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El Alam MB, Sammouri J, Lin D, Lynn EJ, Harris T, Lo DK, Wang R, Karpinets T, Ajami NJ, Wong M, Grover S, Kantelhardt EJ, Firdawoke E, Abebe T, Teka B, Romaguera J, Godoy-Vitorino F, Dorta-Estremera S, Klopp AH, Colbert L. Association of Bacterial Composition and Diversity in the Cervical Tumor Microbiome with HPV Genotype in a Large, International Patient Cohort. Int J Radiat Oncol Biol Phys 2023; 117:S130. [PMID: 37784335 DOI: 10.1016/j.ijrobp.2023.06.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Tumor bacterial composition is strongly associated with response to cancer therapy, and is impacted by environment, including geography. Human papillomavirus (HPV) genotypic diversity composition and load are dynamic during pelvic radiation (RT) and correlate with differential responses to RT in cervical cancer patients. In this multi-institutional, collaborative study, we aimed to explore associations between bacterial composition, HPV serotypes, and geographical distribution in an international patient population. MATERIALS/METHODS Cervical swabs were collected from 287 patients diagnosed with cervical cancer/ dysplasia in four locations: Houston, USA (TX; N = 94), Ethiopia (ETH; N = 85), Puerto Rico (PR; N = 71), and Botswana (BOT; N = 37). Swabs were collected prior to treatment and were subjected to 16S V4 rRNA gene sequencing and HPV genotyping. We compared HPV types and geography via Chi-squared test. We analyzed bacterial composition, alpha diversity (ANOVA), and beta diversity (principal coordinates analysis [PCoA] with PERMANOVA) for HPV type and geography. We used Linear Discriminant Effect Size (LEfSe) analysis to distinguish taxa associated with HPV types. RESULTS Overall, the global bacterial composition for patients with cancer or dysplasia did not significantly vary by location. However, the proportion of patients with each HPV type varied by location (p<0.01); HPV16 was most frequent in TX (54%), BOT (70%) and ETH (61%), while HPV18 was most frequent in PR (62%). The proportion of patients with HPV low-risk/negative tumors was highest in ETH (25%) compared to other sites (2% - 14%). Patients with HPV 16 had significantly higher bacterial alpha diversity across locations (all p<0.01). The bacterial composition also differed by HPV type across locations (p = 0.01). On LEfSe, bacterial genera enriched in HPV 16 samples were Bacteroides, Clostridium, and Prevotella. Non-HPV16 tumors were enriched in species of Lactobacillus and Gardnerella and HPV 18 and high-risk type tumors were enriched in Escherichia. CONCLUSION In thislarge, international cohort of cervical cancer and dysplasia patients, bacterial composition was more closely associated with cervical HPV genotype than with geography. This finding has implications for the development of biomarkers and interventions aimed at improving chemotherapy and radiation response through manipulation of the microbiome.
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Affiliation(s)
- M B El Alam
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Sammouri
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E J Lynn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T Harris
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D K Lo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T Karpinets
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N J Ajami
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M Wong
- The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - S Grover
- Princess Marina Hospital, Gaborone, Botswana
| | | | - E Firdawoke
- Addis Ababa University, Addis Ababa, Ethiopia
| | - T Abebe
- Addis Ababa University, Addis Ababa, Ethiopia
| | - B Teka
- Addis Ababa University, Addis Ababa, Ethiopia
| | - J Romaguera
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - F Godoy-Vitorino
- University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - S Dorta-Estremera
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - A H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L Colbert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Gayatri D, Efremov L, Wienke A, Mikolajczyk R, Kantelhardt EJ. Quality of life assessment in breast cancer patients during palliative treatment in Indonesia. Eur J Public Health 2022. [PMCID: PMC9593967 DOI: 10.1093/eurpub/ckac131.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to prospectively assess quality of life (QOL), QOL domains, and pain severity in advanced stage breast cancer patients during palliative oncology treatment in Indonesia. Methods Advanced stage breast cancer patients > 18 years (n = 160) who began palliative oncology treatment were enrolled in the study using convenience sampling. They completed the EORTC QLQ-C15-PAL questionnaire and pain severity (Visual Analogue Scale, VAS) score at three-time points (baseline (T0), three-(T1) and six-months (T2) follow-up). The repeated measures analysis of variance (ANOVA) model was used to assess the QOL, QOL domains, and pain severity changes over time adjusted for age, place of residence, marital status, and Karnofsky Performance Status score at baseline. We classified the change over time in three qualitative groups (deterioration, improvement, or trivial/no difference). We considered it clinically relevant if patients had a 10-point difference. Results The mean age of included patients (n = 159) was 50 years. Most lived in an urban area (72.3%), had low education (71.7%), and were married (81.8%). The repeated measures ANOVA showed that the QOL score, emotional functioning, fatigue, dyspnea, appetite loss, constipation, and VAS pain score remained stable over the 6-months period. In contrast: physical functioning declined (medium to large deterioration (-19.8 (95% CI -27.2 to -12.5)) between T0 to T2), however there was an improvement in the insomnia domain (medium improvement (-13.4 (95% CI -19.9 to -6.9)) between T0 to T2). Conclusions Our findings indicated that advanced stage breast cancer patients adapted well to palliative oncology treatment over six months of observation. There was deterioration in physical functioning, but improvement in insomnia. However, more attention is needed from clinicians to achieve improvement in the overall QOL score and specific QOL domains. Key messages • Focusing on improvement overall QOL score and specific QOL domains will lead to better advanced stage breast cancer patients’ satisfaction and care. • Information is limited on palliative treatment satisfaction in low and lower middle-income countries, therefore this study has important impact on further policy considerations in Indonesia.
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Affiliation(s)
- D Gayatri
- Institute for Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle, Germany
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia , Depok, Indonesia
| | - L Efremov
- Institute for Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle, Germany
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg , Halle, Germany
| | - A Wienke
- Institute for Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle, Germany
| | - R Mikolajczyk
- Institute for Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle, Germany
| | - EJ Kantelhardt
- Institute for Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle, Germany
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg , Halle, Germany
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Krippl N, Mezger NCS, Fischer H, Schildmann J, Mikolajczyk R, Danquah I, Kantelhardt EJ, Herrmann A. Climate-sensitive health counselling: a quantitative survey on addressing climate change. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Climate change and its mitigation have significant health implications. Hence, medical associations call on physicians to inform the population about health risks of climate change and possible health co-benefits of climate action. However, so far it is unclear what preferences the general public has about climate-sensitive health counselling (CSHC). Therefore, we developed a survey tool to a) characterize experiences of CSHC, b) identify preferences about communication methods and themes, and c) determine associations of socioeconomic characteristics and climate change attitudes with CSHC preferences.
Methods
The tool development for this cross-sectional online-based survey was embedded in a bigger research project on the conceptualization of CSHC, which follows an exploratory mixed-methods design. Results of preceding qualitative interviews about CSHC were integrated into the tool development. After two pilot tests, the tool was administered from April to June 2022 through the population-based HeReCa panel (Health Related Beliefs and Health Care Experiences in Germany), comprising 3200 participants from 5 federal states. Sociodemographic data is available for all participants.
Results
The final tool entails 46 items, sorted into 7 sections. Two sections serve as dependent variables for the association analysis: 13 items about the acceptability of different communicative approaches of CSHC and 18 items on preferences for themes in CSHC. Three sections serve as independent variables for the analysis: attitudes on climate change, level of engagement, and sociodemographic data. Two sections assess experiences with CSHC and preferred information channels to serve as descriptive results.
Conclusions
A rigorous methodology proved helpful for survey development within a mixed methods study. In triangulation with qualitative data, results of the survey will help physicians to deliver CSHC tailored to the preferences of different sociodemographic groups.
Key messages
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Affiliation(s)
- N Krippl
- Institute for Global Health, University of Heidelberg , Heidelberg, Germany
| | - NCS Mezger
- IMEBI, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - H Fischer
- Perception and Action lab, Leibniz-Institut für Wissensmedien , Tübingen, Germany
| | - J Schildmann
- Institute for History and Ethics of Medicine, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - R Mikolajczyk
- IMEBI, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - I Danquah
- Institute for Global Health, University of Heidelberg , Heidelberg, Germany
| | - EJ Kantelhardt
- IMEBI, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - A Herrmann
- Institute for Global Health, University of Heidelberg , Heidelberg, Germany
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Bauer M, Fathke C, Stückrath K, Voigtländer S, Vetter M, Wickenhauser C, Kantelhardt E. Untersuchung tumorinfiltrierender Lymphozyten des Tumorstromas (sTILs) in triple negativen Mammakarzinomen (TNBC) aus Subsahara-Afrika (SAA). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Bauer
- Institut für Pathologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
| | - C Fathke
- Institut für Pathologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
| | - K Stückrath
- Universitätsklinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
| | - S Voigtländer
- Institut für Pathologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
| | - M Vetter
- Universitätsklinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
| | - C Wickenhauser
- Institut für Pathologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
| | - E Kantelhardt
- Universitätsklinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
- Institut für Epidemiologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg
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Griesel M, Parkin DM, Thomssen C, Kantelhardt EJ. Cervical Cancer in Sub-Saharan Africa – a multinational population-based study on treatment guideline adherence. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Griesel
- Universitätsklinik und Poliklinik für Gynäkologie und Institut für Med. Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - DM Parkin
- Universitätsklinik und Poliklinik für Gynäkologie und Institut für Med. Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - C Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie und Institut für Med. Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - EJ Kantelhardt
- Universitätsklinik und Poliklinik für Gynäkologie und Institut für Med. Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
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Woldesonbet Z, Nigussie M, Zeleke T, Bekuretsion Y, Assefa M, Anberbir E, Vetter M, Bukhor J, Barbara S, Kantelhardt E. NanoString nCounter based gene expression assay for the evaluation of breast cancer molecular subtypes in Ethiopian patients. Breast 2019. [DOI: 10.1016/s0960-9776(19)30127-4] [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: 11/16/2022] Open
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Wimberger P, Bachmann HS, Kuhlmann JD, Link T, Kröber E, Thomssen C, Malle B, Vetter M, Kantelhardt EJ. Abstract P6-09-03: Association of Caspase 8 polymorphisms with TILs and disease-free survival in primary breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-09-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: The minor allele of two caspase-8 polymorphisms, namely CASP8 -652 6N InsDel and CASP8 Asp302His, were shown to promote survival of T-lymphocytes and were repeatedly associated with reduced breast cancer susceptibility. However, besides some preliminary findings, clinical relevance of these polymorphisms in patients with already existing primary breast cancer has not yet been established. Considering an immunomodulatory and potentially tumor-protective role of these caspase-8 variants, we genotyped 785 primary breast cancer patients and correlated caspase-8 variants with i) disease-free survival (DFS) and ii) the presence of tumor infiltrating lymphocytes (TILs).
METHODS: Primary breast cancer samples were collected at the Martin-Luther University, Halle-Wittenberg between 2009 and 2011 as part of the multicenter prospective PiA trial (NCT 01592825). The majority of patients had luminal-like tumors (75.9%), followed by triple negative (10.1%), luminal-Her2-like (9.6%) and Her2-enriched tumors (4.5%). Genotyping was performed by pyrosequencing, TILs status was assessed by hematoxylin and eosin staining.
RESULTS: The CASP8 -652 deletion was significantly associated with improved DFS in an allele-dose dependent manner (p=0.027). Homozygosity for the -652 6N Del variant was an independent predictor for improved DFS (p=0.005). In patients with a 302His/His genotype, there was no event of recurrence during the entire observation time. Combined analysis of diplotypes revealed that both polymorphisms had an influence on DFS (p=0.029). Interestingly, patients with the 302His/His variant among the unstratified patient cohort and among the luminal-like subtype alone had tumors with very low lymphocyte infiltration (0-10% TILs in 65% of cases compared to 31% of cases for other genotypes, p=0.025).
CONCLUSION: In line with previous epidemiological findings, we propose a prognostically favorable role of the CASP8 -652 6N Del and the Asp302His variant in primary breast cancer patients. Moreover, we suggest for the first time a role of the Asp302His variant in immunosurveillance and lymphocyte infiltration of breast cancer. Our findings strongly encourage further analyze of these genetic variants as a biomarker for prognostic and immunotherapeutic considerations.
Citation Format: Wimberger P, Bachmann HS, Kuhlmann JD, Link T, Kröber E, Thomssen C, Malle B, Vetter M, Kantelhardt EJ. Association of Caspase 8 polymorphisms with TILs and disease-free survival in primary breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-09-03.
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Affiliation(s)
- P Wimberger
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - HS Bachmann
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - JD Kuhlmann
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - T Link
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - E Kröber
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - C Thomssen
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - B Malle
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - M Vetter
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - EJ Kantelhardt
- Technische Universität Dresden, Dresden, Germany; Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Witten, Germany; Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Griesel M, Feuchtner J, Seraphin T, Hämmerl L, Mezger N, Korir A, Wabinga H, Thomssen C, Wienke A, Parkin DM, Kantelhardt EJ. Cervical cancer in Sub-Saharan Africa: a multinational population-based study on patterns of care. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Griesel
- Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - J Feuchtner
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - T Seraphin
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - L Hämmerl
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - N Mezger
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - A Korir
- Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenia
| | - H Wabinga
- Department of Pathology, Makerere University, Kampala, Uganda
- Kampala Cancer Registry, Makerere University, Kampala, Uganda
| | - C Thomssen
- Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - A Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - DM Parkin
- African Cancer Registry Network, Oxford, Vereinigtes Königreich
- Clinical Trials Service Unit & Epidemiological Studies Unit, University of Oxford, Oxford, Vereinigtes Königreich
| | - EJ Kantelhardt
- Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Weiner CM, Thomssen C, Seidler A, Kantelhardt EJ. Merkmale und Follow-up von Patienten mit metastasiertem Mammakarzinom in Äthiopien: eine Kohortenstudie von 573 Frauen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- CM Weiner
- Abteilung für Gynäkologie und Geburtshilfe, Krankenhaus St. Joseph- Stift, Dresden
| | - C Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - A Seidler
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät Carl Gustav Carus, Dresden
| | - EJ Kantelhardt
- Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
- Institut für Medizinische Epidemiologie, Biostatistik und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
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Woldemariam A, Gwyther L, Deyessa N, Kantelhardt E, Macchia G, Cammelli S, Morganti A. EP-1650: Prevalence and Management of Pain In Tikur Anbessa Hospital Radiotherapy Center. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31959-5] [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: 10/14/2022]
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Griguolo G, Jacot W, Kantelhardt E, Dieci M, Bourgier C, Thomssen C, Bailleux C, Miglietta F, Braccini A, Conte P, Ferrero JM, Guarneri V, Darlix A. External validation of modified breast graded prognostic assessment for breast cancer patients with brain metastases. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.036] [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: 11/15/2022] Open
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Griesel M, Hämmerl L, Dzamatira D, Korir A, Thomssen C, Maxwell Parkin D, Kantelhardt EJ. Therapie und Überleben von Patientinnen mit Zervixkarzinom aus afrikanischen Krebsregistern. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- M Griesel
- Institut für Med. Epidemiologie, Biometrie u. Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - L Hämmerl
- Institut für Med. Epidemiologie, Biometrie u. Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - D Dzamatira
- Radiotherapy Centre, Mpilo Teaching Hospital Bulawayo (Simbabwe)
| | - A Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute (Kenia)
| | - C Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie, Halle (Saale)
| | | | - EJ Kantelhardt
- Institut für Med. Epidemiologie, Biometrie u. Informatik, Martin-Luther-Universität Halle-Wittenberg
- Universitätsklinik und Poliklinik für Gynäkologie, Halle (Saale)
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Harung C, Stückrath K, Porsch M, Kantelhardt E, Thomssen C, Vetter M. Molekularbiologische Subtypisierung von tripel-negativen Mammakarzinomen (in progress). Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- C Harung
- Universitätsklinik für Gynäkologie, Halle (Saale)
| | - K Stückrath
- Universitätsklinik für Gynäkologie, Halle (Saale)
| | - M Porsch
- Institut für Informatik, Martin-Luther-Universität, Halle (Saale)
| | | | - C Thomssen
- Universitätsklinik für Gynäkologie, Halle (Saale)
| | - M Vetter
- Universitätsklinik für Gynäkologie, Halle (Saale)
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Vetter M, Hartung C, Hanf V, Lantzsch T, Uleer C, Peschel S, John J, Buchmann J, Bürrig KF, Weigert E, Thomssen C, Kantelhardt EJ. Abstract P2-05-12: The ASCO-recommended prognostic factors uPA/PAI-1 in a multicenter cohort study (PiA). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
The PiA-study (Prognostic assessment in routine Application, NCT 01592825) was designed as a representative cohort of breast cancer patients to estimate the proportions of traditional and modern prognostic factors. The ASCO-recommended biomarkers uPA (urokinase-type plasminogen activator) and its inhibitor PAI-1 were used for biological risk assessment particularly for intermediate risk breast cancer patients and disease-free survival of the patients after 5 yrs of follow-up (F/U) was calculated.
Material & Methods
Between 2009 and 2011, 1,074 non-metastasized, primarily operated breast cancer patients from six centers in Germany were included. From 815 patients, fresh frozen tissue was obtained and processed for central testing uPA/PAI-1 by ELISA (FEMTELLE®, Sekisui Diagnostics GmbH). Low uPA/PAI-1 status is defined by uPA and PAI-1 concentrations below the published cut-offs, high status means one or both were higher than the corresponding cut-offs. Tumor characteristics were based on local pathology. The centers had to follow the national guidelines. In low-risk patients, adjuvant chemotherapy was spared. The median F/U is 56 months (range 0-78).
Results
In the total cohort of 1,074 patients, 166 had G1- and 237 had G3-tumors. Of the 671 patients with a G2-tumor, the following were allocated to the high-risk group: node-positive (n=371), younger than 35 yrs (n=17), and triple-negative (TN) or HER2-positive (n=118). For 253 tumors of the remaining 355 patients with an intermediate risk of recurrence (pN0, G2, HR positive, HER2-negative, ≥35 yrs), uPA/PAI-1 status was available. 126 (49.8%) were allocated to the low-risk group, one patient had a recurrence. At 5 yrs, in the total cohort 90.6% (95% CI, 89.5-91.7) of the patients were free of invasive disease. Of 114 HER2-positive tumors, 94 (82.4 %) had a high uPA/PAI-1 status, only one of the 38 HR negative/HER2 positive tumors had a low uPA/PAI-1 status. In the TN group, the majority of tumors had a high uPA/PAI-1 status (66 of 81; 81.5 %). In 30 patients lymph nodes were involved, 18.5% (n=15) had a low uPA/PAI-1 status, one event was detected. In N pos. patients with an high uPA/PAI-1 6 events were observed.
Conclusion
Testing for uPA/PAI-1 in the daily routine is feasible, fresh frozen tissue has been prepared from 76% of the tumors of the recruited patients, 37% of them had a low risk status. Using uPA/PAI-1, about half of the node-negative patients with an intermediate risk of recurrence were allocated to a group with an extremely low risk of recurrence and thus chemotherapy could be spared. Also in node-positive disease, uPA/PAI-1 has a prognostic impact.
Tab 1: Proportion of the subgroups according to IHC, grading and uPA/PAI-1-statusTumor typetotallow uPA/PAI-1 statushigh uPA/PAI-1 statusn=815 (100%)n=304 (37%)n=511 (63%)Luminal A-like tumors:HRpos., HER2neg., G1, G2515 (63.2%)240 (78.9%)275 (53.9%)Luminal B/HER2-negative-like tumors:HRpos., HER2neg., G3104 (12.8%)29 (9.5%)75 (14.7%)Luminal B/HER2-positive-like tumors:HR pos., HER2 pos., all grades77 (9.4%)19 (6.2%)58 (11.4%)HER2-positive (nonluminal) - like tumors:HRneg., HER2pos., all grades38 (4.7%)1 (0.3%)37 (7.3%)TN tumors:HRneg., HER2neg., all grades81 (9.9%)15 (4.9%)66 (12.9%)
Citation Format: Vetter M, Hartung C, Hanf V, Lantzsch T, Uleer C, Peschel S, John J, Buchmann J, Bürrig K-F, Weigert E, Thomssen C, Kantelhardt EJ. The ASCO-recommended prognostic factors uPA/PAI-1 in a multicenter cohort study (PiA) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-12.
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Affiliation(s)
- M Vetter
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - C Hartung
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - V Hanf
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - T Lantzsch
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - C Uleer
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - S Peschel
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - J John
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - J Buchmann
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - K-F Bürrig
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - E Weigert
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - C Thomssen
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
| | - EJ Kantelhardt
- Martin-Luther-University, Halle (Saale), Germany; Klinikum Fürth, Fürth, Germany; St. Elisabeth St. Barbara, Halle (Saale), Germany; Praxis Uleer, Hildesheim, Germany; Klinikum St. Bernward, Hildesheim, Germany; Klinikum Hildesheim, Hildesheim, Germany; Institut of Pathology, Krankenhaus Martha-Maria, Halle (Saale), Germany; Institut of Pathology Hildesheim, Hildesheim, Germany; Institut of Pathology, Klinikum Fürth, Fürth, Germany
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Kurtschinski A, Stückrath K, Hüttelmaier S, Thomssen C, Kantelhardt EJ, Vetter M. Genexpressionsanalysen von IGF2BP1, 2, 3 im primären Mammakarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Focke C, Kantelhardt EJ, Thomssen C, Vetter M. Die HER2-Bestimmung an Tumoren der Brust mittels unterschiedlicher Testverfahren. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551604] [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: 10/23/2022] Open
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Steer S, Papendick N, Müller A, Vetter M, Thomssen C, Große R, Kantelhardt EJ. Das Mammakarzinom am Brustzentrum der Universität Halle (Saale) in den letzten 15 Jahren: Was hat sich geändert? Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551606] [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: 10/23/2022] Open
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Peitek K, Müller A, Strauß HG, Thomssen C, Kantelhardt E. Bedeutung des Sicherheitsabstands der Tumorresektion beim Vulvakarzinom – eine retrospektive monozentrische Analyse 1999 bis 2013. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Vetter M, Reinhardt K, Stückrath K, Ditttmer J, Thomssen C, Kantelhardt EJ. Prävalenz von PIK3CA-Genmutationen beim Mammakarzinom. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Stückrath K, Kantelhardt E, Thomssen C, Vetter M. nCounterTM-Analysis-System als Alternative zur qPCR für das molekulare Subtyping beim Mammakarzinom (Pilotprojekt). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376510] [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: 10/25/2022] Open
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Müller A, Peitek K, Strauss HG, Kantelhardt E. Bedeutung des Sicherheitsabstands der Tumorresektion beim Vulvakarzinom – eine retrospektive monozentrische Analyse 1999 bis 2013. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376492] [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: 10/25/2022] Open
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Knauf E, Yonas B, Mathewos A, Thomssen C, Hauptmann S, Vetter M, Kantelhardt EJ. Mammakarzinom-Typen in Äthiopien: Ergebnisse von 46 Mammakarzinom Tumoren 2006 – 2010 aus dem Addis Ababa Universitätskrankenhaus. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376509] [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: 10/25/2022] Open
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Reinhardt K, Stückrath K, Kantelhardt E, Thomssen C, Vetter M. Prävalenz von PIK3CA-Genmutationen beim Mammakarzinom. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376511] [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: 10/25/2022] Open
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Kantelhardt EJ, Zerche P, Mathewos A, Trocchi P, Addissie A, Aynalem A, Wondemagegnehu T, Ersumo T, Reeler A, Yonas B, Tinsae M, Gemechu T, Jemal A, Thomssen C, Stang A, Bogale S. Breast cancer survival in Ethiopia: a cohort study of 1,070 women. Int J Cancer 2014; 135:702-9. [PMID: 24375396 DOI: 10.1002/ijc.28691] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/11/2013] [Indexed: 11/07/2022]
Abstract
There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in 2005-2010. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Cohort Studies
- Combined Modality Therapy
- Ethiopia/epidemiology
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasm Metastasis
- Neoplasm Staging
- Prognosis
- Survival Rate
- Young Adult
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Affiliation(s)
- E J Kantelhardt
- Department of Gynaecology, Martin Luther University, Halle an der Saale, Germany; Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany
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Landstorfer B, Lantzsch T, Kantelhardt EJ, Stückrath K, Große R, Ruschke K, Holzhausen HJ, Buchmann J, Thomssen C, Vetter M. UPA- und PAI-1- Proteinmessungen (ELISA) aus Stanzbiopsie und korrespondierendem OP-Präparat von Mammakarzinomen (n = 115). Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1343512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Stang A, Kantelhardt E. Too many statistical errors for meaningful interpretation. Breast Cancer Res Treat 2013; 138:643-4. [PMID: 23417360 DOI: 10.1007/s10549-013-2438-9] [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] [Received: 01/23/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Jacobs VR, Kates R, Kantelhardt EJ, Vetter M, Thomssen C, Harbeck N. Ökonomische Auswirkungen der durch Biomarker uPA/PAI-1-Testung vermiedenen Chemotherapien bei nodal-negativem primären Mammakarzinom. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1313648] [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: 10/19/2022] Open
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Jacobs VR, Kates R, Kantelhardt EJ, Vetter M, Schmitt M, Jaenicke F, Untch M, Thomssen C, Harbeck N. Modell zur Quantifizierung der gesundheitsökonomischen Folgen einer Risikogruppenauswahl anhand der ASCO-empfohlenen Biomarker uPA und PAI-1 bei nodal-negativem primären Mammakarzinom. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1309198] [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: 10/28/2022] Open
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Braun G, Führer A, Breitenstein E, Tariku W, Abdelbaghi O, Hauptmann S, Bogale S, Kantelhardt E. Cancer in Africa: AORTIC 8th International Cancer Conference 'Entering the 21st Century for Cancer Control in Africa' 30.11.-2.12.2011. ACTA ACUST UNITED AC 2012; 7:177-179. [PMID: 22740807 DOI: 10.1159/000188335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- G Braun
- Department of Gynecology, Martin-Luther-University Halle/Wittenberg, Germany
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Kantelhardt EJ, Vetter M, Steer S, Ruider T, Holzhausen HJ, Strauβ HG, Groβe R, Thomssen C. P4-09-05: CA15-3 Adds Prognostic Information in “Luminal” Type Breast Cancer – A Single Center Experience Evaluating 700 Patients with a Median Follow-Up of 5 Years. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-09-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Prognostic markers are essential for the decision about individual therapy for patients with newly diagnosed breast cancer. Biological meaningful cancer types are revealed by gene expression analysis. Steroid hormone receptor (HR) and HER2 status of the tumor by immunohistochemistry (IHC) are more easily available and predominantly resemble these cancer types. The “luminal” type as HR pos. and HER2 neg., the “luminalHER2” type as HR pos. and HER2 pos., the “HER2” type as HR neg. and HER2 pos. and the “triple neg.” type as HER neg. and HER2 ***neg.. We evaluated preoperative serum CA 15–3 and CEA within IHC-cancer types and outcome using our own cohort from 1999–2010.
Material and Methods: Since 1999 all patients with breast cancer were entered in our tumor registry. Patients were treated by surgery and adjuvant therapy according to national guidelines (www.ago-online.de). Data was entered into SPSS by a specially trained study nurse. Follow-up was obtained yearly using our own out-patient clinic, information from general practitioners and the general cancer registry. Informed consent was taken from the patients at time of diagnosis. CA 15–3 and CEA were defined elevated if above 25 U/ml or 4,6 μg/l respectively.
Results: Preoperative serum CA15-3 available for 1149 patients. Patients with elevated results showed a reduced 5year disease-free survival (DFS) of 74.4% as compared to 84.7% (p<0.001). CA15-3 remained an independent prognostic factor in multivariate analysis (nodal status, grading, HR). Within HR positive disease, normal CA15-3 values predict a significantly better 5years DFS of 89.9% compared to 79.7% (p<0.001). No significant difference was seen in HR negative patients (5year DFS 57.5% vs 68.4%; p=n.s.). Patients with HER2 status available (n=700) were classified into biological tumor types by IHC. Significant differences in DFS were seen for “luminal” (n=435) tumors only (5year DFS 81.0% vs 91.8% (p<0.001). Only trends of differences in DFS were seen in the other less frequent tumor types “luminalHER2” (n=90) or “triple neg.” (n=112) types. Within the “HER2” (n=63) group no discrimination by serum levels of CA15-3 was seen. CEA did not add information on prognosis.
Discussion: Decision on adjuvant therapy is increasingly based on tumor biology. Particularly, in “luminal” tumors additional prognostic information is needed to decide on adjuvant chemotherapy. CA15-3 may be an easily available, independent marker to identify patients with a higher risk of recurrence within this group. Prospective validation and comparison to molecular typing is needed.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-09-05.
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Affiliation(s)
- EJ Kantelhardt
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
| | - M Vetter
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
| | - S Steer
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
| | - T Ruider
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
| | - H-J Holzhausen
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
| | - H-G Strauβ
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
| | - R Groβe
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
| | - C Thomssen
- 1GYN/OB, Halle (Saale), Germany; Inst. of Pathology, Halle (Saale), Germany
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Große R, Kantelhardt EJ, Steer S, Spinda AK, Vetter M, Ruschke K, Thomssen C. P2-08-13: Does Routine Use of Preoperative Magnetic Resonance Imaging (MRI) in Breast Cancer Influence the Outcome? Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-08-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The role of routine preoperative breast MRI in patients diagnosed with breast cancer is still under discussion. In a milestone review, Houssami et al. (CA Cancer J Clin 2009;59;290) did not demonstrate an advantage with regard to DFS or OS. We reviewed our case series (n=793) in order to add evidence to the current discussion of whether or not preoperative MRI would influence the outcome.
Material and Methods: In our database we identified four years of diagnosis (2004-07) in which a high percentage (72%) of patients (349 of 483) with histologically confirmed invasive breast cancer received preoperative MRI. In the following years (2008/09), MRI was still done in 31% of the cases (97 of 309). All pts were treated according to national guidelines; however, patients with additional lesions in MRI were subjected to an additional MRI-guided needle biopsy or additional wire-guided excision. The median follow-up time was 31.5 months (0-81). The patients were followed clinically. In most cases local surveillance was done by mammography.
Results: In the total cohort, 20% of the patients had additional needle biopsies and/or wire-localisation due to MRI-findings. By MRI, lesions that subsequently led to an additional preoperative needle biopsy were found in 82 pts. Interestingly, only ten contralateral second cancers were found. In 357 pts, MRI was used as guidance during the operation with (n=118) or without MRI-supported wire localization (n=238). The percentage of additional MRI-needle biopsy or MRI-supported localisation did not differ between invasive ductal (n=655) and lobular cancer (n=91): 10% versus 13% needle biopsies and 15% versus 20% wire localisations. The number of surgical procedures to achieve tumor-free margins did not differ between patients with or without preoperative MRI. In this series, 69 of 100 patients who received neoadjuvant chemotherapy, also had MRI-imaging. Considering the patient cohort with follow-up available (n=737), no significant difference of DFS probability was observed between pts with and without preoperative MRI.
Discussion: This retrospective analysis did not demonstrate any advantage for routine preoperative MRI with regard to local treatment and DFS probability. The observed rate of 20% additional operative procedures corresponds to similar published data (16% additional multicentric or multifocal lesions found by MRI, Solin, Breast. 2010;19:7).
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-13.
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Affiliation(s)
- R Große
- 1Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - EJ Kantelhardt
- 1Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - S Steer
- 1Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - AK Spinda
- 1Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - M Vetter
- 1Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - K Ruschke
- 1Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - C Thomssen
- 1Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Kantelhardt E, Schmitt W, Ehrke C, Weiß F, Fischer K, Kurtschinsky A, Walther K, Dlugosch T, Hanf V, Lantzsch T, Große R, Uleer C, Bürrig KF, Buchmann J, Holzhausen HJ, Denkert C, Dittmer J, Thomssen C, Vetter M. PiA – Prognose im Alltag; prospektive Erfassung von 1000 Patientinnen mit primärem Mammakarzinom an 5 Brustzentren. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286424] [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: 10/17/2022] Open
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Fuehrer A, Tariku W, Dawit M, Ahrens C, Adamu A, Stang A, Thomssen C, Kantelhardt EJ. Das Ausmaß onkologischer Todesfälle bei Frauen im ländlichen Äthiopien – Ergebnisse von 2500 Interviews mit Angaben zu Frauen und ihren Schwestern; Auswertung von >200 Todesfällen. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286467] [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: 10/17/2022] Open
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Zerche P, Schneider J, Reeler A, Stang A, Thomssen C, Bogale S, Kantelhardt EJ. Der klinische Verlauf von 1600 PatientInnen mit Mammakarzinom am Tikur Anbessa Universitäts-Krankenhaus Addis Ababa/Äthiopien. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286436] [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: 10/17/2022] Open
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Vetter M, Thomssen C, Kantelhardt E, Sweep F, Meisner C, Veyret C, Schmitt M, Hanf V, Augustin D, Paepke D, Minckwitz V, Schmitt M, Harbeck N. Risk Assessment in Node-Negative Breast Cancer by the Invasion Factors (Urokinase-Type Plasminogen Activator) and Its Inhibitor PAI-1. Correlation to the Tumor Characteristics in the Prospective NNBC 3-Europe Trial. On Behalf of the NNBC-3 Trial Group. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:ASCO Tumor Marker Guidelines 2007 recommended clinical routine use of the invasion markers uPA and PAI-1 for risk assessment in N0 breast cancer patients (Harris et al. JCO 2007; 25:5287). We conducted the prospective NNBC 3-Europe trial addressing the direct comparison between risk-assessment by uPA/PAI-1 and clinico-pathological factors, and optimization of adjuvant chemotherapy for high-risk N0 pts: FEC*3-Doc*3 vs. standard FE100C*6.Study Design:Risk assessment was based on grade, and in G2 tumors either by uPA/PAI-1 status (UP) or by a St. Gallen adapted algorithm (CP). Type of assessment was decided by each centre prior to study participation. High-risk patients received adjuvant chemotherapy according to randomisation. Adjuvant endocrine therapy is given according to guidelines. Use of fresh tissue sampling was necessary for determination of uPA/PAI-1 by ELISA. All laboratories took part on the central quality assurance program. HER2 overexpression was confirmed centrally.Results:From Dec 2002 to Jan 2009, 153 centres recruited 4,150 pts (4,145 evaluable). In 2,497 pts., risk was assessed by UP, and in 1,648 by CP. By UP, 38.7% were assigned to the low-risk group, whilst 61.3% of the patients still had to receive adjuvant chemotherapy; by CP-assessment (n=1,648) the risk groups comprised 31.3%, and 68.7 %.Tab.1. Tumor characteristics.risk groupUP lowUP highCP lowCP hightotaln9671,5305161,1324,145age (median)54 (31-70)53 (21-70)57 (34-70)53 (21-70)54 (21-70)pT2178 (18.4%)544 (35.6%)24 (4.7%)603 (53.3%)1,349 (33%)Steroid hormone receptor status pos.951 (98.3%)1,116 (72.9%)513 (99.4%)739 (65.3%)3,331 (80.4%)HER2 overexpression45 (4.7%)284 (18.6%)6 (1.2%)247 (21.8%)582 (14.0%)triple negative (TNBC)15 (1.6%)319 (20.8%)2 (0.4%)295 (26.1%)631 (15.2%)Grading 1417 (43.1%)-164 (32.0%)15 (1.3%)596 (14.4%)Grading 2550 (56.9%)750 (48.9%)345 (67.4%)464 (40.7%)2,115 (51.0%)Grading 3-780 (50.9%)7 (1.4%)639 (56.1%)1,424 (34.4%)uPA value [ng/mg] median1.33.8--2.4PAI-1 value [ng/mg]median9.121.5--15.4 More pT2 tumors were listed as low risk by the UP method. Typical high risk groups (e.g. TNBC, HER2) were identified by UP. A substantial number of HER2 overexpressing tumors (4.7%) in UP were assigned to the low risk group, suggesting an independent effect of UP and HER2. In the QA programm, mean coefficients of variations were 12% for uPA and PAI-1 determination. In total 1,335 pts. were randomised to receive FEC-Doc, and 1.327 to receive FEC. The chemotherapy was well tolerated. However, we observed four therapy related deaths.Conclusions:Determination of uPA and PAI-1 in frozen tissue is feasible and reliable. Using UP for additional prognostic information may prevent chemotherapy from many patients. The effect of the taxane containing regimen will be evaluated with longer follow-up.Cooperation: EORTC Patho-Biology Group, AGO Breast Group, GBG, Unrestricted grants by Sanofi-Aventis, Pfizer, American Diagnostica, Martin-Luther-University Halle-Wittenberg.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4040.
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Affiliation(s)
| | | | | | - F. Sweep
- 2Exp. Endocrinology, The Netherlands
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Kantelhardt E, Thomssen C, Vetter M, Geurts-Moespot A, Schmidt M, Veyret C, Meisner C, Minckwitz GV, Hanf V, Martin P, Augustin D, Schmitt M, Sweep F, Harbeck N. Die Bestimmung der prognostischen Faktoren uPA und PAI 1 zur Risikoevaluation beim nodalnegativen Mammakarzinom – Erfahrungen der NNBC 3-Europe Studie. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Boehm D, Lebrecht A, Kantelhardt EJ, Schmidt M, Siggelkow W, Kölbl H. Quality of life and adjuvant tamoxifen treatment in breast cancer patients. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088800] [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: 10/19/2022] Open
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Kantelhardt EJ, Pauli N, Vetter M, Grosse R, Strauss HG, Thomssen C. Auswertung der präoperativ prognostischen Tumormarker CA 15–3 und CEA beim Mammakarzinom (n=1093) – Patientengut (1998–2006) der Klinik für Gynäkologie des Universitätsklinikums der Martin-Luther-Universität Halle-Wittenberg. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088810] [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: 10/19/2022] Open
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Kantelhardt E, Pauli N, Vetter M, Grosse R, Dittmer J, Strauss H, Thomssen C. Re-evaluation of the old preoperative prognostic markers CA 15-3 and CEA using a cohort of 1093 patients treated for breast cancer 1998–2006 at a single institution. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kantelhardt E, Thomssen C. Onkologie. Die aktuellen Empfehlungen der AGO-Kommission Mamma. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Vetter M, Kantelhardt E, Annecke K, Dittmer J, Paepke D, Prechtl A, Schmitt M, Jänicke F, Minckwitz GV, Kiechle-Bahat M, Thomssen C, Harbeck N. Invasionsfaktoren uPA/PAI‐1 im Tumorgewebe bei Patientinnen mit primärem Mammakarzinom: Von Forschungsergebnissen zur klinischen Anwendung am Beispiel der NNBC 3-Europe-Studie. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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