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Wanka G, Jueckstock J, Wild CM, Vattai A, Fürst S, Heidegger HH, Kuhn C, Schmoeckel E, Jeschke U, Dannecker C. MTA1 as negative prognostic marker in vulvar carcinoma. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04579-4. [PMID: 36689059 PMCID: PMC10356867 DOI: 10.1007/s00432-023-04579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE Vulvar cancer is the fourth most common malignancy of the female genital tract after endometrial, ovarian, and cervical carcinoma and affects mainly elderly women. In 2020 there were registered more than 17,000 deaths worldwide related to vulvar carcinoma. Data about target-based therapies and predictive biomarkers for vulva carcinomas are rare so far. The metastasis-associated gene MTA1 is a transcriptional repressor with a potential effect on cancer. Expression of MTA1 was found to be significantly enhanced in gynecological malignancies as breast or ovarian cancer tissues with advanced cancer stages and higher FIGO grading, indicating an important role of MTA1 in the progression of those tumor entities. Due to the lack of information around MTA1 and its significance regarding vulvar carcinoma, this study focuses on the expression of MTA1 in vulvar carcinoma and its correlation to clinicopathological characteristics and prognosis. METHODS A total of 157 paraffin-embedded vulvar cancer tissues were immunohistochemically stained and examined for MTA1 expression by using the immunoreactive score. Subsequently, the values were correlated with clinicopathological parameters. RESULTS MTA1 was found to be expressed in 94% of the patients in the cytoplasm and 91% in the nucleus. Cytoplasmatic expression of MTA1 was significantly increased in non-keratinizing squamous cell carcinoma and in vulvar carcinoma of the condylomatous type, compared to keratinizing squamous cell carcinoma and vulvar carcinoma of the verrucous type. High MTA1 expression in the nucleus was associated with advanced tumor size as well as higher FIGO grading. In addition, p16 negative vulvar carcinomas showed a higher nuclear expression of MTA1 compared to p16 positive vulvar carcinomas. Suprisingly, Kaplan-Meier analysis showed a significantly lower disease-free survival in tumor samples without a nuclear expression of MTA1. CONCLUSIONS MTA1 was identified as a negative prognostic marker for vulvar carcinoma associated with advanced tumor stage and FIGO grading. A possible explanation could be that the antibody used for this study does not bind to a possible mutation in the C terminal region of MTA leading to negative immunohistochemical staining and this can be correlated with early recurrence in patients with vulvar carcinoma.
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Affiliation(s)
- Giulia Wanka
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,Department of Obstetrics and Gynecology, RoMed Clinic, Krankenhausstraße 2, 83512, Wasserburg am Inn, Germany
| | - Carl Mathis Wild
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Aurelia Vattai
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Sophie Fürst
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Helene H Heidegger
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christina Kuhn
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Elisa Schmoeckel
- Department of Pathology, LMU Munich, Thalkirchner Straße 142, 80337, Munich, Germany
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany. .,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Christian Dannecker
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Woelber L, Bommert M, Harter P, Prieske K, Zu Eulenburg C, Jueckstock J, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann K, Beckmann M, Mustea A, Meier W, Mahner S, Jaeger A. Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study. Ann Surg Oncol 2021; 28:6696-6704. [PMID: 33723714 PMCID: PMC8460538 DOI: 10.1245/s10434-021-09744-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/04/2021] [Indexed: 12/23/2022]
Abstract
Background As the population at risk for pelvic nodal involvement remains poorly described, the role of pelvic lymphadenectomy (LAE) in vulvar squamous cell cancer (VSCC) has been a matter of discussion for decades. Methods In the AGO-CaRE-1 study, 1618 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or higher primary VSCC treated at 29 centers in Germany between 1998 and 2008 were documented. In this analysis, only patients with pelvic LAE (n = 70) were analyzed with regard to prognosis and correlation between inguinal and pelvic lymph node involvement. Results The majority of patients had T1b/T2 tumors (n = 47; 67.1%), with a median diameter of 40 mm (2–240 mm); 54/70 patients (77.1%) who received pelvic LAE had positive groin nodes. For 42 of these 54 patients, the number of affected groin nodes had been documented as a median of 3; 14/42 (33.3%) of these patients had histologically confirmed pelvic nodal metastases (median number of affected pelvic nodes 3 [1–12]). In these 14 patients, the median number of affected groin nodes was 7 (1–30), with a groin metastases median maximum diameter of 42.5 mm (12–50). Receiver operating characteristic analysis showed an area under the curve of 0.85, with 83.3% sensitivity and 92.6% specificity for the prediction of pelvic involvement in cases of six or more positive groin nodes. No cases of pelvic nodal involvement without groin metastases were observed. Prognosis in cases of pelvic metastasis was poor, with a median progression-free survival of only 12.5 months. Conclusion For the majority of node-positive patients with VSCC, pelvic nodal staging appears unnecessary since a relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, LMU - University of Munich, Munich, Germany
| | - Felix Hilpert
- Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Nikolaus de Gregorio
- Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany
| | - Severine Iborra
- Department of Gynecology and Gynecologic Oncology, University Hospital Aachen, RWTH Aachen, Aachen, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Sophie Fuerst
- Department of Obstetrics and Gynecology, University Hospital, LMU - University of Munich, Munich, Germany
| | | | - Klaus Baumann
- Department of Gynecology, Medical Center Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, Bonn, Germany
| | - Werner Meier
- Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU - University of Munich, Munich, Germany
| | - Anna Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Wanka G, Schmoeckel E, Mayr D, Fuerst S, Kuhn C, Mahner S, Knabl J, Karsten MM, Dannecker C, Heidegger HH, Vattai A, Jeschke U, Jueckstock J. LDOC1 as Negative Prognostic Marker for Vulvar Cancer Patients. Int J Mol Sci 2020; 21:ijms21239287. [PMID: 33291445 PMCID: PMC7730493 DOI: 10.3390/ijms21239287] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
So far, studies about targeted therapies and predictive biomarkers for vulva carcinomas are rare. The leucine zipper downregulated in cancer 1 gene (LDOC1) has been identified in various carcinomas as a tumor-relevant protein influencing patients' survival and prognosis. Due to the lack of information about LDOC1 and its exact functionality, this study focuses on the expression of LDOC1 in vulvar carcinoma cells and its surrounding immune cells as well as its correlation to clinicopathological characteristics and prognosis. Additionally, a possible regulation of LDOC1 in vulvar cancer cell lines via the NF-κB signaling pathway was analyzed. Vulvar carcinoma sections of 157 patients were immunohistochemically stained and examined regarding LDOC1 expression by using the immunoreactive score (IRS). To characterize LDOC1-positively stained immune cell subpopulations, immunofluorescence double staining was performed. The effect of the NF-κB inhibitor C-DIM 12 (3,3'-[(4-chlorophenyl)methylene]bis[1 H-indole]) on vulvar cancer cell lines A431 and SW 954 was measured according to MTT and BrdU assays. Baseline expression levels of LDOC1 in the vulvar cancer cell lines A431 and SW 954 was analyzed by real-time PCR. LDOC1 was expressed by about 90% of the cancer cells in the cytoplasm and about half of the cells in the nucleus. Cytoplasmatic expression of LDOC1 was associated with decreased ten-year overall survival of the patient, whereas nuclear staining showed a negative association with disease-free survival. Infiltrating immune cells were mainly macrophages followed by regulatory T cells. Incubation with C-DIM 12 decreased the cell viability and proliferation of vulvar cancer cell line A431, but not of cell line SW 954. LDOC1 expression on mRNA level was twice as high in the cell line A431 compared to the cell line SW 954. Overexpression of LDOC1 was associated with unfavorable overall and disease-free survival. Tumor growth could be inhibited by C-DIM 12 in vitro if the expressed LDOC1 level was high enough.
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Affiliation(s)
- Giulia Wanka
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Elisa Schmoeckel
- Department of Pathology, LMU Munich, Thalkirchner Str. 142, 80337 Munich, Germany; (E.S.); (D.M.)
| | - Doris Mayr
- Department of Pathology, LMU Munich, Thalkirchner Str. 142, 80337 Munich, Germany; (E.S.); (D.M.)
| | - Sophie Fuerst
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Christina Kuhn
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Julia Knabl
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
- Department of Obstetrics, Klinik Hallerwiese, Sankt-Johannis-Mühlgasse 19, 90419 Nürnberg, Germany
| | - Maria Margarete Karsten
- Department of Gynecology and Gynecologic Oncology, Charité University, Charitéplatz 1, 10117 Berlin, Germany;
| | - Christian Dannecker
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglin Street 2, 86156 Augsburg, Germany;
| | - Helene H. Heidegger
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Aurelia Vattai
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
- Department of Obstetrics and Gynecology, University Hospital Augsburg, Stenglin Street 2, 86156 Augsburg, Germany;
- Correspondence: ; Tel.: +49-821-400-165505
| | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany; (G.W.); (S.F.); (C.K.); (S.M.); (J.K.); (H.H.H.); (A.V.); (J.J.)
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Woelber L, Bommert M, Prieske K, Fischer I, zu Eulenburg C, Vettorazzi E, Harter P, Jueckstock J, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann K, Beckmann M, Mustea A, Meier W, Wimberger P, Hanker L, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Mahner S, Schmalfeldt B, Jaeger A. Pelvic Lymphadenectomy in Vulvar Cancer - Does it make sense? Geburtshilfe Frauenheilkd 2020; 80:1221-1228. [PMID: 33293730 PMCID: PMC7714620 DOI: 10.1055/a-1120-0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/12/2020] [Indexed: 01/18/2023] Open
Abstract
Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 - 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 - 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 - 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inger Fischer
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
| | - Julia Jueckstock
- Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
| | - Felix Hilpert
- Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Niko de Gregorio
- Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany
| | - Severine Iborra
- Gynecology and Gynecologic Oncology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Sophie Fuerst
- Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
| | | | - Klaus Baumann
- Department of Gynecology, Medical Center Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, Bonn, Germany
| | - Werner Meier
- Department of Obstetrics and Gynecology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Lars Hanker
- Department of Gynecology and Gynecologic Oncology, University Medical Center Lübeck, Lübeck, Germany
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alexander Luyten
- Department of Gynecology and Obstetrics, Medical Center Wolfsburg, Wolfsburg, Germany
| | - Martin Hellriegel
- Department of Gynecology and Gynecologic Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Kosse
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany
| | - Christoph Heiss
- Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert, Göppingen, Germany
| | - Peer Hantschmann
- Department of Gynecology and Obstetrics, Medical Center Altötting, Altötting, Germany
| | - Peter Mallmann
- Department of Gynecology and Gynecologic Oncology, University Medical Center Köln, Köln, Germany
| | - Berno Tanner
- Department of Gynecology and Obstetrics, Medical Center Oranienburg, Oranienburg, Germany
| | | | - Sven Mahner
- Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Woelber L, Bommert M, Harter P, Prieske K, zu Eulenburg C, Jueckstock J, Hilpert F, de Gregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann K, Thiel F, Mustea A, Meier W, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Mahner S, Jaeger A. Role of pelvic lymph node resection in vulvar cancer – a subset analysis of the AGO-CaRE-1 study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
| | | | | | - K Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
| | - C zu Eulenburg
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf
| | - J Jueckstock
- Department of Gynecology and Obstetrics, University of Munich
| | - F Hilpert
- Oncologic Medical Center at the Jerusalem Hospital Hamburg
| | - N de Gregorio
- Department of Obstetrics and Gynecology, University of Ulm Medical Center
| | - S Iborra
- Gynecology and Gynecologic Oncology, University Hospital Freiburg
| | - J Sehouli
- Department of Gynecology, Charité University Medicine Berlin, Campus Virchow
| | - A Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg
| | - P Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School
| | - S Fuerst
- Department of Gynecology and Obstetrics, University of Munich
| | - HG Strauss
- Department of Gynecology, University Hospital Halle
| | - K Baumann
- Department of Gynecology, Medical Center Ludwigshafen
| | - F Thiel
- Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert
| | - A Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn
| | - W Meier
- Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf
| | - P Wimberger
- Department of Gynecology and Gynecologic Oncology, Technical University Medical Center Dresden
| | - L Hanker
- Department of Gynecology and Gynecologic Oncology, University Medical Center Luebeck
| | - B Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
| | - U Canzler
- Department of Gynecology and Gynecologic Oncology, Technical University Medical Center Dresden
| | - T Fehm
- Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf
| | - A Luyten
- Department of Gynecology and Obstetrics, Medical Center Wolfsburg
| | - M Hellriegel
- Department of Gynecology and Gynecologic Oncology, University Medical Center Goettingen
| | - J Kosse
- Department of Gynecology and Obstetrics, Medical Center Offenbach
| | - C Heiss
- Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert
| | - P Hantschmann
- Department of Gynecology and Obstetrics, Medical Center Altoetting
| | - P Mallmann
- Department of Gynecology and Gynecologic Oncology, University Medical Center Koeln
| | - B Tanner
- Department of Gynecology and Obstetrics, Medical Center Oranienburg
| | - J Pfisterer
- Department of Gynecology and Gynecologic Oncology, University Medical Center Kiel
| | - S Mahner
- Department of Gynecology and Obstetrics, University of Munich
| | - A Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf
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6
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Burgmann M, Jueckstock J, Hoehn H, Reichenbach J, Docheva V, Hasbargen U, Mahner S, Trillsch F. Rezidivierte Ovarialtorsion in graviditate. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Burgmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | - J Jueckstock
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | - H Hoehn
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | - J Reichenbach
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | - V Docheva
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | - U Hasbargen
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | - S Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
| | - F Trillsch
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München
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Jueckstock J, Fuerst S, Bommert M, Harter P, Prieske K, Eulenburg C, Hilpert F, deGregorio N, Iborra S, Sehouli J, Ignatov A, Hillemanns P, Jaeger A, Strauss HG, Baumann K, Thiel F, Mustea A, Meier W, Wimberger P, Hanker L, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Woelber L, Mahner S. Bedeutung der pelvinen Lymphonodektomie beim Plattenepithelkarzinom der Vulva (VSCC) – Subgruppenanalyse der AGO-CaRE-1 Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Jueckstock
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München
| | - S Fuerst
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München
| | - M Bommert
- Klinik für Gynäkologie & Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - P Harter
- Klinik für Gynäkologie & Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - K Prieske
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - C Eulenburg
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - F Hilpert
- Onkologisches Kompetenzzentrum, Krankenhaus Jerusalem, Hamburg
| | - N deGregorio
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm
| | - S Iborra
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen
| | - J Sehouli
- Klinik für Gynäkologie, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin
| | - A Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Magdeburg
| | - P Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover
| | - A Jaeger
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H-G Strauss
- Universitätsklinik und Poliklinik für Gynäkologie, Halle
| | - K Baumann
- Frauenklinik am Klinikum Ludwigshafen
| | - F Thiel
- Frauenklinik mit Gynäkologie und Geburtshilfe, Alb Fils Kliniken, Klinik am Eichert, Göppingen
| | - A Mustea
- Zentrum für Geburtshilfe und Frauenheilkunde, Universitätsklinikum Bonn
| | - W Meier
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf
| | - P Wimberger
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Technische Universität Dresden
| | - L Hanker
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - B Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - U Canzler
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Technische Universität Dresden
| | - T Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf
| | - A Luyten
- Frauenklinik, Klinikum Wolfsburg
| | - M Hellriegel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen
| | - J Kosse
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach
| | - C Heiss
- Frauenklinik mit Gynäkologie und Geburtshilfe, Alb Fils Kliniken, Klinik am Eichert, Göppingen
| | - P Hantschmann
- Klinik für Gynäkologie und Geburtshilfe, Kreiskliniken Altötting-Burghausen, Altötting
| | - P Mallmann
- Klinik für Frauenheilkunde und Geburtshilfe, Uniklinik Köln
| | - B Tanner
- Klinik für Gynäkologie und Geburtshilfe, Oberhavel Klinik Oranienburg
| | | | - L Woelber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - S Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München
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Hartkopf AD, Brucker SY, Taran FA, Harbeck N, von Au A, Naume B, Pierga JY, Hoffmann O, Beckmann MW, Rydén L, Fehm T, Aft R, Montserrat S, Walter V, Rack B, Schuetz F, Borgen E, Ta MH, Bittner AK, Fasching P, Fernö M, Krawczyk N, Weilbaecher K, Margelí M, Hahn M, Jueckstock J, Domschke C, Bidard FC, Kasimir-Bauer S, Schoenfisch B, Kurt AG, Wallwiener M, Gebauer G, Wallwiener D, Janni W, Pantel K. Abstract GS5-07: International pooled analysis of the prognostic impact of disseminated tumor cells from the bone marrow in early breast cancer: Results from the PADDY study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
As early breast cancer might relapse even after complete removal of breast and lymphnodes, the disease must persist in secondary sites. The detection of disseminated tumor cells (DTC) in the bone marrow (BM) has been described as a surrogate of residual disease. Various trials showed an impaired prognosis of DTC positive early breast cancer (EBC) patients. The PADDY (Pooled Analysis of DTC Detection in Early Breast Cancer) study is a large international pooled analysis that aimed to assess the prognostic impact of DTC detection in patients with EBC.
Methods
A pre-specified protocol was followed, and centers known to practice BM sampling for DTC detection were contacted for individual patient data. Patients with EBC, with available follow-up data and BM sampling before any anti-cancer treatment were eligible. BM aspirates were collected at the time of primary surgery. DTC were identified by antibody (A45-B/B3, AE1/AE3, 2E11 and E29) staining against cytokeratin. The DTC status was compared to other prognostic factors using the chi-squared test. Univariate log-rank test and multivariate cox regression were used to compare survival of DTC positive versus DTC negative patients.
Results
Individual data from 10,320 patients (11 centers from Europe and USA) were included with a median follow-up of 91 months. Of all patients, 2,823 (27.4 %) were DTC positive. DTC detection was associated with higher tumor grade, higher T stage, nodal positivity, ER and PR negativity, and HER2 positivity (all p<0.001). In univariate analyses, overall, breast cancer specific, disease-free and distant disease-free survival (OS, BCSS, DFS, DDFS) were significantly shorter in DTC positive patients with p-values of <0.001. Multivariate analyses showed the DTC status to be an independent prognostic marker for OS, BCSS, DFS and DDFS with hazard ratios (HR) and 95%-confidence intervals (CI) of 1.23 (95%-CI: 1.06-1.42, p=0.007), 1.38 (95%-CI: 1.11-1.72, p=0.004), 1.29 (95%-CI: 1.10-1.50, p=0.001) and 1.32 (95%-CI: 1.10-1.58, p=0.003), respectively.
Conclusions
Detection of DTC in the bone marrow is an independent prognostic marker in patients with non-metastatic breast cancer. Further studies should investigate the impact of DTC on metastatic cancer progression and their role for clinical decision making.
Citation Format: Hartkopf AD, Brucker SY, Taran F-A, Harbeck N, von Au A, Naume B, Pierga J-Y, Hoffmann O, Beckmann MW, Rydén L, Fehm T, Aft R, Montserrat S, Walter V, Rack B, Schuetz F, Borgen E, Ta M-H, Bittner A-K, Fasching P, Fernö M, Krawczyk N, Weilbaecher K, Margelí M, Hahn M, Jueckstock J, Domschke C, Bidard F-C, Kasimir-Bauer S, Schoenfisch B, Kurt AG, Wallwiener M, Gebauer G, Wallwiener D, Janni W, Pantel K. International pooled analysis of the prognostic impact of disseminated tumor cells from the bone marrow in early breast cancer: Results from the PADDY study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS5-07.
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Affiliation(s)
- AD Hartkopf
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - SY Brucker
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-A Taran
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Harbeck
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A von Au
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Naume
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J-Y Pierga
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - O Hoffmann
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - MW Beckmann
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Rydén
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Fehm
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Aft
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Montserrat
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Walter
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Rack
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Schuetz
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Borgen
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M-H Ta
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A-K Bittner
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Fasching
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Fernö
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Krawczyk
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Weilbaecher
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Margelí
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Hahn
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Jueckstock
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Domschke
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F-C Bidard
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Kasimir-Bauer
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Schoenfisch
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - AG Kurt
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Wallwiener
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Gebauer
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Wallwiener
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - W Janni
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Pantel
- University of Tuebingen, Tuebingen, Germany; Breast Center, University of Munich (LMU), Munic, Germany; Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany; Oslo University Hospital - and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Institut Curie, Paris and Saint Cloud, Paris, France; University Hospital of Essen, Essen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Lund University, Lund, Sweden; Duesseldorf University Hospital, Duesseldorf, Germany; Washington University, St. Louis, MO; Hospital Germans Trias I Pujol, Badalona, Spain; Ulm University Hospital, Ulm, Germany; Oslo University Hospital, Oslo, Norway; ICO-Badalona, Medical Oncology Service. B-ARGO, Badalona, Germany; Asklepios Klinik Barmbek and Nord-Heidberg, Hamburg, Spain; Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Knabl J, Vattai A, Ye Y, Jueckstock J, Hutter S, Kainer F, Mahner S, Jeschke U. Role of Placental VDR Expression and Function in Common Late Pregnancy Disorders. Int J Mol Sci 2017; 18:ijms18112340. [PMID: 29113124 PMCID: PMC5713309 DOI: 10.3390/ijms18112340] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 12/14/2022] Open
Abstract
Vitamin D, besides its classical role in bone metabolism, plays a distinct role in multiple pathways of the feto-maternal unit. Calcitriol is the major active ligand of the nuclear vitamin D receptor (VDR). The vitamin D receptor (VDR) is expressed in different uteroplacental parts and exerts a variety of functions in physiologic pregnancy. It regulates decidualisation and implantation, influences hormone secretion and placental immune modulations. This review highlights the role of the vitamin D receptor in physiologic and disturbed pregnancy, as preeclampsia, fetal growth restriction, gestational diabetes and preterm birth. We discuss the existing literature regarding common VDR polymorphisms in these pregnancy disorders.
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Affiliation(s)
- Julia Knabl
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
- Department of Obstetrics and Gynecology, Klinik Hallerwiese, 90419 Nürnberg, Germany.
| | - Aurelia Vattai
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Yao Ye
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Julia Jueckstock
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Stefan Hutter
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Franz Kainer
- Department of Obstetrics and Gynecology, Klinik Hallerwiese, 90419 Nürnberg, Germany.
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians Universität München, 80337 Munich, Germany.
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10
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Woelber L, Griebel LF, Eulenburg C, Sehouli J, Jueckstock J, Hilpert F, de Gregorio N, Hasenburg A, Ignatov A, Hillemanns P, Fuerst S, Strauss HG, Baumann KH, Thiel FC, Mustea A, Meier W, Harter P, Wimberger P, Hanker LC, Schmalfeldt B, Canzler U, Fehm T, Luyten A, Hellriegel M, Kosse J, Heiss C, Hantschmann P, Mallmann P, Tanner B, Pfisterer J, Richter B, Neuser P, Mahner S. Role of tumour-free margin distance for loco-regional control in vulvar cancer-a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study. Eur J Cancer 2016; 69:180-188. [PMID: 27837710 DOI: 10.1016/j.ejca.2016.09.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 07/16/2016] [Revised: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY A tumour-free pathological resection margin of ≥8 mm is considered state-of-the-art. Available evidence is based on heterogeneous cohorts. This study was designed to clarify the relevance of the resection margin for loco-regional control in vulvar cancer. METHODS AGO-CaRE-1 is a large retrospective study. Patients (n = 1618) with vulvar cancer ≥ FIGO stage IB treated at 29 German gynecologic-cancer-centres 1998-2008 were included. This subgroup analysis focuses on solely surgically treated node-negative patients with complete tumour resection (n = 289). RESULTS Of the 289 analysed patients, 141 (48.8%) had pT1b, 140 (48.4%) pT2 and 8 (2.8%) pT3 tumours. One hundred twenty-five (43.3%) underwent complete vulvectomy, 127 (43.9%) partial vulvectomy and 37 (12.8%) radical local excision. The median minimal resection margin was 5 mm (1 mm-33 mm); all patients received groin staging, in 86.5% with full dissection. Median follow-up was 35.1 months. 46 (15.9%) patients developed recurrence, thereof 34 (11.8%) at the vulva, after a median of 18.3 months. Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm. When analysed as a continuous variable, the margin distance had no statistically significant impact on local recurrence (HR per mm increase: 0.930, 95% CI: 0.849-1.020; p = 0.125). Multivariate analyses did also not reveal a significant association between the margin and local recurrence neither when analysed as continuous variable nor categorically based on the 8 mm cutoff. Results were consistent when looking at disease-free-survival and time-to-recurrence at any site (HR per mm increase: 0.949, 95% CI: 0.864-1.041; p = 0.267). CONCLUSIONS The need for a minimal margin of 8 mm could not be confirmed in the large and homogeneous node-negative cohort of the AGO-CaRE database.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Lis-Femke Griebel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Eulenburg
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department for Epidemiology, Medical Statistics and Decision Making, University Medical Center Groningen, Groningen, The Netherlands
| | - Jalid Sehouli
- Department of Gynecology, Charité, University Medicine Berlin, Berlin, Germany
| | - Julia Jueckstock
- Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
| | - Felix Hilpert
- University Medical Center Kiel, Kiel, Germany; Jerusalem Hospital, Hamburg, Germany
| | | | - Annette Hasenburg
- Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Gynecology and Obstetrics, University Hospital Mainz, Mainz, Germany
| | - Atanas Ignatov
- Department of Gynecology, University of Magdeburg, Magdeburg, Germany
| | - Peter Hillemanns
- Department of Gynecology, Hannover Medical School, Hannover, Germany
| | - Sophie Fuerst
- Department of Gynecology, University of Munich (LMU), Munich, Germany
| | | | - Klaus H Baumann
- Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany; Department of Gynecology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany; Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany
| | - Alexander Mustea
- Department of Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - Werner Meier
- Department of Gynecology, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany
| | - Philipp Harter
- Department of Gynecology, Kliniken Essen Mitte, Essen, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - Lars Christian Hanker
- Department of Gynecology, University Hospital Frankfurt, Frankfurt, Germany; Department of Gynecology, UKSH Campus Lübeck, Lübeck, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology, University Hospital Technical University of Munich, Germany
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - Tanja Fehm
- Department of Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany; Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - Alexander Luyten
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Martin Hellriegel
- Department of Gynecology, Georg-August-University Goettingen, Goettingen, Germany
| | - Jens Kosse
- Department of Gynecology, Offenbach Hospital, Offenbach, Germany
| | - Christoph Heiss
- Department of Gynecology, Alb Fils Kliniken, Klinik am Eichert, Goeppingen, Germany
| | - Peer Hantschmann
- Department of Gynecology, Hospital Altoettingen, Altoettignen, Germany
| | - Peter Mallmann
- Department of Gynecology, University Hospital Cologne, Cologne, Germany
| | | | | | | | - Petra Neuser
- KKS Philipps University Marburg, Marburg; Germany
| | - Sven Mahner
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology and Obstetrics, University of Munich, Munich, Germany; Department of Gynecology, University of Munich (LMU), Munich, Germany
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11
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Jueckstock J, Rack B, Friedl TWP, Scholz C, Steidl J, Trapp E, Tesch H, Forstbauer H, Lorenz R, Rezai M, Häberle L, Alunni-Fabbroni M, Schneeweiss A, Beckmann MW, Lichtenegger W, Fasching PA, Pantel K, Janni W. Detection of circulating tumor cells using manually performed immunocytochemistry (MICC) does not correlate with outcome in patients with early breast cancer - Results of the German SUCCESS-A- trial. BMC Cancer 2016; 16:401. [PMID: 27387743 PMCID: PMC4936301 DOI: 10.1186/s12885-016-2454-3] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 06/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Recently, the prognostic significance of circulating tumor cells (CTCs) in primary breast cancer as assessed using the Food-and-Drug-Administration-approved CellSearch® system has been demonstrated. Here, we evaluated the prognostic relevance of CTCs, as determined using manually performed immunocytochemistry (MICC) in peripheral blood at primary diagnosis, in patients from the prospectively randomized multicenter SUCCESS-A trial (EudraCT2005000490-21). Methods We analyzed 23 ml of blood from 1221 patients with node-positive or high risk node-negative breast cancer before adjuvant taxane-based chemotherapy. Cells were separated using a density gradient followed by epithelial cell labeling with the anti-cytokeratin-antibody A45-B/B3, immunohistochemical staining with new fuchsin, and cytospin preparation. All cytospins were screened for CTCs, and the cutoff for positivity was at least one CTC. The prognostic value of CTCs with regard to disease-free survival (DFS), distant disease-free survival (DDFS), breast-cancer-specific survival (BCSS), and overall survival (OS) was assessed using both univariate analyses applying the Kaplan–Meier method and log-rank tests, and using multivariate Cox regressions adjusted for other predictive factors. Results In 20.6 % of all patients (n = 251) a median of 1 (range, 1–256) CTC was detected, while 79.4 % of the patients (n = 970) were negative for CTCs before adjuvant chemotherapy. A pT1 tumor was present in 40.0 % of patients, 4.8 % had G1 grading and 34.6 % were node-negative. There was no association between CTC positivity and tumor stage, nodal status, grading, histological type, hormone receptor status, Her2 status, menopausal status or treatment. Univariate survival analyses based on a median follow-up of 64 months revealed no significant differences between CTC-positive and CTC-negative patients with regard to DFS, DDFS, BCSS, or OS. This was confirmed by fully adjusted multivariate Cox regressions, showing that the presence of CTCs (yes/no) as assessed by MICC did not predict DFS, DDFS, BCSS or OS. Conclusions We could not demonstrate prognostic relevance regarding CTCs that were quantified using the MICC method at the time of primary diagnosis in our cohort of early breast cancer patients. Further studies are necessary to evaluate if the presence of CTCs assessed using MICC has prognostic relevance, or can be used for risk stratification and treatment monitoring in adjuvant breast cancer. Trial registration The ClinicalTrial.gov registration ID of this prospectively randomized trial is NCT02181101; the (retrospective) registration date was June 2014 (study start date September 2005).
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Affiliation(s)
- Julia Jueckstock
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany.
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Christoph Scholz
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Julia Steidl
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany
| | - Elisabeth Trapp
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany
| | | | - Helmut Forstbauer
- Haemotologic-Oncologic Practice Dres, Forstbauer/Ziske, Troisdorf, Germany
| | - Ralf Lorenz
- Oncologic Practice Dres, Lorenz/Hecker/Wesche, Braunschweig, Germany
| | | | - Lothar Häberle
- Department of Gynecology and Obstetrics, University Erlangen, Erlangen, Germany
| | | | | | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Erlangen, Erlangen, Germany
| | | | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Erlangen, Erlangen, Germany
| | - Klaus Pantel
- Institute for Tumor Biology, Hamburg University, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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12
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Jueckstock J, Burkhardt N, Kuhn C, Blankenstein T, Mahner S, Schindlbeck C, Janni W, Rack B, Mylonas I. Expression of Activin During and After Chemotherapy in Peripheral Blood of Patients with Primary Breast Cancer. Anticancer Res 2016; 36:2153-2159. [PMID: 27127117] [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: 02/09/2016] [Accepted: 03/31/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIM Activins are dimeric glycoproteins that play a significant role in reproduction and in endocrine-active tumors. The aim of this study was to evaluate the potential correlation between the concentration of activins (activin A, activin B, and activin AB) in patients receiving adjuvant chemotherapy for breast cancer. PATIENTS AND METHODS The serum concentration of activins in 30 patients receiving chemotherapy within the German SUCCESS A study was analyzed using different enzyme-linked immunosorbent assays at three time points: After primary surgery, but before chemotherapy; 4 weeks after the end of chemotherapy; and 2 years after chemotherapy during recurrence-free follow-up. RESULTS The activin concentration decreased in all patients after chemotherapy. Premenopausal patients had significantly lower concentrations of activin AB during follow-up than postmenopausal women (p=0.037). Thirteen out of 16 premenopausal patients developed chemotherapy-related amenorrhea (CRA) but did not significantly differ in their activin concentrations compared to the other premenopausal women. A positive human epidermal growth factor receptor 2/neu status was associated with a significant reduction of activin AB concentration (p=0.02), and trastuzumab treatment correlated with significantly decreased activin A concentration (p=0.012). CONCLUSION Serial measurements of activin A concentration might be used for monitoring trastuzumab treatment. A sudden increase of activin concentration could be an early indicator of disease recurrence.
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Affiliation(s)
| | - Natalie Burkhardt
- Department of Internal Medicine, Schwarzwald-Baar Klinikum, Donaueschingen, Germany
| | - Christina Kuhn
- Department of Gynaecology and Obstetrics, Munich, Germany
| | | | - Sven Mahner
- Department of Gynaecology and Obstetrics, Munich, Germany
| | | | - Wolfgang Janni
- Department of Obstetrics and Gynaecology, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Gynaecology and Obstetrics, Munich, Germany
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13
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Janni W, Harbeck N, Rack B, Augustin D, Jueckstock J, Wischnik A, Annecke K, Scholz C, Huober J, Zwingers T, Friedl TWP, Kiechle M. Randomised phase III trial of FEC120 vs EC-docetaxel in patients with high-risk node-positive primary breast cancer: final survival analysis of the ADEBAR study. Br J Cancer 2016; 114:863-71. [PMID: 27031854 PMCID: PMC4984804 DOI: 10.1038/bjc.2016.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 03/02/2016] [Accepted: 03/05/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Taxane-containing adjuvant chemotherapy has been established as standard treatment in node-positive breast cancer. This study compared efficacy and tolerability of epirubicin (E)/cyclophosphamide (C) followed by docetaxel (Doc) with a dose-dense 5-fluorouracil (F)+E+ C regimen. METHODS The ADEBAR study was a randomised phase III trial for women with primary invasive breast cancer and ⩾4 metastatic axillary lymph nodes (n=1364). Treatment consisted of four 21-day cycles of E plus C, followed by four 21-day cycles of Doc (EC-Doc), or six 28-day cycles of E plus F plus C (FEC120). RESULTS Disease-free survival (DFS) was similar in the two treatment arms as shown by multivariate Cox regression adjusted for other prognostic factors (EC-Doc vs FEC120, hazard ratio (HR): 1.087; 95% confidence interval (CI): 0.878-1.346, P=0.444). In addition, there was no significant difference in overall survival (OS) between the two groups (HR: 0.974; 95% CI: 0.750-1.264, P=0.841). Haematologic toxicity was more common in FEC120 recipients; non-haematologic toxicities occurred more frequently in the EC-Doc arm. The serious adverse event rate was significantly higher in the FEC120 group (29.7% vs 22.5%). CONCLUSIONS EC-Doc provides a feasible and effective alternative therapy option to FEC120 with a different safety profile in this high-risk breast cancer cohort.
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Affiliation(s)
- W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - N Harbeck
- Department of Gynecology and Obstetrics, Breast Center, Ludwig-Maximilian-University Munich, Marchioninistraße 15, 81377 München, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Maistraße 11, 80337 München, Germany
| | - D Augustin
- Breast Center, Department of Gynecology and Obstetrics, Hospital Deggendorf, Perlasberger Strasse 41, 94469 Deggendorf, Germany
| | - J Jueckstock
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Maistraße 11, 80337 München, Germany
| | - A Wischnik
- Breast Center, Department of Gynecology, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - K Annecke
- Department of Obstetrics and Gynecology, Technical University Clinics Rechts der Isar, Ismaninger Strasse 22, 81675 München, Germany
| | - C Scholz
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - J Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - T Zwingers
- Estimate GmbH, Konrad-Adenauer-Allee 1, 86150 Augsburg, Germany
| | - T W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - M Kiechle
- Department of Obstetrics and Gynecology, Technical University Clinics Rechts der Isar, Ismaninger Strasse 22, 81675 München, Germany
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14
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Widschwendter P, Friedl TW, Schwentner L, DeGregorio N, Jaeger B, Schramm A, Bekes I, Deniz M, Lato K, Weissenbacher T, Kost B, Andergassen U, Jueckstock J, Neugebauer J, Trapp E, Fasching PA, Beckmann MW, Schneeweiss A, Schrader I, Rack B, Janni W, Scholz C. The influence of obesity on survival in early, high-risk breast cancer: results from the randomized SUCCESS A trial. Breast Cancer Res 2015; 17:129. [PMID: 26385214 PMCID: PMC4575482 DOI: 10.1186/s13058-015-0639-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/07/2015] [Indexed: 03/18/2023] Open
Abstract
Introduction Obese breast cancer patients have worse prognosis than normal weight patients, but the level at which obesity is prognostically unfavorable is unclear. Methods This retrospective analysis was performed using data from the SUCCESS A trial, in which 3754 patients with high-risk early breast cancer were randomized to anthracycline- and taxane-based chemotherapy with or without gemcitabine. Patients were classified as underweight/normal weight (body mass index (BMI) < 25.0), overweight (BMI 25.0–29.9), slightly obese (BMI 30.0–34.9), moderately obese (BMI 35.0–39.9) and severely obese (BMI ≥ 40.0), and the effect of BMI on disease-free survival (DFS) and overall survival (OS) was evaluated (median follow-up 65 months). In addition, subgroup analyses were conducted to assess the effect of BMI in luminal A-like, luminal B-like, HER2 (human epidermal growth factor 2)-positive and triple-negative tumors. Results Multivariate analyses revealed an independent prognostic effect of BMI on DFS (p = 0.001) and OS (p = 0.005). Compared with underweight/normal weight patients, severely obese patients had worse DFS (hazard ratio (HR) 2.70, 95 % confidence interval (CI) 1.71–4.28, p < 0.001) and OS (HR 2.79, 95 % CI 1.63–4.77, p < 0.001), while moderately obese, slightly obese and overweight patients did not differ from underweight/normal weight patients with regard to DFS or OS. Subgroup analyses showed a similar significant effect of BMI on DFS and OS in patients with triple-negative breast cancer (TNBC), but not in patients with other tumor subtypes. Conclusions Severe obesity (BMI ≥ 40) significantly worsens prognosis in early breast cancer patients, particularly for triple-negative tumors. Trial registration Clinicaltrials.gov NCT02181101. Registered September 2005.
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Affiliation(s)
- Peter Widschwendter
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Thomas Wp Friedl
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Nikolaus DeGregorio
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Bernadette Jaeger
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Amelie Schramm
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Inga Bekes
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Miriam Deniz
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Krisztian Lato
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Tobias Weissenbacher
- Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany.
| | - Bernd Kost
- Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany.
| | - Ulrich Andergassen
- Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany.
| | - Julia Jueckstock
- Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany.
| | - Julia Neugebauer
- Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany.
| | - Elisabeth Trapp
- Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Schloßplatz 4, 91054, Erlangen, Germany.
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Schloßplatz 4, 91054, Erlangen, Germany.
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics, University of Heidelberg, Grabengasse 1, 69117, Heidelberg, Germany.
| | - Ines Schrader
- Gynecologic-Oncological Office, Pelikanplatz 23, 30177, Hannover, Germany.
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Campus Innenstadt Ludwig Maximilian University Munich, Professor Huber Platz 2, 80539, Munich, Germany.
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Christoph Scholz
- Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
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15
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Rauh C, Schuetz F, Rack B, Stickeler E, Klar M, Orlowska-Volk M, Windfuhr-Blum M, Heil J, Rom J, Sohn C, Andergassen U, Jueckstock J, Fehm T, Loehberg CR, Hein A, Schulz-Wendtland R, Hartmann A, Beckmann MW, Janni W, Fasching PA, Häberle L. Hormone Therapy and its Effect on the Prognosis in Breast Cancer Patients. Geburtshilfe Frauenheilkd 2015; 75:588-596. [PMID: 26166840 DOI: 10.1055/s-0035-1546149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/02/2015] [Accepted: 05/19/2015] [Indexed: 12/23/2022] Open
Abstract
Introduction: Use of hormone therapy (HT) has declined dramatically in recent years. Some studies have reported that HT use before a diagnosis of breast cancer (BC) may be a prognostic factor in postmenopausal patients. This study aimed to examine the prognostic relevance of HT use before BC diagnosis. Methods: Four BC cohort studies in Germany were pooled, and 4492 postmenopausal patients with HT use data were identified. Patient data and tumor characteristics were compared between users and nonusers, along with overall survival (OS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS). Cox proportional hazards models were stratified by study center and adjusted for age at diagnosis, tumor stage, grading, nodal status, and hormone receptors. Results: Women with HT use before the diagnosis of BC were more likely to have a lower tumor stage, to be estrogen receptor-negative, and to have a lower grading. With regard to prognosis there were effects seen for OS, DMFS and LRFS, specifically in the subgroup of women with a positive hormone receptor. In these subgroups, BC patients had a better prognosis with previous HT use. Conclusions: HT use before a diagnosis of BC is associated with a more favorable prognosis in women with a positive hormone receptor status. It may be recommended that the prognostic factor HT should be documented and analyzed as a confounder for prognosis in studies of postmenopausal hormone-responsive breast cancers.
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Affiliation(s)
- C Rauh
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - F Schuetz
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - B Rack
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - E Stickeler
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg
| | - M Klar
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg
| | - M Orlowska-Volk
- Institute of Pathology, Freiburg University Medical Center, Freiburg
| | - M Windfuhr-Blum
- Department of Radiology, Freiburg University Medical Center, Freiburg
| | - J Heil
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - J Rom
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - C Sohn
- Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital
| | - U Andergassen
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - J Jueckstock
- Department of Gynecology and Obstetrics, Campus Innenstadt University Hospital, Ludwig Maximilian University, Munich
| | - T Fehm
- Department of Gynecology and Obstetrics, Duesseldorf University Hospital, Düsseldorf
| | - C R Loehberg
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - A Hein
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - R Schulz-Wendtland
- Institute of Diagnostic Radiology, University Breast Center, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - A Hartmann
- Institute of Pathology, University Breast Center, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - M W Beckmann
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen
| | - W Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm
| | - P A Fasching
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen ; Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California at Los Angeles, USA
| | - L Häberle
- University Breast Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Erlangen ; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen
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16
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Jueckstock J, Kasch F, Jaeger B, Schramm A, Janni W, Scholz C. Adjuvant therapeutic decisions in elderly breast cancer patients: the role of chemotherapy in a retrospective analysis. Arch Gynecol Obstet 2015; 292:1101-7. [DOI: 10.1007/s00404-015-3728-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/20/2015] [Indexed: 12/29/2022]
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17
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Mahner S, Jueckstock J, Hilpert F, Neuser P, Harter P, de Gregorio N, Hasenburg A, Sehouli J, Habermann A, Hillemanns P, Fuerst S, Strauss HG, Baumann K, Thiel F, Mustea A, Meier W, du Bois A, Griebel LF, Woelber L. Adjuvant therapy in lymph node-positive vulvar cancer: the AGO-CaRE-1 study. J Natl Cancer Inst 2015; 107:dju426. [PMID: 25618900 PMCID: PMC4356703 DOI: 10.1093/jnci/dju426] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Women with node-positive vulvar cancer have a high risk for disease recurrence. Indication criteria for adjuvant radiotherapy are controversial. This study was designed to further understand the role of adjuvant therapy in node-positive disease. Methods: Patients with primary squamous-cell vulvar cancer treated at 29 gynecologic cancer centers in Germany from 1998 through 2008 were included in this retrospective exploratory multicenter cohort study. Of 1618 documented patients, 1249 had surgical groin staging and known lymph node status and were further analyzed. All statistical tests were two-sided. Results: Four hundred forty-seven of 1249 patients (35.8%) had lymph node metastases (N+). The majority of N+ patients had one (172 [38.5%]) or two (102 [22.8%]) positive nodes. The three-year progression-free survival (PFS) rate of N+ patients was 35.2%, and the overall survival (OS) rate 56.2% compared with 75.2% and 90.2% in node-negative patients (N-). Two hundred forty-four (54.6%) N+ patients had adjuvant therapy, of which 183 (40.9%) had radiotherapy directed at the groins (+/-other fields). Three-year PFS and OS rates in these patients were better compared with N+ patients without adjuvant treatment (PFS: 39.6% vs 25.9%, hazard ratio [HR] = 0.67, 95% confidence interval [CI[= 0.51 to 0.88, P = .004; OS: 57.7% vs 51.4%, HR = 0.79, 95% CI = 0.56 to 1.11, P = .17). This effect was statistically significant in multivariable analysis adjusted for age, Eastern Cooperative Oncology Group, Union internationale contre le cancer stage, grade, invasion depth, and number of positive nodes (PFS: HR = 0.58, 95% CI = 0.43 to 0.78, P < .001; OS: HR = 0.63, 95% CI = 0.43 to 0.91, P = .01). Conclusion: This large multicenter study in vulvar cancer observed that adjuvant radiotherapy was associated with improved prognosis in node-positive patients and will hopefully help to overcome concerns regarding adjuvant treatment. However, outcome after adjuvant radiotherapy remains poor compared with node-negative patients. Adjuvant chemoradiation could be a possible strategy to improve therapy because it is superior to radiotherapy alone in other squamous cell carcinomas.
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Affiliation(s)
- Sven Mahner
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Julia Jueckstock
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Felix Hilpert
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Petra Neuser
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Nikolaus de Gregorio
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Annette Hasenburg
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Jalid Sehouli
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Annika Habermann
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Peter Hillemanns
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Sophie Fuerst
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Hans-Georg Strauss
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Klaus Baumann
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Falk Thiel
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Werner Meier
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Lis-Femke Griebel
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
| | - Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM)
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Jaeger BAS, Finkenzeller C, Bock C, Majunke L, Jueckstock J, Andergassen U, Neugebauer J, Pestka A, Friedl T, Jeschke U, Janni W, Doisneau-Sixou S, Rack B. Abstract P1-04-06: Discordance of the ER- and HER2-status on disseminated tumor cells compared to the primary tumor in patients with early breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-04-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Differences in ER- and HER2-expression on metastases compared to the primary tumor (PT) are a known phenomenon and may have clinical implications in respect of targeted systemic treatment approaches. The aim of this study was to evaluate both ER- and HER2-status on disseminated tumor cells (DTCs) in the bone marrow (BM) of patients (pts) with early breast cancer (EBC) and to compare these with the corresponding PT.
Methods: BM aspirates were obtained at the time of first surgery. After Ficoll enrichment for mononuclear cells two cytospins with 106 BM cells were evaluated for ER-, HER2- and cytokeratin (CK) -expressions simultaneously by immunocytochemistry using a triple fluorescence staining method with antibodies directed against human ER (secondly labeled with Cy3, red), HER2 (Coumarin-AMCA, blue) and CK (DyLight488, green). The manual analysis was conducted using a computerized fluorescence microscope (Axioskop, Zeiss, Germany). Criteria for CK- and HER2-positivity were the ring-like appearance of the respective membrane stainings and for ER-expression a nuclear staining. Only pts with the detection of CK positive cells (DTC+) and known ER- and HER2-status of the PT (n = 54) were selected for this analysis.
Results: The median number of DTCs was 13 (range 1-95; total number of DTCs detected: 1082). 40 (74%) of the pts had at least one ER-positive (pos) DTC, 24 (44%) at least one HER2-pos DTC, 14 (26%) at least one ER-pos/HER2-pos DTC, and 50 (93%) at least one ER-negative/HER2-negative (neg) DTC, while 10 (19%) pts had only ER-neg/HER2-neg DTCs.
The concordance rate between ER-status on DTCs and PT was 74%. Pts with an ER-pos PT were significantly more likely to have at least one ER-pos DTC (34 out of 42) than pts with an ER-neg PT (6 out of 12; Chi-square test, χ2 = 4.66, p = 0.031). 39 (93%) of the 42 pts with ER-pos PT had at least 1 ER-neg DTC.
The concordance rate between HER2-status on DTCs and PT was 52%. The probability of having at least one HER2-pos DTC was not related to the HER2-status of the PT (Chi-square test, χ2 = 0.34, p = 0.56). 22 (46%) of the 48 pts with a HER2-neg PT had at least one HER2-pos DTC. All of the 6 pts with a HER2-pos PT had at least one HER2-neg DTC.
7 out of 10 pts with a triple-neg PT had at least one DTC pos for ER, HER2 or both. Further the heterogeneity of the ER- and HER2-expression on DTCs compared to the PT for different DTC counts was evaluated. We detected all possible combinations of ER- and HER2-experssion on DTCs regardless of the respective status of the PT.
Conclusions: Our study confirms that the ER- and/or HER2-status on DTCs may differ compared to the PT. This discordance could be especially important for pts with a triple-neg PT and ER-pos or HER2-pos DTCs, since they might respond favorably to an endocrine or HER2-targeted therapy. On the other hand, the presence of ER-neg or HER2-neg DTCs in pts with ER-pos or HER2-pos PT might explain some of the failures of adjuvant endocrine or HER2 targeted therapy.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-04-06.
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Affiliation(s)
- BAS Jaeger
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - C Finkenzeller
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - C Bock
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - L Majunke
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - J Jueckstock
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - U Andergassen
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - J Neugebauer
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - A Pestka
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - T Friedl
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - U Jeschke
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - W Janni
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - S Doisneau-Sixou
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - B Rack
- University Hospital Ulm, Ulm, Germany; Hospital of the Ludwig-Maximilians-University, Munich, Germany
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Sann LK, Jueckstock J, Sigg W, Kaestner R, Friese K, Teubner TK. Metastasiertes Rektumkarzinom in der Schwangerschaft: ein Fallbericht. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hagenbeck C, Muschler B, Jaeger BAS, Jueckstock J, Andergassen U, Katzorke N, Hepp P, Melcher CA, Janni JW, Rack BK. Abstract P4-13-11: Prognostic factors in young breast cancer patients over time – a 40 year longitudinal analysis. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-13-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In younger patients (pts) breast cancer (BC) is associated with a worse prognosis compared to older pts. Only few data are available presenting the development of prognostic factors regarding a period of several decades. This 40 year (y) longitudinal comparison of the main prognostic factors was performed to investigate differences in younger women with primary BC in contrast to older women over time.
Patients and Methods: In this retrospective analysis a consecutive pts cohort of 4010 pts was analyzed. Pts were documented and treated for primary invasive breast cancer between 1963 and 2003 at two University Hospitals in Germany. To be eligible, pts were required to have identified tumor characteristics, including TNM-status. Pts with carcinoma in situ or distant metastases were excluded. The cohort was divided in two age groups, ≤40y and >40y. Furthermore to reveal trends and changes over the duration of 41 years the period of analysis was split into 3 time frames: 1963–1976, 1977–1989 and 1990–2003. We analyzed the main prognostic factors for BC including tumor size, grading, nodal status and HR-status in longitudinal comparison regarding the three time frames, respectively. During 1963–77 HR-status was determined in just 12.6% of pts. Thus, this time frame was excluded in the analysis of HR-status.
Results: In 41 yrs, 747 (18.6%) pts were treated between 1963–76, 1722 pts (42.9%) in 1977–89 and 1541 pts (38.4%) in 1990–2003. Overall 358 pts were ≤40y and 3652 pts were over the age of 40.
A significant reduction of tumor size (metric assessment) at primary diagnosis was observed for both age groups (pts≤40y: p = 0.012; pts>40y: p < 0.0001) with no difference between the time frames, respectively (1963–76: p = 0.289; 1977–89: p = 0.647; 1990–2003: p = 0.937).
The number of node-positive pts significantly decreased in pts >40 y (p = 0.001) whereas no difference could be seen in pts aged ≤40 y (p = 0.991).
In both age groups the number of G2/3 tumors increased over the yrs (pts≤40y: p = 0.001; pts>40y: p < 0.0001). Between 1963–76 more G1-tumors were diagnosed in younger pts (p = 0.041) whereas in the two following periods significantly more G2/3 tumors (p = 0.001; p = 0.002) were observed in this group.
In young pts, 54.2% were HR-negative in 1977–89 and 47.6% in 1990–2003 (p = 0.323). In pts >40y 38.4% and 21.7% were HR-negative, respectively (p < 0.0001). Comparing the age groups, significantly more pts were HR-negative in the young patient group (p = 0.001 (1977–89) and p < 0.0001 (1990–2003)).
Conclusions: Concerning the large period of 40yrs, technical improvement and increasing awareness for BC are reasons for decreasing tumor size at the time of primary diagnosis. However, the rate of node-positive pts in the young patient group remained stable. Furthermore, the high percentage of HR-negative pts and the increasing number of pts with unfavorable tumor grade demonstrate more aggressive tumor types in younger pts. These data confirm the need to improve screening tools to early identify young women with the risk to develop breast cancer, and for personalized treatment approaches in these patients.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-11.
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Affiliation(s)
- C Hagenbeck
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - B Muschler
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - BAS Jaeger
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - J Jueckstock
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - U Andergassen
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - N Katzorke
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - P Hepp
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - CA Melcher
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - JW Janni
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
| | - BK Rack
- Heinrich Heine University, Duesseldorf, Germany; Freising Hospital, Freising, Germany; Ludwig-Maximilians-University, Munich, Germany
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Jaeger BAS, Rack B, Jueckstock J, Salmen J, Ortmann U, Lorenz R, Rezai M, Beck T, Schneeweiss A, Zwingers T, Beckmann MW, Friese K, Janni W. P4-07-06: Correlation of Two Analytical Methods for Circulating Tumor Cells in Peripheral Blood of Patients with Primary Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-07-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
While the evidence for circulating tumor cells (CTCs) as a prognostic marker in metastatic breast cancer has been well established, there is still a lack of data in primary disease. In the SUCCESS A trial two different techniques for the detection of CTCs in early breast cancer were prospectively evaluated.
Material and Methods: SUCCESS A compared FEC-Docetaxel vs. FEC-Docetaxel-Gemcitabine and 5 vs. 2 years of treatment with zoledronic acid in primary breast cancer patients and node positive or high-risk node negative disease. Two different techniques to detect CTCs were prospectively evaluated in two consecutive, but comparable subgroups of the whole study population.
In 3515 samples the CellSearch® System (Veridex, Warren, USA) was used for CTC detection. Immunomagnetic enrichment with an EPCAM-antibody was followed by labeling with monoclonal antibodies specific for cytokeratin (8, 18, 19) and leukocytes (CD45). 2165 samples were evaluated with a manual immunocytochemistry (MICC) protocol. Cytospins were prepared after mononuclear cell enrichment based on Oncoquick® centrifugation (greiner bio-one, Frickenhausen, Germany). Staining was performed with the monoclonal pancytokeratin antibody A45-B/B3 (Micromet, Munich, Germany) and the APAAP technique. Conventional light field microscopy (Axiophot; Zeiss, Oberkochen, Germany) was used for the detection of stained cells.
For both methods, the cut-off value for positivity was ≥ 1 CTC. All events were evaluated by two independent observers.
Results: CTCs were examined in a total number of 3243 patients before and after chemotherapy (CHT). The two subgroups evaluated with one or the other method were well-balanced regarding clinical parameters as tumor size, grading, lymph node-status, hormone receptors and Her2. Furthermore there was no significant correlation between the CTC positivity and one of these clinical parameters using CellSearch or the MICC, respectively (p > 0,05 using the chi square test each time).
Before adjuvant CHT 21. 3% (424 out of 1994) and 21.1 % (264 out of 1249) of the patients were found positive for CTCs using CellSearch® or the MICC respectively, with a mean CTC level of 5.9 (range: 1 to 827) and 3.1 (range: 1 to 256).
Immediately after CHT 21.9% (333 out of 1521) and 16.5% (151 out of 916) of the patients were positive for CTCs using CellSearch® or the MICC. The mean CTC level decreased to 3.0 (range: 1 to 124) and 2.1 (range: 1 to 23) in both analytical methods.
Using CellSearch® there was a significant correlation between the presence of CTCs before CHT and disease progression (p = 0.0044), as well as survival (p = 0.0001), whereas the MICC did not predict any of these (p = 0.3143 and p = 0.0801 respectively; the chi-square test was used each time).
Conclusion: We found comparable prevalence of CTCs before and after adjuvant chemotherapy both with the CellSearch® System or the MICC. However, prognostic relevance could only be shown for CTCs detected with the CellSearch® System. This may be attributed to the high standardization and reproducibility of the automated system, as well as the additional CD45 counterstaining. According to our findings, the FDA approved CellSearch® System should be used as gold standard for CTC detection in future clinical trials.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-07-06.
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Affiliation(s)
- BAS Jaeger
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - B Rack
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - J Jueckstock
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - J Salmen
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - U Ortmann
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - R Lorenz
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - M Rezai
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - T Beck
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - A Schneeweiss
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - T Zwingers
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - MW Beckmann
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - K Friese
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
| | - W Janni
- 1Klinikum der Ludwig-Maximilians-Universitaet -Campus Innenstadt, Munich, Germany; Heinrich Heine-Universitaet, Duesseldorf, Germany; Gemeinschaftspraxis Lorenz-HeckerWesche, Braunschweig, Germany; Luisenkrankenhaus, Duesseldorf, Germany; RoMed Klinikum Rosenheim, Rosenheim, Germany; University Hospital Heidelberg, Heidelberg, Germany; Estimate, Augsburg, Germany; Frauenklinik der Universitaet Erlangen, Erlangen, Germany
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Salmen JC, Fasching PA, Hepp P, Jueckstock J, Haeberle L, Mohrmann S, Beckmann MW, Hartmann A, Wachter DL, Friese K, Janni W, Rack B. P4-02-07: Influence of the Progesterone Receptor on the Prognosis of Breast Cancer in Interaction with Other Prognostic Factors. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-02-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The expression of the estrogen receptor (ER) and/or the progesterone receptor (PR) is a predictive factor for the response to endocrine treatment and to chemotherapy in primary breast cancer. Knowledge about the prognostic relevance of the PR is rare and partly controversial. Aim of this retrospective study was to analyze the prognostic relevance of PR.
Methods: Between 1995 and 2008, data from 5,144 patients with heterogeneously treated primary breast cancers have been collected in 3 German university hospitals.
The laboratories used immunhistochemical assays for the investigation of the ER and PR.
The PR-expression was correlated with patient and tumor characteristics.
For each outcome parameter overall survival (OS), distant disease free survival (DDFS) and local recurrence free survival (LRFS) cox proportional hazad models were built. Furthermore the effect of the PR status was analyzed according to tumor subgroups.
Results: PR status was associated with a more favourable OS, DDFS and LRFS in the univariate analysis. PR remained an independent prognostic factor for OS and DDFS but not for LRFS in the cox proportional hazard model.
For OS and DDFS the prognostic effect of PR seemed to be consistent among the subgroups and was significant for most of them. Comparing subgroups there was a difference between the HR for ER negatives and ER positives. In ER negative tumors the prognostic effect of the PR seemed to be larger (HR=0.40; 95%CI: 0.25−0.63) than in ER positives (HR=0.68; 95%CI: 0.53−0.87). For all other subgroups there seemed to be no interaction between PR status and the other prognostic factors.
Conclusion: PR positivity results into a similarly favourable prognosis in ER negative and ER positive patients. ER positivity alone seems not to be sufficient to define a group of patients with the most favourable prognosis. On the contrary, patients with ER positive, PR negative tumors have a signicantly deteriorated prognosis and seem to be a patient group, which should be investigated concerning drug resistance mechanisms.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-02-07.
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Affiliation(s)
- JC Salmen
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - PA Fasching
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - P Hepp
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - J Jueckstock
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - L Haeberle
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - S Mohrmann
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - MW Beckmann
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - A Hartmann
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - DL Wachter
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - K Friese
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - W Janni
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
| | - B Rack
- 1Frauenklinik der Heinrich-Heine-Universitaet, Duesseldorf, Germany; University of California at Los Angeles, Los Angeles; LMU Muenchen, Frauenklinik Innenstadt Maistrasse 11, Muenchen, Germany; Frauenklinik des Universitaetsklinikums Erlangen, Erlangen, Germany; Universitaetsklinikum Erlangen, Erlangen, Germany
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Schindlbeck C, Pfab G, Jueckstock J, Andergassen U, Sommer H, Janni W, Friese K, Rack B. Prognostic relevance of disseminated tumor cells in the bone marrow of patients with primary breast cancer--results of a standardized follow-up. Anticancer Res 2011; 31:2749-2755. [PMID: 21868516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The prognostic significance of disseminated tumor cells from bone marrow (BM-DTCs) of breast cancer patients has been demonstrated previously. In this study, data of a standardized long term follow-up of 829 patients with examination of BM-DTCs at primary diagnosis are presented. PATIENTS AND METHODS BM aspiration and immunocytochemical examination of DTCs was performed according to a standardized protocol. Follow-up data of all patients were adjusted with the cancer registries of southern Bavaria. RESULTS A total of 268 patients (32%) had BM-DTCs with a median of 2 (1-1223)/2 x 10⁶ cells. Positive BM findings correlated with tumor size (p=0.032), but not with other histopathological parameters. After a median follow-up of 73 months, BM-DTCs were highly relevant for the development of distant metastases (p=0.006) and, beneath standard histological parameters, reduced overall survival (p=0.038). CONCLUSION These results confirm the prognostic relevance of the detection of BM-DTCs. Newer methods, such as detection of circulating tumor cells in blood, will have to demonstrate comparable prognostic information in the future.
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Affiliation(s)
- C Schindlbeck
- Department of Obstetrics and Gynecology, Klinikum Traunstein, Cuno-Niggl-Str. 3, D-83278 Traunstein, Germany.
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Janni W, Zwingers T, Hepp P, Andergassen U, Schneeweiss A, Lichtenegger W, Beckmann MW, Sommer H, Pantel K, Salmen J, Jueckstock J, Rack BK. Abstract PD04-08: Circulating tumor cells (CTC) in peripheral blood of breast cancer patients two years after adjuvant chemotherapy depending on endocrine treatment — The German SUCCESS-Trial. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd04-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The prognostic significance of CTC in metastatic, as well as in primary breast cancer has been demonstrated (Rack et al., ASCO 2010). The optimal endocrine treatment strategy for postmenopausal patients (pts) with hormone sensitive breast cancer remains unclear.We analyzed the prevalence of CTC two years after primary diagnosis in patients with tamoxifen or anastrozole treatment.
Methods: As part of the translational research project of the German SUCCESS-trial, we analyzed 23ml of peripheral blood from 307 N+ and high risk N-postmenopausal pts with hormone sensitive breast cancer two years after adjuvant taxane based chemotherapy and with tamoxifen or anastrozole treatment. The presence of CTCs was assessed with the CellSearchSystem (Veridex, USA). After immunomagnetic enrichment with an anti-Epcam-antibody, cells were labelled with anti-cytokeratin (8,18,19) and anti-CD45 antibodies to distinguish between epithelial cells and leukocytes. Standard within the study was early switch treatment (tamoxifen for 2 years, followed by anastrozle), while pts with contraindications against tamoxifen were allowed to receive anastrozole up-front.
Results: In 10.1% of pts (n=31) >1 CTC was detected after the completion of chemotherapy (range 2-33), while 7.8% (n=24) presented with >1 CTC (range 2-99) two years after completion of chemotherapy. The median age in the tamoxifen group was 59.9 years and 59.8 in the anastrozole group. In the tamoxifen group, 33.0% of the pts had a pT1 tumor, 5.3% G1 grading and 21.6% of the pts were node negative. In the anastrozole group, 30.0% of the pts had a pT1 tumor, 7.5% G1 grading and 22.5% of the pts were node negative, respectively. None of these differences were statistically significant. After the completion of chemotherapy, 9.7% of the pts were CTC positive in the tamoxifen group (range number of cells: 2-33) and 11.3% in the anastrozole group (range of cells: 2-24), p=0.69. Two years after primary diagnosis, 7.9% of the pts were CTC positive in the tamoxifen group (range number of cells:2-99) and 7.5% in the anastrozole group (range cells: 2-5), p=0.90. Actuarial disease free and overall survival will be presented at the meeting.
Conclusions: The prognostic relevance of CTC in peripheral blood of early breast cancer patients both before and after chemotherapy has been demonstrated. The presented data will add information on the monitoring potential of CTC during adjuvant endocrine treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD04-08.
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Affiliation(s)
- W Janni
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - T Zwingers
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - P Hepp
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - U Andergassen
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - A Schneeweiss
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - W Lichtenegger
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - MW Beckmann
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - H Sommer
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - K Pantel
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - J Salmen
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - J Jueckstock
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
| | - BK. Rack
- Heinrich Heine University, Duesseldorf, Germany; Estimate GmbH, Germany; LMU Munich, Germany; University Heidelberg, Germany; Charite, Germany; University Erlangen, Germany; University Hamburg, Germany
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Schindlbeck C, Mayr D, Olivier C, Rack B, Engelstaedter V, Jueckstock J, Jenderek C, Andergassen U, Jeschke U, Friese K. Topoisomerase IIalpha expression rather than gene amplification predicts responsiveness of adjuvant anthracycline-based chemotherapy in women with primary breast cancer. J Cancer Res Clin Oncol 2010; 136:1029-37. [PMID: 20052594 DOI: 10.1007/s00432-009-0748-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 12/07/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adjuvant anthracycline-based chemotherapy (AbCTX) is a standard treatment for patients with primary breast cancer. Its main target is topoisomerase IIalpha (TopIIa), a nuclear protein which is important for DNA replication and mitosis. We propose that the overexpression of the TopIIa protein or amplification of the TopIIa gene may be useful in predicting increased responsiveness towards AbCTX. METHODS Tumor tissues of 118 patients who received adjuvant AbCTX were examined by immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH) for TopIIa and HER2. For IHC, the primary antibodies 485 (Dako) and NCL-TOPOIIA (Novocastra) were used. FISH analysis was performed with the SPEC HER2/CEP 17 Dual Color Probe (Zytovision) and LSI TOP 2A Spectrum Orange/CEP 17 Spectrum Green probe (Abbott). TopIIa IHC was evaluated by the immunoreactive score (IRS). FISH amplification was stated at an HER2-TopIIa/CEP 17 ratio > or = 2, deletion of TopIIa at a ratio <0.8. RESULTS The median age of the patient population was 50 years (range 23-77), 76 (64%) had tumors >2 cm in size, 98 (85%) were nodal positive, and 72 (66%) estrogen-receptor positive. Chemotherapy regimes consisted of epirubicin-cyclophosphamide (EC 40 pts), EC-CMF (18 pts), FAC/FEC (33 pts), anthracycline-taxane combinations (23 pts) and others (4 pts). After IHC, it was found that 19% of the tumors were positive for HER2 (3+) and the median IRS for TopIIa staining was 2 (49% positive); 28 (24%) tumors showed HER2 amplification, therefrom 20/22 (91%) within the HER2 3+ group. TopIIa gene was amplified in 17 cases (16%) and deletion was seen in 6 (5%) tumors. Of all cases with HER2 gene amplification, 14 (50%) cases of TopIIa co-amplification and one case of deletion were seen. Looking at histological parameters, TopIIa IHC correlated with nodal status (P = 0.018) and high grading (G3) (P = 0.047). After a median follow-up of 42 months (range 1-242), a significant prognostic factor for local recurrence was HER2 positivity (IHC P = 0.013 and FISH P = 0.023). Thirty-two patients developed metastasis (27%), which was correlated with HER2 FISH positivity (P = 0.024) and, as a trend, Top IIa IHC negativity (P = 0.094); 25 (21%) patients died from the disease. Negative prognostic parameters were the lack of estrogen-receptor expression (P = 0.008), lymphangiosis (P = 0.02), and TopIIa IHC negativity (P = 0.03). CONCLUSION In this cohort of patients, HER2 positivity indicated higher rates of local and distant recurrence. In contrast, TopIIa IHC positivity predicted lower risk of metastases and death, thus being a positive-predictive factor for the responsiveness to AbCTX. TopIIa gene amplification did not add predictive information. Therefore, we conclude that TopIIa protein expression might rather be the target of anthracyclines independent from gene copy number.
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Affiliation(s)
- Christian Schindlbeck
- Department of Obstetrics and Gynecology, Campus Innenstadt, Ludwig-Maximilians-University, Maistrasse 11, 80337 Munich, Germany.
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Rack B, Burkhardt N, Jueckstock J, Kuhn C, Noeding S, Hoenig A, Friedrich M, Schindlbeck C, Sommer H, Friese K, Janni W, Mylonas [. Inhibin A Is Downregulated during Chemotherapy in Patients with Early Breast Cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Inhibins are dimeric glycoproteins, composed of an alpha-subunit (INH-a) and one of two possible beta-subunits (ßA or ßB), with substantial roles in human reproduction and in endocrine-responsive tumours. In breast cancer tissue, the growth factor Inhibin A is involved in cell differentiation and proliferation, thus suggesting a possible role as tumor marker. Aims of this study were to determine the serological measurement of Inhibin A (a- bA) in breast cancer patients during chemotherapy.Material and Methods: A series of 28 high risk N0 and N+ breast cancer patients who underwent standardized chemotherapy (3 x FEC and 3 x Docetaxel) followed by two years of zoledronate in the German SUCCESS trial were prospectively evaluated before chemotherapeutic treatment as well as after chemotherapy and two years after chemotherapy for the serological expression of Inhibin A. For serological analysis the ultrasensitive Inhibin A ELISA (DSL – U.S.A.) was used according to manufactures instruction. For statistical analysis the Wilcoxon rang sum test was used for paired samples. Statistical significance was assumed at p< 0.05.Results: The concentration of Inhibin A showed a significant decrease between data obtained before chemotherapy and after chemotherapy (p<0.005) and two-year follow up (p<0.001). Interestingly, there were seen no differences between the time point four weeks after chemoherapy and at two years (p=0.744).Discussion: Therefore, chemotherapy decreases significantly the Inhibin A concentration during chemotherapy. This might reflect a suppression of ovarian function and might be a marker for chemotherapy-induced amenorrhoea. Moreover, it has been suggested that Inhibin A might be a tumour marker for breast cancer, and therefore a sudden increase of its concentration might be indicative of breast cancer recurrence.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3028.
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Affiliation(s)
- B. Rack
- 1Ludwig-Maximilians-University, Germany
| | | | | | - C. Kuhn
- 1Ludwig-Maximilians-University, Germany
| | | | - A. Hoenig
- 3Julius-Maximilians-University, Germany
| | - M. Friedrich
- 4University of Schleswig-Holstein, Campus Luebeck, Germany
| | | | - H. Sommer
- 1Ludwig-Maximilians-University, Germany
| | - K. Friese
- 1Ludwig-Maximilians-University, Germany
| | - W. Janni
- 5Heinrich-Heine-University, Germany
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Janni W, Harbeck N, Sommer H, Rack B, Augustin D, Simon W, Jueckstock J, Wischnik A, Annecke K, Hepp P, Friese K, Kiechle M. Sequential Treatment with Epirubicin/Cyclophosphamide, Followed by Docetaxel Is Equieffective, but Less Toxic Than FEC120 in the Adjuvant Treatment of Breast Cancer Patients with Extensive Lymph Node Involvement: The German ADEBAR Phase III Study. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-604] [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: 11/16/2022]
Abstract
Abstract
Background: Based on meta-analytic evidence, taxane containing adjuvant chemotherapy has been established as standard treatment in node-positive breast cancer. However, in the MA-21 study, adriamycin-cyclophosphamide, followed by paclitaxel (AC-P) was significantly inferior to the gold standard of anthracycline treatment, FEC120 (Burnell, SABCS 2006). We prospectively compared a sequential epirubicin-docetaxel chemotherapy regimen to FEC120.Patients and Methods:The ADEBAR study was a multicenter phase III trial (n=1502) to evaluate whether breast cancer (BC) pts with > 3 axillary lymph node metastases benefit from a sequential anthracycline-docetaxel regimen (E90C–D: 4 cycles epirubicin [E] 90 mg/m2 plus cyclophosphamide [C] 600 mg/m2 q21 days followed by 4 cycles docetaxel [D] 100mg/m2 q21 days) compared to dose-intensive anthracycline-containing polychemotherapy (FE120C: 6 cycles E 60 mg/m² d 1+8, 5-FU 500mg/m² d 1+8 and C 75 mg/m² d 1-14, q4 weeks). The median follow-up time was 47 mts.(range 2-83 mts).Results:Treatment was stopped prematurely in 3.7% of the pts in the E90C–D arm and in 8.0% in the FE120C arm due to toxicity (p=0.0009). Antibiotic treatment was given in 10.4% (E90C–D) vs. 19.7% (FE120C), G-CSF support in 39.2% vs 61.4 % and erythropoietin stimulation in 8.7% vs. 20.0%, respectively (p<0.0001). Haematological toxicity (leucopenia, neutropenic fever, thrombocytopenia, anemia) was significantly higher in the FE120C-arm.At the time of the current analysis, 281 events of recurrence of breast cancer, were observed: 128 events in the FE120C group and 153 in the E90C–D group. The unadjusted hazard ratio (HR) was 0.88 (95 percent confidence interval, 0.694 to 1.115; p=0.2197, log-rank test). Overall survival in the two groups was not significantly different: (84 deaths with FE120C vs. 88 with E90C–D (HR 0.999, 0.738-1.352, p=0.99). Subgroup analyses, stratifying for tumor size, lymph node involvement, hormone receptor and HER2-neu status showed no significant difference between the two treatment arms.Conclusion:Different toxicity profiles given, hematological toxicity in the FE120C group was more severe than in the E90C–D.In contrast to AC-P in earlier studies, EC-Doc provides a feasible and effective alternative option to dose-intensified FEC with different saftey profile in this high risk breast cancer cohort.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 604.
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Affiliation(s)
- W. Janni
- 1 Heinrich-Heine-University, Germany
| | | | - H. Sommer
- 2 Ludwig-Maximilians-University, Germany
| | - B. Rack
- 2 Ludwig-Maximilians-University, Germany
| | | | - W. Simon
- 6 Robert Bosch Krankenhaus, Germany
| | | | | | | | - P. Hepp
- 1 Heinrich-Heine-University, Germany
| | - K. Friese
- 2 Ludwig-Maximilians-University, Germany
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Gottschalk N, Janni W, Harbeck N, Sommer H, Rack B, Augustin D, Simon W, Jueckstock J, Wischnik A, Annecke K, Friese K, Kiechle M. Toxizitätsdaten der ADEBAR-Studie – Multizentrische Phase III-Studie zum Einsatz von Taxanen in der adjuvanten Therapie des nodal-positiven Mammakarzinoms. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079145] [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] Open
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Janni WJ, Wiedswang G, Fehm T, Jueckstock J, Borgen E, Rack B, Braun S, Sommer H, Pantel K, Naume B. Persistence of disseminated tumor cells (DTC) in bone marrow (BM) of breast cancer patients predicts increased risk for relapse—Results of pooled European data. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10083 Background: The prognostic significance of DTC in the BM of breast cancer patients at the time of primary diagnosis has recently been confirmed by a large pooled analysis. If the persistence of DTC after adjuvant therapy confers a similar risk for relapse, there might be an indication for secondary adjuvant treatment. Methods: We analyzed BM aspirates of 697 patients from academic breast cancer units in Oslo (n=356), Munich (n=228) and Tuebingen (n=113) during recurrence-free follow-up at a median interval of 32.4 months (standard deviation [std] 19.4 mon) after primary diagnosis of breast cancer pT1–4, pN0–3 pM0. Carcinoma cells were detected using a standardized immunoassay with the monoclonal antibodies A45-B/B3 (Munich, Tuebingen), or AE1 and AE3 (Oslo), directed against cytokeratin (CK). Patients were followed for a median of 54.2 months (std 24.5 mon) after primary diagnosis. Results: Persistent DTC in the BM were detected in 15.6% of the patients (n=109). The Kaplan-Meier estimate for mean distant relapse-free survival estimate was 155.6 mon (142.4 - 168.9 95%CI) in patients with negative and 102.3 mon (93.6 - 111.0, 95% CI, p< .0001, log rank test) in patients with positive BM status. Patients without evidence of persistent DTC had a significantly longer overall survival (164.4 [155.6 - 173.3]), than patients with positive BM status (101.7 mon [89.4 - 113.9], p< .0001). In multivariate Cox regression analysis, allowing for bone marrow status, tumor size, nodal status, histopathological grading and hormone receptor status, DTC was of higher independent prognostic significance for subsequent reduced breast cancer specific survival (RR 5.9, 2.8 - 12.8, 95% CI, p< .0001), than nodal status at time of primary diagnosis (RR 1.2, 1.0 - 1.3, 95% CI, p=.014). Conclusion: Evidence of persistent DTC in breast cancer patients indicates an increased risk for subsequent relapse, and may serve for monitoring in future clinical trials. Such trials might investigate the benefit of individualized secondary adjuvant treatment or extended adjuvant therapy of patients with DTC. No significant financial relationships to disclose.
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Affiliation(s)
- W. J. Janni
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - G. Wiedswang
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - T. Fehm
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - J. Jueckstock
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - E. Borgen
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - B. Rack
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - S. Braun
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - H. Sommer
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - K. Pantel
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
| | - B. Naume
- LMU Muenchen, Munich, Germany; llevaal University Hospital, Oslo, Norway; Universität Tuebingen, Tuebingen, Germany; Radiumhospitalet, Oslo, Germany; Leopold-Franzens-Universität, Innsbruck, Austria; UKE, Munich, Germany
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