1
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Angelaki E, Marketou M, Barmparis G, Maragkoudakis S, Peponaki E, Kalomoirakis P, Zervakis S, Fragkiadakis K, Plevritaki A, Pateromichelakis T, Vardas P, Kochiadakis G, Tsironis G. Detection of left ventricular hypertrophy on the ECG through machine learning with a focus on obesity. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac remodeling, an important aspect of cardiovascular disease (CVD) progression, is emerging as a significant therapeutic target. The electrocardiogram (ECG) is of paramount importance in the initial evaluation of a patient. However, the ECG is not a sensitive method of detecting left ventricular hypertrophy (LVH), and as far as we know, it cannot detect changes in left ventricular geometry (LVG) at early stages, especially before LVH is present. Its sensitivity is particularly low for obese patients.
Purpose
To use a machine learning (ML) classifier to detect abnormal LVG from ECG parameters/markers, even before it becomes LVH, and to propose some indicative markers useful for practitioners. We also looked at the results of our model for obese patients to test the markers in this population.
Methods
We enrolled consecutive subjects, aged 30 years or older (mean age: 61.6±12 years old) with and without essential hypertension and no indications of CVD. All patients underwent a full echocardiographic evaluation and were classified into 2 groups; those with normal geometry (NG) vs. those with concentric remodeling (CR) or LVH defined as concentric hypertrophy (CH) and eccentric hypertrophy (EH). Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). We analyzed the EKG waveforms deduced to single beat averages for each lead using custom software and extracted 70 markers. We then trained a Random Forest machine learning model to classify subjects with abnormal LVG and calculated SHAP values to perform feature importance and interaction.
Results
After screening 1120 individuals, we enrolled 594 subjects, aged 30 years or older (mean age: 61.6±12 years old). The percentage of women was 56.5%, while 71.3% of all patients were hypertensive. Hypertension, age, body mass index divided by the Sokolow-Lyon voltage (BMI/S-L), QRS-T angle, and QTc duration were among the most important parameters (Figure, left panel) identified by the model as being predictive of abnormal LVG (AUC/ROC = 0.84, sensitivity = 0.94, specificity 0.61). Specifically for obese patients, whose prevalence in our population was 60.3%, our model performed well (sensitivity = 0.71, specificity = 0.92. When we tried our model without the the BMI/S-L parameter, the specificity dropped to 0.88. We also found that a cut-off point of 18 for the BMI/S-L marker predicted the patients who were more probable to have developed abnormal LVG.
Conclusions
This study is the first to demonstrate the promising potential of ML modeling for the efficient and cost-effective diagnostic screening of abnormal LVG and cardiac remodeling through ECG. We found specific clinical and ECG parameters that can predict early pathological changes of LVG in patients without established CVD and detect the population who will benefit from a detailed echocardiographic evaluation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Angelaki
- University of Crete, Physics , Heraklion , Greece
| | - M Marketou
- Heraklion University Hospital , Heraklion , Greece
| | - G Barmparis
- University of Crete, Physics , Heraklion , Greece
| | | | - E Peponaki
- Heraklion University Hospital , Heraklion , Greece
| | | | - S Zervakis
- Heraklion University Hospital , Heraklion , Greece
| | | | - A Plevritaki
- Heraklion University Hospital , Heraklion , Greece
| | | | - P Vardas
- Heraklion University Hospital , Heraklion , Greece
| | | | - G Tsironis
- Heraklion University Hospital , Heraklion , Greece
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2
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Angelaki E, Barmparis G, Kochiadakis G, Maragkoudakis S, Tsiavos A, Kalomoirakis P, Kampanieris E, Zervakis S, Plevritaki A, Savva E, Kassotakis S, Vardas P, Tsironis G, Marketou M. Artificial intelligence-based opportunistic screening for the detection of arterial hypertension through ECG signals. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertension is a major risk factor for cardiovascular disease (CVD) which often escapes the diagnosis or should be confirmed by several office visits. The electrocardiogram (ECG) is one of the most widely used diagnostic tools and could be of paramount importance in patients' initial evaluation.
Purpose
To detect whether a person is hypertensive using features from the ECG, as well as basic anthropometric features such as age, sex, and body mass index (BMI).
Methods
We used machine learning (ML) techniques based features derived from the electrocardiogram for detecting hypertension in a population without CVD. We enrolled 1091 subjects who were classified into hypertensive and normotensive group. We trained 3 ML models, specifically logistic regression, k-nearest-neighbors, and random forest (RF), to predict the existence of hypertension in patients based only on a few basic clinical parameters and ECG-derived features. We also calculated Shapley additive explanations (SHAP), a sophisticated feature importance analysis, to interpret each feature's role in the random forest's predictions.
Results
Our RF model was able to distinguish hypertensive from normotensive patients with accuracy 84.2%, specificity 66.7%, sensitivity 91.4%, and area under the receiver-operating curve 0.86. Age, BMI, BMI-adjusted Cornell criteria (BMI multiplied by RaVL+SV3), R wave amplitude in aVL, and BMI-modified Sokolow-Lyon voltage (BMI divided by SV1+RV5), were the most important anthropometric and ECG-derived features in terms of the success of our model. Figure 1 shows the results in detecting hypertension by the Random Forest.
Conclusions
Our ML algorithm is effective in the detection of hypertension in patients using ECG-derived and basic anthropometric criteria. Our findings open new horizon in the detection of many undiagnosed hypertensive individuals who have an increased cardiovascular disease risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Angelaki
- University of Crete, Physics , Heraklion , Greece
| | - G Barmparis
- University of Crete, Physics , Heraklion , Greece
| | | | | | - A Tsiavos
- Heraklion University Hospital , Heraklion , Greece
| | | | | | - S Zervakis
- Heraklion University Hospital , Heraklion , Greece
| | - A Plevritaki
- Heraklion University Hospital , Heraklion , Greece
| | - E Savva
- Heraklion University Hospital , Heraklion , Greece
| | - S Kassotakis
- Heraklion University Hospital , Heraklion , Greece
| | - P Vardas
- Heraklion University Hospital , Heraklion , Greece
| | - G Tsironis
- University of Crete, Physics , Heraklion , Greece
| | - M Marketou
- Heraklion University Hospital , Heraklion , Greece
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3
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Papatheodorou P, Taliadoros A, Thrasyvoulou C, Tsironis G. Sclerosing angiomatoid nodular transformation of the spleen: a case report. BMJ Case Rep 2021; 14:e246993. [PMID: 34949583 PMCID: PMC8704970 DOI: 10.1136/bcr-2021-246993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/04/2022] Open
Abstract
Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an uncommon primary benign condition with specific histopathological characteristics. The majority of the patients are usually asymptomatic and present for treatment after an incidental finding on a routine abdominal imaging. The differential diagnosis includes other benign tumours, as well as primary malignancy or metastases of unknown origin. We report a 55-year-old woman who was presented to the surgical team of our hospital for splenectomy after the investigation of an incidental splenic lesion led to the diagnosis of SANT. The pathology report of the specimen repeated the initial diagnosis. The patient has not yet presented any complication or recurrence of the disease 8 months after the operation. From such infrequent cases, the most valuable conclusion which can be yielded is that the more the number of patients reported, the more the knowledge about the disease is broadened.
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Affiliation(s)
| | | | | | - George Tsironis
- Oncology Department, Nicosia General Hospital, Leukosia, Cyprus
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4
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Aggelaki E, Marketou M, Barmparis G, Patrianakos A, Kochiadakis G, Vardas P, Parthenakis F, Tsironis G. Prediction of abnormal left ventricular geometry on the ECG through machine learning with a focus on obesity. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac remodeling, an important aspect of cardiovascular disease (CVD) progression, is emerging as a significant therapeutic target. However, the ECG is not a sensitive method of detecting left ventricular hypertrophy (LVH), and as far as we know, it cannot detect changes in left ventricular geometry (LVG) at early stages, especially before LVH is present. Its sensitivity is particularly low for obese patients.
Purpose
To use a machine learning (ML) classifier to detect abnormal LVG from EKG parameters/markers, even before it becomes LVH, and to propose some indicative markers useful for practitioners. We also looked at the results of our model for obese patients to test the markers in this population.
Methods
We enrolled 594 consecutive subjects, aged 30 years or older (mean age: 61.6±12 years old) with and without essential hypertension and no indications of CVD. We tried to build a “clean” dataset through which we can target the clinical, anthropometric, and electrocardiogram measurements indicative of abnormal LVG. All patients underwent a full echocardiographic evaluation and were classified into 2 groups; those with normal geometry (NG) vs. those with concentric remodeling (CR) or LVH. Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). We analyzed the EKG waveforms deduced to single beat averages for each lead using custom software and extracted 70 markers. We then trained a Random Forest machine learning model to classify subjects with abnormal LVG and calculated SHAP values to perform feature importance and interaction.
Results
The percentage of women was 56.5%, while 71.3% of all patients were hypertensive. Hypertension, age, body mass index divided by the Sokolow-Lyon voltage (BMI/S-L), QRS-T angle, and QTc duration were among the most important parameters (Figure, left panel) identified by the model as being predictive of abnormal LVG (AUC/ROC = 0.84, sensitivity = 0.94, specificity 0.61). Specifically for obese patients, whose prevalence in our population was 60.3%, our model performed well (sensitivity = 0.71, specificity = 0.92. When we tried our model without the the BMI/S-L parameter, the specificity dropped to 0.88. We also found that a cut-off point of 18 for the BMI/S-L marker predicted the patients who were more probable to have developed abnormal LVG (Figure 1).
Conclusions
This study is the first to demonstrate the promising potential of ML modeling for the efficient and cost-effective diagnostic screening of abnormal LVG through ECG. We found specific clinical and ECG parameters that can predict early pathological changes of LVG in patients without established CVD and detect the population who will benefit from a detailed echocardiographic evaluation. Our model contributes to the development of human-centered and autonomous technologies and can optimize patient-management and treatment.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- E Aggelaki
- University of Crete, Physics, Heraklion, Greece
| | - M Marketou
- Heraklion University Hospital, Heraklion, Greece
| | - G Barmparis
- University of Crete, Physics, Heraklion, Greece
| | | | | | - P Vardas
- Heraklion University Hospital, Heraklion, Greece
| | | | - G Tsironis
- University of Crete, Physics, Heraklion, Greece
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5
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Tsironis G, Liontos M, Kyriazoglou A, Koutsoukos K, Tsiara A, Kaparelou M, Zakopoulou R, Cohen A, Skafida E, Fontara S, Zagouri F, Bamias A, Dimopoulos MA. Axitinib as a third or further line of treatment in renal cancer: a single institution experience. BMC Urol 2020; 20:60. [PMID: 32487200 PMCID: PMC7265645 DOI: 10.1186/s12894-020-00618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney cancer is a lethal neoplasm that affects several thousands of people every year. Renal cell carcinoma (RCC) is the most common histologic type. Recent developments in the therapeutic approach include antiangiogenic targeted approaches and Immunotherapy. Thus, the therapeutic algorithm of RCC patients and the survival outcomes have changed dramatically. METHODS Herein we present a retrospective study of the patients treated in our Department with an antiangiogenic agent -Axitinib, a tyrosine kinase inhibitor- as a third or further line treatment. Statistical analysis was performed with SPSS, including the available clinicopathological data of the patients included. RESULTS Axitinib was found to be active in patients who received this treatment beyond second line. The toxicity profile of this regimen did not reveal any unknown adverse events. CONCLUSIONS Our real world data reflect that axitinib is a safe and effective option, even beyond the second line.
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Affiliation(s)
- G Tsironis
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M Liontos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Kyriazoglou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece.
| | - K Koutsoukos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Tsiara
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M Kaparelou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - R Zakopoulou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Cohen
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - E Skafida
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - S Fontara
- 1st Department of Radiology, Aretaieio University hospital, Athens, Greece
| | - F Zagouri
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Bamias
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M A Dimopoulos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
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6
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Kyriazoglou A, Konteles V, Liontos M, Sofianidis G, Zagouri F, Koutsoukos K, Tsironis G, Tsiara A, Kaparelou M, Zakopoulou R, Cohen A, Dimitriadis E, Mahaira L, Michali D, Arnogiannaki N, Stefanaki K, Dimopoulos M, Kattamis A. Expression analysis of NHEJ and HR genes in Ewing sarcomas: Indications of DSB repair dysfunction. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.060] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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7
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Bamias A, Tsironis G, Dimitriadis I, Tzanis K, Tsiara A, Xirokosta A, Kaparelou M, Kyriazoglou A, Cohen A, Barbarousi D, Koutsoukos K, Liontos M, Zakopoulou R, Kostouros E, Pagoni S, Matsouka C, Dimopoulos MA. Risk for vascular thromboembolic events (VaTEs) in patients (pts) with advanced urinary tract cancer (aUTC) treated with chemotherapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
383 Background: Venous thromboembolism (VTE) is a frequent complication of cancer or its treatment. Khorana (KRS) and Compass scores are two Risk Assessment Models for VTE. However, aUTC was not adequately represented and arterial events were not included, in these models. Methods: Data from pts with aUTC treated with at least one line of chemotherapy in our institution were analyzed. VaTE definition included: DVT and PE defined as venous events and peripheral arterial thrombosis or embolus, ischemic stroke and coronary events, grouped as arterial events. The association of baseline and treatment-related factors with the development of VaTE was assessed using competing-risk regressions. According to the results of our multivariate analysis we stratified patients according to the number of the identified risk factors. Results: 354 aUTC pts treated between 4/1995 and 9/2015 entered our study. 53% of pts had received cisplatin and 42% carboplatin-based regimens. 44 pts (12.4%) suffered 45 VaTEs (13 arterial, 32 venous) within a median time of 3.3 months. The cumulative and 6-month incidence was 14.8% (95% CI: 10.9-19.4) and 9.7% (95% CI: 6.8-13.1), [venous 10.5% (95% CI: 7.3-14.3)/7.5% (95% CI: 5-10.7); arterial 5.3% (95% CI: 2.8-9)/2.7% (95% CI: 1.3-5), respectively]. No association of the KRS and the COMPASS score with the incidence of VaTEs was observed. In the univariate and multivariate analysis, cumulative VaTE incidence was significantly increased in pts with “peripheral arterial disease (PAD) or history of VΤE” (adjusted SHR: 3.29; 95% CI: 1.65-6.55; p=0.001) and pts with other solid tumor (SHR: 2.20; 95% CI: 1.05-4.62; p=0.038). There was a strong correlation between the number of risk factors and the risk for VaTE development (p<0.001). Patients with 1 or 2, vs 0 factors had a 3-fold increased risk [cumulative incidence was 10.9% (95% CI: 7.4.-15.2) and 30.2% (95% CI: 18.4-42.8), respectively; SHR: 3.01 95% CI: 1.65-5.51]. Conclusions: Development of tumor-specific algorithms for the risk of vascular events is supported by our results. Pts with aUTC and a history of VTE, PAD and other solid tumor have a very high risk for VaTE. The role of prophylaxis should be prospectively studied.
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Affiliation(s)
- Aristotelis Bamias
- Haematology- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Tsironis
- Haematology- Oncology Unit, Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Dimitriadis
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Tzanis
- Hellenic Genitourinary Cancer Group (HGUCG), Athens, Greece
| | - Anna Tsiara
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Kaparelou
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Kyriazoglou
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Abis Cohen
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Koutsoukos
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Michael Liontos
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Roubini Zakopoulou
- Haematology- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Euthymios Kostouros
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatina Pagoni
- Third Department of Internal Medicine, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | | | - Meletios A. Dimopoulos
- Haematology- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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8
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Liontos M, Sotiropoulou M, Kaparelou M, Tzannis K, Tsironis G, Kyriazoglou A, Tsiara A, Zakopoulou R, Koutsoukos K, Zagouri F, Vlachos D, Thomakos N, Haidopoulos D, Rodolakis A, Dimopoulos M, Bamias A. Evaluation of chemotherapy response score and lymphocytic infiltration as prognostic markers in ovarian cancer patients treated with neoadjuvant chemotherapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.177] [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: 11/12/2022] Open
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9
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Papaxoinis G, Kotoula V, Giannoulatou E, Koliou GA, Karavasilis V, Lakis S, Koureas A, Bobos M, Chalaralambous E, Daskalaki E, Chatzopoulos K, Tsironis G, Pazarli E, Chrisafi S, Samantas E, Kaklamanos IG, Varthalitis I, Konstantara A, Syrigos KN, Pentheroudakis G, Pectasides D, Fountzilas G. Phase II study of panitumumab combined with capecitabine and oxaliplatin as first-line treatment in metastatic colorectal cancer patients: clinical results including extended tumor genotyping. Med Oncol 2018; 35:101. [PMID: 29855806 DOI: 10.1007/s12032-018-1160-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/27/2018] [Indexed: 12/12/2022]
Abstract
This clinical trial assessed the efficacy and toxicity of panitumumab combined with oxaliplatin and capecitabine as first-line treatment in KRAS exon 2 wild-type metastatic colorectal cancer (mCRC) patients. Patients with exon 2 KRAS wild-type mCRC received panitumumab 9 mg/Kg, oxaliplatin 130 mg/m2, and capecitabine 2000 mg/m2 repeated every 3 weeks. The primary endpoint was objective response rate (ORR, minimum 42 responses). We retrospectively assessed mutations in genes implicated in CRC with massively parallel sequencing; ERBB2 and EGFR amplification with fluorescence in situ hybridization, and tumor-infiltrating lymphocyte density. Among 78 patients enrolled, 45 (57.7%) completed 6 cycles. Most common grade 3-4 toxicities were skin rash (19.2%), diarrhea (18%), and neuropathy (6.4%). Among 5 (6.4%) potentially treatment-related deaths, 2 (2.6%) were characterized toxic. Objective response occurred in 43 (55.1%) of the patients (complete 6.4% and partial response 48.7%; stable 17.9% and progressive disease 7.7%), while 3.8% were non-evaluable and 15% discontinued their treatment early. Additional mutations in KRAS/NRAS/BRAF were found in 11/62 assessable (18%) tumors. After 51 months median follow-up, median progression-free (PFS) was 8.1 and overall survival 20.2 months, independently of KRAS/NRAS/BRAF or PI3K-pathway mutation status. Patients with TP53 mutations (n = 34; 55%), as well as those with left colon primary tumors (n = 66; 85%), had significantly better PFS, also confirmed in multivariate analysis. Although the clinical trial met its primary endpoint, according to the current standards, the efficacy and tolerability of the drug combination are considered insufficient. Extended genotyping yielded interesting results regarding the significance of TP53 mutations.ClinicalTrials.gov identifier: NCT01215539, Registration date: Sep 29, 2010.
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Affiliation(s)
- George Papaxoinis
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527, Athens, Greece.
| | - Vassiliki Kotoula
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia.,The University of New South Wales, Kensington, NSW, Australia
| | | | - Vasilios Karavasilis
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Lakis
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Koureas
- Department of Radiology, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elpida Chalaralambous
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emily Daskalaki
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Chatzopoulos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Tsironis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Elisavet Pazarli
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Chrisafi
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Epaminontas Samantas
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Ioannis G Kaklamanos
- Department of Surgery, School of Health Sciences, General Oncologic Hospital of Kifisia, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Konstantinos N Syrigos
- Oncology Unit GPP, Sotiria General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Tsironis G, Zakopoulou R, Koutsoukos K, Tzanis K, Varkarakis J, Papatsoris A, Stravodimos K, Kostouros E, Fragkoulis C, Choreftaki T, Filippiadis D, Fontara S, Dellis A, Ntai S, Zygogianni A, Ntoumas K, Constantinides CA, Korkolopoulou P, Dimopoulos MA, Bamias A. Neoadjuvant chemotherapy (NAC) with dose-dense gemcitabine/cisplatin (DDGC) in localized muscle-invasive bladder cancer (MIBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- George Tsironis
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Roubini Zakopoulou
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Koutsoukos
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - John Varkarakis
- Second Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece
| | - Athanasios Papatsoris
- Second Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece
| | - Kostas Stravodimos
- First University Urology Clinic, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymios Kostouros
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Fragkoulis
- Department of Urology, General Hospital of Athens "G.N.A. G. Gennimatas", Athens, Greece
| | - Theodosia Choreftaki
- Department of Pathology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Dimitrios Filippiadis
- Second Radiology Department, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Fontara
- First Department of Radiology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- First Department of Urology, Aretaieion Hospital, National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - Sparti Ntai
- Department of Radiology, Alexandra Hospital, Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Ntoumas
- Department of Urology, General Hospital of Athens "G.N.A. G. Gennimatas", Athens, Greece
| | | | - Penelope Korkolopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A. Dimopoulos
- Dept of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristotelis Bamias
- Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Koutsoukos K, Zagouri F, Tzannis K, Karavasilis V, Samantas E, Aravantinos G, Koutras A, Gkerzelis I, Chamylos E, Kostouros E, Lykka M, Tsironis G, Dimitriadis I, Liontos M, Fountzilas G, Dimopoulos M, Bamias A. Efficacy and safety of the combination of bevacizumab (BEV) and temsirolimus (TEM) in patients with metastatic renal cancer (mRCC) after first-line anti-VEGF treatment: A Hellenic Cooperative Oncology group (HeCOG) phase II trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.51] [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: 11/13/2022] Open
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12
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Liontos M, Gavalas N, Tzanis K, Trachana SP, Kostouros E, Zagouri F, Koutsoukos K, Lykka M, Tsironis G, Dimitriadis I, Terpos E, Dimopoulos M, Bamias A. Prognostic and predictive significance of VEGF and TNF&agr; levels in ascites of patients with epithelial ovarian cancer. Correlation with lymphocytes subpopulations. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.16] [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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13
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Vassos D, Tsironis G, Kopitopoulou A, Tsagkouli S, Tsimpoukis S, Charpidou A, Bamias A, Syrigos K. 212P: 2nd line chemotherapy in malignant mesothelioma: A center's experience. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30319-7] [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: 10/21/2022]
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14
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Satogata T, Chen T, Cole B, Finley D, Gerasimov A, Goderre G, Harrison M, Johnson R, Kourbanis I, Manz C, Merminga N, Michelotti L, Peggs S, Pilat F, Pruss S, Saltmarsh C, Saritepe S, Talman R, Trahern CG, Tsironis G. Driven response of a trapped particle beam. Phys Rev Lett 1992; 68:1838-1841. [PMID: 10045233 DOI: 10.1103/physrevlett.68.1838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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15
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Chen T, Gerasimov A, Cole B, Finley D, Goderre G, Harrison M, Johnson R, Kourbanis I, Manz C, Merminga N, Michelotti L, Peggs S, Pilat F, Pruss S, Saltmarsh C, Saritepe S, Satogata T, Talman R, Trahern CG, Tsironis G. Measurements of a Hamiltonian system and their description by a diffusive model. Phys Rev Lett 1992; 68:33-36. [PMID: 10045105 DOI: 10.1103/physrevlett.68.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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16
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Tsironis G, Nicolopoulou P. [Overdentures (a case report)]. Hell Stomatol Chron 1990; 34:47-51. [PMID: 2130033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this article, the advantages, disadvantages, indications, contraindications, and the details of overdenture treatment are outlined and a case is presented. We prepared an overdenture for a patient who came to the Clinic of Removable Prosthodontics of the University of Athens. The patient had a severe abrasion of his teeth as well as reduced vertical dimension (2.5 cm). The construction was made in such a way that we obtained a good esthetic results with no great expense, as the financial condition of the patient was the factor that influenced the plan of treatment basically.
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Karaiskos S, Dimitriou P, Tsironis G, Spyropoulos ND. [A clinical and epidemiological study of Tori mandibularis]. Odontostomatol Proodos 1989; 43:443-9. [PMID: 2518071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This is a study aiming at: a) reviewing the information found in the relevant literature as regards the etiology, incidence, distribution, implication and management of the tori mandibularis, b) evaluating the incidence, location and morphology of this bony mass in a sample of Greek population and c) comparing the findings with those of other investigators. The material consisted of 357 patients, from 20 years old and onwards, who had consecutively visited the Clinic of Removable Prosthodontics for some problem. After clinical examination and tabulation of the findings, the following conclusions were drawn: a) the etiology of appearance of tori mandibularis remains unknown; b) in our sample, 12.8% had this condition; c) the incidence was higher in men (60.4%) than in women (39.5%); d) in our sample, the higher percentage of individuals showing the condition originated from Thraci (Northern Greece) while the lower came from Hepiros; e) No indication of a heredity factor was found; f) this condition is more often bilateral than unilateral and g) the torus mandibularis was extending from the canine to the area of the first premolar in 54.4% of the cases.
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Kopsiaftis GP, Tsironis G. [In vitro study of whether the residual monomer is washed away and to what extent in the thermal polymerization of acrylic resins]. Odontostomatol Proodos 1986; 40:147-52. [PMID: 3095743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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