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Bossart M, Plett H, Krämer B, Braicu E, Czogalla B, Klar M, Singer S, Mayr D, Staebler A, du Bois A, Kommoss S, Link T, Burges A, Heitz F, Grube M, Trillsch F, Harter P, Wimberger P, Buderath P, Hasenburg A. Depression and anxiety in women with malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST): an analysis of the AGO-CORSETT database. Arch Gynecol Obstet 2023; 307:1155-1162. [PMID: 36127525 PMCID: PMC10023613 DOI: 10.1007/s00404-022-06781-0] [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] [Received: 07/20/2022] [Accepted: 08/31/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The intention of this study was to evaluate the level of anxiety and depression of malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) survivors and to identify possible alterable cofactors. METHODS CORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO Studygroup. Women who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Hospital Anxiety and Depression Scale (HADS) to evaluate distress. Predictors of distress (type of surgery, chemotherapy, time since diagnosis, recurrence, second tumor, pain) were investigated using multivariate linear regression analysis. RESULTS 150 MOGCT and SCST patients with confirmed histological diagnosis completed the questionnaire median seven years after diagnosis. They had a HADS total score ≥ 13 indicating severe mental distress in 34% of cases. Patients after fertility-conserving surgery had lower probability of severe mental distress than those without fertility-conserving treatment (β = - 3.1, p = 0.04). Pain was associated with the level of distress in uni- and multivariate analysis (coef 0.1, p < 0.01, coef. Beta 0.5). DISCUSSION Severe mental distress was frequent in patients with MOGCT and SCST and the level of pain was associated with the level of distress. Fertility conserving therapy, however, was associated with less mental distress. Screening and treatment of pain and depression is required to improve mental well-being in survivors of MOGCT and SCST.
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Affiliation(s)
- M Bossart
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg im Breisgau, Germany.
- Department of Gynecology and Obstetrics, St. Josefskrankenhaus Freiburg, Freiburg im Breisgau, Germany.
| | - H Plett
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - B Krämer
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - E Braicu
- Department of Gynecology, Charité Berlin, Campus Virchow Clinic, Berlin, Germany
| | - B Czogalla
- Department of Obstetrics and Gynecology, University Hospital, Ludwig- Maximilians- University Munich, Munich, Germany
| | - M Klar
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Care Research, University Medical Center Mainz, Mainz, Germany
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
| | - D Mayr
- Institut of Pathology, Ludwig-Maximilians- University Munich, Munich, Germany
| | - A Staebler
- Division of Gynecologic Pathology, Institute of Pathology and Neuropathology, University of Tuebingen, Tuebingen, Germany
| | - A du Bois
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - S Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - T Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, Ludwig- Maximilians- University Munich, Munich, Germany
| | - F Heitz
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - M Grube
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - F Trillsch
- Department of Obstetrics and Gynecology, University Hospital, Ludwig- Maximilians- University Munich, Munich, Germany
| | - P Harter
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - P Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - P Buderath
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - A Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
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Klar M, Plett H, Harter P, Heitz F, Kommoss S, Hartkopf AD, Grube M, Roser E, Sehouli J, Braicu I, Czogalla B, Burges A, Bossart M, Hasanov MF, Link T, Staebler A, Mayr D, Buderath P, Hasenburg A. Treatment and survival of patients with malignant ovarian sex cord-stromal cell tumours: An analysis of the Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO) study group CORSETT database. J Surg Oncol 2023. [PMID: 36975108 DOI: 10.1002/jso.27248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/08/2023] [Accepted: 03/04/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Malignant sex cord-stromal cell tumours (SCST) account for only 7% of ovarian malignancies. The Arbeitsgemeinschaft fuer Gynaekologische Onkologie (AGO) study group has established a clinicopathological database to provide an overview of the current treatment strategies and survival of SCST patients and to identify research needs. METHODS Twenty centres provided mixed retro- and prospective data of patients with tumour specimens and second-opinion pathology review treated between 2000 and 2014. Descriptive analyses of treatment strategies, Kaplan-Meier curves and cox regression analyses were conducted. RESULTS Two hundred and sixty-two SCST patients were included. One hundred and ninety-one Granulosa-cell tumour (GCT) and 17 Sertoli-Leydig cell tumour (SLCT) patients were stage I disease (>80%). Forty four GCT (18.7%) and two (8.3%) SLCT patients received adjuvant systemic treatment. After a median observation time of 78.2 months, 46% of all SCST patients experienced disease recurrence, treated predominantly with secondary debulking surgery (> 90%). Advanced FIGO stage, lymph node involvement and intra-operative capsule rupture were associated with disease recurrence on univariate analysis (all p < 0.05). Median OS time was not reached. DISCUSSION In this analysis of SCST patients, adjuvant chemotherapy was unable to prevent disease recurrence. Despite high recurrence rates, overall survival rates were excellent.
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Affiliation(s)
- Maximilian Klar
- Department of Obstetrics and Gynaecology, Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Helmut Plett
- Department of Gynaecology and Gynaecological Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynaecology and Gynaecological Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Florian Heitz
- Department of Gynaecology and Gynaecological Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Center for Oncological Surgery, Charité University Medical Center Berlin, Berlin, Germany
| | - Stefan Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | | | - Marcel Grube
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Eva Roser
- Department of Gynecology with Center for Oncological Surgery, Charité University Medical Center Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité University Medical Center Berlin, Berlin, Germany
| | - Iona Braicu
- Department of Gynecology with Center for Oncological Surgery, Charité University Medical Center Berlin, Berlin, Germany
| | - Bastian Czogalla
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Michaela Bossart
- Department of Obstetrics and Gynaecology, Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mir Fuad Hasanov
- Department of Gynecology and Obstetrics, Universitätsklinikum Göttingen, Göttingen, Germany
| | - Teresa Link
- Department of Gynecology and Obstetrics, Universitätsklinikum Carl Gustav Carus Dresden; TU Dresden, Dresden, Germany
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Doris Mayr
- Institute of Pathology, Ludwig-Maximillians-University Munich, Munich, Germany
| | - Paul Buderath
- Department of Gynaecology and Obstetrics, Faculty of Medicine Essen, University Clinics Essen, Essen, Germany
| | - Annette Hasenburg
- Department of Gynaecology and Obstetrics, University Centre Mainz, Faculty of Medicine, Mainz, Germany
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Plett H, Ricciardi E, Vacaru V, Ramspott JP, Colombo N, Sehouli J, du Bois A, Garbi A, Richter R, Ataseven B, Aletti G, Braicu E, Heitz F, Portuesi R, Muallem MZ, Dagres T, Parma G, Roser E, Traut A, Multinu F, Harter P. Adult ovarian granulosa cell tumors: analysis of outcomes and risk factors for recurrence. Int J Gynecol Cancer 2023; 33:734-740. [PMID: 36759002 DOI: 10.1136/ijgc-2022-003854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Adult granulosa cell tumors represent less than 5% of all ovarian malignancies. The aim of this study was to analyze the clinicopathological parameters and their impact on progression-free and overall survival. METHODS Patients with primary adult granulosa cell tumors treated in three international referral centers between July 1999 and December 2018 were included. The following data were anonymously exported from the prospective database: age at diagnosis, International Federation of Gynecology and Obstetrics (FIGO) stage, adjuvant therapy, surgical procedures, progression-free survival, and overall survival. Descriptive statistical analysis regarding tumor and treatment characteristics was performed. Survival analyses included Kaplan-Meier functions and Cox proportional hazard ratios (HR). RESULTS A total of 168 patients with primary adult granulosa cell tumors were included. Median age was 50 years (range 13-82). With regard to stage distribution, 54.2% (n=91) of patients were FIGO stage IA, 1.2% (n=2) were stage IB, 26.8% (n=45) were stage IC, and 17.9% (n=30) were FIGO stage II-IV. 66.7% (n=112) of patients underwent surgical restaging, of whom 17.9% (n=20) were moved to a higher stage. In addition, 36 (21.4%) patients underwent fertility-sparing surgery. After a median follow-up of 61 months (range 0-209), 10.7% of patients (n=18) had recurrent disease and 4.8% (n=8) died of disease. Five-year progression-free survival was 86.1% and estimated overall survival was 95.7%. Five-year progression-free survival was worse for patients with advanced stages (FIGO stage IA/B vs IC: HR 5.09 (95% CI 1.53 to 16.9); FIGO stage IA/B vs II-IV: HR 5.62 (95% CI 1.58 to 19.9)). Nineteen patients receiving adjuvant chemotherapy had lower estimated 5-year progression-free survival compared with patients not receiving chemotherapy (49.7% vs 91.1%, p<0.001; HR 9.15 (95% CI 3.62 to 23.1)). CONCLUSION The prognosis of patients with primary adult granulosa cell tumors is mainly determined by FIGO stage. The outcome of patients with FIGO stage IC is comparable to those with advanced stages. Fertility-sparing surgery seems to be a safe procedure in stage IA. Our data do not support the use of adjuvant chemotherapy in early and advanced stages of adult granulosa cell tumors.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany .,Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Enzo Ricciardi
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Ospedale Sandro Pertini, Rome, Italy.,Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Vlad Vacaru
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany.,Division of Gynecology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Jan Philipp Ramspott
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Nicoletta Colombo
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,Faculty of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Annalisa Garbi
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Giovanni Aletti
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Elena Braicu
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Rosalba Portuesi
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mustafa-Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Timoleon Dagres
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Gabriella Parma
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Eva Roser
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Francesco Multinu
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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Ramspott JP, Baert T, MacKintosh ML, Traut A, Ataseven B, Bommert M, Heitz F, Plett H, Schneider S, Waltering KU, Heikaus S, Harter P, du Bois A. Response evaluation after neoadjuvant therapy: evaluation of chemotherapy response score and serological and/or radiological assessment of response in ovarian cancer patients. Arch Gynecol Obstet 2021; 304:1021-1032. [PMID: 33661392 DOI: 10.1007/s00404-021-06020-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The chemotherapy response score (CRS) is a histopathological tool to evaluate response to neoadjuvant chemotherapy (NACT) in high-grade serous ovarian cancer (OC). We critically evaluated the clinical value of CRS and compared its predictive power to standard serological (CA125) and radiological response. METHODS A retrospective analysis of 277 OC patients, who received primary chemotherapy, was performed. CRS, serological, and radiological findings were correlated with progression-free (PFS) and overall survival (OS). RESULTS CRS could be determined in 172 of 277 patients (62.1%). In patients with CRS3, a longer median PFS and OS was observed compared with CRS1/2 patients (31.2 vs. 18.9, P < 0.001; 55.0 vs. 36.1 months, P = 0.050). CA125 and radiological response evaluation were also predictive for PFS and OS. Patients with serological and radiological complete response showed longer PFS (23.0 vs. 14.4, P = 0.011; 21.4 vs. 9.6 months, P < 0.001) and OS (49.5 vs. 29.0, P = 0.003; 45.0 vs. 12.9 months, P < 0.001). Patients with pathological complete response (pCR) had the best median PFS (52.8 months), even compared with non-pCR CRS3 (27.8 months). In the total study cohort, serological, and radiological complete response was better at predicting PFS (hazard ratio 2.23 and 2.77). CONCLUSION In this study, evaluation of response to chemotherapy by CRS was not superior to conventional methods (CA125 or radiology). Independent of the evaluation method, response to NACT was predictive of PFS and OS. We observed no added value for CRS as a prognostic marker. The clinical relevance of CRS should be discussed, as no therapeutic consequences result from CRS evaluation.
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Affiliation(s)
- Jan Philipp Ramspott
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany. .,Department of Gynecology and Obstetrics, Münster University Hospital, Münster, Germany.
| | - Thaïs Baert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | - Michelle Louise MacKintosh
- Department of Gynaecological Oncology, St Mary's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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Güngördük K, Plett H, Gülseren V, Meydanlı M, Boyraz G, Özdemir İ, Şahin H, Şenol T, Yıldırım N, Turan T, Öge T, Gökçü M, Taşkın S, Ayhan A, Ataseven B. Is the Oncological Outcome of Early Stage Uterine Carcinosarcoma Different from That of Grade 3 Endometrioid Adenocarcinoma? Oncol Res Treat 2020; 44:43-51. [PMID: 33249415 DOI: 10.1159/000511288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
Abstract
AIM The clinicopathologic characteristics, recurrence patterns, and survival of patients with grade 3 endometrial cancer (G3-EAC) and uterine carcinosarcoma (UCS) were compared. MATERIALS AND METHODS The medical records of patients treated for G3-EAC and UCS between January 1996 and December 2016 at 11 gynecologic oncology centers in Turkey and Germany were analyzed. RESULTS Of all patients included in the study, 161 (45.1%) were diagnosed with UCS and 196 (54.9%) with G3-EAC at FIGO stage I-II (early stage) disease. The recurrence rate was higher in patients with UCS than in those with G3-EAC (17.4 vs. 9.2%, p = 0.02). The 5-year disease-free survival (DFS; 75.2 and 80.8%, respectively; p = 0.03) and overall survival (OS; 79.4 and 83.4%, respectively; p = 0.04) rates were significantly lower in the UCS group compared to the G3-EAC group. UCS histology was an independent prognostic factor for decreased 5-year DFS (HR 1.8, 95% CI 1.2-3.2; p = 0.034) and OS (HR 2.7, 95% CI 1.3-6.9; p = 0.041) rates. CONCLUSIONS The recurrence rate was higher in UCS patients than in G3-EAC patients, regardless of disease stage. DFS and OS were of shorter duration in UCS than in G3-EAC patients. Adequate systematic lymphadenectomy and omentectomy were an independent prognostic factor for increased 5-year DFS and OS rates.
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Affiliation(s)
- Kemal Güngördük
- Department of Gynecologic Oncology, Mugla Sıtkı Kocman University Education and Research Hospital, Izmir, Turkey
| | - Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Varol Gülseren
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey,
| | - Mutlu Meydanlı
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gökhan Boyraz
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - İsaAykut Özdemir
- Department of Gynecologic Oncology, Dr. Sadi Konuk Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Hanifi Şahin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Taylan Şenol
- Department of Gynecologic Oncology, Zenyep Kamil Women's Health Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Nuri Yıldırım
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Tufan Öge
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Eskişehir Osman Gazi University, Eskişehir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Salih Taşkın
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Beyhan Ataseven
- Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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6
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Grabowski JP, Glajzer J, Richter R, Plett H, Muallem MZ, Braicu EI, Taube E, Sehouli J. Lymphovascular space invasion and Ki67 as predictors of lymph node metastasis in primary low grade serous ovarian cancer. Int J Gynecol Cancer 2020; 31:98-103. [PMID: 33127866 DOI: 10.1136/ijgc-2020-001950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Low grade serous ovarian cancers characterize a unique clinical pattern and likely less frequent incidence of lymphatic metastasis. The expression level of Ki67 is associated with differences in prognosis and therapy outcome. However, its expression in combination with lymphovascular space invasion has not been evaluated in the prediction of lymphatic metastasis. METHODS Patients with low grade serous ovarian cancer were identified in an institutional database. Patients with primary low grade serous ovarian cancer diagnosed and/or treated at our center between September 2000 and December 2018 were identified. Receiver operator characteristics curve analysis was performed to find the cut-off values of per cent Ki67 to discriminate patients with lymph node metastasis. The association between the presence of lymphovascular space invasion and lymph node involvement was analyzed. RESULTS A total of 109 patients with primary low grade serous ovarian cancer were identified in our institution's database. Of these, 72 (66.1%) patients underwent primary surgery with pelvic and para-aortic lymph node dissection. Complete data for Ki67 expression and lymphovascular space invasion were obtained for 61 (84.7%) of these patients. Among them, 37 (60.7%) patients had lymph node metastasis. The presence of lymphovascular space invasion was associated with an increased risk of lymph node metastases (odds ratio (OR)=12.78, 95% confidence interval (CI) 3.15 to 51.81; p<0.001). In multivariate analysis including age >65 years, peritoneal carcinomatosis, and ascites>500 mL, lymphovascular space invasion remained a significant risk factor for lymphatic metastases (OR=35.11, 95% CI 2.38 to 517.69; p=0.010). Ki67 ≥6% was associated with a higher risk of lymphovascular space invasion (OR=3.67, 95% CI 1.26 to 10.64; p=0.017). No significant correlation between Ki67 expression level and nodal metastases was found (OR=2.19, 95% CI 0.76 to 6.26; p=0.14). Neither presence of lymphovascular space invasion or nodal metastases was associated with a statistically poorer prognosis. CONCLUSIONS We showed an association between lymphovascular space invasion, Ki67 expression, and risk of lymph node metastasis in primary low grade ovarian cancer. Further prospective trials evaluating lymphovascular space invasion and Ki-67 as predictors of lymph node metastasis are needed.
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Affiliation(s)
- Jacek P Grabowski
- Department of Gynecology with Center of Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Joanna Glajzer
- Department of Gynecology with Center of Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Rolf Richter
- Department of Gynecology with Center of Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Helmut Plett
- Department of Gynecology with Center of Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Mustafa-Zelal Muallem
- Department of Gynecology with Center of Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Elena Ioana Braicu
- Department of Gynecology with Center of Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Eliane Taube
- Institute of Pathology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, Campus Virchow Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
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7
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Ataseven B, Tripon D, Rhiem K, Harter P, Schneider S, Heitz F, Baert T, Traut A, Pauly N, Ehmann S, Plett H, Schmutzler RK, du Bois A. Prevalence of BRCA1 and BRCA2 Mutations in Patients with Primary Ovarian Cancer - Does the German Checklist for Detecting the Risk of Hereditary Breast and Ovarian Cancer Adequately Depict the Need for Consultation? Geburtshilfe Frauenheilkd 2020; 80:932-940. [PMID: 32905297 PMCID: PMC7467803 DOI: 10.1055/a-1222-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023] Open
Abstract
BackgroundBRCA1/2
mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the
BRCA1/2
mutation(s) based on the checklist score (CLS).
Methods
A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 – 5/2019 at the Central Essen Clinics, where a
BRCA1/2
genetic analysis result and a CLS was available. Out of 545 cases with a
BRCA1/2
result (cohort A), 453 cases additionally had an extended gene panel result (cohort B).
Results
A
BRCA1/2
mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non-
BRCA1/2
genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a
BRCA1
(n = 92) or
BRCA2
(n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a
BRCA1/2
mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively.
Conclusions
The
BRCA1/2
mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a
BRCA1/2
mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.
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Affiliation(s)
- Beyhan Ataseven
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der LMU München, München
| | - Denise Tripon
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinik Köln, Köln
| | - Philipp Harter
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Stephanie Schneider
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Florian Heitz
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité - Universitätsmedizin Berlin, Berlin
| | - Thais Baert
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Abteilung für Onkologie und Tumorimmunologie, KU Leuven, Leuven, Belgien
| | - Alexander Traut
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Nina Pauly
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Sarah Ehmann
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Helmut Plett
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité - Universitätsmedizin Berlin, Berlin
| | - Rita K Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinik Köln, Köln
| | - Andreas du Bois
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
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8
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Hasenburg A, Plett H, Krämer B, Braicu E, Czogalla B, Bossart M, Singer S, Mayr D, Staebler A, du Bois A, Kommoss S, Link T, Burges A, Heitz F, Keul J, Trillsch F, Harter P, Wimberger P, Buderath P, Klar M. 876P The effect of surgical techniques on sexuality and global quality of life (Qol) in women with ovarian germ cell (OGCT) and sex cord stromal tumours (SCST): An analysis of the AGO-CORSETT database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1015] [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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9
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Plett H, Ricciardi E, Harter P, Ataseven B, Heitz F, Prader S, Schneider S, Heikaus S, Fisseler-Eckhoff A, Kommoss F, Lax SF, Staebler A, Traut A, du Bois A. Dataset on patients with Recurrent Borderline Ovarian Tumors and Table with Review of Literature on Fertility and Oncologic Outcomes of patients with Borderline Ovarian Tumors. Data Brief 2020; 30:105653. [PMID: 32395597 PMCID: PMC7206201 DOI: 10.1016/j.dib.2020.105653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
The data presented here is related to the research article entitled "FERTILITY-SPARING SURGERY AND REPRODUCTIVE-OUTCOMES IN PATIENTS WITH BORDERLINE OVARIAN TUMORS" by Plett et al. in Journal of Gynecologic Oncology [1] and is analysed and discussed in detail. 18 Patients with Recurrent Borderline Ovarian Tumors (BOT) were identified and listed in Table 1. All patients underwent treatment for primary BOT either per radical surgery (RS) or fertility sparing surgery (FSS) by the same team in Horst Schmidt Klinik (HSK) in Wiesbaden and the Department of Gynecology and Gynecologic Oncology at Kliniken Essen-Mitte between January 2000 and December 2018 and were followed up closely. Details on patients` and surgical characteristics are given as well as management of character of recurrent disease. In Table 2 important publications from the last 20 years are listed in order to visualize better the oncologic outcomes (invasive and non-invasive relapses) and calculated risks of recurrence with the purpose to understand better the important findings of the related article cited above.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Enzo Ricciardi
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Sigurd F. Lax
- Department of Pathology, LKH Graz II, Graz and Johannes Kepler University, Linz, Austria
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University of Tuebingen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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10
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Plett H, Harter P, Ataseven B, Heitz F, Prader S, Schneider S, Heikaus S, Fisseler-Eckhoff A, Kommoss F, Lax SF, Staebler A, Traut A, du Bois A. Fertility-sparing surgery and reproductive-outcomes in patients with borderline ovarian tumors. Gynecol Oncol 2020; 157:411-417. [PMID: 32115229 DOI: 10.1016/j.ygyno.2020.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 11/15/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Borderline ovarian tumors (BOT) are considered a biological category with increased epithelial proliferation and cellular atypia in the absence of invasive growth. Since BOT occur often in young patients fertility sparing surgery (FSS) is an important issue. With this study we aimed to evaluate risk factors for relapses and fertility of patients after FSS. METHODS Patients diagnosed with BOT and treated between 2000 and 2018 were included. External pathological review was done in all patients. FSS was performed after individual discussion and a complete surgical staging according to FIGO, without lymphadenectomy and with a waiver for preservation of uterus and one ovary. RESULTS Among 352 Patients 80.2% had FIGO I and 63.9% had a serous BOT. Eighteen patients (5.1%) relapsed and 4 cases of malignant transformation were reported (1.1%). One patient of the latter died, all others have no evidence of disease. The overall recurrence-rate was 1.1% in FIGO-Stage I and 25.5% in FIGO III-IV (HR = 27; 95%-CI 7.7-95; p ≤.001). 95 patients underwent FSS. Thirteen (13.7%) of these patients relapsed, all as BOT. In multivariate analysis FIGO stages II-IV (HR = 27; 95%-CI: 8.1-102; p ≤.001) and FSS (HR = 12; 95%-CI: 2.9-47; p = .001) remained significant risk factors for recurrent disease. Pregnancy rate among forty-one patients attempting to conceive was 82.9%. 29 patients experienced at least one life-birth, in total 38 life-births were reported. CONCLUSION FSS in stage I is a safe procedure and life-birth-rates after FSS are high. More advanced FIGO stages have to be discussed individually and relapse rates have to be weighed against FSS. A central review of pathology, as we performed routinely, is mandatory and may have contributed to our low rate of invasive relapses.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Charité University Hospital, Berlin, Germany.
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Charité University Hospital, Berlin, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Sigurd F Lax
- Department of Pathology, LKH Graz II, Graz and Johannes Kepler University, Linz, Austria
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University of Tuebingen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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11
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Grabowski JP, Martinez Vila C, Richter R, Taube E, Plett H, Braicu E, Sehouli J. Ki67 expression as a predictor of chemotherapy outcome in low-grade serous ovarian cancer. Int J Gynecol Cancer 2020; 30:498-503. [PMID: 31996397 DOI: 10.1136/ijgc-2019-000976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Low-grade serous ovarian cancers characterize a unique clinical pattern and lower chemotherapy responsiveness. The expression level of Ki67 is associated with differences in prognosis; however, this has not yet been evaluated in regard to predicting the outcome of therapy. METHODS Patients with low-grade serous ovarian cancers were identified in an institutional database. Receiver-operator characteristics (ROC) curve analysis was performed to find cut-off values of Ki67 to discriminate patients with residual tumor mass after surgery from maximal debulked patients: therapy response and therapy-free interval (TFI). RESULTS A total of 68 patients with low-grade serous ovarian cancer were identified. All patients underwent surgery. 61 (89.7%) patients received platinum-based first-line chemotherapy; of these 61 patients, 13 (21.3%) had residual mass (>0 mm) after primary cytoreduction and 11 (18%) received neo-adjuvant chemotherapy. Ki67 ≥3.6% was associated with higher risk of residual mass after surgery (OR 8.1, 95% CI 1.45 to 45.18; p=0.017). Patients with Ki67 <3.6% showed a therapy-free interval of ≥6 months more often (OR 13.9, 95% CI 1.62 to 118.40; p=0.016). In the multivariate analysis of TFI <6 months, including CA125, age at diagnosis, peritoneal carcinomatosis, and ascites, Ki67 <3.6% remained a significant prognostic factor (OR 18.8, 95% CI 1.77 to 199.09; p=0.015). Chemotherapy responsiveness was evaluated in 21 patients who had residual disease and/or received neo-adjuvant chemotherapy. Ki67 ≥4.0% (OR 44.1, 95%CI 2.36-825.17, p = 0.011) was related to a significantly higher response rate (complete and partial response). CONCLUSIONS This is the first study to show an association between Ki67 expression and chemotherapy response, duration of TFI to platinum-based chemotherapy as well as outcome of surgery in low-grade serous ovarian cancers. Further prospective trials should use Ki-67 as a stratification factor to explore the effect of chemotherapy and endocrine strategies.
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Affiliation(s)
- Jacek P Grabowski
- Department of Gynecology with Center of Oncological Surgery, Virchow Campus Clinic, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Clara Martinez Vila
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Rolf Richter
- Department of Gynecology with Center of Oncological Surgery, Virchow Campus Clinic, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Eliane Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Helmut Plett
- Department of Gynecology with Center of Oncological Surgery, Virchow Campus Clinic, Charite Universitatsmedizin Berlin, Berlin, Germany.,Department of Gynecology and Gynecologic Oncology, Kliniken-Essen-Mitte, Essen, Germany
| | - Elena Braicu
- Department of Gynecology with Center of Oncological Surgery, Virchow Campus Clinic, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center of Oncological Surgery, Virchow Campus Clinic, Charite Universitatsmedizin Berlin, Berlin, Germany
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12
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Ricciardi E, Plett H, Sangiorgio V, Paderno M, Landoni F, Aletti G, Prader S, du Bois A, Harter P, Colombo N. Adult primary cervical rhabdomyosarcomas: A Multicentric cross-national case series. Int J Gynecol Cancer 2019; 30:21-28. [PMID: 31780571 DOI: 10.1136/ijgc-2019-000821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/04/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Adult primary cervical rhabdomyosarcoma is a very rare disease and data regarding treatment are sparce. The goal of this study was to report on our experience with the management of this rare entity, along with an evaluation of the literature. METHODS We conducted a review of the medical records at four centers from January 1990 to December 2017. We reviewed clinical characteristics including age at diagnosis, BMI, medical history and tumor stage, as well as treatment in the primary and recurrent settings and follow-up data. We reclassified tumors according to the Intergroup Rhabdomyosarcoma Study (IRS) clinical group. RESULTS A total of 15 patients were included in the analysis. Median age at diagnosis was 35 years (range 17-55). Median tumor size at presentation was 5 cm (range 3-10). Eleven patients had the embryonal variant, including five showing the botryoid subtype. Four patients had a pleomorphic rhabdomyosarcoma. Eleven patients had disease classified as IRS Clinical Group I, while the remaining four fell into groups II or III. Fertility-sparing treatment was offered to five patients. Primary treatment types were: surgery alone in eight patients, surgery followed by adjuvant chemotherapy in six patients, and neoadjuvant chemotherapy in two patients. The main risk factors for relapse were: IRS clinical group greater than I, tumor size greater than 5 cm, lymph nodal involvement, and non-embryonal histology. At a median follow-up of 35 months (range 3-282), we observed a 5-year overall survival rate of 78.2% and a progression-free survival of 58.2%. No patient in the IRS I group died of the disease. Three out of four patients in the IRS II-III group died of the disease (survival range 5-16 months following treatment). CONCLUSION Our data show that cervical rhabdomyosarcomas account for at least two prognostic groups, demonstrating the existence of low-risk and high-risk patterns. The best predictor of prognosis appearsd to be the IRS clinical group classification system. IRS Group I tumors had an overall good prognosis and rarely recurred; when they did recur they were mainly local, following conservative treatment.
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Affiliation(s)
- Enzo Ricciardi
- Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Helmut Plett
- Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany.,Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Valentina Sangiorgio
- Pathology, Istituto Europeo di Oncologia, Milano, Lombardia, Italy.,Pathology, The Royal London Hospital, London, UK
| | | | - Fabio Landoni
- Gynecology, University of Milan-Bicocca, Monza, Lombardia, Italy
| | - Giovanni Aletti
- Gynecology, Istituto Europeo di Oncologia, Milano, Italy.,Universita degli Studi di Milano, Milano, Lombardia, Italy
| | - Sonia Prader
- Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Andreas du Bois
- Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Philipp Harter
- Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Nicoletta Colombo
- Universita degli Studi di Milano, Milano, Lombardia, Italy.,Medical Gynecologic Oncology Unit; University of Milan Bicocca; Milan; Italy, European Institute of Oncology, Milano, Italy
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13
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Plett H, Harter P, Prader S, Ataseven B, Heitz F, Bommert M, Schneider S, Alesina PF, Traut A, du Bois A. Role of primary surgery for persistent residual disease after more than 5 cycles of chemotherapy for primary advanced ovarian cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671315] [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)
- H Plett
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - P Harter
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - S Prader
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - B Ataseven
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - F Heitz
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - M Bommert
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - S Schneider
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - PF Alesina
- Kliniken-Essen-Mitte, Chirurgie, Essen, Deutschland
| | - A Traut
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
| | - A du Bois
- Kliniken-Essen-Mitte, Gynäkologische Onkologie, Essen, Deutschland
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14
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Harter P, Plett H, Prader S, Ataseven B, Heitz F, Bommert M, Schneider S, Alesina P, Traut A, Du Bois A. Role of primary surgery for persistent residual disease after more than 5 cycles of chemotherapy for primary advanced ovarian cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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
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15
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Sehouli J, Plett H, Richter R, Denkert C, Darb-Esfahani S, Chekerov R, Schmitt WD, Grabowski J, Taube ET, Braicu EI. Ki67 as a prognostic factor in low grade serous ovarian cancer (LGSOC): A retrospective analysis of the Tumor Bank Ovarian Cancer (TOC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
5562 Background: LGSOC is a rare and distinct entity characterized by younger age, lower response to chemotherapy and better clinical outcome. Aim of this study was to evaluate the impact of Ki67, estrogen and progesterone receptors (ER and PR) on platinum response and survival in primary LGSOC patients. Methods: 80 primary LGSOC patients with available FFPEs were identified within TOC. The histology was confirmed at a second histological evaluation. For Ki67 analysis conventional immunohistochemical staining was performed with the Mib-1 clone on Ventana. Slides were explored with a light microscope camera. A representative field for Ki-67 evaluation was selected, in case of heterogeneous staining a hot spot was chosen. The software classified detected cells into non-tumor, negative and positive cells. When necessary, a correction of tumor and non-tumor areas was performed by an experienced pathologist. The counted cells ranged between 175 and 2398. Overall the method allows a precise, continuous and standardized means to quantify Ki-67. ER and PR status was determined on scanned IHC TMA slides. ER and PR positive tumors were defined if the percentage of stained tumor cells was at least 10%. Statistical analysis was performed using IBM SPSS Statistics. Results: Median age at diagnosis was 56 years (range: 20-81), 81.3% of patients presented in advanced stage and 96.3% received platinum based chemotherapy. Ki67 median value was 5.09 (IQR: 1.56-10.5). 93.1% and 47.9% of the patients showed ER and PR positive tumors, respectively. Median overall survival (OS) was 45.5 months (range: 0.1-182.8). Our analysis showed that platinum free interval (PFI) was significant longer in patients with lower Ki67 (p = 0.006). Higher proliferation rates were significant associated with poorer progression free (p = 0.011, HR = 1.039, 95%CI: 1.009-1.070) and OS rates (p = 0.001, HR = 1.059, 95%CI: 1.025-1.095). No differences in clinical outcome were seen in patients with different ER and PR status. Conclusions: This is the first study showing that higher Ki67 values correlate with shorter PFI and poorer survival rates in LGSOC, underlying the heterogeneous character of this disease.
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Affiliation(s)
- Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Helmut Plett
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Rolf Richter
- Department of Gynecological Oncology, Berlin, Germany
| | - Carsten Denkert
- Charité Universitätsmedizin Berlin - Institut für Pathologie, Berlin, Germany
| | | | - Radoslav Chekerov
- NOGGO and Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Elena Ioana Braicu
- Charité Universitätsmedizin Berlin, Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité Campus Virchow-Klinikum, Berlin, Germany
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16
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Muallem MZ, Almuheimid J, Braicu EI, Plett H, Richter R, Osman S, Sehouli J. Oberbauchchirurgie beim Ovarialkarzinom (Zwerchfellresektion im Fokus). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592691] [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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Nasser S, Almuheimid J, Plett H, Sehouli J, Muallem MZ. Feasibility and Safety of Laparoscopic Total Mesometrial Resection in Early-stage Cervical Cancer. Anticancer Res 2016; 36:4903-7. [PMID: 27630347 DOI: 10.21873/anticanres.11055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022]
Abstract
AIM In this study we aimed to analyze the safety and feasibility of total mesometrial resection (TMMR) using the laparoscopic approach. PATIENTS AND METHODS Laparoscopic TMMR and pelvic lymphadenectomy (LNE) was carried out in 34 patients with cervical cancer FIGO IA-IIB from April 2012-April 2016 at our tertiary center. Para-aortic LNE was performed when indicated. The main outcomes included surgical margins, a number of retrieved lymph node, intra- and post-operative complications, and recurrence rates. RESULTS Complete microscopic tumor resection was confirmed in 33/34 (97%) patients. No conversion to open surgery was necessary. Mean intra-operative blood loss was only 65.2 ml with no blood transfusions required. Intra-operative complications occurred in 4/34 (11.8%) cases (2 bladder injuries and 2 ureteric injuries). Post-operative complications were observed in 10/35 (29.4%) cases. Only one complication occurred after 30 days (vesico-vaginal fistula). There was a loco-regional recurrence within a mean follow-up time of 25.9 months. CONCLUSION Laparoscopic TMMR appears to be feasible and safe in the treatment of early-stage cervical cancer. Further large-scale studies are required.
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Affiliation(s)
- Sara Nasser
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Jumana Almuheimid
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Helmut Plett
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Mustafa Zelal Muallem
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
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Muallem MZ, Sehouli J, Almuheimid J, Richter R, Joukhadar R, Plett H. Risk Factors of Lymph Nodes Metastases by Endometrial Cancer: A Retrospective One-center Study. Anticancer Res 2016; 36:4219-4225. [PMID: 27466535] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM We aimed to identify the surgical-pathological risk factors separately for pelvic and para-aortic lymph nodes (LN) metastases in endometrial cancer (EC). PATIENTS AND METHODS The study cohort consisted of 179 patients with first diagnosis of EC, who were operated in our Institution between 2007 and 2014. RESULTS Pelvic and para-aortic LN dissection was performed in 115 patients (64.2%). The positive pelvic and para-aortic LN were diagnosed in 11.3% and 16.1% of cases, respectively. Patients with bad differentiated tumors (G3) showed about 5-times more risk to have affected LN. Deep infiltration of myometrium elevated the risk of pelvic LN infiltration 5 times and of para-aortic LN infiltration 14 times. G3, myometrial infiltration >50% and type II endometrial cancer correlated with a worse progression free survival (PFS) and overall survival (OS). CONCLUSION Tumor grade and deep myometrial invasion were the only significant predictors of pelvic and para-aortic lymph node metastases.
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Affiliation(s)
- Mustafa Zelal Muallem
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Jumana Almuheimid
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Rolf Richter
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
| | - Ralf Joukhadar
- Department for Obstetrics and Gynaecology, Julius-Maximilians-University Würzburg, School of Medicine, Würzburg, Germany
| | - Helmut Plett
- Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany
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Plett H. [The law and medicine--from the viewpoint of the district attorney's office]. Med Welt 1982; 33:1270-3. [PMID: 7132681] [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: 01/23/2023]
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