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands; Alrijne Hospital, Department of Oral and Maxillofacial Surgery, Leiderdorp, the Netherlands.
| | - A M Kullaa
- Institute of Dentistry, University of Eastern Finland, Kuopio Campus, and Educational Dental Clinic, Kuopio University Hospital, Kuopio, Finland.
| | - N Bravenboer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Chemistry, the Netherlands; Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology and Center for Bone Quality, Leiden, the Netherlands.
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Nauta IH, Rietbergen MM, van Bokhoven AAJD, Bloemena E, Lissenberg-Witte BI, Heideman DAM, Baatenburg de Jong RJ, Brakenhoff RH, Leemans CR. Evaluation of the eighth TNM classification on p16-positive oropharyngeal squamous cell carcinomas in the Netherlands and the importance of additional HPV DNA testing. Ann Oncol 2019; 29:1273-1279. [PMID: 29438466 DOI: 10.1093/annonc/mdy060] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Oropharyngeal squamous cell carcinomas (OPSCCs) are traditionally caused by smoking and excessive alcohol consumption. However, in the last decades high-risk human papillomavirus (HPV) infections play an increasingly important role in tumorigenesis. HPV-driven OPSCCs are known to have a more favorable prognosis, which has led to important and marked changes in the recently released TNM-8. In this 8th edition, OPSCCs are divided based on p16 immunostaining, with p16 overexpression as surrogate marker for the presence of HPV. The aims of this study are to evaluate TNM-8 on a Dutch consecutive cohort of patients with p16-positive OPSCC and to determine the relevance of additional HPV DNA testing. Patients and methods All OPSCC patients without distant metastases at diagnosis and treated with curative intent at VU University Medical Center (2000-2015) and Erasmus Medical Center (2000-2006) were included (N = 1204). HPV status was determined by p16 immunostaining followed by HPV DNA PCR on the p16-immunopositive cases. We compared TNM-7 and TNM-8 using the Harrell's C index. Results In total, 388 of 1204 (32.2%) patients were p16-immunopositive. In these patients, TNM-8 had a markedly better predictive prognostic power than TNM-7 (Harrell's C index 0.63 versus 0.53). Of the 388 p16-positive OPSCCs, 48 tumors (12.4%) were HPV DNA-negative. This subgroup had distinct demographic, clinical and morphologic characteristics and showed a significantly worse five-year overall survival compared with the HPV DNA-positive tumors (P < 0.001). Conclusions TNM-8 has a better predictive prognostic power than TNM-7 in patients with p16-positive OPSCC. However, within p16-positive OPSCCs, there is an HPV DNA-negative subgroup with distinct features and a worse overall survival, indicating the importance to perform additional HPV DNA testing when predicting prognosis and particularly for selecting patients for de-intensified treatment regimens.
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Affiliation(s)
- I H Nauta
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - M M Rietbergen
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - A A J D van Bokhoven
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - E Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center Amsterdam, The Netherlands; Academic Center for Dentistry Amsterdam (ACTA), The Netherlands; Departments of Pathology
| | - B I Lissenberg-Witte
- Epidemiology and Biostatistics, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | | | - R J Baatenburg de Jong
- Department of Otorhinolaryngology/Head and Neck Surgery, Erasmus Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - R H Brakenhoff
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands.
| | - C R Leemans
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
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Boeve K, Den Toom I, Van Weert S, Bloemena E, Brouwers A, Hoekstra O, De Keizer B, Van der Vegt B, Willems S, Leemans C, Witjes M, De Bree R. OC-022 Unexpected drainage patterns and high accuracy of SLNB in OSCC after previous neck treatment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30188-4] [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: 10/27/2022]
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Ankersmit M, Hoekstra OS, van Lingen A, Bloemena E, Jacobs MAJM, Vugts DJ, Bonjer HJ, van Dongen GAMS, Meijerink WJHJ. Perioperative PET/CT lymphoscintigraphy and fluorescent real-time imaging for sentinel lymph node mapping in early staged colon cancer. Eur J Nucl Med Mol Imaging 2019; 46:1495-1505. [PMID: 30798428 PMCID: PMC6533411 DOI: 10.1007/s00259-019-04284-w] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/04/2019] [Indexed: 01/22/2023]
Abstract
Purpose Using current optical imaging techniques and gamma imaging modalities, perioperative sentinel lymph node (SLN) identification in colon cancer can be difficult when the SLN is located near the primary tumour or beneath a thick layer of (fat) tissue. Sentinel lymph node mapping using PET/CT lymphoscintigraphy combined with real-time visualization of the SLN using near-infrared imaging has shown promising results in several types of cancer and may facilitate the successful identification of the number and location of the SLN in early colon cancer. Methods Clinical feasibility of PET/CT lymphoscintigraphy using preoperative endoscopically injected [89Zr]Zr-Nanocoll and intraoperative injection of the near-infrared (NIR) tracer Indocyanine Green (ICG) was evaluated in ten early colon cancer patients. Three preoperative PET/CT scans and an additional ex vivo scan of the specimen were performed after submucosal injection of [89Zr]Zr-Nanocoll. All SLNs and other lymph nodes underwent extensive pathological examination for metastases. A histopathological proven lymph node visible at preoperative PET/CT and identified at PET/CT of the specimen was defined as SLN. Results A total of 27 SLNs were harvested in seven out of eight patients with successful injection of both tracers. In one patient no SLNs were assigned preoperatively. In two patients injection of [89Zr]Zr-Nanocoll failed due to incorrect needle positioning. Twenty-one (78%) SLNs were found intraoperatively using NIR-imaging. Eleven of the 27 (41%) SLNs were located near the primary tumour (< 2 cm). Those six SLNs not found intraoperatively with NIR-imaging were all located close to the tumour. In all seven patients at least one SLN could be assigned at preoperative imaging 24 h after tracer administration. One SLN contained metastases detected by immunohistochemistry. No metastases were found in the non-SLNs. Conclusions This study shows the potential of preoperative PET/CT lymphoscintigraphy to inform the surgeon about the number and location of SLNs in patients with early colon cancer. The additional use of NIR-imaging allows for intraoperative identification of these SLNs which are invisible with conventional white light imaging. Further research is necessary to improve and simplify the technique. We recommend perioperative SLN identification using a preoperative lymphoscintigraphy scan just before surgery approximately 24 h after injection. Additionally a postoperative scan of the specimen combined with intraoperative real-time NIR-imaging should be performed. Electronic supplementary material The online version of this article (10.1007/s00259-019-04284-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Ankersmit
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands.
| | - O S Hoekstra
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A van Lingen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E Bloemena
- Department of Pathology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M A J M Jacobs
- Department of Gastroenterology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - D J Vugts
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H J Bonjer
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - G A M S van Dongen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - W J H J Meijerink
- Department of Operation Rooms and MITeC Technology Center, Radboud University Medical Centre, Nijmegen, The Netherlands
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Dekker H, Bravenboer N, van Dijk D, Bloemena E, Rietveld D, ten Bruggenkate C, Schulten E. The irradiated human mandible: A quantitative study on bone vascularity. Oral Oncol 2018; 87:126-130. [DOI: 10.1016/j.oraloncology.2018.10.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/14/2018] [Accepted: 10/22/2018] [Indexed: 01/16/2023]
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Boon E, Valstar MH, van der Graaf WTA, Bloemena E, Willems SM, Meeuwis CA, Slootweg PJ, Smit LA, Merkx MAW, Takes RP, Kaanders JHAM, Groenen PJTA, Flucke UE, van Herpen CML. Clinicopathological characteristics and outcome of 31 patients with ETV6-NTRK3 fusion gene confirmed (mammary analogue) secretory carcinoma of salivary glands. Oral Oncol 2018; 82:29-33. [PMID: 29909898 DOI: 10.1016/j.oraloncology.2018.04.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES In 2010, a new subtype of salivary gland cancer (SGC), (mammary analogue) secretory carcinoma (SC), was defined, characterized by the ETV6-NTRK3 fusion gene. As clinical behavior and outcome data of this histological subtype tumor are still sparse, we aimed to describe the clinicopathological course and outcome of a series of translocation positive SC patients. PATIENT AND METHODS We re-evaluated the pathological diagnosis of a subset of SGCs, diagnosed in 4 of 8 Dutch head and neck centers. Subsequently, tumors with a morphological resemblance to SC were tested for the ETV6-NTRK3 fusion gene using RT-PCR. Furthermore, patients prospectively diagnosed with SC were included. The clinical characteristics and outcomes were retrieved from the patient files. RESULTS Thirty-one patients with ETV6-NTRK3 fusion gene positive SC were included. The median age was 49 years, 17 patients (55%) were male. Eighteen tumors (58%) arose in the parotid gland. One patient presented with lymph node metastasis. All patients underwent tumor resection and 4 patients had a neck dissection. Four patients had re-resection and 15 patients (48%) received postoperative radiotherapy. One patient developed a local recurrence, no regional recurrences or distant metastases were observed. After a median follow-up of 49 months the 5- and 10-year overall survival were 95%, the 5- and 10-year disease free survival were 89%. CONCLUSION The clinical course of SC is favorable with a low rate of locoregional recurrence and excellent survival. Given the low incidence of nodal metastases, elective neck treatment, i.e. surgery and/or radiotherapy, does not seem to be indicated.
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Affiliation(s)
- E Boon
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - M H Valstar
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - W T A van der Graaf
- Radboud University Medical Centre, Nijmegen, Netherlands; The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London UK
| | - E Bloemena
- Radboud University Medical Centre, Nijmegen, Netherlands; VU University Medical centre, Amsterdam, Netherlands
| | - S M Willems
- University Medical Centre Utrecht, Utrecht, Netherlands
| | - C A Meeuwis
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | - P J Slootweg
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - L A Smit
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - M A W Merkx
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - R P Takes
- Radboud University Medical Centre, Nijmegen, Netherlands
| | | | | | - U E Flucke
- Radboud University Medical Centre, Nijmegen, Netherlands
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Rietbergen MM, van Bokhoven AAJD, Lissenberg-Witte BI, Heideman DAM, Leemans CR, Brakenhoff RH, Bloemena E. Epidemiologic associations of HPV-positive oropharyngeal cancer and (pre)cancerous cervical lesions. Int J Cancer 2018; 143:283-288. [PMID: 29441569 DOI: 10.1002/ijc.31315] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/05/2018] [Accepted: 02/01/2018] [Indexed: 11/11/2022]
Abstract
Human papillomavirus (HPV)-induced oropharyngeal squamous cell carcinoma (OPSCC) remains increasing worldwide. We aimed to investigate if the HPV-prevalence of OPSCC in the Netherlands is rising as well, also in female patients. In addition, we evaluated the association between HPV-positive OPSCC and suspicious Pap results of the cervix in these female patients. Patients with OPSCC treated in the period 2000-2015 at the VU University Medical Center Amsterdam, were included (n = 926). The presence of an oncogenic HPV infection was determined by p16-immunostaining, followed by a high-risk HPV general primer 5+/6+ DNA PCR on the p16-immunopositive cases. A review of pathology reports in all female patients (n = 305) was undertaken to identify cytological signs of HPV-related (pre)cancer of the cervix. In total 281 of 926 (30.3%) OPSCCs were HPV-positive. Moreover, a significant increase in the prevalence of HPV-positive OPSCCs was observed from 14.0% in 2000 to 48.1% in 2015 (p < 0.001). Among the female patients with an HPV-positive OPSSC (n = 70), the results of cervical smears were available in 56 of 70 patients (80.0%). Of the female patients with HPV-positive OPSCC, 9 of 56 (16.1%) patients had a vaginal cuff Papanicolaou (Pap) test ≥3b in their medical history compared to 7 of 168 (4.2%) in the HPV-negative group (p = 0.003). In conclusion, a continuous increase in the HPV-attributable fraction of OPSCC was demonstrated in the period 2000-2015 in the Amsterdam region. HPV-positive OPSCC has a significant association with a history of suspicious Pap results of the cervix in female patients.
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Affiliation(s)
- M M Rietbergen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - A A J D van Bokhoven
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - C R Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - R H Brakenhoff
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Cancer Center Amsterdam, The Netherlands
| | - E Bloemena
- Department of Pathology, VU University Medical Center, Cancer Center Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), The Netherlands
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11
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Boon E, Valstar M, van der Graaf W, Bloemena E, Willems S, Meeuwis C, Smit L, Merkx M, Takes R, Flucke U, Herpen C. Mammary analogue secretory carcinoma (MASC): clinical characteristics in 28 ETV6-NTRK3 fusion gene confirmed patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Herpen C, Boxtel W, Flucke U, Bloemena E, Boon E, Verhaegh G, Aalders M, Jonker M, Schalken J, Versleijen-Jonkers Y. Overexpression of the c-MET proto-oncogene in salivary duct carcinoma patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Den Toom I, Van Schie A, Van Weert S, Hoekstra O, Karagozoglu H, Bloemena E, De Bree R. PO-109: The added value of SPECT-CT for identification of sentinel lymph nodes in early stage oral cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Kuiper JL, Hashemi SMS, Thunnissen E, Snijders PJF, Grünberg K, Bloemena E, Sie D, Postmus PE, Heideman DAM, Smit EF. Non-classic EGFR mutations in a cohort of Dutch EGFR-mutated NSCLC patients and outcomes following EGFR-TKI treatment. Br J Cancer 2016; 115:1504-1512. [PMID: 27875527 PMCID: PMC5155366 DOI: 10.1038/bjc.2016.372] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 06/10/2016] [Revised: 09/24/2016] [Accepted: 10/15/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Data on non-small-cell lung cancer (NSCLC) patients with non-classic epidermal growth factor receptor (EGFR) mutations are scarce, especially in non-Asian populations. The purpose of this study was to evaluate prevalence, clinical characteristics and outcome on EGFR-TKI treatment according to type of EGFR mutation in a Dutch cohort of NSCLC patients. METHODS We retrospectively evaluated a cohort of 240 EGFR-mutated NSCLC patients. Data on demographics, clinical and tumour-related features, EGFR-TKI treatment and clinical outcome were collected and compared between patients with classic EGFR mutations, EGFR exon 20 insertions and other uncommon EGFR mutations. RESULTS Classic EGFR mutations were detected in 186 patients (77.5%) and non-classic EGFR mutations in 54 patients (22.5%); 23 patients with an exon 20 insertion (9.6%) and 31 patients with an uncommon EGFR mutation (12.9%). Median progression-free survival (PFS) and overall survival (OS) on EGFR-TKI treatment were 2.9 and 9.7 months, respectively, for patients with an EGFR exon 20 insertion, and 6.4 and 20.2 months, respectively, for patients with an uncommon EGFR mutation. Patients with a double uncommon EGFR mutation that included G719X/L861Q/S768I had longer PFS and OS on EGFR-TKI treatment compared with patients with a single G719X/L861Q/S768I EGFR mutation (both P=0.02). CONCLUSIONS In our Dutch cohort, prevalence and genotype distribution of non-classic EGFR mutations were in accordance with previously reported data. The PFS and OS on EGFR-TKI treatment in patients with an uncommon EGFR mutation were shorter compared with patients with classic EGFR mutations, but varied among different uncommon EGFR mutations.
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Affiliation(s)
- J L Kuiper
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - S M S Hashemi
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - E Thunnissen
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - P J F Snijders
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - K Grünberg
- Department of Pathology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - E Bloemena
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - D Sie
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - P E Postmus
- Clatterbridge Cancer Centre and Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool, Merseyside L14 3PE, UK
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - E F Smit
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.,Department of Pulmonary Diseases, The Netherlands Cancer Institute, PO Box 90203, 1006 BE Amsterdam, The Netherlands
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15
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Martens-de Kemp S, Rietbergen M, Brink A, Walsum MSV, Bloemena E, van Wieringen W, Slijper M, Braakhuis B, Leemans C, Brakenhoff R. 6 CD98 identifies a clinically relevant subpopulation of head and neck squamous cell carcinoma cells with stem cell properties. Oral Oncol 2015. [DOI: 10.1016/j.oraloncology.2015.02.009] [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: 11/26/2022]
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16
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Rietbergen M, Braakhuis B, Bloemena E, Leemans C, Brakenhoff R. 41 Is HPV infection the first genetic hit in head and neck cancer? Oral Oncol 2015. [DOI: 10.1016/j.oraloncology.2015.02.041] [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: 11/24/2022]
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17
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Schouten CS, de Graaf P, Bloemena E, Witte BI, Braakhuis BJM, Brakenhoff RH, Leemans CR, Castelijns JA, de Bree R. Quantitative diffusion-weighted MRI parameters and human papillomavirus status in oropharyngeal squamous cell carcinoma. AJNR Am J Neuroradiol 2015; 36:763-7. [PMID: 25721078 DOI: 10.3174/ajnr.a4271] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/08/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Patients with human papillomavirus-positive oropharyngeal squamous cell carcinomas have a better survival rate than those with human papillomavirus-negative oropharyngeal squamous cell carcinomas. DWI characterizes biologically relevant tumor features, and the generated ADC may also provide prognostic information. We explored whether human papillomavirus status and ADC values are independent tumor characteristics. MATERIALS AND METHODS Forty-four patients with oropharyngeal squamous cell carcinomas underwent pretreatment DWI. ADC values for the primary tumors were determined by using 3 b-values in an ROI containing the largest area of solid tumor on a single section of an axial DWI image. Human papillomavirus status was determined with p16 immunostaining, followed by high-risk human papillomavirus DNA detection on the p16-positive cases. RESULTS Twenty-two patients were human papillomavirus-positive (50.0%). ADC values were not significantly different between human papillomavirus-negative (ADC(mean) = 1.56 [1.18-2.18] × 10(3) mm(2)/s) and human papillomavirus-positive tumors (ADC(mean) = 1.46 [1.07-2.16] × 10(3) mm(2)/s). CONCLUSIONS No significant association between ADC and human papillomavirus status was found in oropharyngeal squamous cell carcinomas. In our study population, differences in genetic and histologic features between human papillomavirus-positive and human papillomavirus-negative oropharyngeal squamous cell carcinomas did not translate into different ADC values. Long-term follow-up studies are needed to establish whether ADC has prognostic value and whether this is independent of the human papillomavirus status.
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Affiliation(s)
- C S Schouten
- From the Departments of Otolaryngology-Head and Neck Surgery (C.S.S., B.J.M.B., R.H.B., C.R.L., R.d.B.)
| | - P de Graaf
- Radiology and Nuclear Medicine (P.d.G., J.A.C.)
| | - E Bloemena
- Pathology (E.B.) Department of Oral and Maxillofacial Surgery/Oral Pathology (E.B.), VU University Medical Center/Academic Center for Dentistry Amsterdam, Amsterdam, the Netherlands
| | - B I Witte
- Epidemiology and Biostatistics (B.I.W.), VU University Medical Center, Amsterdam, the Netherlands
| | - B J M Braakhuis
- From the Departments of Otolaryngology-Head and Neck Surgery (C.S.S., B.J.M.B., R.H.B., C.R.L., R.d.B.)
| | - R H Brakenhoff
- From the Departments of Otolaryngology-Head and Neck Surgery (C.S.S., B.J.M.B., R.H.B., C.R.L., R.d.B.)
| | - C R Leemans
- From the Departments of Otolaryngology-Head and Neck Surgery (C.S.S., B.J.M.B., R.H.B., C.R.L., R.d.B.)
| | | | - R de Bree
- From the Departments of Otolaryngology-Head and Neck Surgery (C.S.S., B.J.M.B., R.H.B., C.R.L., R.d.B.)
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18
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Schouten CS, de Graaf P, Alberts FM, Hoekstra OS, Comans EFI, Bloemena E, Witte BI, Sanchez E, Leemans CR, Castelijns JA, de Bree R. Response evaluation after chemoradiotherapy for advanced nodal disease in head and neck cancer using diffusion-weighted MRI and 18F-FDG-PET-CT. Oral Oncol 2015; 51:541-7. [PMID: 25725587 DOI: 10.1016/j.oraloncology.2015.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 11/17/2014] [Revised: 01/25/2015] [Accepted: 01/28/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Evaluation of accuracy and interobserver variation of diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDGPET-CT) to detect residual lymph node metastases after chemoradiotherapy (CRT) in advanced staged head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Retrospectively, routinely performed DW-MRI (n=73) and 18F-FDG-PET-CT (n=58) 3months after CRT in HNSCC-patients with advanced nodal disease (N2-N3) were assessed by two radiologists and two nuclear medicine physicians (individually and in consensus). Imaging was scored dichotomously and on a five-point Likert scale. We also explored different scenarios for the potential added value of DW-MRI to PET-CT using the consensus Likert scale. Histopathology and a follow-up of 9months after CRT served as reference standard. RESULTS Five patients (7%) had residual regional disease. DW-MRI showed a sensitivity of 60% and a specificity of 93%, vs. 100% and 84% for PET-CT, respectively. DW-MRI and PET-CT observers had 'moderate' and 'substantial' interobserver agreement (κ=0.58 and κ=0.64, respectively) with the dichotomous system. The combination of PET-CT and DW-MRI showed a sensitivity of 100% and a specificity of 95%. CONCLUSION The high sensitivity of PET-CT authorizes a neck dissection in all patients with a positive test result and the high specificity of DW-MRI justifies avoidance of invasive neck dissections if the test is negative. Interobserver agreement varied as a function of test positivity criteria. Adding DW-MRI to PET-CT seemed to increase the specificity of PET-CT alone, thereby ensuring that less patients are exposed to unnecessary neck dissections.
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Affiliation(s)
- Charlotte S Schouten
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Femke M Alberts
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Emile F I Comans
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - E Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - E Sanchez
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Head and Neck Surgery, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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19
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Van Weert S, Witte B, Bloemena E, Leemans C. PO-160: Adenoid cystic carcinoma of the head and neck: proposal for a simplified histopathological grading scheme. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34920-3] [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: 11/30/2022]
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20
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Hooijberg E, Turksma A, Scholten K, Leemans C, Bloemena E, Meijer C. Immunotherapy for Head and Neck Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu302.3] [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: 11/14/2022] Open
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21
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Flach GB, Bloemena E, Klop WMC, van Es RJJ, Schepman KP, Hoekstra OS, Castelijns JA, Leemans CR, de Bree R. Sentinel lymph node biopsy in clinically N0 T1-T2 staged oral cancer: the Dutch multicenter trial. Oral Oncol 2014; 50:1020-4. [PMID: 25164950 DOI: 10.1016/j.oraloncology.2014.07.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/28/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Results of the Dutch multi-institutional trial on sentinel lymph node (SLN) biopsy in oral cancer. PATIENTS AND METHODS Patients were consecutively enrolled from 4 institutions, with T1/T2 oral cancer and cN0 neck based on palpation and ultrasound guided fine needle aspiration cytology. Lymphatic mapping consisted of preoperative lymphoscintigraphy. For intraoperative SLN detection a gamma-probe was used and in some patients additional blue dye. SLN negative patients were carefully observed, SLN positive patients were treated by neck dissection, radiotherapy or a combination of both. Endpoints of the study were risk of occult lymp node metastases, neck control, accuracy, 5-year disease-free survival (DFS), overall survival (OS) and disease-specific survival (DSS). RESULTS Twenty of 62 patients (32%) had positive SLNs. Macrometastases were found in 9 patients, micrometastases in 8, and isolated tumour cells in 3 patients. Median follow-up was 52.5 months. Of the 42 SLN negative patients, 5 developed a regional recurrence of whom 4 patients could be successfully salvaged. DFS, OS and DSS of SLN negative patients were 72.0%, 92.7% and 97.4%, and for SLN positive patients these numbers were 73.7%, 79.7%, 85.0%, respectively (DFS: p=0.916, OS: p=0.134, DSS: p=0.059, respectively). Neck control rate was 97% in SLN negative and 95% in SLN positive patients. Sensitivity was 80% and negative predictive value 88%. CONCLUSION SLN biopsy is able to reduce the risk of occult lymph node metastases in T1/T2 oral cancer patients from 40% to 8%, and enables excellent control of the neck.
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Affiliation(s)
- Géke B Flach
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - E Bloemena
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center, Utrecht, The Netherlands
| | - Kees-Pieter Schepman
- Department of Oral and Maxillofacial Surgery, University Medical Center, Groningen, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jonas A Castelijns
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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22
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Eskens FALM, van Erpecum KJ, de Jong KP, van Delden OM, Klumpen HJ, Verhoef C, Jansen PLM, van den Bosch MAAJ, Méndez Romero A, Verheij J, Bloemena E, de Man RA. Hepatocellular carcinoma: Dutch guideline for surveillance, diagnosis and therapy. Neth J Med 2014; 72:299-304. [PMID: 25319854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) is rare in the Netherlands, even though the incidence has increased quite sharply in recent years. Standard treatment options consist of surgery, orthotopic liver transplantation, radiofrequency ablation, transarterial chemoembolisation (TACE) and systemic therapy with sorafenib. The consensus-based Dutch HCC guideline, established in 2013, serves to guide surveillance, diagnosis and treatment options: Surveillance should be performed by ultrasound at six-month intervals in well-defined cirrhotic patients and in selected high-risk hepatitis B carriers; A nodule > 1 cm in cirrhotic patients with arterial hypervascularity and venous or delayed phase washout at four-phase CT or MRI scan establishes the diagnosis of HCC; In patients with HCC without underlying cirrhosis, resection should be considered regardless of tumour size; In cirrhotic HCC patients, tumour stage, severity of underlying cirrhosis, and performance status determine treatment options. The algorithm of the Barcelona Clinic Liver Cancer (BCLC) staging system should be followed; Patients with Child-Pugh A-B cirrhosis (CP < 8 points) and performance status 0-2 are candidates for any active treatment other than transplantation; In early stage HCC (BCLC stage 0 or A, compensated cirrhosis without portal hypertension) surgical resection, liver transplantation, or radiofrequency ablation should be considered; In intermediate stage HCC (BCLC stage B) TACE and÷ or radiofrequency ablation should be considered; In advanced stage HCC (BCLC stage C) sorafenib should be considered. CONCLUSION The Dutch HCC guideline offers advice for surveillance, diagnosis and treatment of HCC.
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Affiliation(s)
- F A L M Eskens
- Department of Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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23
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Braakhuis BJM, Rietbergen MM, Buijze M, Snijders PJF, Bloemena E, Brakenhoff RH, Leemans CR. TP53 mutation and human papilloma virus status of oral squamous cell carcinomas in young adult patients. Oral Dis 2013; 20:602-8. [PMID: 24112103 DOI: 10.1111/odi.12178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 06/21/2013] [Revised: 07/15/2013] [Accepted: 07/21/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Little is known about the molecular carcinogenesis of oral squamous cell carcinoma (OSCC) in young adult patients. The aim of this study was to investigate the detailed TP53 mutation and human papilloma virus (HPV) status of OSCC in patients, younger than 45 years. METHODS TP53 mutations were determined with direct sequencing on paraffin-embedded carcinoma tissue from 31 young patients and compared with two older age OSCC reference groups: one from the same institute (N = 87) and an independent one (N = 675). Biologically active tumour HPV was detected by p16-immunohistochemistry followed by a HPV-DNA GP5 + /6 + -PCR. RESULTS HPV16 was present in one OSCC (3%). TP53 mutations were found in 14 (45%) OSCC: five were missense and nine resulted in a truncated protein. Six of these latter were insertions or deletions of one or more nucleotides leading to frameshift, one was at a splice site and two resulted in a stop codon. The percentage of truncating mutations (64% of all mutations) was higher than that observed in the institute's reference group (44%, P = 0.23) and in the independent reference group (24%, P = 0.002). CONCLUSIONS This study shows that TP53 mutations are common in OSCC of young adult patients; infection with biologically active HPV is rare.
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Affiliation(s)
- B J M Braakhuis
- Department of Otolaryngology/Head-Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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24
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Rietbergen MM, Brakenhoff RH, Bloemena E, Witte BI, Snijders PJF, Heideman DAM, Boon D, Koljenovic S, Baatenburg-de Jong RJ, Leemans CR. Human papillomavirus detection and comorbidity: critical issues in selection of patients with oropharyngeal cancer for treatment De-escalation trials. Ann Oncol 2013; 24:2740-5. [PMID: 23946330 DOI: 10.1093/annonc/mdt319] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [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: 12/18/2022] Open
Abstract
BACKGROUND The presence of human papillomavirus (HPV)-infection in oropharyngeal squamous cell carcinoma (OPSCC) is a major determinant in prognostic risk modeling. However, most risk models are based on clinical trials which only include a selected patient population. The clinical significance of HPV and other prognostic factors in patients with OPSCC remains to be evaluated in a large, unselected cohort, which also includes patients with stage I/II disease and patients with severe comorbidity. PATIENTS AND METHODS All patients diagnosed with OPSCC in 2000-2006 in two Dutch university hospitals were included. The presence of an oncogenic HPV infection was determined by p16-immunostaining, followed by a high-risk HPV general primer 5+/6+ DNA PCR on the p16-positive cases. Cox regression analysis was carried out to compare survival rates between HPV-positive and HPV-negative patients and a prognostic model was generated by recursive partitioning. RESULTS In total, 163 of 841 (19.4%) tumors were HPV-positive. Patients with HPV-positive OPSCC had a more favorable overall survival [73.5% versus 40.9% after 5 years; P < 0.001; hazard ratio = 0.34, 95% confidence interval (CI) 0.25-0.48] compared with patients with HPV-negative OPSCC. Patients with p16-positive but HPV DNA-negative tumors showed a significantly less favorable survival than patients with p16-positive and HPV DNA-positive tumors (P < 0.001). A prognostic model was developed in which patients were classified into three risk groups according to HPV status, nodal stage and comorbidity. [Harrell's concordance index of 0.68 (95% CI 0.65-0.71)]. CONCLUSIONS Tumor HPV status is a strong and independent prognostic factor for survival among patients with OPSCC. A prognostic risk model was proposed, based on our large, unselected cohort of patients with HPV status, comorbidity and nodal stage being the important prognostic factors. In addition, this study emphasizes the importance of performing an HPV DNA-specific test besides p16-immunostaining.
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Affiliation(s)
- M M Rietbergen
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam
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25
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Brouns EREA, Baart JA, Karagozoglu KH, Aartman IHA, Bloemena E, van der Waal I. Malignant transformation of oral leukoplakia in a well-defined cohort of 144 patients. Oral Dis 2013; 20:e19-24. [DOI: 10.1111/odi.12095] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- EREA Brouns
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - JA Baart
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - KH Karagozoglu
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - IHA Aartman
- Department of Social Dentistry and Behavioural Sciences; Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - E Bloemena
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
- Department of Pathology; VU University Medical Center (VUmc); Amsterdam The Netherlands
| | - I van der Waal
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
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26
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Turksma AW, Bontkes HJ, van den Heuvel H, de Gruijl TD, von Blomberg BME, Braakhuis BJM, Leemans CR, Bloemena E, Meijer CJLM, Hooijberg E. Effector memory T-cell frequencies in relation to tumour stage, location and HPV status in HNSCC patients. Oral Dis 2012. [DOI: 10.1111/odi.12037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- AW Turksma
- Department of Pathology; VU University Medical Center; Amsterdam; The Netherlands
| | - HJ Bontkes
- Department of Pathology; VU University Medical Center; Amsterdam; The Netherlands
| | - H van den Heuvel
- Department of Pathology; VU University Medical Center; Amsterdam; The Netherlands
| | - TD de Gruijl
- Department of Oncology; VU University Medical Center; Amsterdam; The Netherlands
| | - BME von Blomberg
- Department of Pathology; VU University Medical Center; Amsterdam; The Netherlands
| | - BJM Braakhuis
- Department of Otolaryngology/Head and Neck Surgery; VU University Medical Center; Amsterdam; The Netherlands
| | - CR Leemans
- Department of Otolaryngology/Head and Neck Surgery; VU University Medical Center; Amsterdam; The Netherlands
| | | | - CJLM Meijer
- Department of Pathology; VU University Medical Center; Amsterdam; The Netherlands
| | - E Hooijberg
- Department of Pathology; VU University Medical Center; Amsterdam; The Netherlands
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Brouns EREA, Baart JA, Karagozoglu KH, Aartman IHA, Bloemena E, van der Waal I. Treatment results of CO2laser vaporisation in a cohort of 35 patients with oral leukoplakia. Oral Dis 2012; 19:212-6. [DOI: 10.1111/odi.12007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 07/25/2012] [Accepted: 07/29/2012] [Indexed: 11/29/2022]
Affiliation(s)
- EREA Brouns
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - JA Baart
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - KH Karagozoglu
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - IHA Aartman
- Department of Social Dentistry and Behavioural Sciences; Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
| | - E Bloemena
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
- Department of Pathology; VU University Medical Center (VUmc); Amsterdam The Netherlands
| | - I van der Waal
- Department of Oral and Maxillofacial Surgery and Oral Pathology; VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA); Amsterdam The Netherlands
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van Weert S, Bloemena E, Bree R, Rietveld D, Kuik J, Leemans C. ADENOID CYSTIC CARCINOMA OF THE HEAD AND NECK: A SINGLE-CENTER ANALYSIS OF 105 CASES. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70091-3] [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: 11/29/2022]
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Veenhof AAFA, Bloemena E, Engel AF, van der Peet DL, Meijer OWM, Cuesta MA. The relationship of histological tumor regression grade (TRG) and two different time intervals to surgery following radiation therapy for locally advanced rectal cancer. Int J Colorectal Dis 2009; 24:1091-6. [PMID: 19415307 DOI: 10.1007/s00384-009-0722-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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] [Accepted: 04/16/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of this study was to assess the effect of two different time intervals between radiation therapy and surgery for rectal cancer on the histological tumor regression grade (TRG) in the resected specimen. METHODS Between 1995 and 2000, patients undergoing preoperative radiation therapy and TME for locally advanced (T3N0 and T3N1) mid and low rectal tumors treated in the VU University Medical Center or the Zaans Medical Center were entered into this study. All patients received identical radiation treatment (5 x 5 Gy) in the VU University medical center and were subsequently operated on within 2 weeks in the Zaans Medical Center (SI group) and after 6-8 weeks in the VU University Medical Center (LI group). All available histological material was reevaluated for TRG and correlated to survival. RESULTS Sixty-seven patients were included in the present study, 28 in the LI group and 39 in the SI group. Patient gender was comparable for both groups with 21 (75%) male patients in the LI group versus 26 (67%) male patients in the SI group (p = 0.46). A T3N0 preoperative tumor stage was found in 21 (75%) patients in the LI group and in 33 (85%) patients in the SI group (p = 0.36). All tumors were histologically proven adenocarcinoma. Patients in the SI group were significantly older (67 vs. 58 years). In the LI group, a significantly more pronounced histological tumor regression was found. A complete response (TRG1), combined with a near complete histological response (TRG 2), were present in 12 patients in the LI group and in four patients in the SI group (p = 0.002). Radicality of resection was comparable for both groups. With a follow-up of over 60 months, there were no statistically significant differences between the SI and LI groups regarding local control, overall, or disease-free survival. CONCLUSION Although histological tumor regression is significantly more pronounced following a long interval between radiation therapy and surgery, in the present study, this is not reflected in a better radical resection rate, local control or better overall and disease-free survival.
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Affiliation(s)
- A A F A Veenhof
- Department of Surgery, VU University Medical Center, Postbus 7057, de Boelelaan 1117, 1007 MB Amsterdam, The Netherlands.
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30
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de Bree R, Flach GB, Hoekstra OS, Bloemena E, van der Waal I, Leemans CR. [Potential clinical applications of the sentinel node procedure in oral cancer]. Ned Tijdschr Tandheelkd 2008; 115:674-677. [PMID: 19149135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In cases of oral cavity cancer a reliable diagnostic technique is needed to detect occult regional lymph node metastases and to avoid futile elective neck dissections as well as undertreatment. The first studies revealed a sensitivity of 94%. However, the sentinel node procedure is not yet a routinely performed procedure in oral cancer.
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Affiliation(s)
- R de Bree
- Keel-, Neus- en Oorheelkunde/Hoofd-halschirurgie, Vrije Universiteit Medisch Centrum/Academisch Centrum Tandheelkunde Amsterdam (ACTA), Amsterdam.
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31
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Vékony H, Röser K, Löning T, Raaphorst FM, Leemans CR, Van der Waal I, Bloemena E. Deregulated expression of p16INK4aand p53 pathway members in benign and malignant myoepithelial tumours of the salivary glands. Histopathology 2008; 53:658-66. [DOI: 10.1111/j.1365-2559.2008.03184.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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32
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Bloemena E. [Cancer and oncogenesis]. Ned Tijdschr Tandheelkd 2008; 115:180-185. [PMID: 18512515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The term cancer is generally used for malignant neoplasms. A malignant tumour displays invasive growth, i.e. growth beyond its anatomical boundaries, and can result in the formation of distant metastases. Cancer arises from unregulated cell growth, due to alterations in the genome of cells. The cells consequently no longer react to regulatory signals. The accumulation of various genetic defects in a cell ultimately lead to cancer. Cancer is often preceded by a histologically recognizable premalignant stage, called dysplasia. During the past decades, considerable advances have been achieved in characterizing the genetic changes in cells which lead to the beginning of the cell growth. The most important genes involved in these processes are oncogenes, tumour suppressor genes and the so-called DNA mismatch repair genes.
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Affiliation(s)
- E Bloemena
- Uit de afdeling Mondziekte, Kaak- en Aangezichtschirurgie/Orale Pathologie van het Vrije Universiteit Medisch Centrum in Amsterdam, Academisch Centrum voor Tandheelkunde Amsterdam (ACTA), Amsterdam.
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33
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Vékony H, Raaphorst FM, Otte AP, van Lohuizen M, Leemans CR, van der Waal I, Bloemena E. High expression of Polycomb group protein EZH2 predicts poor survival in salivary gland adenoid cystic carcinoma. J Clin Pathol 2008; 61:744-9. [PMID: 18326020 DOI: 10.1136/jcp.2007.054262] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The prognosis of adenoid cystic carcinoma (ACC), a malignant salivary gland tumour, depends on clinicopathological parameters. To decipher the biological behaviour of ACC, and to identify patients at risk of developing metastases, additional markers are needed. METHODS Expression of the cell cycle proteins p53, cyclin D1, p16(INK4a), E2F1 and Ki-67, together with the Polycomb group (PcG) proteins BMI-1, MEL-18, EZH2 and EED was investigated immunohistochemically 21 formalin-fixed, paraffin-embedded primary ACCs in relation to tumour characteristics. RESULTS ACC revealed significantly increased expression of the cell cycle proteins compared to normal salivary tissue (n = 17). Members of the two PcG complexes displayed mutually exclusive expression in normal salivary gland tissue, with BMI-1 and MEL-18 being abundantly present. In ACC, this expression pattern was disturbed, with EZH2 and EED showing significantly increased expression levels. In univariate analysis, presence of recurrence, poor differentiation and high EZH2 levels (>25% immunopositivity) significantly correlated with unfavourable outcome. ACCs with high proliferative rate (>25% Ki-67 immunopositivity) significantly correlated with high levels of EZH2 and p16. Only the development of recurrence was an independent prognostic factor of survival in multivariate analysis. CONCLUSIONS Expression of PcG complexes and of essential cell cycle proteins is highly deregulated in ACC. Also, EZH2 expression has prognostic relevance in this malignancy.
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Affiliation(s)
- H Vékony
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Academic Centre for Dentistry (ACTA), VU University Medical Center, Amsterdam, The Netherlands.
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34
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Haanen JBAG, Baars A, Gomez R, Weder P, Smits M, de Gruijl TD, von Blomberg BME, Bloemena E, Scheper RJ, van Ham SM, Pinedo HM, van den Eertwegh AJM. Melanoma-specific tumor-infiltrating lymphocytes but not circulating melanoma-specific T cells may predict survival in resected advanced-stage melanoma patients. Cancer Immunol Immunother 2006; 55:451-8. [PMID: 16034562 PMCID: PMC11030194 DOI: 10.1007/s00262-005-0018-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 04/19/2005] [Indexed: 01/18/2023]
Abstract
PURPOSE To study the effect of autologous tumor cell vaccinations on the presence and numbers of circulating CD8+ T cells specific for tumor-associated antigens (TAA) in metastatic melanoma patients. To investigate the correlation between the presence of tumor-infiltrating lymphocytes (TIL) and circulating TAA-specific CD8+ T cells before and after autologous tumor cell vaccination with overall survival. EXPERIMENTAL DESIGN Twenty-five stage III and resected stage IV metastatic melanoma patients were adjuvantly treated with a series of intracutaneously injected autologous tumor cell vaccinations, of which the first two contained BCG as an immunostimulatory adjuvant. Tumor samples and blood samples obtained before and after vaccination of these patients were studied for the presence of TAA-specific T cells using HLA-tetramers and results were correlated with survival. RESULTS In 5 of 17 (29%) melanoma patients, circulating TAA-specific T cells were detectable prior to immunizations. No significant changes in the frequency and specificity were found during the treatment period in all patients. Presence of circulating TAA-specific T cells was not correlated with survival (log rank, P=0.215). Inside melanoma tissue, TAA-specific TIL could be detected in 75% of 16 available tumor samples. In case of detectable TAA-specific TIL, median survival was 22.5 months compared to median survival of 4.5 months in case of absence of TAA-specific T cells (log rank, P=0.0094). In none of the patients, TAA-specific T cells were found both in tumor tissue and blood at the same time. CONCLUSIONS These data suggest that the presence of TAA-specific TILs forms a prognostic factor, predicting improved survival in advanced-stage melanoma patients. The absence of TAA-specific T cells in the circulation suggests that homing of the tumor-specific T cell population to the tumor site contributes to the effectiveness of antitumor immunity.
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Affiliation(s)
- J. B. A. G. Haanen
- Division of Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 Amsterdam, The Netherlands
| | - A. Baars
- Department of Medical Oncology, Vrije Universiteit Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - R. Gomez
- Division of Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 Amsterdam, The Netherlands
| | - P. Weder
- Division of Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 Amsterdam, The Netherlands
| | - M. Smits
- Division of Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 Amsterdam, The Netherlands
| | - T. D. de Gruijl
- Department of Medical Oncology, Vrije Universiteit Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - B. M. E. von Blomberg
- Department of Pathology, Vrije Universiteit Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - E. Bloemena
- Department of Pathology, Vrije Universiteit Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - R. J. Scheper
- Department of Pathology, Vrije Universiteit Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - S. M. van Ham
- Department of Immunopathology, Sanquin Research at CLB, Plesmanlaan 125, 1066 Amsterdam, The Netherlands
| | - H. M. Pinedo
- , Vrije Universiteit Cancer Center, P.O.Box 7057, 1007 Amsterdam, The Netherlands
| | - A. J. M. van den Eertwegh
- Department of Medical Oncology, Vrije Universiteit Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
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35
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Bloemena E. [Pre-chewed...]. Ned Tijdschr Tandheelkd 2004; 111:316. [PMID: 15384926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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36
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Zur Hausen A, van Rees BP, van Beek J, Craanen ME, Bloemena E, Offerhaus GJA, Meijer CJLM, van den Brule AJC. Epstein-Barr virus in gastric carcinomas and gastric stump carcinomas: a late event in gastric carcinogenesis. J Clin Pathol 2004; 57:487-91. [PMID: 15113855 PMCID: PMC1770299 DOI: 10.1136/jcp.2003.014068] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND To determine at what stage during gastric carcinogenesis Epstein-Barr virus (EBV) enters the gastric epithelial cells, the presence of EBV was investigated in two pathogenetically related but distinct forms of adenocarcinoma of the stomach-gastric carcinoma of the intact stomach (GCIS) and gastric stump carcinoma (GSC)-and their presumed precursor lesions. PATIENTS AND METHODS Eleven patients with EBV positive GCIS and eight patients with EBV positive GSC, demonstrated by the highly sensitive EBV encoded RNA 1/2 (EBER1/2) RNA in situ hybridisation (RISH) technique, were studied. Paraffin wax embedded tissue available from preoperative gastric biopsies and tumour adjacent tissue from the resection specimens containing normal gastric mucosa, inflamed gastric mucosa, and preneoplastic lesions (intestinal metaplasia and dysplasia) was investigated by EBER1/2 RISH, in addition to EBV nuclear antigen 1 (EBNA-1) and latent membrane protein 1 (LMP-1) immunohistochemistry (IHC). RESULTS In both GCIS and GSC and their precursor lesions EBER1/2 transcripts were restricted to the carcinoma cells. In addition, positivity of EBNA-1 IHC was also restricted to the tumour cells. IHC for LMP-1 was negative in all cases tested. CONCLUSIONS The absence of EBER1/2 transcripts in preneoplastic gastric lesions (intestinal metaplasia and dysplasia) and their presence in two distinct types of gastric carcinoma strongly suggest that EBV can only infect neoplastic gastric cells and thus is a late event in gastric carcinogenesis.
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Affiliation(s)
- A Zur Hausen
- Department of Pathology, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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37
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Veerman ECI, van den Keijbus PAM, Nazmi K, Vos W, van der Wal JE, Bloemena E, Bolscher JGM, Amerongen AVN. Distinct localization of MUC5B glycoforms in the human salivary glands. Glycobiology 2003; 13:363-6. [PMID: 12626387 DOI: 10.1093/glycob/cwg037] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Salivary mucins, encoded by the MUC5B gene, make up a heterogeneous family of molecules, which are secreted by several glands, including the submandibular, sublingual, and palatine glands. Previous studies have shown that heterogeneity in the salivary mucin population is related to its multiglandular origin. In the present study we address the question to what extent the mucin (MUC5B) population from a single human salivary gland is made up of different glycoforms. Using monoclonal antibodies to defined protein and sulfated carbohydrate epitopes specific to MUC5B, we conduct an immunohistochemical study of different salivary gland types, including submandibular, sublingual, and labial glands. In all tissues studied we found a mosaic expression pattern of sulfo-Lewis a antigen, recognized by mAb F2, which in salivary glands is exclusively present on MUC5B. On the other hand, mucous acini were uniformly labeled by mAb EU-MUC5Bb, evoked against a peptide-stretch of the tandem repeat region of MUC5B. Double staining with both antibodies confirmed the presence of MUC5B-positive/sulfo-Lewis a-positive cells, as well as MUC5B-positive/sulfo-Lewis a-negative cells within one glandular unit. These results indicate that one and the same salivary gland synthesizes different MUC5B glycoforms.
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Affiliation(s)
- E C I Veerman
- Department of Dental Basic Sciences, Section of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (acta), Vrije Universiteit, Van Der Boechorststraat 7, 1081 Bt Amsterdam, The Netherlands.
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38
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Vermeer MH, Dukers DF, ten Berge RL, Bloemena E, Wu L, Vos W, de Vries E, Tensen CP, Meijer CJLM, Willemze R. Differential expression of thymus and activation regulated chemokine and its receptor CCR4 in nodal and cutaneous anaplastic large-cell lymphomas and Hodgkin's disease. Mod Pathol 2002; 15:838-44. [PMID: 12181269 DOI: 10.1097/01.mp.0000021006.53593.b0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent studies demonstrated that Hodgkin/Reed-Sternberg (H/RS) cells in Hodgkin's disease (HD) express thymus and activation-regulated chemokine (TARC), whereas reactive lymphocytes surrounding H/RS cells express its ligand, CC-chemokine receptor 4 (CCR4). Because in vitro studies showed that CCR4 expression is a marker for lymphocytes bearing a T-helper 2 (Th2) phenotype, it was suggested that expression of TARC is a new immune escape mechanism in HD. To find out whether this mechanism might also be operative in CD30+ malignant lymphomas other than HD, TARC and CCR4 expression was investigated by immunohistochemistry on paraffin and frozen-tissue sections of 39 nodal CD30+ anaplastic large cell lymphomas (ALCL), including 27 ALK-negative and 12 ALK-positive ALCL, 25 primary cutaneous CD30+ ALCL, including 11 patients with lymphomatoid papulosis, and 31 cases of HD. TARC was expressed by the neoplastic cells in 12/27 (44%) nodal ALK-negative ALCL and all cases of classic HD, but not in nodal ALK-positive ALCL (0/12) and only rarely in primary cutaneous CD30+ ALCL (3/25). In contrast, CCR4 was expressed by the neoplastic cells in 9/9 cutaneous CD30+ ALCL, and in 9/15 (60%) nodal ALK-negative ALCL, but only in 1/4 (25%) nodal ALK-positive ALCL and not by the H/RS cells in HD (0/8). Apart from three cases of HD showing 10 to 15% CCR4-positive lymphocytes surrounding TARC-positive H/RS cells, CCR4-positive reactive T cells were few (<5%) in all other cases studied. Our results demonstrate a differential expression of TARC and CCR4 in different types of CD30+ malignant lymphomas. The small number of CCR4-positive reactive T cells in most cases studied argues against an important role of TARC expression in the evasion of antitumor responses.
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Affiliation(s)
- M H Vermeer
- Department of Dermatology, Vrije Universiteit Amsterdam, The Netherlands
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39
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Peters GJ, Backus HHJ, Freemantle S, van Triest B, Codacci-Pisanelli G, van der Wilt CL, Smid K, Lunec J, Calvert AH, Marsh S, McLeod HL, Bloemena E, Meijer S, Jansen G, van Groeningen CJ, Pinedo HM. Induction of thymidylate synthase as a 5-fluorouracil resistance mechanism. Biochim Biophys Acta 2002; 1587:194-205. [PMID: 12084461 DOI: 10.1016/s0925-4439(02)00082-0] [Citation(s) in RCA: 273] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thymidylate synthase (TS) is a key enzyme in the de novo synthesis of 2'-deoxythymidine-5'-monophosphate (dTMP) from 2'-deoxyuridine-5'-monophosphate (dUMP), for which 5,10-methylene-tetrahydrofolate (CH(2)-THF) is the methyl donor. TS is an important target for chemotherapy; it is inhibited by folate and nucleotide analogs, such as by 5-fluoro-dUMP (FdUMP), the active metabolite of 5-fluorouracil (5FU). FdUMP forms a relatively stable ternary complex with TS and CH(2)THF, which is further stabilized by leucovorin (LV). 5FU treatment can induce TS expression, which might bypass dTMP depletion. An improved efficacy of 5FU might be achieved by increasing and prolonging TS inhibition, a prevention of dissociation of the ternary complex, and prevention of TS induction. In a panel of 17 colon cancer cells, including several variants with acquired resistance to 5FU, sensitivity was related to TS levels, but exclusion of the resistant variants abolished this relation. For antifolates, polyglutamylation was more important than the intrinsic TS level. Cells with low p53 levels were more sensitive to 5FU and the antifolate raltitrexed (RTX) than cells with high, mutated p53. Free TS protein down-regulates its own translation, but its transcription is regulated by E2F, a cell cycle checkpoint regulator. Together, this results in low TS levels in stationary phase cells. Although cells with a low TS might theoretically be more sensitive to 5FU, the low proliferation rate prevents induction of DNA damage and 5FU toxicity. TS levels were not related to polymorphisms of the TS promoter. Treatment with 5FU or RTX rapidly induced TS levels two- to five-fold. In animal models, 5FU treatment resulted in TS inhibition followed by a two- to three-fold TS induction. Both LV and a high dose of 5FU not only enhanced TS inhibition, but also prevented TS induction and increased the antitumor effect. In patients, TS levels as determined by enzyme activity assays, immunohistochemistry and mRNA expression, were related to a response to 5FU. 5FU treatment initially decreased TS levels, but this was followed by an induction, as seen with an increased ratio of TS protein over TS-mRNA. The clear retrospective relation between TS levels and response now forms the basis for a prospective study, in which TS levels are measured before treatment in order to determine the treatment protocol.
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MESH Headings
- Animals
- Antimetabolites, Antineoplastic/metabolism
- Antimetabolites, Antineoplastic/pharmacology
- Drug Resistance, Neoplasm/physiology
- Enzyme Induction/drug effects
- Fluorouracil/metabolism
- Fluorouracil/pharmacology
- Folic Acid Antagonists/pharmacology
- Humans
- In Vitro Techniques
- Neoplasms/drug therapy
- Neoplasms/enzymology
- Neoplasms/genetics
- Polymorphism, Genetic
- Promoter Regions, Genetic
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- Thymidylate Synthase/antagonists & inhibitors
- Thymidylate Synthase/biosynthesis
- Thymidylate Synthase/genetics
- Tumor Cells, Cultured
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- G J Peters
- Department of Medical Oncology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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40
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Backus HHJ, Van Groeningen CJ, Vos W, Dukers DF, Bloemena E, Wouters D, Pinedo HM, Peters GJ. Differential expression of cell cycle and apoptosis related proteins in colorectal mucosa, primary colon tumours, and liver metastases. J Clin Pathol 2002; 55:206-11. [PMID: 11896073 PMCID: PMC1769617 DOI: 10.1136/jcp.55.3.206] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [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] [Indexed: 11/04/2022]
Abstract
AIMS Tumour cell growth results from a disturbance in the balance between the rate of proliferation and cell death. In this study, proteins involved in the regulation of cell cycle arrest and apoptosis were studied as possible factors responsible for uncontrolled cell growth in colorectal cancer. METHODS The expression of proteins involved in these processes was investigated in 48 metastases from patients with colorectal cancer and compared with eight normal colon mucosa samples and 14 primary tumours. Both primary tumours and metastases were obtained from eight patients. The expression of thymidylate synthase (TS), p53, retinoblastoma protein (Rb), Fas receptor, Fas ligand, bcl-2, mcl-1, bax, and bcl-x was measured using immunohistochemistry. Proliferation was determined by Ki67 staining, whereas apoptosis was assessed by M30 immunostaining, which recognises cleaved cytokeratin 18. RESULTS In the limited number of cases in which paired comparisons were possible, the expression of TS and Ki67 was significantly higher in metastases than in the matched primary tumour samples (p = 0.014 and 0.016, respectively), whereas Rb expression was lower in metastases than in primary tumours (p = 0.024). Fas receptor expression was high in normal mucosa but absent in primary tumours and metastases, whereas the opposite was seen for p53. The expression of bax, mcl-1, and bcl-x in normal mucosa was more apical than that seen in malignant cells, where a more diffuse expression pattern was seen (p < 0.04). Apoptosis was more abundant in primary tumours than in metastases. CONCLUSIONS These results demonstrate that proliferation and apoptosis are disturbed during colorectal cancer progression, and this is accompanied by loss of Rb and Fas expression, the accumulation of p53 and TS, and changes in the expression patterns of bax, mcl-1, and bcl-xl.
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Affiliation(s)
- H H J Backus
- Department of Medical Oncology, VU University Medical Center, PO Box 7057, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands
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41
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van Grieken NC, Meijer GA, Weiss MM, Bloemena E, Lindeman J, Baak JP, Meuwissen SG, Kuipers EJ. Quantitative assessment of gastric corpus atrophy in subjects using omeprazole: a randomized follow-up study. Am J Gastroenterol 2001; 96:2882-6. [PMID: 11693321 DOI: 10.1111/j.1572-0241.2001.04242.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Atrophy of the gastric mucosa most frequently results from chronic Helicobacter pylori infection and is a risk factor for the development of gastric cancer. Profound acid suppression has been suggested to accelerate the onset of gastric mucosal atrophy. The aim of the present study was to evaluate the effects of H. pylori eradication and acid inhibition by omeprazole on gastric atrophy by means of quantitative analysis of tissue morphology. METHODS Corpus biopsy specimens were obtained during endoscopy in 71 gastroesophageal reflux disease (GERD) patients at baseline and after 3 and 12 months. A total of 48 subjects were H. pylori positive and 23 were H. pylori negative. All subjects received omeprazole 40 mg once daily after the first endoscopy for 12 months. After randomization, 27 of the 48 H. pylori-positive patients also received eradication therapy. In hematoxylin and eosin-stained slides the volume percentages of glands (VPGL), volume percentages of stroma (VPS), and volume percentages of infiltrate (VPI) were measured in the glandular zone of the mucosa. The results were evaluated by computerized morphometric analysis. RESULTS In the eradication group, the mean VPGL increased from 63.0% to 67.7% and 71.5% after 3 and 12 months (p < 0.001), respectively. The mean VPS and VPI decreased from 33.1% and 4.0% to 29.3% and 3.0% and to 26.4% and 2.1% (p < 0.001 and p = 0.04), respectively. Patients with the lowest VPGL at baseline showed the largest increases of VPGL after eradication treatment as compared to patients with high a VPGL at baseline. In the H. pylori-persistent group the VPI showed a significant increase (p = 0.01), and in the H. pylori-negative group VPGL increased significantly from 71.9% to 75.2% (p = 0.03) after 12 months. CONCLUSIONS Eradication of H. pylori leads to restitution of the volume percentage of glandular epithelium to normal levels, even during treatment with proton pump inhibitors. Whether this effect can also be seen in patients with marked atrophy needs further investigation.
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Affiliation(s)
- N C van Grieken
- Department of Gastroenterology, Free University Hospital, Amsterdam, The Netherlands
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van Grieken NC, Meijer GA, Weiss MM, Bloemena E, Lindeman J, Baak JP, Meuwissen SG, Kuipers EJ. Quantitative assessment of gastric corpus atrophy in subjects using omeprazole: a randomized follow-up study. Am J Gastroenterol 2001. [PMID: 11693321 DOI: 10.1016/s0002-9270(01)02804-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 01/16/2023]
Abstract
OBJECTIVES Atrophy of the gastric mucosa most frequently results from chronic Helicobacter pylori infection and is a risk factor for the development of gastric cancer. Profound acid suppression has been suggested to accelerate the onset of gastric mucosal atrophy. The aim of the present study was to evaluate the effects of H. pylori eradication and acid inhibition by omeprazole on gastric atrophy by means of quantitative analysis of tissue morphology. METHODS Corpus biopsy specimens were obtained during endoscopy in 71 gastroesophageal reflux disease (GERD) patients at baseline and after 3 and 12 months. A total of 48 subjects were H. pylori positive and 23 were H. pylori negative. All subjects received omeprazole 40 mg once daily after the first endoscopy for 12 months. After randomization, 27 of the 48 H. pylori-positive patients also received eradication therapy. In hematoxylin and eosin-stained slides the volume percentages of glands (VPGL), volume percentages of stroma (VPS), and volume percentages of infiltrate (VPI) were measured in the glandular zone of the mucosa. The results were evaluated by computerized morphometric analysis. RESULTS In the eradication group, the mean VPGL increased from 63.0% to 67.7% and 71.5% after 3 and 12 months (p < 0.001), respectively. The mean VPS and VPI decreased from 33.1% and 4.0% to 29.3% and 3.0% and to 26.4% and 2.1% (p < 0.001 and p = 0.04), respectively. Patients with the lowest VPGL at baseline showed the largest increases of VPGL after eradication treatment as compared to patients with high a VPGL at baseline. In the H. pylori-persistent group the VPI showed a significant increase (p = 0.01), and in the H. pylori-negative group VPGL increased significantly from 71.9% to 75.2% (p = 0.03) after 12 months. CONCLUSIONS Eradication of H. pylori leads to restitution of the volume percentage of glandular epithelium to normal levels, even during treatment with proton pump inhibitors. Whether this effect can also be seen in patients with marked atrophy needs further investigation.
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Affiliation(s)
- N C van Grieken
- Department of Gastroenterology, Free University Hospital, Amsterdam, The Netherlands
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Leen A, Meij P, Redchenko I, Middeldorp J, Bloemena E, Rickinson A, Blake N. Differential immunogenicity of Epstein-Barr virus latent-cycle proteins for human CD4(+) T-helper 1 responses. J Virol 2001; 75:8649-59. [PMID: 11507210 PMCID: PMC115110 DOI: 10.1128/jvi.75.18.8649-8659.2001] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human CD4(+) T-helper 1 cell responses to Epstein-Barr virus (EBV) infection are likely to be important in the maintenance of virus-specific CD8(+) memory and/or as antiviral effectors in their own right. The present work has used overlapping peptides as stimulators of gamma interferon release (i) to identify CD4(+) epitopes within four EBV latent-cycle proteins, i.e., the nuclear antigens EBNA1 and EBNA3C and the latent membrane proteins LMP1 and LMP2, and (ii) to determine the frequency and magnitude of memory responses to these proteins in healthy virus carriers. Responses to EBNA1 and EBNA3C epitopes were detected in the majority of donors, and in the case of EBNA1, their antigen specificity was confirmed by in vitro reactivation and cloning of CD4(+) T cells using protein-loaded dendritic cell stimulators. By contrast, responses to LMP1 and LMP2 epitopes were seen much less frequently. EBV latent-cycle proteins therefore display a marked hierarchy of immunodominance for CD4(+) T-helper 1 cells (EBNA1, EBNA3C >> LMP1, LMP2) which is different from that identified for the same proteins with respect to CD8(+)-T-cell responses (EBNA3C > EBNA1 > LMP2 >> LMP1). Furthermore, the range of CD4(+) memory T-cell frequencies in peripheral blood of healthy virus carriers was noticeably lower and narrower than the corresponding range of latent antigen-specific CD8(+)-T-cell frequencies.
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Affiliation(s)
- A Leen
- CRC Institute for Cancer Studies and MRC Centre for Immune Regulation, Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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zur Hausen A, van Grieken NC, Meijer GA, Hermsen MA, Bloemena E, Meuwissen SG, Baak JP, Meijer CJ, Kuipers EJ, van den Brule AJ. Distinct chromosomal aberrations in Epstein-Barr virus-carrying gastric carcinomas tested by comparative genomic hybridization. Gastroenterology 2001; 121:612-8. [PMID: 11522745 DOI: 10.1053/gast.2001.27200] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Approximately 10% of gastric adenocarcinomas carry the human pathogenic Epstein-Barr virus (EBV). The role of EBV in the pathogenesis of these carcinomas remains to be established. METHODS To obtain a comprehensive overview of chromosomal aberrations in EBV-carrying and EBV-negative gastric carcinomas we performed comparative genomic hybridization (CGH) on 44 gastric carcinomas, 10 EBV-positive, and 34 EBV-negative. Additionally, DNA flow cytometry was done. RESULTS Loss of chromosome 4p (P < 0.001) and of 11p (P < 0.02) was exclusively restricted to EBV-carrying gastric carcinomas. In addition, loss of 18q (P < 0.02) was significantly more frequent in EBV-carrying gastric carcinomas. The latter involves loci, which have already been linked to gastric carcinogenesis such as the DCC and SMAD4 gene. In contrast, the losses on chromosome 4 and 11 do not yet harbor a gene related to gastric carcinogenesis. No significant correlation was found between DNA-ploidy and the EBV-status. A number of chromosomal aberrations were found at comparable frequencies in both groups, i.e., losses of chromosome 17, 12q, and loss of 1p. Interestingly, gains of 13q (10/34) and 3q (5/34) and loss of 1q (5/34) were solely observed in EBV-negative gastric carcinomas. CONCLUSIONS These data indicate that EBV-carrying and EBV-negative gastric carcinomas have different pathogenetic pathways in which EBV might play a crucial role.
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Affiliation(s)
- A zur Hausen
- Department of Pathology, Section Molecular Pathology, University Hospital Vrije Universiteit, Amsterdam, the Netherlands
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Heideman DA, Snijders PJ, Bloemena E, Meijer CJ, Offerhaus GJ, Meuwissen SG, Gerritsen WR, Craanen ME. Absence of tpr-met and expression of c-met in human gastric mucosa and carcinoma. J Pathol 2001; 194:428-35. [PMID: 11523050 DOI: 10.1002/path.934] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The c-met proto-oncogene, encoding the hepatocyte growth factor receptor, can be activated by various mechanisms. These include, among others, gene amplification with concomitant overexpression and the tpr-met oncogenic rearrangement. In the case of gastric cancer, contradictory results on the presence of the tpr-met oncogenic rearrangement have been published. The current study aimed therefore to assess the prevalence of tpr-met expression in Caucasian gastric adenocarcinomas, to evaluate the importance of this oncogene in their carcinogenesis. In addition, the level of c-met expression was determined, to evaluate the role of this alternative mode of activation of the proto-oncogene. A series of Caucasian gastric adenocarcinomas (n=43) and normal gastric mucosal samples (n=14) was analysed for tpr-met and c-met expression. Expression of tpr-met mRNA in the samples was performed by two reverse transcriptase polymerase chain reaction (RT-PCR) assays, with excellent correlation. The specificity of both methods was confirmed by direct sequencing of the PCR products of the MNNG-HOS cell line, which is known to contain the rearrangement. The level of c-met expression was assessed using semi-quantitative RT-PCR assays and immunohistochemistry (IHC). None of the normal gastric mucosal or gastric adenocarcinoma samples expressed tpr-met mRNA, as determined by both RT-PCR assays. Seventy per cent of the adenocarcinomas showed overexpression of c-met, according to elevated c-met mRNA levels, compared with the expression level of normal gastric mucosa. A significant correlation was found between the level of c-met mRNA and protein expression. In conclusion, these results strongly suggest that tpr-met activation does not play a role in Caucasian gastric carcinogenesis, while overexpression of the c-met gene occurs in the majority of Caucasian gastric adenocarcinomas.
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Affiliation(s)
- D A Heideman
- Department of Gastroenterology, University Hospital Vrije Universiteit, 1081 HV Amsterdam, The Netherlands.
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Backus HH, van Riel JM, van Groeningen CJ, Vos W, Dukers DF, Bloemena E, Wouters D, Pinedo HM, Peters GJ. Rb, mcl-1 and p53 expression correlate with clinical outcome in patients with liver metastases from colorectal cancer. Ann Oncol 2001; 12:779-85. [PMID: 11484952 DOI: 10.1023/a:1011112227044] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Thymidylate synthase (TS) has been associated with clinical outcome in disseminated colorectal cancer. However, many patients with low TS expression still fail to respond to treatment. Therefore, we studied the cell cycle proteins, Rb, E2F2, Ki67, p21 and p53 and the apoptotic proteins, mcl-1, hax, bcl-xl, bcl-2, Fas receptor, Fas ligand, caspase-3, M30 and PARP as potential predictive factors. PATIENTS AND METHODS In biopsy specimens of liver metastases from 31 colorectal cancer patients, protein expression was retrospectively determined by immunohistochemistry and related to response to hepatic arterial or intravenous (i.v.) 5-fluorouracil (5-FU) treatment, time to tumour progression (TTP) and overall survival. RESULTS Expression of both p53 and Rb correlated with survival benefit after 5-FU treatment. A median survival time of 79 weeks was found in patients with high levels of p53 or Rb compared to 36 and 44 weeks for patients expressing low levels of p53 (P = 0.027) or Rb (P = 0.030), respectively. Multivariate analysis showed that p53 was the best predictor of survival independent of sex, age or prior treatment. Following 5-FU hepatic arterial infusion, patients with a high TS expression had a shorter survival time than those with a low expression (P = 0.025). The anti-apoptotic protein mcl-1 was the only factor, which correlated with response to 5-FU treatment. Thirty-five percent of patients with a diffuse mcl-1 expression responded whereas ninety percent of patients with a peri-nuclear expression responded (P = 0.041). CONCLUSIONS These results indicate that besides TS, also Rb, p53 and mcl-1 are correlated with clinical outcome in patients with liver metastases from colorectal cancer.
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Affiliation(s)
- H H Backus
- Department of Medical Oncology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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47
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Heideman DA, Snijders PJ, Craanen ME, Bloemena E, Meijer CJ, Meuwissen SG, van Beusechem VW, Pinedo HM, Curiel DT, Haisma HJ, Gerritsen WR. Selective gene delivery toward gastric and esophageal adenocarcinoma cells via EpCAM-targeted adenoviral vectors. Cancer Gene Ther 2001; 8:342-51. [PMID: 11477454 DOI: 10.1038/sj.cgt.7700313] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2001] [Indexed: 11/08/2022]
Abstract
Application of recombinant adenoviral vectors for cancer gene therapy is currently limited due to lack of specificity for tumor cells. For gastric and esophageal adenocarcinoma, we present here that the relative abundant expression of the primary adenovirus receptor, coxsackie/adenovirus receptor (CAR), on normal epithelium compared to carcinoma favors the transduction of the epithelium. As such, to achieve specific transduction of cancer cells, targeting approaches are required that ablate the binding of the virus to CAR and redirect the virus to tumor-specific receptors. By immunohistochemistry and reverse transcriptase polymerase chain reaction assays, we demonstrate a marked difference in expression of the human epithelial cell adhesion molecule (EpCAM) between normal and (pre)malignant lesions of the stomach and esophagus. Based on this, we explored the feasibility of using EpCAM to achieve gastric and esophageal adenocarcinoma selective gene transfer. Adenoviral vectors redirected to EpCAM using bispecific antibodies against the adenovirus fiber-knob protein and EpCAM specifically infected gastric and esophageal cancer cell lines. Using primary human cells, an improved ratio of tumor transduction over normal epithelium transduction was accomplished by the EpCAM-targeted vectors. This study thus indicates that EpCAM-targeted adenoviral vectors may be useful for gastric and esophageal cancer-specific gene therapy in patients.
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Affiliation(s)
- D A Heideman
- Department of Gastroenterology, University Hospital Vrije Universiteit, Amsterdam.
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Meij P, Bloemena E, Palmen N, Brink A, Vervoort MB, Meijer CJ, Middeldorp JM. Functional CD4(+) and CD8(+) T-cell responses induced by autologous mitomycin C treated Epstein-Barr virus transformed lymphoblastoid cell lines. Cell Immunol 2001; 208:25-33. [PMID: 11277616 DOI: 10.1006/cimm.2001.1760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Epstein-Barr virus (EBV) gene expression in tumor cells of posttransplant lymphoproliferative disorder (PTLD) patients resembles that of EBV transformed B-cell lines (LCL). EBV-specific cytotoxic T-lymphocytes can be generated by stimulating peripheral blood lymphocytes with autologous LCL. We describe a standardized method for the growth inactivation and cryopreservation of LCL for optimal T-cell stimulation and analyzed the function and phenotype of responding T-cells. LCL growth was completely blocked by mitomycin C treatment (McLCL) and McLCL could be cryopreserved while retaining excellent APC function. McLCL stimulated both CD4(+) and CD8(+) T-cells as measured by HLA-DR and CD25 expression using FACS analysis. EBV-specific CTL activity and T-cell proliferation were induced and immunocytochemical staining showed CD4(+) and (granzyme B positive) CD8(+) T-cells rosetting with McLCL. Granzymes A and B, IFN-gamma, and IL-6 were detected at significant levels in the supernatant. Thus, ex vivo T-cell activation with cryopreserved McLCL results in activation of both CD4(+) and CD8(+) T-cells producing a Th1-like cytokine profile, making this a suitable protocol for adoptive therapy of PTLD.
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MESH Headings
- Adoptive Transfer/methods
- Antigen Presentation/drug effects
- Antigen Presentation/immunology
- CD4-Positive T-Lymphocytes/cytology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/cytology
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Cell Division/drug effects
- Cell Line, Transformed
- Cryopreservation/methods
- Cytotoxicity, Immunologic/drug effects
- Cytotoxicity, Immunologic/immunology
- Enzyme-Linked Immunosorbent Assay
- Flow Cytometry
- Granzymes
- Herpesvirus 4, Human/immunology
- Herpesvirus 4, Human/physiology
- Humans
- Interferon-gamma/immunology
- Interferon-gamma/metabolism
- Interleukin-6/metabolism
- Lymphocyte Activation/drug effects
- Mitomycin/pharmacology
- Phenotype
- Rosette Formation
- Serine Endopeptidases/metabolism
- T-Lymphocytes, Cytotoxic/cytology
- T-Lymphocytes, Cytotoxic/drug effects
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/metabolism
- Tumor Cells, Cultured
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Affiliation(s)
- P Meij
- Department of Pathology, University Hospital Vrije Universiteit, 1007 MB Amsterdam, The Netherlands
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49
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Backus HH, Dukers DF, van Groeningen CJ, Vos W, Bloemena E, Wouters D, van Riel JM, Smid K, Giaccone G, Pinedo HM, Peters GJ. 5-Fluorouracil induced Fas upregulation associated with apoptosis in liver metastases of colorectal cancer patients. Ann Oncol 2001; 12:209-16. [PMID: 11300326 DOI: 10.1023/a:1008331525368] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In vitro, thymidylate synthase (TS) inhibition by 5-fluorouracil (5-FU) induces thymineless apoptosis possibly via Fas receptor Fas ligand interactions and cell-cycle arrest. In colorectal cancer patients we evaluated whether 5-FU administration also resulted in apoptosis and cell-cycle arrest and which proteins might be involved. PATIENTS AND METHODS Biopsy specimens were taken from 36 patients 2, 22 or 46 hours after administration of 500 mg/m2 5-FU, and from 12 control patients who did not receive 5-FU. In frozen tissue-sections from liver metastases immunohistochemistry was performed with antibodies directed against p53, p21, E2F2, Rb, Ki67 and TS (cell-cycle related) and bax, BCL-2, BCL-x, mcl-1, PARP, caspase-3, Fas receptor and Fas ligand (apoptosis related). Apoptosis was determined by M30 immunostaining, which recognises a cleavage product of cytokeratin 18. RESULTS Fas receptor expression was 50% higher (P = 0.036) 46 hours after 5-FU administration compared to the control group. This was associated with a 12% increase (P < 0.02) in M30 positive tumour cells and with elevation of caspase-3 and PARP expression. The expression of Ki67 and E2F2 was 30% lower after 46 hours compared to the control group, whereas TS was 56% lower after 2 hours and 32% higher again after 46 hours. No differences in the expression of the other proteins were found. CONCLUSIONS These results suggest that 5-FU decreases proliferation status and induces apoptosis possibly via the Fas pathway. Since Fas mediated cell killing is important for cytotoxic T cells this indicates that clinical studies combining immunotherapy for activation of T cells and chemotherapy using 5-FU might be very effective.
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Affiliation(s)
- H H Backus
- Department of Medical Oncology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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van Grieken NC, Weiss MM, Meijer GA, Bloemena E, Lindeman J, Offerhaus GJ, Meuwissen SG, Baak JP, Kuipers EJ. Rapid quantitative assessment of gastric corpus atrophy in tissue sections. J Clin Pathol 2001; 54:63-9. [PMID: 11271791 PMCID: PMC1731262 DOI: 10.1136/jcp.54.1.63] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND/AIMS Grading of Helicobacter pylori induced atrophic gastritis using the updated Sydney system is severely limited by high interobserver variability. The aim of this study was to set up a quantitative test of gastric corpus mucosal atrophy in tissue sections and test its reproducibility and correlation with the Sydney scores of atrophy. METHOD Mucosal atrophy was assessed in 124 haematoxylin and eosin stained corpus biopsy specimens by two experienced gastrointestinal pathologists (EB, JL) according to the updated Sydney system as none (n = 33), mild (n = 33), moderate (n = 33), or pronounced (n = 25). In each specimen, the proportions of glands, stroma, infiltrate, and intestinal metaplasia in the glandular zone were measured as volume percentages using a point counting method. The optimal point sample size, intra-observer and interobserver reproducibility, discriminative power for degrees of atrophy, and correlations with H pylori status were evaluated. RESULTS Counting 400 points in 200 fields of vision provided the smallest sample size that still had excellent intra-observer and interobserver reproducibility (r > or = 0.96). Overall, the volume percentage of glands (VPGL), infiltrate (VPI), and stroma (VPS) correlated well with the Sydney scores for atrophy (p < or = 0.003). However, no differences were found between non-atrophic mucosa and mild atrophy. No correlation was found between age and either the Sydney grade of atrophy or the VPGL or VPS. In non-atrophic mucosa and mild atrophy, H pylori positive cases showed a significantly higher VPI than did H pylori negative cases. A lower VPGL was seen in H pylori positive cases than in H pylori negative cases in the mild atrophy group. VPS did not correlate with H pylori status within each grade of atrophy. CONCLUSION Point counting is a powerful and reproducible tool for the quantitative analysis of mucosal corpus atrophy in tissue sections. These data favour the combination of "none" and "mild" atrophy into one category, resulting in a three class grading system for corpus atrophy, when using the updated Sydney system.
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Affiliation(s)
- N C van Grieken
- Department of Gastroenterology, Free University Hospital, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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