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Ritter T, Leha A, Sülberg H, Kreutzer J, Klie S, Dröge LH, Kitz J, Liersch T. Total neoadjuvant therapy (TNT) for rectal cancer (UICC stages ≥ II): A highly promising approach for long-term survival to all? J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.162] [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: 01/26/2023] Open
Abstract
162 Background: TNT, consisting of preoperative chemoradiation (CRT +5-FU) followed by 3 cycles FOLFOX chemotherapy (cCTX) and total mesorectal excison (TME), was performed in rectal cancer patients (stages UICC ≥ II) according to the TransValid-B-phase-I/II-protocol (WHO-UTN-U1111-1132-0235) at a single site. The aim was to evaluate safety, feasibility, and long-term survival. Furthermore, the impact of postsurgical surrogate-parameters was determined. Methods: 62 patients (15 f, 47 m; median age: 62 years) with resectable LARC of the lower (43.5%; < 6 cm from the anal verge) or mid rectal third (56.5%, ≥ 6 - 12 cm) were included. Staging procedures revealed a positive circumferential resection margin (CRM < 2 mm) in 85.5% and clinical stages II to IV in 3.2%, 88.7% and 8.1%, respectively. TNT was performed by radiation (28x 1.8 Gy; total 50.4 Gy), civ infusion of FU (250 mg/m2/d; d1 - d14 and d22 - d35) and OX (50 mg/m2 on d1, d8, d22 and d29). Four weeks later, 3 FOLFOX cycles were applied with OX (80-100 mg/m2), followed by FA (400 mg/m2) and 5-FU (civ, 2400 mg/m2 over 46h, on d1, d15 and d30). Five to six weeks after cCTx, TME was performed with peri-/postoperative control of the specimen (MERCURY-criteria, 7th TNM/UICC-classification). Acute toxicities were recorded according to NCI-CTC-AE criteria (v4.03). Progression-free (PFS), overall (OS) and cancer-specific survival (CSS) were calculated using Kaplan-Meier estimators, logrank tests and multiparametric Cox proportional-hazards models. Results: During CRT (n = 62) and cCTx (n = 60), CTC-AE grades ≥ 3 occurred in 25.8% and 8.5%, respectively. Complete irradiation, concomitant CTx and consolidation FOLFOX-CTx were administered in 98.4%, 95.2% and 83.3%, respectively. After TNT, preoperative re-assessment showed a shift from stages ≥ III to ≤ II in 65% and from positive to negative CRM in 48,3%. 58 patients (93.5%) underwent TME-surgery with R0, negative CRM and optimal quality of the specimen in 94.8%, 91.4%, and 89.7%, respectively. Postoperatively, stages 0 to IV and complete remission (pCR; T0 N0) were diagnosed in 15.5%, 19%, 31%, 24.1%, 10.3% and 17.2%, respectively. Nearly complete remission (nCR; T1-T2 N0 and TRG 2 or TRG 3) occurred in 17.2%. Median follow-up time was 63 months (mo; quartiles: 48-103 months). Mean PFS and CSS were significantly higher for ypUICC stage ≤ II compared to stage ≥ III (111 ± 7.2 mo vs. 67 ± 12.2 mo; p = 0.006 and 130 ± 3.5 mo vs. 94 ± 10.2 mo; p = 0.004). Mean OS was 117 ± 6.4 mo for stages ≤ II vs. 91 ± 10.1 mo for stages ≥ III (p = 0.087). OS and PFS for patients with good (pCR and nCR) vs. poor response were 125 ± 7.0 mo vs. 101.5 ± 7.8 mo (p = 0.043) and 114 ± 9.6 mo vs. 87.9 ± 9.2 mo (p = 0.083). Conclusions: TNT is a safe, highly feasible and well-tolerated regimen with a good response of the primary rectal cancer and locoregional lymph nodes. Good response (pCR, nCR) or stage ≤ II results in higher rates for PFS, OS, and CSS. Clinical trial information: 2011-004228-37 .
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Affiliation(s)
- Timotheus Ritter
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Andreas Leha
- Institute for Medical Statistics, University Medical Center, Goettingen, Germany
| | - Heiko Sülberg
- X-act Cologne Clinical Research GmbH, Cologne, Germany
| | - Johanna Kreutzer
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Susanne Klie
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Leif Hendrik Dröge
- Department of Irradiation and Radiooncology, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Kitz
- Institute for Pathology, University Medical Center, Goettingen, Germany
| | - Torsten Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
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2
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Emons G, Auslander N, Jo P, Kitz J, Azizian A, Hu Y, Hess CF, Roedel C, Sax U, Salinas G, Stroebel P, Kramer F, Beissbarth T, Grade M, Ghadimi M, Ruppin E, Ried T, Gaedcke J. Gene-expression profiles of pretreatment biopsies predict complete response of rectal cancer patients to preoperative chemoradiotherapy. Br J Cancer 2022; 127:766-775. [PMID: 35597871 PMCID: PMC9381580 DOI: 10.1038/s41416-022-01842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/19/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Preoperative (neoadjuvant) chemoradiotherapy (CRT) and total mesorectal excision is the standard treatment for rectal cancer patients (UICC stage II/III). Up to one-third of patients treated with CRT achieve a pathological complete response (pCR). These patients could be spared from surgery and its associated morbidity and mortality, and assigned to a “watch and wait” strategy. However, reliably identifying pCR based on clinical or imaging parameters remains challenging. Experimental design We generated gene-expression profiles of 175 patients with locally advanced rectal cancer enrolled in the CAO/ARO/AIO-94 and -04 trials. One hundred and sixty-one samples were used for building, training and validating a predictor of pCR using a machine learning algorithm. The performance of the classifier was validated in three independent cohorts, comprising 76 patients from (i) the CAO/ARO/AIO-94 and -04 trials (n = 14), (ii) a publicly available dataset (n = 38) and (iii) in 24 prospectively collected samples from the TransValid A trial. Results A 21-transcript signature yielded the best classification of pCR in 161 patients (Sensitivity: 0.31; AUC: 0.81), when not allowing misclassification of non-complete-responders (False-positive rate = 0). The classifier remained robust when applied to three independent datasets (n = 76). Conclusion The classifier can identify >1/3 of rectal cancer patients with a pCR while never classifying patients with an incomplete response as having pCR. Importantly, we could validate this finding in three independent datasets, including a prospectively collected cohort. Therefore, this classifier could help select rectal cancer patients for a “watch and wait” strategy. Translational relevance Forgoing surgery with its associated side effects could be an option for rectal cancer patients if the prediction of a pathological complete response (pCR) after preoperative chemoradiotherapy would be possible. Based on gene-expression profiles of 161 patients a classifier was developed and validated in three independent datasets (n = 76), identifying over 1/3 of patients with pCR, while never misclassifying a non-complete-responder. Therefore, the classifier can identify patients suited for “watch and wait”.
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Affiliation(s)
- Georg Emons
- Section of Cancer Genomics, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Noam Auslander
- Section of Cancer Genomics, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Cancer Data Science Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Program in Molecular and Cellular Oncogenesis, The Wistar Institute, Philadelphia, PA, USA
| | - Peter Jo
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center, Göttingen, Germany
| | - Azadeh Azizian
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Yue Hu
- Section of Cancer Genomics, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Clemens F Hess
- Department of Radiotherapy and Radio-oncology, University Medical Center, Göttingen, Germany
| | - Claus Roedel
- Department of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Ulrich Sax
- Department of Medical Informatics, University Medical Center, Göttingen, Germany
| | - Gabriela Salinas
- Transcriptome and Genome Analysis Laboratory (TAL), Department of Developmental Biochemistry, University of Göttingen, Göttingen, Germany
| | - Philipp Stroebel
- Department of Pathology, University Medical Center, Göttingen, Germany
| | - Frank Kramer
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Tim Beissbarth
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Marian Grade
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Eytan Ruppin
- Cancer Data Science Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas Ried
- Section of Cancer Genomics, Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany.
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3
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Julius K, Kromer C, Schnabel V, Vlahova L, Kitz J, Schön MP, Sahlmann CO, Kretschmer L. Ansprechen eines metastasierten akrolentiginösen Melanoms mit Exon-11-BRAF-G469A-Mutation auf BRAF/MEK-Inhibition. J Dtsch Dermatol Ges 2022; 20:527-529. [PMID: 35446501 DOI: 10.1111/ddg.14737_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katharina Julius
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Christian Kromer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Viktor Schnabel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Lyubomira Vlahova
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Julia Kitz
- Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Michael P Schön
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.,Niedersächsisches Institut für Berufsdermatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | | | - Lutz Kretschmer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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4
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Julius K, Kromer C, Schnabel V, Vlahova L, Kitz J, Schön MP, Sahlmann CO, Kretschmer L. Response of metastatic acral melanoma with exon 11 BRAF G469A mutation to BRAF/MEK inhibition. J Dtsch Dermatol Ges 2022; 20:528-530. [PMID: 35218304 DOI: 10.1111/ddg.14737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katharina Julius
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Viktor Schnabel
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Lyubomira Vlahova
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center, Göttingen, Germany
| | | | - Lutz Kretschmer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany
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5
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Schade S, Koenig U, Mekolli A, Gaedcke J, Neesse A, Reinecke J, Brunner M, Amir Hosseini AS, Kitz J, Stroebel P, Lotz J, Ghadimi M, Ellenrieder V, Koenig A. Cure Is Possible: Extensively Metastatic HER2-Positive Gastric Carcinoma with 5 years of Complete Remission after Therapy with the FLOT Regimen and Trastuzumab. Case Rep Gastroenterol 2022; 16:80-88. [PMID: 35350679 PMCID: PMC8921895 DOI: 10.1159/000520057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Gastric cancer (GC) represents one of the most fatal neoplasms in gastrointestinal oncology and affected patients can only hope for cure in limited disease. In a metastatic situation however, patients have a worse prognosis finally resulting in cancer-related death. Some improvements were made by using intensified chemotherapy such as the FLOT protocol (5-FU, leucovorin, oxaliplatin and docetaxel). However, a breakthrough in the treatment of advanced GC has been achieved by pre-therapeutical tumor analysis for potentially targetable alterations. Microsatellite instability, PD-L1 expression, Epstein Barr virus, and human epidermal growth factor receptor-2 (HER2) overexpression or amplification are the most beneficial targets, if addressed, can prolong survival in a palliative situation. Whether the combination of these targeted therapeutics with chemotherapy can bring long-term survival or even a chance of cure in a metastatic situation is not clear. Here, we report the case of a 30-year-old man with GC and extensive metastases who was cured by anti-HER2 antibody Trastuzumab combined with the FLOT regime. Initial staging showed an exophytic Siewert type III tumor and extensive hepatic metastases. Histology resulted in gastric adenocarcinoma with HER2 overexpression (2+, FISH positive). Twelve courses of chemotherapy comprising Trastuzumab and FLOT were administered. After treatment, the extensive liver metastases had disappeared with no evidence of residual tumor growth on the CT scans. Monotherapy of Trastuzumab was continued until gastrectomy with D2 lymph node dissection and probing of liver tissue, which revealed no residual tumor cells. Five years after surgery, there is continued complete remission. In conclusion, Trastuzumab in combination with FLOT may have curative potential even for metastatic stages of HER-2-positive GC.
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Affiliation(s)
- Sebastian Schade
- Department of Clinical Neurophysiology, University Medical Center, Goettingen, Germany
| | - Ute Koenig
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
- * Ute Koenig,
| | - Ardian Mekolli
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Jochen Gaedcke
- Department of General-, Visceral- and Pediatric Surgery, University Medical Center, Goettingen, Germany
| | - Albrecht Neesse
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Johanna Reinecke
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Marius Brunner
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center, Goettingen, Germany
| | - Philipp Stroebel
- Institute of Pathology, University Medical Center, Goettingen, Germany
| | - Joachim Lotz
- Department of Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany
| | - Michael Ghadimi
- Department of General-, Visceral- and Pediatric Surgery, University Medical Center, Goettingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Alexander Koenig
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
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6
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Lowes K, Reinecke J, Brunner M, Scholz M, Kitz J, Michels B, Mekolli A, Gaedcke J, Seif Amir Hosseini A, Ströbel P, Ghadimi M, Ellenrieder V, Koenig A, Koenig U. Effectiveness of fourth-line dual immunotherapy in hepatocellular carcinoma with simultaneous steroid administration for immune-related hepatitis. Therap Adv Gastroenterol 2022; 15:17562848211051026. [PMID: 35178123 PMCID: PMC8844730 DOI: 10.1177/17562848211051026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 08/12/2021] [Indexed: 02/04/2023] Open
Abstract
Medical therapy of advanced hepatocellular carcinoma (HCC) remains an emerging subject, but therapeutic sequences together with toxicity management are rarely described. Herein, we report the case of a therapeutic sequence and toxicity management in a 72-year old White male with advanced non-cirrhotic HCC. The HCC of this patient was refractory against treatment with several tyrosine kinase inhibitors, including lenvatinib and cabozantinib or immune combination of pembrolizumab and lenvatinib. Double immune combination of nivolumab and ipilimumab was effective in fourth-line treatment but resulted in immunotherapy-related grade 4 hepatitis. This toxicity responded well to high doses of corticosteroids, and reinduction of dual immune combination remained effective despite continuation of high-dose corticosteroids in a non-cirrhotic HCC. This case demonstrated the efficacy of double immune therapy in higher treatment lines in advanced non-cirrhotic HCC even if the patient was treated with other immune modulatory therapies earlier. Moreover, it can remain effective under concomitant administration of high-dose corticosteroids.
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Affiliation(s)
- Kristina Lowes
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Johanna Reinecke
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Marius Brunner
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Matthias Scholz
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Beate Michels
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Ardian Mekolli
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Jochen Gaedcke
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Ute Koenig
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
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7
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Azizian A, König A, Hartmann A, Schuppert F, Seif Amir Hosseini A, Kitz J, Ghadimi M. Surgical treatment of metastatic VIPoma: a case report. Therap Adv Gastroenterol 2021; 14:17562848211051132. [PMID: 34899986 PMCID: PMC8655459 DOI: 10.1177/17562848211051132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/15/2021] [Indexed: 02/04/2023] Open
Abstract
VIPoma, a neuroendocrine tumour mostly occurring in the human pancreas and producing high levels of vasoactive intestinal peptide, is a rare disease that presents with a wide spectrum of symptoms, including intense diarrhoea, hypokalaemia, and cardiac complications, with life-threatening consequences. In most cases, metastatic lesions are present at VIPoma diagnosis. Treatment options include symptomatic therapy, chemotherapy, radiation and surgery. Due to its low incidence, there are no evidence-based therapy recommendations to date. Here, we present a case of a 39-year-old woman with severe symptoms due to VIPoma of the pancreas with diffuse hepatic metastasis, who underwent simultaneous resection of the primary tumour, extensive liver resection and radiofrequency ablation. The patient was released in good health and was recurrence-free during 12 months surveillance. According to the existing literature and our own experience, surgical procedures appear to be the most promising therapy option for cases with diffuse hepatic metastasis, offering patients relief from their symptoms and (chemo)therapy-free time.
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Affiliation(s)
- Azadeh Azizian
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Alexander König
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Amelie Hartmann
- Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel GmbH, Kassel, Germany
| | - Frank Schuppert
- Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel GmbH, Kassel, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
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8
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Kettwig M, Ternka K, Wendland K, Krüger DM, Zampar S, Schob C, Franz J, Aich A, Winkler A, Sakib MS, Kaurani L, Epple R, Werner HB, Hakroush S, Kitz J, Prinz M, Bartok E, Hartmann G, Schröder S, Rehling P, Henneke M, Boretius S, Alia A, Wirths O, Fischer A, Stadelmann C, Nessler S, Gärtner J. Interferon-driven brain phenotype in a mouse model of RNaseT2 deficient leukoencephalopathy. Nat Commun 2021; 12:6530. [PMID: 34764281 PMCID: PMC8586222 DOI: 10.1038/s41467-021-26880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/14/2021] [Indexed: 12/13/2022] Open
Abstract
Infantile-onset RNaseT2 deficient leukoencephalopathy is characterised by cystic brain lesions, multifocal white matter alterations, cerebral atrophy, and severe psychomotor impairment. The phenotype is similar to congenital cytomegalovirus brain infection and overlaps with type I interferonopathies, suggesting a role for innate immunity in its pathophysiology. To date, pathophysiological studies have been hindered by the lack of mouse models recapitulating the neuroinflammatory encephalopathy found in patients. In this study, we generated Rnaset2-/- mice using CRISPR/Cas9-mediated genome editing. Rnaset2-/- mice demonstrate upregulation of interferon-stimulated genes and concurrent IFNAR1-dependent neuroinflammation, with infiltration of CD8+ effector memory T cells and inflammatory monocytes into the grey and white matter. Single nuclei RNA sequencing reveals homeostatic dysfunctions in glial cells and neurons and provide important insights into the mechanisms of hippocampal-accentuated brain atrophy and cognitive impairment. The Rnaset2-/- mice may allow the study of CNS damage associated with RNaseT2 deficiency and may be used for the investigation of potential therapies.
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Affiliation(s)
- Matthias Kettwig
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.
| | - Katharina Ternka
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Kristin Wendland
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Dennis Manfred Krüger
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Silvia Zampar
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Charlotte Schob
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
- Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
- Max Planck Institute for Experimental Medicine, Göttingen, Germany
| | - Abhishek Aich
- Department of Cellular Biochemistry, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Anne Winkler
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - M Sadman Sakib
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Lalit Kaurani
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Robert Epple
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Hauke B Werner
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Bartok
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
- Unit of Experimental Immunology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - Simone Schröder
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Peter Rehling
- Department of Cellular Biochemistry, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Marco Henneke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Susann Boretius
- Functional Imaging Laboratory, German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany
| | - A Alia
- Institute for Medical Physics and Biophysics, University of Leipzig, Leipzig, Germany
- Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Oliver Wirths
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Andre Fischer
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Stefan Nessler
- Institute of Neuropathology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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9
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Jakob M, Mattes LM, Unger K, Kueffer S, Hess J, Canis M, Schirmer M, Spiegel JL, Haubner F, Ihler F, Weiss BG, Kitz J. Human microRNA-182-5p and kinectin 1: Potential biomarkers for prognosis in oral squamous cell carcinoma. Head Neck 2021; 43:3707-3719. [PMID: 34591354 DOI: 10.1002/hed.26857] [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: 03/08/2021] [Revised: 07/08/2021] [Accepted: 08/12/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The prognostic impact of hsa-miRNA-182-5p in oral cancer remains unexplored. Therefore, the aim of this study was to investigate the prognostic value of hsa-miRNA-182-5p and its predicted target kinectin 1 (KTN1) in oral squamous cell carcinoma (OSCC). METHOD Expression level of hsa-miRNA-182-5p was analyzed in tumor tissue (n = 36) and healthy oral mucosal tissue (n = 17) using quantitative real-time polymerase chain reaction. Protein level of the predicted target KTN1 was detected via immunohistochemistry. Results were validated in a cohort of The Cancer Genome Atlas (TCGA). RESULTS After dividing the data into a subgroup with high and low hsa-miRNA-182-5p expression level, a significant better overall (p = 0.016), recurrence-free (p = 0.009), and progression-free survival (p = 0.004) was observed in an upregulation of hsa-miRNA-182-5p. Staining intensity of KTN1 showed a reciprocal impact on the prognosis. Validation in a TCGA cohort confirmed these results. CONCLUSION Our results indicate hsa-miRNA-182-5p and KTN1 as potential biomarkers for OSCC.
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Affiliation(s)
- Mark Jakob
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,Department of Otorhinolaryngology, Pan Klinik am Neumarkt Köln, Cologne, Germany
| | - Lena M Mattes
- Department of Otorhinolaryngology, University Medical Center Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Kristian Unger
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Kueffer
- Institute of Pathology, University Medical Center Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Julia Hess
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Markus Schirmer
- Department of Radiation Oncology, University Medical Center Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
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10
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Weiss BG, Anczykowski MZ, Ihler F, Bertlich M, Spiegel JL, Haubner F, Canis M, Küffer S, Hess J, Unger K, Kitz J, Jakob M. MicroRNA-182-5p and microRNA-205-5p as potential biomarkers for prognostic stratification of p16-positive oropharyngeal squamous cell carcinoma. Cancer Biomark 2021; 33:331-347. [PMID: 34542062 DOI: 10.3233/cbm-203149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND MicroRNAs constitute promising biomarkers. OBJECTIVE The aim was to investigate diagnostic and prognostic implications of miR-182-5p and miR-205-5p in p16-positive and p16-negative oropharyngeal squamous cell carcinomas (OPSCCs). METHODS Expression of miR-182-5p, miR-205-5p were determined via quantitative real-time-PCR in fresh frozen tissues of 26 p16-positive, 19 p16-negative OPSCCs and 18 HPV-negative oropharyngeal controls. Associations between miRNA-expression, clinicopathological characteristics and prognosis were analyzed. RESULTS Higher miR-182-5p expression was associated with significant inferior disease-specific survival for p16-positive OPSCCs (HR = 1.98E+09, 95% CI 0-Inf; P= 0.028) and a similar trend was observed for p16-negative OPSCCs (HR = 1.56E+09, 95% CI 0-Inf; P= 0.051). Higher miR-205-5p expression was associated with an inferior progression-free survival (HR = 4.62, 95% CI 0.98-21.83; P= 0.034) and local control rate (HR = 2.18E+09, 95% CI 0-Inf; P= 0.048) for p16-positive OPSCCs. CONCLUSIONS Results indicate that miR-182-5p and miR-205-5p can further stratify patients with p16-positive OPSCC into prognostic groups.
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Affiliation(s)
- Bernhard G Weiss
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Mahalia Zoe Anczykowski
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munich, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Stefan Küffer
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Hess
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Germany.,Clinical Cooperation Group "Personalized Radiotherapy in Head and Neck Cancer", Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany
| | - Kristian Unger
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Germany.,Clinical Cooperation Group "Personalized Radiotherapy in Head and Neck Cancer", Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Mark Jakob
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
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11
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Dusch N, Oldani M, Steffen T, Kitz J, Koenig U, Azizian A, König A, Ströbel P, Beissbarth T, Ghadimi M, Gaedcke J. Intensified Histopathological Work-Up after Pancreatic Head Resection Reveals Relevant Prognostic Markers. Digestion 2021; 102:265-273. [PMID: 31962319 DOI: 10.1159/000504648] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/07/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Local recurrence remains a major problem after pancreatic head resection. Intensified histopathological work-up of surgical specimens after pancreatic head resection has revealed an increased number of incomplete resections (R1) depending on tumor infiltration front at the resection margins (RMs). It remains unclear to which extent the increased R1 resection rate has a clinical relevance for the patients' prognosis. MATERIALS AND METHODS Pancreatic head resections between 2006 and 2012 were histologically intensively worked-up by a previously described protocol. The distance between the tumor infiltration front and the resection planes or organ surfaces was documented. The impact of the size of the tumor and an additional portal vein resection was analyzed. The effect of a R1 resection status on development and type of recurrence was evaluated. RESULTS A total of 203 pancreatic head resections were evaluated. Different definitions of R1 resection were applied. These led to significantly different prognosis for patients. A greater distance between the tumor infiltration front and the resection plane or organ surface was associated with a better outcome for the patients. For the ventral surface, the mesopancreas and the pancreatic body these differences were statistically significant comparing the different R1 definitions. For the dorsal surface, a significant difference in prognosis was found if the tumor was >2 mm away from the resection surface. A tumor size of 3 cm was identified to play a relevant role for the prognosis. Patients who had a portal vein resection without a histologically proven infiltration showed a statistically significant higher overall survival. Patients with R1 resection were at highest risk for developing local recurrence as well as distant metastasis. CONCLUSION Intensified histopathological work-up with an increased number of R1 resections has a clinical relevance for patients' prognosis. Tumors with a smaller size or with a greater distance to the organ surface or RM have a better outcome.
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Affiliation(s)
- Niloufar Dusch
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Massimo Oldani
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Tobias Steffen
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Ute Koenig
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Azadeh Azizian
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Alexander König
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Tim Beissbarth
- Institute of Medical Bioinformatics, University Medical Center Goettingen, Goettingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Jochen Gaedcke
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany,
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12
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Bremer SCB, Conradi LC, Mechie NC, Amanzada A, Mavropoulou E, Kitz J, Ghadimi M, Ellenrieder V, Ströbel P, Hessmann E, Gaedcke J, Bohnenberger H. Enhancer of Zeste Homolog 2 in Colorectal Cancer Development and Progression. Digestion 2021; 102:227-235. [PMID: 31694013 DOI: 10.1159/000504093] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/12/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the leading gastrointestinal malignancy. The development from premalignant intraepithelial lesions leading to invasive cancer is paradigmatic for the stepwise carcinogenesis of epithelial cancers, but the knowledge of the underlying mechanism of carcinogenesis and progression of CRC is still incomplete. The understanding of epigenetic mechanisms of carcinogenesis has led to new therapeutic approaches during the last years. Enhancer of zeste homolog 2 (EZH2) is one central epigenetic silencer of the polycomb repressor complex 2 (PRC2) that is already in clinical use as a novel drug target and is associated with poorer prognosis in several cancer entities. PATIENTS AND METHODS The protein expression of EZH2 and other members of the PRC2 as well as resulting posttranslational modifications were investigated by immunohistochemistry in 187 patients with CRC and in 94 patients with premalignant colorectal lesions and correlated with their clinical outcome. Furthermore, the corresponding mRNA expression levels were analyzed in 217 patients with rectal cancer that were enrolled in a prospective clinical trial. RESULTS We found a weak expression of EZH2 in normal colon mucosa that increased in low grade, peaked in high grade intraepithelial neoplasia, and decreased again in invasive CRC. The posttranslational modification caused by EZH2 as a measure of EZH2 activity showed the same behavior. Strong protein and mRNA expression of EZH2 were significantly correlated with favorable prognosis in both investigated cohorts. CONCLUSION The expression and activity of EZH2 are associated with colorectal carcinogenesis and most expressed in intraepithelial high-grade lesions. Strong expression of EZH2 is associated with a significantly favorable prognosis in patients suffering from CRC.
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Affiliation(s)
- Sebastian C B Bremer
- Clinic for Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany,
| | - Lena-Christin Conradi
- Clinic for General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Nicolae-Catalin Mechie
- Clinic for Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Ahmad Amanzada
- Clinic for Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Eirini Mavropoulou
- Clinic for Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Michael Ghadimi
- Clinic for General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Volker Ellenrieder
- Clinic for Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Elisabeth Hessmann
- Clinic for Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Jochen Gaedcke
- Clinic for General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Hanibal Bohnenberger
- Institute of Pathology, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
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13
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Bertlich M, Kitz J, Kruizenga M, Spiegel JL, Canis M, Ihler F, Haubner F, Weiss BG, Jakob M. Cancer Stem Cell Markers in Squamous Cell Carcinomas of the Salivary Glands. Oncology 2021; 99:402-412. [PMID: 33756477 DOI: 10.1159/000514101] [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: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cancer stem cells (CSC) are cells that exhibit stem cell properties and are pivotal in tumor biology. CSC markers have been described for many tumorous entities. However, to this date, there is no data on CSC markers in respect to squamous cell carcinomas (SCC) of the salivary glands. METHODS Histologic samples from patients with salivary gland SCCs were stained for CSC markers (ALDH-1/BMI-1/SOX-2/CD-44/vimentin) and divided into high and low expression subgroups. These were then correlated with tumor and patient characteristics as well as overall survival (OS), disease-specific survival, recurrence-free survival and local control rates (LCR) after 3 and 5 years. RESULTS Overall, 31 samples were included. CD-44 and ALDH-1 expression were associated with tumor origin (metastatic/primary disease, p = 0.048 and p = 0.011, respectively). Strong BMI-1 expression was associated with poorer OS (62.9 vs. 27.3%, p = 0.029), strong SOX-2 expression was associated with poorer LCR (62.5 vs. 21.9%, p = 0.007). CONCLUSION CD-44 and ALDH-1 may be useful in differentiating between primary SCCs and metastatic disease. BMI-1 and SOX-2 are correlated with poorer prognosis.
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Affiliation(s)
- Mattis Bertlich
- Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Marie Kruizenga
- Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Jennifer Lee Spiegel
- Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany,
| | - Mark Jakob
- Department of Otorhinolaryngology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
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14
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Leu M, Kitz J, Pilavakis Y, Hakroush S, Wolff HA, Canis M, Rieken S, Schirmer MA. Monocarboxylate transporter-1 (MCT1) protein expression in head and neck cancer affects clinical outcome. Sci Rep 2021; 11:4578. [PMID: 33633176 PMCID: PMC7907348 DOI: 10.1038/s41598-021-84019-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/08/2020] [Accepted: 02/04/2021] [Indexed: 01/31/2023] Open
Abstract
Treatment of locally advanced, unresectable head and neck squamous cell carcinoma (HNSCC) often yields only modest results with radiochemotherapy (RCT) as standard of care. Prognostic features related to outcome upon RCT might be highly valuable to improve treatment. Monocarboxylate transporters-1 and -4 (MCT1/MCT4) were evaluated as potential biomarkers. A cohort of HNSCC patients without signs for distant metastases was assessed eliciting 82 individuals eligible whereof 90% were diagnosed with locally advanced stage IV. Tumor specimens were stained for MCT1 and MCT4 in the cell membrane by immunohistochemistry. Obtained data were evaluated with respect to overall (OS) and progression-free survival (PFS). Protein expression of MCT1 and MCT4 in cell membrane was detected in 16% and 85% of the tumors, respectively. Expression of both transporters was not statistically different according to the human papilloma virus (HPV) status. Positive staining for MCT1 (n = 13, negative in n = 69) strongly worsened PFS with a hazard ratio (HR) of 3.1 (95%-confidence interval 1.6-5.7, p < 0.001). OS was likewise affected with a HR of 3.8 (2.0-7.3, p < 0.001). Multivariable Cox regression confirmed these findings. We propose MCT1 as a promising biomarker in HNSCC treated by primary RCT.
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Affiliation(s)
- Martin Leu
- grid.411984.10000 0001 0482 5331Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - J. Kitz
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Y. Pilavakis
- grid.411984.10000 0001 0482 5331Clinic of Otorhinolaryngology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - S. Hakroush
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - H. A. Wolff
- Department of Radiology, Nuclear Medicine and Radiotherapy, Radiology Munich, Maximiliansplatz 2, 80333 Munich, Germany ,grid.7727.50000 0001 2190 5763Department of Radiation Oncology, Medical Center, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - M. Canis
- grid.5252.00000 0004 1936 973XDepartment of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - S. Rieken
- grid.411984.10000 0001 0482 5331Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - M. A. Schirmer
- grid.411984.10000 0001 0482 5331Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
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15
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Spiegel JL, Jakob M, Kruizenga M, Freytag S, Bertlich M, Canis M, Ihler F, Haubner F, Kitz J, Weiss BG. Cancer stem cell markers in adenocarcinoma of the salivary glands - reliable prognostic markers? Eur Arch Otorhinolaryngol 2020; 278:2517-2528. [PMID: 33009929 PMCID: PMC8165058 DOI: 10.1007/s00405-020-06389-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Abstract
Purpose Adenocarcinoma of the salivary glands is of low incidence and a broad range of histopathological subtypes. Cancer stem cell markers (CSC) might serve as novel prognostic parameters. To date, only a few studies examined the expression of CSC in adenocarcinoma of the salivary glands with diverging results. To further investigate the reliability in terms of prognostic value, a histopathological analysis of CSCs on a cohort of patients with adenocarcinomas of the major salivary glands was performed. Methods Tumor samples of 40 consecutive patients with adenocarcinoma of the major salivary gland treated with curative intend at one tertiary center were stained with the CSCs ALDH1, BMI-1, CD44, Nanog, and SOX2. Expression of these markers was correlated with clinicopathological parameters and survival estimates. Results Correlation of high expression of ALDH1 with higher grading (p < 0.001) and high expression of CD44 with the localization of the neoplasm (p = 0.05), larger tumor size (p = 0.006), positive pN-category (p = 0.023), and advanced UICC stage (p = 0.002) was found. Furthermore, high expression of SOX2 correlated with a negative perineural invasion (p = 0.02). No significant correlation of any investigated marker with survival estimates was observed. Conclusion In conclusion, our study did not find a significant correlation of the investigated CSCs with survival estimates in adenocarcinoma of the major salivary glands. Recapitulating the results of our study in conjunction with data in the literature, the CSCs ALDH1, BMI-1, CD44, Nanog, and SOX2 do not seem to serve as reliable prognostic parameters in the treatment of adenocarcinoma of the salivary glands.
Electronic supplementary material The online version of this article (10.1007/s00405-020-06389-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Spiegel
- Department for Otorhinolaryngology, LMU Klinikum, Marchioninistr, Ludwig-Maximilians-Universität München, 81377, Munich, Germany.
| | - Mark Jakob
- Department for Otorhinolaryngology, LMU Klinikum, Marchioninistr, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Marie Kruizenga
- Department of Otorhinolaryngology, Georg August University, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Saskia Freytag
- Molecular Medicine, Harry Perkins Institute of Medical Research, Perth, WA, 6009, Australia
| | - Mattis Bertlich
- Department for Otorhinolaryngology, LMU Klinikum, Marchioninistr, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Martin Canis
- Department for Otorhinolaryngology, LMU Klinikum, Marchioninistr, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Friedrich Ihler
- Department for Otorhinolaryngology, LMU Klinikum, Marchioninistr, Ludwig-Maximilians-Universität München, 81377, Munich, Germany.,German Centre for Vertigo and Balance 508 Disorders, LMU Klinikum, Marchioninistr. 15, Ludwig-Maximilians-Universität , 81377, Munich, Germany
| | - Frank Haubner
- Department for Otorhinolaryngology, LMU Klinikum, Marchioninistr, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Julia Kitz
- Institute of Pathology, University Hospital Göttingen, Georg August University, Robert-Koch-Str. 40,, 37075, Göttingen, Germany
| | - Bernhard G Weiss
- Department for Otorhinolaryngology, LMU Klinikum, Marchioninistr, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
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16
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Jo P, Bernhardt M, Nietert M, König A, Azizian A, Schirmer MA, Grade M, Kitz J, Reuter-Jessen K, Ghadimi M, Ströbel P, Schildhaus HU, Gaedcke J. KRAS mutation status concordance between the primary tumor and the corresponding metastasis in patients with rectal cancer. PLoS One 2020; 15:e0239806. [PMID: 33002027 PMCID: PMC7529221 DOI: 10.1371/journal.pone.0239806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Oncogenic mutation within the KRAS gene represents a negative predictor for treatment response to anti-epidermal growth factor receptor (EGFR) in patients with colorectal cancer. Recently, we have shown no relevant heterogeneity for KRAS mutation status within and between pre- and posttherapeutic samples from the primary tumor in patients with locally advanced rectal cancer. The aim of this study was to evaluate the intertumoral heterogeneity of KRAS mutation status between the primary tumor and the corresponding metastasis or local recurrence in the similar cohort and to evaluate the ideal representative tissue for KRAS mutation testing. MATERIALS AND METHODS KRAS mutation status was analyzed from 47 patients with locally advanced rectal cancer, which were enrolled in the CAO/ARO/AIO-94 or CAO/ARO/AIO-04 trial. Mutations in KRAS codons 12, 13, and 61 were analyzed by using the KRAS RGQ PCR Kit (therascreen® KRAS test). Six patients needed to be excluded due to incomplete follow up data. 11 patients showed a relapse of the disease during the follow up presented by distant metastases or local recurrence. DNA from representative areas of metastatic tissue was obtained from formalin-fixed paraffin-embedded specimens. RESULTS The mean patient age was 64.13 ± 10.64 years. In total, 19 patients showed a KRAS mutation (46.34%) in the primary tumor. Of the eleven patients with a metastatic disease or local recurrence, five patients showed a KRAS mutation whereas six patients had a KRAS wildtype status. Metastatic localizations included the liver (n = 2), lung (n = 4), local recurrence (n = 1), liver + lung (n = 3), lung + local recurrence (n = 1). For these eleven patients with paired data available for the primary tumor and metastatic tissue, a significant KRAS mutation status concordance was detected in 81.18% (9/11) of the patients (p = 0.03271). Only two patients showed intertumoral heterogeneity, which harbored in one patient a KRAS G12C mutation status in the primary tumor, but a G12V KRAS mutation status in the corresponding lung lesion, and in the other patient a G12A mutation in the primary lesion and a WT in the lung metastasis. CONCLUSIONS We show a significant concordance of the KRAS mutation status between tumor samples obtained from the primary tumor and the corresponding metastasis and/ or local recurrence in patients with rectal cancer indicating no relevant intertumoral heterogeneity. Our data suggest that sampling either the primary (pre- or posttherapeutical tumor tissue) or metastatic lesion may be valid for the initial evaluation of KRAS mutation status predicting the response to anti-EGFR treatment and guiding clinical decisions.
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Affiliation(s)
- Peter Jo
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
- * E-mail:
| | - Markus Bernhardt
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Manuel Nietert
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Alexander König
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Azadeh Azizian
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Markus A. Schirmer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Marian Grade
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
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17
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Jakob M, Sharaf K, Schirmer M, Leu M, Küffer S, Bertlich M, Ihler F, Haubner F, Canis M, Kitz J. Role of cancer stem cell markers ALDH1, BCL11B, BMI-1, and CD44 in the prognosis of advanced HNSCC. Strahlenther Onkol 2020; 197:231-245. [PMID: 32588101 PMCID: PMC7892527 DOI: 10.1007/s00066-020-01653-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 03/11/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
Purpose Cancer stem cells (CSCs) are held accountable for the progress of head and neck squamous cell carcinoma (HNSCC). In the presented study, the authors evaluated the prognostic value of CSC markers in two particular HNSCC cohorts. Methods This two cohort study consisted of 85 patients with advanced stage HNSCC, treated with primary radio(chemo)therapy (pRCT), and 95 patients with HNSCC, treated with surgery and partially adjuvant radio(chemo)therapy. Overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were assessed. Samples were assessed for the expression of different molecular stem cell markers (ALDH1, BCL11B, BMI‑1, and CD44). Results In the pRCT cohort, none of the baseline patient and tumor features exhibited a statistically significant relation with survival in either the cohort or the human papillomavirus (HPV)-stratified subcohorts. High expression of BMI‑1 significantly decreased OS and DFS, while high expression of CD44 decreased all modes of survival. Multivariate analysis showed significant prognostic influence for all tested CSC markers, with high BMI‑1 and CD44 decreasing survival (BMI-1: OS, DFS, DSS; CD44: OS, DFS) and high ALDH1 and BCL11B showing a beneficial effect on survival (ALDH1: OS, DFS; BCL11B: OS, DSS). In the surgical cohort, classical prognosticators such as HPV status, R1 resection, and nodal status in HPV-negative HNSCC played a significant role, but the tested CSC markers showed no significant effect on prognosis. Conclusion Although validation in independent cohorts is still needed, testing for CSC markers in patients with advanced or late stage HNSCC might be beneficial, especially if many comorbidities exist or disease is irresectable. The findings might guide the development and earlier use of targeted therapies in the future. Electronic supplementary material The online version of this article (10.1007/s00066-020-01653-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Jakob
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. .,Department of Otolaryngology, University Medical Center Göttingen, Göttingen, Germany.
| | - Kariem Sharaf
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Markus Schirmer
- Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Leu
- Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Küffer
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Mattis Bertlich
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Friedrich Ihler
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,German Center of Vertigo and Dizziness, University Hospital, LMU Munich, Munich, Germany
| | - Frank Haubner
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Martin Canis
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
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18
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Weiss BG, Anczykowski MZ, Flach S, Spiegel JL, Kitz J, Bertlich M, Canis M, Jakob M, Ihler F. Benefit of postoperative radiotherapy for early tumors with single ipsilateral lymph node metastasis. Laryngoscope 2019; 130:E530-E538. [PMID: 31837151 DOI: 10.1002/lary.28394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/27/2019] [Accepted: 09/27/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS Indication for postoperative radiotherapy in patients with locally circumscribed tumors (pT1-pT2) and a single ipsilateral lymph node metastasis (pN1) is debatable. The aim of this study was to evaluate the oncological long-term outcome of patients with pT1-pT2 pN1 squamous cell carcinoma (SCC) of the oral cavity, the oropharynx, and the hypopharynx without extracapsular spread (ECS) after a margin-negative surgical resection, who either received or did not receive postoperative (chemo)radiotherapy. STUDY DESIGN Retrospective case series. METHODS The oncological outcome of patients with pT1-pT2 pN1 SCC without ECS was evaluated retrospectively. All patients underwent primary tumor resection that included transoral laser microsurgery and neck dissection at an academic tertiary referral center. RESULTS Of 65 identified patients treated between 1986 and 2015 (18 oral cavity, 30 oropharynx, 17 hypopharynx), 21 (32%) received postoperative radiotherapy, and 44 (68%) were treated by surgery alone. The group of patients receiving postoperative treatment showed a significantly superior 5-year disease-specific (94.4% vs. 73.2%, P = .029) and recurrence-free survival (85.2% vs. 43.2%, P = .002), as well as a higher local control rate (90.2% vs. 64.9%, P = .042). The overall survival was 71.4% vs. 62.6% (P = .53). The mean follow-up was 80.7 months. CONCLUSIONS Patients with locally circumscribed carcinomas and a single ipsilateral ECS-negative lymph node metastasis seem to benefit from postoperative radiotherapy. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E530-E538, 2020.
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Affiliation(s)
- Bernhard G Weiss
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Mahalia Z Anczykowski
- Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Flach
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Mark Jakob
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
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19
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Flebbe H, Hamdan FH, Kari V, Kitz J, Gaedcke J, Ghadimi BM, Johnsen SA, Grade M. Epigenome Mapping Identifies Tumor-Specific Gene Expression in Primary Rectal Cancer. Cancers (Basel) 2019; 11:cancers11081142. [PMID: 31404997 PMCID: PMC6721540 DOI: 10.3390/cancers11081142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022] Open
Abstract
Epigenetic alterations play a central role in cancer development and progression. The acetylation of histone 3 at lysine 27 (H3K27ac) specifically marks active genes. While chromatin immunoprecipitation (ChIP) followed by next-generation sequencing (ChIP-seq) analyses are commonly performed in cell lines, only limited data are available from primary tumors. We therefore examined whether cancer-specific alterations in H3K27ac occupancy can be identified in primary rectal cancer. Tissue samples from primary rectal cancer and matched mucosa were obtained. ChIP-seq for H3K27ac was performed and differentially occupied regions were identified. The expression of selected genes displaying differential occupancy between tumor and mucosa were examined in gene expression data from an independent patient cohort. Differential expression of four proteins was further examined by immunohistochemistry. ChIP-seq for H3K27ac in primary rectal cancer and matched mucosa was successfully performed and revealed differential binding on 44 regions. This led to the identification of genes with increased H3K27ac, i.e., RIPK2, FOXQ1, KRT23, and EPHX4, which were also highly upregulated in primary rectal cancer in an independent dataset. The increased expression of these four proteins was confirmed by immunohistochemistry. This study demonstrates the feasibility of ChIP-seq-based epigenome mapping of primary rectal cancer and confirms the value of H3K27ac occupancy to predict gene expression differences.
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Affiliation(s)
- Hannah Flebbe
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Feda H Hamdan
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany
- Gene Regulatory Mechanisms and Molecular Epigenetics Laboratory, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vijayalakshmi Kari
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - B Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Steven A Johnsen
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany.
- Gene Regulatory Mechanisms and Molecular Epigenetics Laboratory, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Marian Grade
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany.
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20
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Jakob M, Mattes LM, Küffer S, Unger K, Hess J, Bertlich M, Haubner F, Ihler F, Canis M, Weiss BG, Kitz J. MicroRNA expression patterns in oral squamous cell carcinoma: hsa-mir-99b-3p and hsa-mir-100-5p as novel prognostic markers for oral cancer. Head Neck 2019; 41:3499-3515. [PMID: 31355988 DOI: 10.1002/hed.25866] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND MicroRNAs (miRNA) recently evolved as potential cancer biomarkers. Therefore, the aim of the present study was to evaluate the prognostic impact of eight miRNAs connected to oral squamous cell carcinoma (OSCC). METHOD Expression levels of hsa-mir-21-5p, hsa-mir-29b-3p, hsa-mir-31-5p, hsa-mir-99a-5p, hsa-mir-99b-3p, hsa-mir-100-5p, hsa-mir-143-3p and hsa-mir-155-5p were analyzed in tumor tissue (n = 36) and healthy oral mucosal tissue (n = 17) and correlated with clinical variables. Results of the study cohort were validated in an OSCC cohort of The Cancer Genome Atlas. RESULTS Increased hsa-mir-99b-3p expression level showed a tendency toward advanced tumor stages, and high levels of hsa-mir-100-5p expression were associated with extracapsular extension. While a high expression level of hsa-mir-99b-3p was associated with better survival, a high expression level of hsa-mir-100-5p was correlated with a poorer survival in the study cohort. CONCLUSION Our results indicate that hsa-mir-99b-3p and hsa-mir-100-5p may serve as novel prognostic biomarkers in OSCC.
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Affiliation(s)
- Mark Jakob
- Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lena M Mattes
- Department of Otorhinolaryngology, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Stefan Küffer
- Institute of Pathology, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Kristian Unger
- Clinical Cooperation Group "Personalized Radiotherapy in Head and Neck Cancer", Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany
| | - Julia Hess
- Clinical Cooperation Group "Personalized Radiotherapy in Head and Neck Cancer", Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Munich, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Kitz
- Institute of Pathology, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
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21
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Weiss BG, Ihler F, Anczykowski MZ, Bertlich M, Kitz J, Steiner W, Canis M, Jakob M. Transoral laser microsurgery for treatment of oropharyngeal cancer in 368 patients. Head Neck 2019; 41:3144-3158. [PMID: 31179614 DOI: 10.1002/hed.25806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/24/2019] [Accepted: 04/29/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Oncological and functional outcome of transoral laser microsurgery (TLM) for primary treatment of oropharyngeal cancer was examined using a multimodal treatment concept. METHODS A total of 368 patients with oropharyngeal squamous cell carcinoma (pT1-4, pN0-2, M0) underwent TLM +/- neck dissection (85%), +/- (chemo)radiotherapy (57%). The majority of patients had advanced stage III and IVa disease (79%). RESULTS Five-year Kaplan-Meier estimates for local control were 83.5% for pT1, 74.1% for pT2, 77.3% for pT3, and 76.0% for pT4a tumors. Five-year estimates of overall, disease-specific, and recurrence-free survival for stage I were 76.0%, 92.8%, and 69.1%; for stage II 71.1%, 85.7%, and 49.6%; for stage III 61.7%, 72.5%, and 58.8%; and for stage IVa 57.3%, 73.7%, and 63.9%, respectively. Postoperative (chemo)radiotherapy improved the outcome for advanced disease. p16-positive tumors had superior survival estimates. Overall, 93.5% maintained regular oral nutrition without feeding tube dependency. CONCLUSION Primary TLM in multimodal concepts of treatment offers good oncologic outcome even for advanced-stage oropharyngeal cancer.
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Affiliation(s)
- Bernhard G Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Munich, Germany
| | - Mahalia Zoe Anczykowski
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Steiner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Mark Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.,Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
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22
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Bohnenberger H, Kaderali L, Ströbel P, Yepes D, Plessmann U, Dharia NV, Yao S, Heydt C, Merkelbach-Bruse S, Emmert A, Hoffmann J, Bodemeyer J, Reuter-Jessen K, Lois AM, Dröge LH, Baumeister P, Walz C, Biggemann L, Walter R, Häupl B, Comoglio F, Pan KT, Scheich S, Lenz C, Küffer S, Bremmer F, Kitz J, Sitte M, Beißbarth T, Hinterthaner M, Sebastian M, Lotz J, Schildhaus HU, Wolff H, Danner BC, Brandts C, Büttner R, Canis M, Stegmaier K, Serve H, Urlaub H, Oellerich T. Comparative proteomics reveals a diagnostic signature for pulmonary head-and-neck cancer metastasis. EMBO Mol Med 2019; 10:emmm.201708428. [PMID: 30097507 PMCID: PMC6127892 DOI: 10.15252/emmm.201708428] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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] [Indexed: 12/21/2022] Open
Abstract
Patients with head‐and‐neck cancer can develop both lung metastasis and primary lung cancer during the course of their disease. Despite the clinical importance of discrimination, reliable diagnostic biomarkers are still lacking. Here, we have characterised a cohort of squamous cell lung (SQCLC) and head‐and‐neck (HNSCC) carcinomas by quantitative proteomics. In a training cohort, we quantified 4,957 proteins in 44 SQCLC and 30 HNSCC tumours. A total of 518 proteins were found to be differentially expressed between SQCLC and HNSCC, and some of these were identified as genetic dependencies in either of the two tumour types. Using supervised machine learning, we inferred a proteomic signature for the classification of squamous cell carcinomas as either SQCLC or HNSCC, with diagnostic accuracies of 90.5% and 86.8% in cross‐ and independent validations, respectively. Furthermore, application of this signature to a cohort of pulmonary squamous cell carcinomas of unknown origin leads to a significant prognostic separation. This study not only provides a diagnostic proteomic signature for classification of secondary lung tumours in HNSCC patients, but also represents a proteomic resource for HNSCC and SQCLC.
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Affiliation(s)
| | - Lars Kaderali
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Diego Yepes
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany.,German Cancer Research Center, German Cancer Consortium, Heidelberg, Germany
| | - Uwe Plessmann
- Bioanalytical Mass Spectrometry Group, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | - Neekesh V Dharia
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Pediatric Hematology/Oncology, Boston Childrens Hospital, Boston, MA, USA.,The Broad Institute, Cambridge, MA, USA
| | - Sha Yao
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Carina Heydt
- Institute of Pathology, University Hospital Cologne, University of Cologne, Köln, Germany
| | | | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Göttingen, Germany
| | - Jonatan Hoffmann
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Julius Bodemeyer
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | | | - Anna-Maria Lois
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Leif Hendrik Dröge
- Department of Radiooncology, University Medical Center, Göttingen, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, University Hospital Munich, Ludwig-Maximilian-University München, München, Germany
| | - Christoph Walz
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Lorenz Biggemann
- Institute for Diagnostic and Interventional Radiology, University Medical Center, Göttingen, Germany
| | - Roland Walter
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Björn Häupl
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany.,German Cancer Research Center, German Cancer Consortium, Heidelberg, Germany
| | - Federico Comoglio
- Department of Haematology, University of Cambridge, Cambridge, UK.,Cambridge Institute for Medical Research, Wellcome Trust/MRC Stem Cell Institute, Cambridge, UK
| | - Kuan-Ting Pan
- Bioanalytical Mass Spectrometry Group, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | - Sebastian Scheich
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Christof Lenz
- Bioanalytical Mass Spectrometry Group, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany.,Bioanalytics, University Medical Center, Göttingen, Germany
| | - Stefan Küffer
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Felix Bremmer
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Maren Sitte
- Institute of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Tim Beißbarth
- Institute of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Göttingen, Germany
| | - Martin Sebastian
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center, Göttingen, Germany.,German Cardiovascular Research Center, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partnersite Göttingen, Germany
| | | | - Hendrik Wolff
- University Medical Center, Göttingen, Germany.,Department of Radiooncology, University Medical Center, Regensburg, Germany
| | - Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Göttingen, Germany
| | - Christian Brandts
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany.,German Cancer Research Center, German Cancer Consortium, Heidelberg, Germany
| | - Reinhard Büttner
- Institute of Pathology, University Hospital Cologne, University of Cologne, Köln, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital Munich, Ludwig-Maximilian-University München, München, Germany
| | - Kimberly Stegmaier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Pediatric Hematology/Oncology, Boston Childrens Hospital, Boston, MA, USA.,The Broad Institute, Cambridge, MA, USA
| | - Hubert Serve
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany.,German Cancer Research Center, German Cancer Consortium, Heidelberg, Germany
| | - Henning Urlaub
- Bioanalytical Mass Spectrometry Group, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, University Medical Center, Göttingen, Germany
| | - Thomas Oellerich
- Department of Medicine II, Hematology/Oncology, Goethe University, Frankfurt, Germany .,German Cancer Research Center, German Cancer Consortium, Heidelberg, Germany
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23
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Patzak MS, Kari V, Patil S, Hamdan FH, Goetze RG, Brunner M, Gaedcke J, Kitz J, Jodrell DI, Richards FM, Pilarsky C, Gruetzmann R, Rümmele P, Knösel T, Hessmann E, Ellenrieder V, Johnsen SA, Neesse A. Cytosolic 5'-nucleotidase 1A is overexpressed in pancreatic cancer and mediates gemcitabine resistance by reducing intracellular gemcitabine metabolites. EBioMedicine 2019; 40:394-405. [PMID: 30709769 PMCID: PMC6413477 DOI: 10.1016/j.ebiom.2019.01.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/08/2019] [Accepted: 01/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cytosolic 5'-nucleotidase 1A (NT5C1A) dephosphorylates non-cyclic nucleoside monophosphates to produce nucleosides and inorganic phosphates. Here, we investigate NT5C1A expression in pancreatic ductal adenocarcinoma (PDAC) and its impact on gemcitabine metabolism and therapeutic efficacy. METHODS NT5C1A expression was determined by semiquantitative immunohistochemistry using tissue microarrays. Gemcitabine metabolites and response were assessed in several human and murine PDAC cell lines using crystal violet assays, Western blot, viability assays, and liquid chromatography tandem mass-spectrometry (LC-MS/MS). FINDINGS NT5C1A was strongly expressed in tumor cells of a large subgroup of resected PDAC patients in two independent patient cohorts (44-56% score 2 and 8-26% score 3, n = 414). In contrast, NT5C1A was expressed at very low levels in the tumor stroma, and neither stromal nor tumoral expression was a prognostic marker for postoperative survival. In vitro, NT5C1A overexpression increased gemcitabine resistance by reducing apoptosis levels and significantly decreased intracellular amounts of cytotoxic dFdCTP in +NT5C1A tumor cells. Co-culture experiments with conditioned media from +NT5C1A PSCs improved gemcitabine efficacy in tumor cells. In vivo, therapeutic efficacy of gemcitabine was significantly decreased and serum levels of the inactive gemcitabine metabolite dFdU significantly increased in mice bearing NT5C1A overexpressing tumors. INTERPRETATION NT5C1A is robustly expressed in tumor cells of resected PDAC patients. Moreover, NT5C1A mediates gemcitabine resistance by decreasing the amount of intracellular dFdCTP, leading to reduced tumor cell apoptosis and larger pancreatic tumors in mice. Further studies should clarify the role of NT5C1A as novel predictor for gemcitabine treatment response in patients with PDAC.
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MESH Headings
- 5'-Nucleotidase/genetics
- Animals
- Biomarkers, Tumor
- Carcinoma, Pancreatic Ductal/drug therapy
- Carcinoma, Pancreatic Ductal/genetics
- Carcinoma, Pancreatic Ductal/metabolism
- Carcinoma, Pancreatic Ductal/pathology
- Cell Line, Tumor
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/pharmacokinetics
- Deoxycytidine/pharmacology
- Disease Models, Animal
- Drug Resistance, Neoplasm/genetics
- Gene Expression
- Humans
- Mice
- Mice, Transgenic
- Models, Biological
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/genetics
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/pathology
- Prognosis
- Xenograft Model Antitumor Assays
- Gemcitabine
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Affiliation(s)
- Melanie S Patzak
- University Medical Center Goettingen, Department of Gastroenterology and Gastrointestinal Oncology, Goettingen, Germany
| | - Vijayalakshmi Kari
- University Medical Center Goettingen, Department of General, Visceral and Pediatric Surgery, Goettingen, Germany
| | - Shilpa Patil
- University Medical Center Goettingen, Department of Gastroenterology and Gastrointestinal Oncology, Goettingen, Germany
| | - Feda H Hamdan
- University Medical Center Goettingen, Department of General, Visceral and Pediatric Surgery, Goettingen, Germany
| | - Robert G Goetze
- University Medical Center Goettingen, Department of Gastroenterology and Gastrointestinal Oncology, Goettingen, Germany
| | - Marius Brunner
- University Medical Center Goettingen, Department of Gastroenterology and Gastrointestinal Oncology, Goettingen, Germany
| | - Jochen Gaedcke
- University Medical Center Goettingen, Department of General, Visceral and Pediatric Surgery, Goettingen, Germany
| | - Julia Kitz
- University Medical Center Goettingen, Institute of Pathology, Goettingen, Germany
| | - Duncan I Jodrell
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Frances M Richards
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Christian Pilarsky
- University Medical Center Erlangen, Department of Surgery, Erlangen, Germany
| | - Robert Gruetzmann
- University Medical Center Erlangen, Department of Surgery, Erlangen, Germany
| | - Petra Rümmele
- University Medical Center Erlangen, Institute of Pathology, Erlangen, Germany
| | - Thomas Knösel
- Ludwig Maximilian University Munich, Institute of Pathology, Munich, Germany
| | - Elisabeth Hessmann
- University Medical Center Goettingen, Department of Gastroenterology and Gastrointestinal Oncology, Goettingen, Germany
| | - Volker Ellenrieder
- University Medical Center Goettingen, Department of Gastroenterology and Gastrointestinal Oncology, Goettingen, Germany
| | - Steven A Johnsen
- University Medical Center Goettingen, Department of General, Visceral and Pediatric Surgery, Goettingen, Germany
| | - Albrecht Neesse
- University Medical Center Goettingen, Department of Gastroenterology and Gastrointestinal Oncology, Goettingen, Germany.
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24
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Pan M, Schinke H, Luxenburger E, Kranz G, Shakhtour J, Libl D, Huang Y, Gaber A, Pavšič M, Lenarčič B, Kitz J, Jakob M, Schwenk-Zieger S, Canis M, Hess J, Unger K, Baumeister P, Gires O. EpCAM ectodomain EpEX is a ligand of EGFR that counteracts EGF-mediated epithelial-mesenchymal transition through modulation of phospho-ERK1/2 in head and neck cancers. PLoS Biol 2018; 16:e2006624. [PMID: 30261040 PMCID: PMC6177200 DOI: 10.1371/journal.pbio.2006624] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/09/2018] [Accepted: 09/12/2018] [Indexed: 12/18/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) are characterized by outstanding molecular heterogeneity that results in severe therapy resistance and poor clinical outcome. Inter- and intratumoral heterogeneity in epithelial-mesenchymal transition (EMT) was recently revealed as a major parameter of poor clinical outcome. Here, we addressed the expression and function of the therapeutic target epidermal growth factor receptor (EGFR) and of the major determinant of epithelial differentiation epithelial cell adhesion molecule (EpCAM) in clinical samples and in vitro models of HNSCCs. We describe improved survival of EGFRlow/EpCAMhigh HNSCC patients (n = 180) and provide a molecular basis for the observed disparities in clinical outcome. EGF/EGFR have concentration-dependent dual capacities as inducers of proliferation and EMT through differential activation of the central molecular switch phosphorylated extracellular signal–regulated kinase 1/2 (pERK1/2) and EMT transcription factors (EMT-TFs) Snail, zinc finger E-box-binding homeobox 1 (Zeb1), and Slug. Furthermore, soluble ectodomain of EpCAM (EpEX) was identified as a ligand of EGFR that activates pERK1/2 and phosphorylated AKT (pAKT) and induces EGFR-dependent proliferation but represses EGF-mediated EMT, Snail, Zeb1, and Slug activation and cell migration. EMT repression by EpEX is realized through competitive modulation of pERK1/2 activation strength and inhibition of EMT-TFs, which is reflected in levels of pERK1/2 and its target Slug in clinical samples. Accordingly, high expression of pERK1/2 and/or Slug predicted poor outcome of HNSCCs. Hence, EpEX is a ligand of EGFR that induces proliferation but counteracts EMT mediated by the EGF/EGFR/pERK1/2 axis. Therefore, the emerging EGFR/EpCAM molecular cross talk represents a promising target to improve patient-tailored adjuvant treatment of HNSCCs. Head and neck squamous cell carcinomas (HNSCCs) display poor survival, with death rates above 55%. Major factors affecting survival are metastases’ formation and therapy resistance. Phenotypic changes during partial epithelial-mesenchymal transition (EMT) provide tumor cells with increased migration, invasion, and therapy resistance. Understanding molecular mechanisms of EMT, as a central process of the metastatic cascade and the development of therapy resistance, is therefore important. In the present work, we identified molecular cross talk between epidermal growth factor receptor (EGFR) and epithelial cell adhesion molecule (EpCAM) as a novel determinant of clinical outcome in HNSCCs. Low levels of EGFR but high levels of EpCAM (EGFRlow/EpCAMhigh) were associated with favorable prognosis, with survival rates above 90%, whereas EGFRhigh/EpCAMlow correlated with poor survival, below 10%. EGFR was shown to have a concentration-dependent capacity to induce proliferation and EMT. Proteolytic cleavage of the extracellular domain of EpCAM (EpEX) produces a ligand of EGFR that induces EGFR-dependent proliferation but counteracts EGF-induced EMT. We delineate an EGFR/extracellular signal–regulated kinase 1/2 (ERK1/2)/EpCAM signaling axis that may be a promising therapeutic target for HNSCCs.
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Affiliation(s)
- Min Pan
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Henrik Schinke
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Elke Luxenburger
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Gisela Kranz
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Julius Shakhtour
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Darko Libl
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Yuanchi Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Aljaž Gaber
- Department of Chemistry and Biochemistry, Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Pavšič
- Department of Chemistry and Biochemistry, Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia
| | - Brigita Lenarčič
- Department of Chemistry and Biochemistry, Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia
- Department of Biochemistry, Molecular and Structural Biology, Institute Jožef Stefan, Ljubljana, Slovenia
| | - Julia Kitz
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Mark Jakob
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Sabina Schwenk-Zieger
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Julia Hess
- Clinical Cooperation Group “Personalized Radiotherapy in Head and Neck Cancer“, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Kristian Unger
- Clinical Cooperation Group “Personalized Radiotherapy in Head and Neck Cancer“, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
- Clinical Cooperation Group “Personalized Radiotherapy in Head and Neck Cancer“, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Olivier Gires
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
- Clinical Cooperation Group “Personalized Radiotherapy in Head and Neck Cancer“, Helmholtz Zentrum München, Research Center for Environmental Health (GmbH), Neuherberg, Germany
- * E-mail:
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25
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Kitz J, Fokas E, Beissbarth T, Ströbel P, Wittekind C, Hartmann A, Rüschoff J, Papadopoulos T, Rösler E, Ortloff-Kittredge P, Kania U, Schlitt H, Link KH, Bechstein W, Raab HR, Staib L, Germer CT, Liersch T, Sauer R, Rödel C, Ghadimi M, Hohenberger W. Association of Plane of Total Mesorectal Excision With Prognosis of Rectal Cancer: Secondary Analysis of the CAO/ARO/AIO-04 Phase 3 Randomized Clinical Trial. JAMA Surg 2018; 153:e181607. [PMID: 29874375 DOI: 10.1001/jamasurg.2018.1607] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Previous retrospective studies have shown that surgical quality affects local control in rectal cancer.. Objective In this secondary end point analysis, we evaluated the prognostic effect of the total mesorectal excision (TME) plane in the CAO/ARO/AIO-04 phase 3 randomized clinical trial. Design, Setting, and Participants The CAO/ARO/AIO-04 trial enrolled 1236 patients with cT3-4 and/or node-positive rectal adenocarcinoma from 88 centers in Germany between July 25, 2006, and February 26, 2010. Interventions Patients were randomized to receive treatment with standard fluorouracil-based preoperative chemoradiotherapy (CRT) alone (control arm) or oxaliplatin (experimental arm) followed by TME and adjuvant chemotherapy. Main Outcomes and Measures The TME quality (mesorectal, intramesorectal, and muscularis propria plane) was prospectively assessed in 1152 operation specimens. An assessment was performed independently by pathologists and surgeons. The results were correlated with clinicopathologic data and the clinical outcome was tested, including multivariable analysis with the Cox regression model. Results Of 1152 German Caucasian participants, 332 (28.8) were women and the mean age was 63 years. The plane of TME was mesorectal in 930 patients (80.7%), intramesorectal in 169 (14.7%), and muscularis propria in 53 (4.6%). In a univariable analysis, the TME plane was significantly associated with 3-year disease-free survival (mesorectal vs intramesorectal vs muscularis propria, 95% CI, 73.1-78.8 vs 61.6-76.0 vs 55.6-81.3, respectively; P = .01), cumulative incidence of local and distant recurrences (mesorectal vs intramesorectal vs muscularis propria, 95% CI, 2.0-4.5 vs 1.2-8.1 vs 2.5-20.5, respectively; P < .001; and mesorectal vs intramesorectal vs muscularis propria, 95% CI, 17.0-22.4 vs 18.3-32.0 vs 14.2-39.0, respectively; P = .03, respectively), and overall survival (mesorectal vs intramesorectal vs muscularis propria, 95% CI, 88.3-92.3 vs 79.7-91.0 vs 81.6-98.7, respectively; P = .02). In contrast to the pathologist-based evaluation, the assessment of TME plane by the operating surgeon failed to demonstrate prognostic significance for any of these clinical end points. In a multivariable analysis, the plane of surgery (mesorectal vs muscularis propria TME) constituted an independent factor for local recurrence (P = .002). Conclusions and Relevance This phase 3 randomized clinical trial confirms the long-term clinical effect of TME plane quality on local recurrence, as initially reported in the MRC CR07 study. The data highlight the key role of pathologists and surgeons in the multidisciplinary management of rectal cancer. Trial Registration ClinicalTrials.gov Identifier: NCT00349076.
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Affiliation(s)
- Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Tim Beissbarth
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Arndt Hartmann
- Institute of Pathology, University Medical Center Erlangen, Erlangen, Germany
| | | | | | | | | | - Ulrich Kania
- Department of General and Visceral Surgery, Krankenhaus Maria Hilf, Mönchengladbach, Germany
| | - Hans Schlitt
- Department of Visceral Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Karl-Heinrich Link
- Department of Visceral Surgery, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Germany
| | - Wolf Bechstein
- Department of General and Visceral Surgery, University Medical Center Frankfurt, Frankfurt, Germany
| | - Hans-Rudolf Raab
- Department of General and Visceral Surgery, University Medical Center Oldenburg, Oldenburg, Germany
| | - Ludger Staib
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Torsten Liersch
- Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Rolf Sauer
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Werner Hohenberger
- Department of General and Visceral Surgery, University of Erlangen, Erlangen, Germany
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26
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Martin D, Balermpas P, Winkelmann R, Wieland U, Rave-Fränk M, Helmke C, Raab M, Kitz J, Matthess Y, Strebhardt K, Rödel C, Rödel F, Fokas E. OC-0150: Assessing the immune contexture of anal squamous cell carcinoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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27
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Claßen A, Kitz J, Perske C, Overbeck T, Bertsch HP, Schön MP, Lippert U. Leucaemia cutis bei einem Patienten mit chronischer myelomonozytärer Leukämie. J Dtsch Dermatol Ges 2018; 16:82-84. [DOI: 10.1111/ddg.13398_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anna Claßen
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
| | - Julia Kitz
- Institut für Pathologie; Universitätsmedizin Göttingen
| | | | - Tobias Overbeck
- Klinik für Hämatologie und Medizinische Onkologie; Universitätsmedizin Göttingen
| | - Hans Peter Bertsch
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
| | - Michael P. Schön
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
| | - Undine Lippert
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsmedizin Göttingen
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28
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Claßen A, Kitz J, Perske C, Overbeck T, Bertsch HP, Schön MP, Lippert U. Leukemia cutis in a patient with chronic myelomonocytic leukemia. J Dtsch Dermatol Ges 2017; 16:81-83. [PMID: 29288601 DOI: 10.1111/ddg.13398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Claßen
- Department of Dermatology, Venereology, and Allergology, University Medicine Göttingen, Göttingen, Germany
| | - Julia Kitz
- Institute for Pathology, University Medicine Göttingen, Göttingen, Germany
| | - Christina Perske
- Institute for Pathology, University Medicine Göttingen, Göttingen, Germany
| | - Tobias Overbeck
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Hans Peter Bertsch
- Department of Dermatology, Venereology, and Allergology, University Medicine Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology, and Allergology, University Medicine Göttingen, Göttingen, Germany
| | - Undine Lippert
- Department of Dermatology, Venereology, and Allergology, University Medicine Göttingen, Göttingen, Germany
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29
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Bohnenberger H, Yepes D, Merkelbach-Bruse S, Emmert A, Lois AM, Yao S, Sitte M, Pan KT, Dröge LH, Bremmer F, Strecker J, Küffer S, Sebastian M, Hinterthaner M, Kitz J, Biggemann L, Lotz J, Schildhaus HU, Wolff H, Canis M, Danner B, Beißbarth T, Büttner R, Ströbel P, Serve H, Urlaub H, Oellerich T. Abstract 4640: Proteomic differentiation of pulmonary cancer with squamous cell histology. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4640] [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
Histologic classification of pulmonary cancer with squamous cell histology is challenging as reliable immunohistochemical biomarkers are lacking. In particular smokers with head and neck cancer can develop both lung metastases and primary lung cancer. However, their differentiation is clinically important for therapy and risk stratification. Moreover, molecular targeted therapies for squamous cell carcinoma of the lung are largely lacking. To identify proteomic diagnostic biomarkers, signaling patterns and potential novel drug targets we characterized a broad panel of primary patient-derived formalin-fixed squamous cell carcinomas from lung and head and neck cancer by quantitative mass spectrometry
Proteins were isolated from formalin-fixed paraffin-embedded (FFPE) patient-derived genetically characterized cancer tissues by using a “filter-aided sample preparation (FASP)” method. The resulting proteins were analyzed by a Super-SILAC-based mass spectrometry approach and data was analyzed using the software suites MaxQuant and Perseus to determine the tumor-type-specific protein expression and signaling patterns.
In this study we quantitatively analyzed the protein-expression-profiles of 50 primary patient-derived non-small cell lung cancer specimens with squamous cell histology and 30 squamous cell carcinomas from the head-neck-region derived from patients that developed lung tumors with similar histology in the course of their disease. Using the mass spectrometric approach we were able to quantify in average around 2500 proteins per sample. Unsupervised clustering- and principal component analyses revealed that the detected protein expression patterns show a strong correlation with the cellular origin of the analyzed carcinomas. Furthermore, secondary lesions with similar histological morphology in the lung in patients with squamous cell carcinoma of the head-neck-region could be classified as primary or metastatic cancer according to their protein expression profiles.
Collectively, this study provides a large set of potential proteomic biomarkers that might be useful to improve diagnostics in the context of lung tumors with squamous cell histology in the future. In particular the differentiation of squamous cell carcinoma and head and neck cancer-derived metastases in the lung - that is still a challenge for diagnostics - will be improved by the presented biomarker panel. Moreover, the expression of kinases and activation patterns of signaling pathways discovered in our study are of interest regarding potential novel lung cancer therapies as overexpression or hyperactivation of certain kinases can potentially contribute to the malignant phenotype of lung cancer cells.
Citation Format: Hanibal Bohnenberger, Diego Yepes, Sabine Merkelbach-Bruse, Alexander Emmert, Anna-Maria Lois, Sha Yao, Maren Sitte, Kuan-Ting Pan, Leif Hendrik Dröge, Felix Bremmer, Jasmin Strecker, Stefan Küffer, Martin Sebastian, Martin Hinterthaner, Julia Kitz, Lorenz Biggemann, Joachim Lotz, Hans-Ulrich Schildhaus, Hendrik Wolff, Martin Canis, Bernd Danner, Tim Beißbarth, Reinhard Büttner, Philipp Ströbel, Hubert Serve, Henning Urlaub, Thomas Oellerich. Proteomic differentiation of pulmonary cancer with squamous cell histology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4640. doi:10.1158/1538-7445.AM2017-4640
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Affiliation(s)
- Hanibal Bohnenberger
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Diego Yepes
- 2German Cancer Research Center, Frankfurt, Germany
| | | | - Alexander Emmert
- 4Department of Thoraxic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Anna-Maria Lois
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Sha Yao
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Maren Sitte
- 5Institute of Medical Statistic, University Medical Center Goettingen, Goettingen, Germany
| | - Kuan-Ting Pan
- 6Bioanalytical Mass Spectrometry, Max Planck Institute Goettingen, Goettingen, Germany
| | - Leif Hendrik Dröge
- 7Department of Radiooncology, University Medical Center Goettingen, Goettingen, Germany
| | - Felix Bremmer
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Jasmin Strecker
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Stefan Küffer
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Martin Sebastian
- 8Department of Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin Hinterthaner
- 4Department of Thoraxic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Kitz
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Lorenz Biggemann
- 9Institute of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Joachim Lotz
- 9Institute of Radiology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Hendrik Wolff
- 7Department of Radiooncology, University Medical Center Goettingen, Goettingen, Germany
| | - Martin Canis
- 10Department Of Otorhinolaryngology, University Medical Center Goettingen, Goettingen, Germany
| | - Bernd Danner
- 4Department of Thoraxic Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Tim Beißbarth
- 5Institute of Medical Statistic, University Medical Center Goettingen, Goettingen, Germany
| | - Reinhard Büttner
- 3Institute of Pathology, University medical Center Cologne, Cologne, Germany
| | - Philipp Ströbel
- 1Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Hubert Serve
- 8Department of Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Henning Urlaub
- 6Bioanalytical Mass Spectrometry, Max Planck Institute Goettingen, Goettingen, Germany
| | - Thomas Oellerich
- 8Department of Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
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Chen NM, Neesse A, Dyck ML, Steuber B, Koenig AO, Lubeseder-Martellato C, Winter T, Forster T, Bohnenberger H, Kitz J, Reuter-Jessen K, Griesmann H, Gaedcke J, Grade M, Zhang JS, Tsai WC, Siveke J, Schildhaus HU, Ströbel P, Johnsen SA, Ellenrieder V, Hessmann E. Context-Dependent Epigenetic Regulation of Nuclear Factor of Activated T Cells 1 in Pancreatic Plasticity. Gastroenterology 2017; 152:1507-1520.e15. [PMID: 28188746 DOI: 10.1053/j.gastro.2017.01.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/23/2016] [Accepted: 01/17/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS The ability of exocrine pancreatic cells to change the cellular phenotype is required for tissue regeneration upon injury, but also contributes to their malignant transformation and tumor progression. We investigated context-dependent signaling and transcription mechanisms that determine pancreatic cell fate decisions toward regeneration and malignancy. In particular, we studied the function and regulation of the inflammatory transcription factor nuclear factor of activated T cells 1 (NFATC1) in pancreatic cell plasticity and tissue adaptation. METHODS We analyzed cell plasticity during pancreatic regeneration and transformation in mice with pancreas-specific expression of a constitutively active form of NFATC1, or depletion of enhancer of zeste 2 homologue 2 (EZH2), in the context of wild-type or constitutively activate Kras, respectively. Acute and chronic pancreatitis were induced by intraperitoneal injection of caerulein. EZH2-dependent regulation of NFATC1 expression was studied in mouse in human pancreatic tissue and cells by immunohistochemistry, immunoblotting, and quantitative reverse transcription polymerase chain reaction. We used genetic and pharmacologic approaches of EZH2 and NFATC1 inhibition to study the consequences of pathway disruption on pancreatic morphology and function. Epigenetic modifications on the NFATC1 gene were investigated by chromatin immunoprecipitation assays. RESULTS NFATC1 was rapidly and transiently induced in early adaptation to acinar cell injury in human samples and in mice, where it promoted acinar cell transdifferentiation and blocked proliferation of metaplastic pancreatic cells. However, in late stages of regeneration, Nfatc1 was epigenetically silenced by EZH2-dependent histone methylation, to enable acinar cell redifferentiation and prevent organ atrophy and exocrine insufficiency. In contrast, oncogenic activation of KRAS signaling in pancreatic ductal adenocarcinoma cells reversed the EZH2-dependent effects on the NFATC1 gene and was required for EZH2-mediated transcriptional activation of NFATC1. CONCLUSIONS In studies of human and mouse pancreatic cells and tissue, we identified context-specific epigenetic regulation of NFATc1 activity as an important mechanism of pancreatic cell plasticity. Inhibitors of EZH2 might therefore interfere with oncogenic activity of NFATC1 and be used in treatment of pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Nai-Ming Chen
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Germany
| | - Albrecht Neesse
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Germany
| | - Moritz Lino Dyck
- Signaling and Transcription Laboratory, Department of Gastroenterology, Philipp's University, Marburg, Germany
| | - Benjamin Steuber
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Germany
| | - Alexander O Koenig
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Germany
| | - Clara Lubeseder-Martellato
- II. Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Thore Winter
- Signaling and Transcription Laboratory, Department of Gastroenterology, Philipp's University, Marburg, Germany
| | - Teresa Forster
- Signaling and Transcription Laboratory, Department of Gastroenterology, Philipp's University, Marburg, Germany
| | | | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Germany
| | | | - Heidi Griesmann
- Department of Internal Medicine I, University Medical Center Halle, Germany
| | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Germany
| | - Marian Grade
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Germany
| | - Jin-San Zhang
- Schulze Center for Novel Therapeutics, Division of Oncology Research, Mayo Clinic, Rochester, Minnesota; School of Pharmaceutical Sciences and Key Laboratory of Biotechnology and Pharmaceutical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Wan-Chi Tsai
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jens Siveke
- German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany; Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Germany
| | - Steven A Johnsen
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Germany
| | - Elisabeth Hessmann
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Germany.
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Styczen H, Nagelmeier I, Beissbarth T, Nietert M, Homayounfar K, Sprenger T, Boczek U, Stanek K, Kitz J, Wolff HA, Ghadimi BM, Middel P, Liersch T, Rüschoff J, Conradi LC. HER-2 and HER-3 expression in liver metastases of patients with colorectal cancer. Oncotarget 2016; 6:15065-76. [PMID: 25915155 PMCID: PMC4558136 DOI: 10.18632/oncotarget.3527] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/09/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE In this study, we evaluate the frequency of HER-2 and HER-3 expression in liver metastases from patients with colorectal cancer (CRLM). We analyzed the potential of HER-2 and HER-3 as therapeutic targets and evaluated their prognostic value. PATIENTS AND METHODS Overall 208 patients with CRLM were enrolled. HER-2 and HER-3 expression were determined in metastatic tissue of diagnostic punch biopsies (n = 29) or resection specimens (n = 179). The results of immunohistochemistry (IHC) scoring and In-situ-hybridization (ISH)-amplification were correlated with clinical parameters and for the 179 resected patients with cancer-specific (CSS) and overall survival (OS). The mean follow-up time was 56.7 months. RESULTS Positivity of HER-2 status (IHC score 2+/ISH+ and IHC 3+) was found in 8.2% of CRLM. High expression of HER-3 (IHC score 2+ and IHC 3+) was detected in 75.0% of liver metastases. CSS after liver surgery was determined and was independent from the HER-2 status (p = 0.963); however HER-3 was prognostic with a favorable course for patients showing an overexpression of HER-3 (p = 0.037). CONCLUSIONS HER-2 overexpression occurs in only 8% of patients with CRLM but with 75% of cases HER-3 is frequently overexpressed in CRLM. Therefore, HER-2 and particularly HER-3 could serve as novel targets to be addressed within multimodal treatment approaches.
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Affiliation(s)
- Hanna Styczen
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Iris Nagelmeier
- Targos Molecular Pathology, Pathology Nordhessen, Kassel, Germany
| | - Tim Beissbarth
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Manuel Nietert
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Kia Homayounfar
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Thilo Sprenger
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Ute Boczek
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Kathrin Stanek
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center, Göttingen, Germany
| | - Hendrik A Wolff
- Department of Radiotherapy and Radiooncology, University Medical Center, Göttingen, Germany
| | - B Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Peter Middel
- Targos Molecular Pathology, Pathology Nordhessen, Kassel, Germany
| | - Torsten Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Josef Rüschoff
- Targos Molecular Pathology, Pathology Nordhessen, Kassel, Germany
| | - Lena-Christin Conradi
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
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Azizian A, Epping I, Kramer F, Jo P, Bernhardt M, Kitz J, Salinas G, Wolff HA, Grade M, Beißbarth T, Ghadimi BM, Gaedcke J. Prognostic Value of MicroRNAs in Preoperative Treated Rectal Cancer. Int J Mol Sci 2016; 17:568. [PMID: 27092493 PMCID: PMC4849024 DOI: 10.3390/ijms17040568] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 02/09/2016] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 12/26/2022] Open
Abstract
Background: Patients with locally advanced rectal cancer are treated with preoperative chemoradiotherapy followed by surgical resection. Despite similar clinical parameters (uT2-3, uN+) and standard therapy, patients’ prognoses differ widely. A possible prediction of prognosis through microRNAs as biomarkers out of treatment-naïve biopsies would allow individualized therapy options. Methods: Microarray analysis of 45 microdissected preoperative biopsies from patients with rectal cancer was performed to identify potential microRNAs to predict overall survival, disease-free survival, cancer-specific survival, distant-metastasis-free survival, tumor regression grade, or nodal stage. Quantitative real-time polymerase chain reaction (qPCR) was performed on an independent set of 147 rectal cancer patients to validate relevant miRNAs. Results: In the microarray screen, 14 microRNAs were significantly correlated to overall survival. Five microRNAs were included from previous work. Finally, 19 miRNAs were evaluated by qPCR. miR-515-5p, miR-573, miR-579 and miR-802 demonstrated significant correlation with overall survival and cancer-specific survival (p < 0.05). miR-573 was also significantly correlated with the tumor regression grade after preoperative chemoradiotherapy. miR-133b showed a significant correlation with distant-metastasis-free survival. miR-146b expression levels showed a significant correlation with nodal stage. Conclusion: Specific microRNAs can be used as biomarkers to predict prognosis of patients with rectal cancer and possibly stratify patients’ therapy if validated in a prospective study.
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Affiliation(s)
- Azadeh Azizian
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Ingo Epping
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Frank Kramer
- Department of Medical Statistics, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Peter Jo
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Markus Bernhardt
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Julia Kitz
- Department of Pathology, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Gabriela Salinas
- Department of Developmental Biochemistry, University of Göttingen, Göttingen 37075, Germany.
| | - Hendrik A Wolff
- Medical Practice Radiotherapy München, Burgstraße 7, München 80331, Germany.
| | - Marian Grade
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Tim Beißbarth
- Department of Medical Statistics, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - B Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
| | - Jochen Gaedcke
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany.
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Jo P, König A, Schirmer M, Kitz J, Conradi LC, Azizian A, Bernhardt M, Wolff HA, Grade M, Ghadimi M, Ströbel P, Schildhaus HU, Gaedcke J. Heterogeneity of KRAS Mutation Status in Rectal Cancer. PLoS One 2016; 11:e0153278. [PMID: 27064574 PMCID: PMC4827807 DOI: 10.1371/journal.pone.0153278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 03/25/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Anti-EGFR targeted therapy is of increasing importance in advanced colorectal cancer and prior KRAS mutation testing is mandatory for therapy. However, at which occasions this should be performed is still under debate. We aimed to assess in patients with locally advanced rectal cancer whether there is intra-specimen KRAS heterogeneity prior to and upon preoperative chemoradiotherapy (CRT), and if there are any changes in KRAS mutation status due to this intervention. MATERIALS AND METHODS KRAS mutation status analyses were performed in 199 tumor samples from 47 patients with rectal cancer. To evaluate the heterogeneity between different tumor areas within the same tumor prior to preoperative CRT, 114 biopsies from 34 patients (mean 3 biopsies per patient) were analyzed (pre-therapeutic intratumoral heterogeneity). For the assessment of heterogeneity after CRT residual tumor tissue (85 samples) from 12 patients (mean 4.2 tissue samples per patient) were analyzed (post-therapeutic intratumoral heterogeneity) and assessment of heterogeneity before and after CRT was evaluated in corresponding patient samples (interventional heterogeneity). Primer extension method (SNaPshot™) was used for initial KRAS mutation status testing for Codon 12, 13, 61, and 146. Discordant results by this method were reevaluated by using the FDA-approved KRAS Pyro Kit 24, V1 and the RAS Extension Pyro Kit 24, V1 Kit (therascreen® KRAS test). RESULTS For 20 (43%) out of the 47 patients, a KRAS mutation was detected. With 12 out of 20, the majority of these mutations affected codon 35. We did not obtained evidence that CRT results in changes of the KRAS mutation pattern. In addition, no intratumoral heterogeneity in the KRAS mutational status could be proven. This was true for both the biopsies prior to CRT and the resection specimens thereafter. The discrepancy observed in some samples when using the SNaPshot™ assay was due to insufficient sensitivity of this technique upon massive tumor regression by CRT as application of the therascreen® KRAS test revealed concordant results. CONCLUSION Our results indicate that the KRAS mutation status at the primary tumor site of rectal cancer is homogenous. Its assessment for therapeutic decisions is feasible in pre-therapeutic biopsies as well as in post-therapeutic resected specimens. The amount of viable tumor cells seems to be an important determinant for assay sensitivity and should thus be considered for selection of the analytical method.
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Affiliation(s)
- Peter Jo
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Alexander König
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Markus Schirmer
- Department of Clinical Pharmacology, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Lena-Christin Conradi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Azadeh Azizian
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Markus Bernhardt
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Marian Grade
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
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Rave-Fränk M, Tehrany N, Kitz J, Leu M, Weber HE, Burfeind P, Schliephake H, Canis M, Beissbarth T, Reichardt HM, Wolff HA. Prognostic value of CXCL12 and CXCR4 in inoperable head and neck squamous cell carcinoma. Strahlenther Onkol 2015; 192:47-54. [PMID: 26374452 DOI: 10.1007/s00066-015-0892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 06/24/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The chemokine CXCL12 and its receptor CXCR4 can affect tumor growth, recurrence, and metastasis. We tested the hypothesis that the CXCL12 and CXCR4 expression influences the prognosis of patients with inoperable head and neck cancer treated with definite radiotherapy or chemoradiotherapy. METHODS Formalin-fixed paraffin-embedded pretreatment tumor tissue from 233 patients with known HPV/p16(INK4A) status was analyzed. CXCL12 and CXCR4 expressions were correlated with pretreatment parameters and survival data by univariate and multivariate Cox regression. RESULTS CXCL12 was expressed in 43.3 % and CXCR4 in 66.1 % of the samples and both were correlated with HPV/p16(INK4A) positivity. A high CXCL12 expression was associated with increased overall survival (p = 0.036), while a high CXCR4 expression was associated with decreased metastasis-free survival (p = 0.034). CONCLUSION A high CXCR4 expression could be regarded as a negative prognostic factor in head and neck cancer because it may foster metastatic spread. This may recommend CXCR4 as therapeutic target for combating head and neck cancer metastasis.
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Affiliation(s)
- Margret Rave-Fränk
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Narges Tehrany
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Martin Leu
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Hanne Elisabeth Weber
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Peter Burfeind
- Department of Human Genetics, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Tim Beissbarth
- Institute of Medical Statistics, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Holger Michael Reichardt
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Hendrik Andreas Wolff
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Scheel AH, Reineke RA, Sprenger T, Lokka S, Kitz J, Ghadimi BM, Rüschoff J, Liersch T, Middel P. Comprehensive lymph node morphometry in rectal cancer using acetone compression. J Clin Pathol 2015; 68:458-64. [DOI: 10.1136/jclinpath-2014-202555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 02/22/2015] [Indexed: 11/04/2022]
Abstract
AimsAcetone compression (AC) is an elution compression technique for the comprehensive pathological examination of fatty tissue. Here AC is combined with digital morphometry to evaluate the impact of preoperative (neoadjuvant) chemoradiotherapy (neoCRT) on lymph node (LN) numbers and morphology in locally advanced rectal cancer. AC is compared with complete embedding of the mesorectal fat (whole mesorectal embedding (WME)) to exclude artificial alterations and to the standard technique, manual dissectioning (MD).Methods320 rectal cancer specimens were subjected to LN morphometry. Neoadjuvant CRT was applied in 204 specimens. LNs were prepared either with AC (n=138), WME (n=51) or MD (n=131). 8523 LNs were assessed including 530 nodes with metastases.ResultsLN prepared by AC and WME showed similar morphologies. AC revealed reduced LN sizes in neoCRT specimens compared with primary resection (2.2; 2.4 mm, p=0.049) while the LN number was comparable (27; 30/specimen). AC yielded 28 LN/specimen on average, MD yielded 22 LN (p<0.001). In neoCRT specimens, MD yielded less LN compared with primary resection (19; 25). MD detected less small LN (<2 mm; MD: 25%; AC: 56%) while 24 of the 135 LN metastases found by AC were ≤2 mm in diameter.ConclusionsAC does not alter LN morphology and is especially suited to retrieve small LN after neoadjuvant CRT of rectal cancer. Neoadjuvant multimodality treatment caused reduced LN sizes while the LN numbers were not affected. When compared with MD, AC proved more reliable in the retrieval of LN from rectal cancer specimens after neoCRT.
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Tehrany N, Kitz J, Rave-Fränk M, Lorenzen S, Li L, Küffer S, Hess CF, Burfeind P, Reichardt HM, Canis M, Beissbarth T, Wolff HA. High-grade acute organ toxicity and p16(INK4A) expression as positive prognostic factors in primary radio(chemo)therapy for patients with head and neck squamous cell carcinoma. Strahlenther Onkol 2015; 191:566-72. [PMID: 25575976 DOI: 10.1007/s00066-014-0801-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Superior treatment response and survival for patients with human papilloma virus (HPV)-positive head and neck cancer (HNSCC) are documented in clinical studies. However, the relevance of high-grade acute organ toxicity (HGAOT), which has also been correlated with improved prognosis, has attracted scant attention in HPV-positive HNSCC patients. Hence we tested the hypothesis that both parameters, HPV and HGAOT, are positive prognostic factors in patients with HNSCC treated with definite radiotherapy (RT) or radiochemotherapy (RCT). PATIENTS AND METHODS Pretreatment tumor tissue and clinical records were available from 233 patients receiving definite RT (62 patients) or RCT (171 patients). HPV infection was analysed by means of HPV DNA detection or p16(INK4A) expression; HGAOT was defined as the occurrence of acute organ toxicity >grade 2 according to the Common Toxicity Criteria. Both variables were correlated with overall survival (OS) using Cox proportional hazards regression. RESULTS Positivity for HPV DNA (44 samples, 18.9 %) and p16(INK4A) expression (102 samples, 43.8 %) were significantly correlated (p < 0.01), and HGAOT occurred in 77 (33 %) patients. Overall, the 5-year OS was 23 %; stratified for p16(INK4A) expression and HGAOT, OS rates were 47 %, 42 %, 20 % and 10 % for patients with p16(INK4A) expression and HGAOT, patients with HGAOT only, patients with p16(INK4A) expression only, and patients without p16(INK4A) expression or HGAOT, respectively. After multivariate testing p16(INK4A) expression (p = 0.003) and HGAOT (p < 0.001) were significantly associated with OS. CONCLUSION P16(INK4A) expression and HGAOT are independent prognostic factors for OS of patients with HNSCC, whereas p16(INK4A) expression is particularly important for patients without HGAOT.
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Affiliation(s)
- Narges Tehrany
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Rödel F, Wieland U, Fraunholz I, Kitz J, Rave-Fränk M, Wolff HA, Weiss C, Wirtz R, Balermpas P, Fokas E, Rödel C. Human papillomavirus DNA load and p16INK4a expression predict for local control in patients with anal squamous cell carcinoma treated with chemoradiotherapy. Int J Cancer 2014; 136:278-88. [PMID: 24839133 DOI: 10.1002/ijc.28979] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/18/2014] [Accepted: 05/05/2014] [Indexed: 12/19/2022]
Abstract
As the detection rate of HPV-DNA in anal carcinoma commonly exceeds 90%, a comparison between sole HPV-positive and HPV-negative cancers with respect to treatment response following chemoradiotherapy (CRT) and long-term oncological outcome is challenging. Against this background, we aimed to assess HPV types and HPV DNA load in formalin-fixed paraffin-embedded tissue (FFPE) of 95 patients treated with standard CRT for anal cancer to correlate viral load (≤/> median) with local failure, distant metastases, cancer-specific (CSS) and overall survival (OS) rates. Various clinicopathologic parameters and the immunohistochemical marker p16(INK4a) were evaluated for any correlation with HPV16 DNA load and were included in uni- and multivariate analyses. The overall prevalence of HPV DNA was 95.8% with HPV16 monoinfection being the most commonly encountered HPV type (78.9%), followed by HPV16 and 31, 35, 39, 44, 58, 66 and 81 dual infection in 9 patients (9.5%). HPV16 DNA load was significantly associated with p16(INK4a) expression (p = 0.001). Patients with HPV16 DNA load ≤ median and low p16(INK4a) expression showed significantly worse local control (HPV16 DNA load: univariate p = 0.023, multivariate p = 0.042; p16(INK4a): univariate p = 0.021), and OS (HPV16 DNA load: univariate p = 0.02, multivariate p = 0.03). Moreover, a combined HPV16 DNA load and p16(INK4a) variable revealed a significant correlation to decreased local failure, and increased CSS and OS (p = 0.019, p = 0.04 and p = 0.031). In conclusion, these data indicate that HPV16 DNA load and p16(INK4a) expression are significant prognostic factors for local tumor control and overall survival of patients with anal SCC following CRT.
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Affiliation(s)
- Franz Rödel
- Department of Radiotherapy and Oncology, Goethe-University, Frankfurt am Main, Germany
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Spitzner M, Roesler B, Bielfeld C, Emons G, Gaedcke J, Wolff HA, Rave-Fränk M, Kramer F, Beissbarth T, Kitz J, Wienands J, Ghadimi BM, Ebner R, Ried T, Grade M. STAT3 inhibition sensitizes colorectal cancer to chemoradiotherapy in vitro and in vivo. Int J Cancer 2013; 134:997-1007. [PMID: 23934972 DOI: 10.1002/ijc.28429] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/23/2013] [Indexed: 01/05/2023]
Abstract
Increased activity of signal transducer and activator of transcription 3 (STAT3) is common in human malignancies, including colorectal cancers (CRCs). We have recently reported that STAT3 gene expression correlates with resistance of CRC cell lines to 5-fluorouracil (5-FU)-based chemoradiotherapy (CT/RT). This is of considerable clinical importance, because a large proportion of rectal cancers are resistant to preoperative multimodal treatment. To test whether STAT3 contributes to CT/RT-resistance, we first confirmed that STAT3 protein expression correlated positively with increasing resistance. While STAT3 was not constitutively active, stimulation with interleukin-6 (IL-6) resulted in remarkably higher expression levels of phosphorylated STAT3 in CT/RT-resistant cell lines. A similar result was observed when we determined IL-6-induced expression levels of phosphorylated STAT3 following irradiation. Next, STAT3 was inhibited in SW480 and SW837 using siRNA, shRNA and the small-molecule inhibitor STATTIC. Successful silencing and inhibition of phosphorylation was confirmed using Western blot analysis and a luciferase reporter assay. RNAi-mediated silencing as well as STATTIC treatment resulted in significantly decreased clonogenic survival following exposure to 3 µM of 5-FU and irradiation in a dose-dependent manner, with dose-modifying factors of 1.3-2.5 at a surviving fraction of 0.37. Finally, STAT3 inhibition led to a profound CT/RT-sensitization in a subcutaneous xenograft model, with a significantly delayed tumor regrowth in STATTIC-treated mice compared with control animals. These results highlight a potential role of STAT3 in mediating treatment resistance and provide first proof of concept that STAT3 represents a promising novel molecular target for sensitizing resistant rectal cancers to CT/RT.
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Affiliation(s)
- Melanie Spitzner
- Department of General and Visceral Surgery, University Medicine Göttingen, Göttingen, Germany
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Salendo J, Spitzner M, Kramer F, Zhang X, Jo P, Wolff HA, Kitz J, Kaulfuß S, Beißbarth T, Dobbelstein M, Ghadimi M, Grade M, Gaedcke J. Identification of a microRNA expression signature for chemoradiosensitivity of colorectal cancer cells, involving miRNAs-320a, -224, -132 and let7g. Radiother Oncol 2013; 108:451-7. [PMID: 23932154 DOI: 10.1016/j.radonc.2013.06.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/26/2013] [Accepted: 06/28/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative chemoradiotherapy (CRT) represents the standard treatment for locally advanced rectal cancer. Tumor response and progression vary considerably. MicroRNAs represent master regulators of gene expression, and may therefore contribute to this diversity. MATERIAL AND METHODS Genome-wide microRNA (miRNA) profiling was performed for 12 colorectal cancer (CRC) cell lines and an individual in vitro signature of chemoradiosensitivity was established. Functional relevance of selected miRNAs was established by transfecting miRNA-mimics into SW480 and SW837 cells. The prognostic value of selected miRNAs was assessed in 128 pretherapeutic patient biopsies. RESULTS Thirty-six miRNAs were identified to significantly correlate with sensitivity to CRT (Q < 0.05) including miR-320a and other miRNAs involved in the MAPK-, TGF- and Wnt-pathway. Transfection of selected miRNAs (let-7g, miR-132, miR-224, miR-320a) each induced a shift of sensitivity. High expression of let-7 g was associated with a good prognosis in rectal cancer patients (P = 0.03). CONCLUSIONS This is the first report of a miRNA expression signature for in vitro chemoradiosensitivity of CRC cell lines. Many of the identified miRNAs have not been linked to the response to CRT and may represent potential molecular targets to sensitize resistant cancers. If further validated, let7g expression may serve as predictive biomarker.
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Affiliation(s)
- Junius Salendo
- Department of General and Visceral Surgery, University Medical Center Göttingen, Germany
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Scheel AH, Kitz J, Heimbucher J, Ströbel P, Rüschoff J. [Angioinvasion by neuroendocrine jejunal tumor. Demonstration of a malignancy sign by acetone compression]. Pathologe 2013; 34:352-5. [PMID: 23468136 DOI: 10.1007/s00292-012-1737-y] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neuroendocrine neoplasms of the digestive system are classified by current World Health Organization (WHO) guidelines as G1 and G2 neuroendocrine tumors (NET) as well as neuroendocrine carcinoma (NEC) based on proliferation and differentiation. The G1 NET tumors are highly differentiated, low proliferating and usually exhibit a favorable course of the disease without the development of metastases. In the case presented here, angioinvasion by a pT3 NET G1 was demonstrated after complete work-up of the mesenterial fat by acetone compression. The findings indicate an unfavorable course of disease requiring intensive surveillance.
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Affiliation(s)
- A H Scheel
- Institut für Pathologie Nordhessen, Germaniastrasse 7, Kassel, Germany.
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Warth A, Cortis J, Fink L, Fisseler-Eckhoff A, Geddert H, Hager T, Junker K, Kayser G, Kitz J, Länger F, Morresi-Hauf A, Ott G, Petersen I, Stenzinger A, Soltermann A, Ting S, Tischler V, Vollmer E, Schnabel PA, Weichert W. Training increases concordance in classifying pulmonary adenocarcinomas according to the novel IASLC/ATS/ERS classification. Virchows Arch 2012; 461:185-93. [DOI: 10.1007/s00428-012-1263-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 12/01/2022]
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Jo P, Jung K, Grade M, Conradi LC, Wolff HA, Kitz J, Becker H, Rüschoff J, Hartmann A, Beissbarth T, Müller-Dornieden A, Ghadimi M, Schneider-Stock R, Gaedcke J. CpG island methylator phenotype infers a poor disease-free survival in locally advanced rectal cancer. Surgery 2011; 151:564-70. [PMID: 22001634 DOI: 10.1016/j.surg.2011.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 08/16/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Locally advanced rectal cancers are treated with preoperative radiochemotherapy (RCT). However, subsets of patients have no benefit from preoperative treatment. Since epigenetic modifications, including DNA methylation, may influence response to neoadjuvant treatment we studied the CpG island methylator phenotype (CIMP) in patients who received a 5-fluouracil based RCT. METHODS One hundred fifty patients with locally advanced rectal cancer, treated within a phase III clinical trial (CAO/ARO/AIO-94 and -04), were included in this analysis. CIMP was assessed by methylation specific PCR (MSP) using RUNX3, SOCS1, NEUROG1, IGF2, and CACNA1G as a marker panel. Loss of mismatch repair gene (MMR) expression was assessed by immunohistochemistry for a subset of patients. KRAS and BRAF mutation status were assessed using Sanger sequencing. RESULTS The CIMP status could be established in all 150 patients. Fifteen (10%) revealed CIMP positivity (≥3 methylated promoters), whereas 135 patients (90%) where classified as CIMP negative. Analysis for MMR status did not reveal any microsatellite instability (MSI). A single mutation of the BRAF gene (D594G) was detected. The KRAS gene (exon 1, 2, and 3) was mutated in 65 tumors (43%) but was not correlated to a specific CIMP status. Three- and 5-year disease-free survival was notably worse in CIMP positive patients (56% and 0% vs 80% and 75%; P < .01) suggesting an increased likelihood of poor clinical outcome (HR 5.5; 95%CI: [2.1, 13.9]). CONCLUSION CIMP positivity, defined by methylation of at least 3 specific gene promoters, is an infrequent event in locally advanced rectal cancer. However, it increases the likelihood of distant metastases. Therefore, the CIMP status may be included as a molecular marker for the identification of high-risk patients and might contribute to individual treatment stratification.
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Affiliation(s)
- Peter Jo
- Department of General and Visceral Surgery, University Medicine Göttingen, Germany
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Quentin T, Kitz J, Steinmetz M, Poppe A, Bär K, Krätzner R. Different expression of the catalytic alpha subunits of the AMP activated protein kinase--an immunohistochemical study in human tissue. Histol Histopathol 2011; 26:589-96. [PMID: 21432774 DOI: 10.14670/hh-26.589] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AMPK is an ubiquitously distributed multienzyme complex. It is an important energy sensor and regulator of cellular metabolic activity. In this study we analyzed for the first time the cellular distribution of the catalytically active subunits AMPKα1 and α2 in different human tissues by immunohistochemistry. We found different expression patterns for both isoforms. AMPKα2 expression clearly dominates in skeletal myocytes and cardiomyocytes, whereas AMPKα1 dominates in a number of secreting cells, like mammary glands, islets of langerhans and cells of the colon crypts.
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Affiliation(s)
- Thomas Quentin
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Georg-August University, Göttingen, Germany.
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Danner BC, Didilis VN, Wiemeyer S, Stojanovic T, Kitz J, Emmert A, Füzesi L, Schöndube FA. Long-term survival is linked to serum LDH and partly to tumour LDH-5 in NSCLC. Anticancer Res 2010; 30:1347-1351. [PMID: 20530451] [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: 05/29/2023]
Abstract
BACKGROUND Lactate formation is up-regulated in tumorous cells by lactate dehydrogenase (LDH). High serum LDH level is linked to many malignancies with poorer survival, but tumour LDH-5 has not been well investigated in non-small cell lung cancer (NSCLC). PATIENTS AND METHODS In 89 patients operated on for NSCLC stage I-III, the serum LDH level was assayed and immunohistochemistry for tumour LDH-5 was performed. Impact on long-term survival and correlation was analysed. RESULTS High serum LDH was associated with poorer survival (p<0.001). No correlation was revealed between serum LDH and the tumour LDH-5. Only in tumours greater than 3 cm were high tumour LDH-5 values associated with higher serum LDH values (p=0.04) and in this subgroup, high tumor LDH-5 was associated with poorer long-term survival (p=0.024). CONCLUSION High serum LDH has a negative impact on long-term survival in NSCLC, whereas for tumour LDH-5, this was seen only in a subgroup of patients with larger tumours.
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Affiliation(s)
- Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Göttingen, Germany.
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Grapp M, Teichler S, Kitz J, Dibaj P, Dickel C, Knepel W, Krätzner R. The homeodomain of PAX6 is essential for PAX6-dependent activation of the rat glucagon gene promoter: Evidence for a PH0-like binding that induces an active conformation. Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms 2009; 1789:403-12. [DOI: 10.1016/j.bbagrm.2009.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/23/2009] [Accepted: 02/06/2009] [Indexed: 10/21/2022]
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Cameron S, Savvoukidis T, Armbrust T, Haller F, Kitz J, Füzesi L, Ramadori G. Analysis of a case with disappearance of the primary gastrointestinal stromal tumor and progressive liver metastases under long-term treatment with tyrosine kinase inhibitors. Med Oncol 2009; 27:213-8. [PMID: 19294538 DOI: 10.1007/s12032-009-9193-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 02/26/2009] [Indexed: 12/12/2022]
Abstract
The response of gastrointestinal stromal tumors (GISTs) to tyrosine kinase receptor inhibitors (TKR-I) has been a breakthrough for small molecular therapy. We report here on the very different long-term outcome of a synchronous metastatic GIST with complete remission of the primary tumor and progressive liver metastases under TKR-I therapy. In 2003, a 52-year-old patient was diagnosed with gastric GIST and synchronous multiple liver metastases. Therapy with imatinib, 400 mg daily, was started immediately. Fifteen months later, the primary was no longer detectable by endoscopy. In 2006, progression of the liver metastases was observed. Mutation analysis of the initial biopsy specimen from the primary, as well as the biopsy from the three main liver metastases after 3 years of imatinib treatment, revealed the common KIT exon 11 deletion (W557_K558del) in all tumor samples. Two of the metastases had a separate secondary mutation in KIT exon 14 and 17, respectively, while the largest cystic metastatic lesion had no other mutation. Imatinib was then increased to a daily dose of 800 mg, and in April 2007 the treatment was changed to sunitinib. Fifty-two months after initial diagnosis, the patient died of liver failure. At no time point, relapse of the gastric primary tumor was observed. Whilst TKR-Is are commonly very effective in treating GISTs, the present case illustrates their varying effects regarding the clinical behavior and genetic variations within different tumors of the same patient after long-term treatment.
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Affiliation(s)
- Silke Cameron
- Department of Gastroenterology and Endocrinology, University Clinic of Göttingen, Robert-Koch-Strasse 40, Göttingen D-37099, Germany
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