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Höhn AK, Forberger M, Alfaraidi M, Gilks CB, Brambs CE, Höckel M, Hoang L, Singh N, Horn LC. High concordance of molecular subtyping between pre-surgical biopsy and surgical resection specimen (matched-pair analysis) in patients with vulvar squamous cell carcinoma using p16- and p53-immunostaining. Gynecol Oncol 2024; 185:17-24. [PMID: 38342005 DOI: 10.1016/j.ygyno.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Vulvar squamous cell carcinoma (VSCC) can be stratified into three molecular subtypes based on the immunoexpression of p16 and p53: HPV-independent p53-abnormal (p53abn) (most common, biologically aggressive), HPV-associated, with p16-overexpression (second most common, prognostically more favourable) and more recently recognised HPV-independent p53-wildtype (p53wt) (rarest subtype, prognostically intermediate). Our aim was to determine whether molecular subtypes can be reliably identified in pre-operative biopsies and whether these correspond to the subsequent vulvectomy specimen. METHODS Matched-paired pre-surgical biopsies and subsequent resection specimen of 57 patients with VSCC were analysed for the immunohistochemical expression of p16 and p53 by performing a three-tiered molecular subtyping to test the accuracy rate. RESULTS Most cases 36/57 (63.2%) belonged to the HPV-independent (p53-abn) molecular subtype, followed by HPV-associated 17/57 (29.8%) and HPV-independent (p53wt) 4/57 (7.0%). The overall accuracy rate on biopsy was 91.2% (52/57): 97.3% for p53-abnormal, 94.1% for p16-overexpression and 50% for p16-neg/p53-wt VSCC. Incorrect interpretation of immunohistochemical p53 staining pattern was the reason for discordant results in molecular subtyping in all five cases. In one case there was an underestimation of p53 pattern (wildtype instead of abnormal/aberrant) and in one case an overestimation of the p53 staining pattern (abnormal/aberrant instead of wildtype). In 3/5 there was a "double positive" staining result (p16 overexpression and abnormal/aberrant p53 staining pattern). In that cases additional molecular workup is required for correct molecular subtyping, resulting in an overall need for molecular examination of 3/57 (3.5%). CONCLUSIONS Compared to the final resections specimen, the three-tiered molecular classification of VSCC can be determined on pre-surgical biopsies with a high accuracy rate. This enables more precise surgical planning, prediction of the response to (chemo) radiation, selection of targeted therapies and planning of the optimal follow-up strategy for patients in the age of personalised medicine.
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Affiliation(s)
- Anne Kathrin Höhn
- Institute of Pathology, Division of Gynecologic Pathology, University Hospital of Leipzig, Germany.
| | - Mirjam Forberger
- Institute of Pathology, Division of Gynecologic Pathology, University Hospital of Leipzig, Germany
| | - Mona Alfaraidi
- Vancouver General Hospital, University of British Columbia, Canada; Prince Sultan Military Medical City, Riyah, Saudi Arabia
| | - C Blake Gilks
- Vancouver General Hospital, University of British Columbia, Canada
| | | | - Michael Höckel
- Leipzig School of Radical Pelvic Surgery, Division of Surgical Gynecologic Oncology, University Hospital, Leipzig, Germany
| | - Lynn Hoang
- Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Naveena Singh
- Vancouver General Hospital, University of British Columbia, Canada
| | - Lars-Christian Horn
- Institute of Pathology, Division of Gynecologic Pathology, University Hospital of Leipzig, Germany
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Porth J, Ajouri J, Kleinlein M, Höckel M, Elke G, Meybohm P, Culmsee C, Muellenbach RM. [Application and control of intravenous fluids in German intensive care units : A national survey among critical care physicians]. Anaesthesiologie 2024; 73:85-92. [PMID: 38289347 DOI: 10.1007/s00101-024-01379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/06/2023] [Accepted: 12/25/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The administration of intravenous fluids includes various indications, e.g., fluid replacement, nutritional therapy or as a solvent for drugs and is a common routine in the intensive care unit (ICU); however, overuse of intravenous fluids can lead to fluid overload, which can be associated with a poorer outcome in critically ill patients. OBJECTIVE The aim of this survey was to find out the current status of the use and management of intravenous fluids as well as the interprofessional cooperation involving clinical pharmacists on German ICUs. METHODS An online survey with 33 questions was developed. The answers of 62 participants from the Scientific Working Group on Intensive Care Medicine of the German Society for Anesthesiology and Intensive Care Medicine were evaluated. RESULTS Fluid overload occurs "frequently" in 62.9% (39/62) and "very frequently" in 9.7% (6/62) of the ICUs of respondents. An established standard for an infusion management system is unknown to 71.0% (44/62) of participants and 45.2% of the respondents stated that they did not have a patient data management system. In addition, the participants indicated how they define fluid overload. This was defined by the presence of edema by 50.9% (28/55) and by positive fluid balance by 30.9% (17/55). According to the participants septic patients (38/60; 63.3%) and cardiological/cardiac surgical patients (26/60; 43.3%) are most susceptible to the occurrence of fluid overload. Interprofessional collaboration among intensive care physicians, critical care nurses, and clinical pharmacists to optimize fluid therapy was described as "relevant" by 38.7% (24/62) and "very relevant" by 45.2% (28/62). Participants with clinical pharmacists on the wards (24/62; 38.7%) answered this question more often as "very relevant" with 62.5% (15/24). CONCLUSION Fluid overload is a frequent and relevant problem in German intensive care units. Yet there are few established standards in this area. There is also a lack of validated diagnostic parameters and a clear definition of fluid overload. These are required to ensure appropriate and effective treatment that is tailored to the patient and adapted to the respective situation. Intravenous fluids should be considered as drugs that may exert side effects or can be overdosed with severe adverse consequences for the patients. One approach to optimize fluid therapy could be achieved by a fluid stewardship corresponding to comparable established procedures of the antibiotic stewardship. In particular, fluid stewardship will contribute to drug safety of intravenous fluids profiting from joined expertise in a setting of interprofessional collaboration. An important principle of fluid stewardship is to consider intravenous fluids in the same way as medication in terms of their importance. Furthermore, more in-depth studies are needed to investigate the effects of interprofessional fluid stewardship in a prospective and controlled manner.
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Affiliation(s)
- J Porth
- Zentralbereich Apotheke im Klinikum Kassel, Gesundheit Nordhessen Holding AG, Kassel, Deutschland
- Institut für Pharmakologie und Klinische Pharmazie, Phillips Universität Marburg, Marburg, Deutschland
| | - J Ajouri
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Kassel, Deutschland
| | - M Kleinlein
- Zentralbereich Apotheke im Klinikum Kassel, Gesundheit Nordhessen Holding AG, Kassel, Deutschland
| | - M Höckel
- Zentralbereich Apotheke im Klinikum Kassel, Gesundheit Nordhessen Holding AG, Kassel, Deutschland
| | - G Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - P Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - C Culmsee
- Institut für Pharmakologie und Klinische Pharmazie, Phillips Universität Marburg, Marburg, Deutschland
| | - R M Muellenbach
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Kassel, Kassel, Deutschland.
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Thompson EF, Hoang L, Höhn AK, Palicelli A, Talia KL, Tchrakian N, Senz J, Rusike R, Jordan S, Jamieson A, Huvila J, McAlpine JN, Gilks CB, Höckel M, Singh N, Horn LC. Molecular subclassification of vulvar squamous cell carcinoma: reproducibility and prognostic significance of a novel surgical technique. Int J Gynecol Cancer 2022; 32:977-985. [PMID: 35764349 DOI: 10.1136/ijgc-2021-003251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Vulvar squamous cell carcinoma is subclassified into three prognostically relevant groups: (i) human papillomavirus (HPV) associated, (ii) HPV independent p53 abnormal (mutant pattern), and (iii) HPV independent p53 wild type. Immunohistochemistry for p16 and p53 serve as surrogates for HPV viral integration and TP53 mutational status. We assessed the reproducibility of the subclassification based on p16 and p53 immunohistochemistry and evaluated the prognostic significance of vulvar squamous cell carcinoma molecular subgroups in a patient cohort treated by vulvar field resection surgery. METHODS In this retrospective cohort study, 68 cases treated by vulvar field resection were identified from the Leipzig School of Radical Pelvic Surgery. Immunohistochemistry for p16 and p53 was performed at three different institutions and evaluated independently by seven pathologists and two trainees. Tumors were classified into one of four groups: HPV associated, HPV independent p53 wild type, HPV independent p53 abnormal, and indeterminate. Selected cases were further interrogated by (HPV RNA in situ hybridization, TP53 sequencing). RESULTS Final subclassification yielded 22 (32.4%) HPV associated, 41 (60.3%) HPV independent p53 abnormal, and 5 (7.3%) HPV independent p53 wild type tumors. Interobserver agreement (overall Fleiss' kappa statistic) for the four category classification was 0.74. No statistically significant differences in clinical outcomes between HPV associated and HPV independent vulvar squamous cell carcinoma were observed. CONCLUSION Interobserver reproducibility of vulvar squamous cell carcinoma subclassification based on p16 and p53 immunohistochemistry may support routine use in clinical practice. Vulvar field resection surgery showed no significant difference in clinical outcomes when stratified based on HPV status.
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Affiliation(s)
- Emily F Thompson
- Department of Molecular Oncology, BC Cancer Research Center, Vancouver, British Columbia, Canada
| | - Lynn Hoang
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Anne Kathrin Höhn
- Division of Gynecologic Pathology, University of Leipzig, Leipzig, Germany
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Karen L Talia
- Royal Women's Hospital and VCS Foundation, Melbourne, Victoria, Australia
| | - Nairi Tchrakian
- Department of Molecular Oncology, BC Cancer Research Center, Vancouver, British Columbia, Canada.,Barts Health NHS Trust, London, UK
| | - Janine Senz
- Department of Molecular Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | | | | | - Amy Jamieson
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jutta Huvila
- Department of Pathology, University of Turku, Turku, Finland
| | - Jessica N McAlpine
- Gynecology and Obstetrics, Division Gynecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michael Höckel
- Leipzig School of Radical Pelvis Surgery, Division of Gynecologic Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Naveena Singh
- Cellular Pathology, Barts Health and NHS Trust and Queen Mary University, London, UK
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Wolf B, Horn LC, Höckel M, Aktas B. Tumor-stroma interaction in cervical cancer: The prognostic importance of desmoplasia. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17519 Background: During tumor growth, cancer cells can induce the formation of new extracellular matrix, mainly by activating peritumoral fibroblasts. This stromal reconfiguration has been termed desmoplasia. In pancreatic and ovarian cancer models, targeting desmoplasia therapeutically to normalize the microenvironment has recently shown promising results. We investigated the frequency and prognostic relevance of peritumoral desmoplasia, as well as its association with other prognostic factors such as lymph node involvement and parametrial tumor extension in cervical cancer patients. Methods: A retrospective cohort study based on data from the prospective monocentric observational Leipzig School Mesometrial Resection study was conducted. Cervical cancer patients staged IB1 to IVA according to the Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) who underwent primary surgery between 1999 and 2017 were included. Information regarding desmoplastic tumor reaction was retrospectively retrieved from the pathology reports. All other data had been collected prospectively during the trial period. Using non-parametric tests, we calculated the association of peritumoral desmoplasia with other common risk factors. To determine the prognostic significance of desmoplasia, we used the Kaplan-Meier estimator and performed multivariable Cox-regression modelling. Results: Overall, 355 patients were included. Desmoplasia was present in 298 cases and was associated with a significantly higher likelihood of lymphovascular space involvement (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.4 – 5.1, p = 0.001) and venous infiltration (OR 5.1, 95%-CI 1.3 – 44.9, p = 0.01). Lymph node metastasis was more common in patients with desmoplasia (OR 2.4, 95%-CI 1.2 – 5.0, p = 0.01), as was parametrial involvement (OR 3.5, 95%-CI 1.7 – 7.9, p = 0.0002). Interestingly, the presence of desmoplasia was not associated with larger tumor size. Patients with desmoplastic tissue reaction were significantly older than those without desmoplasia (median 41 years [inter quartile range 34 – 51] vs. 47 years [IQR 39-56], p = 0.009). These prognostically negative parameters in patients with desmoplastic disease translated into inferior overall (94.5% vs 80.5%, OR 3.9 [95%-CI 1.2 – 12.5], p = 0.02) and recurrence-free survival (86.8% vs. 74.2%, OR 2.3 [95%-CI 1.0 – 4.9], p = 0.04). A multivariable Cox-regression model including tumor size, patient age, and nodal status indicated that desmoplasia was an independent risk factor for overall death (OR 4.2, 95%-CI 1.03 – 17.5, p = 0.04). Conclusions: Desmoplastic stromal remodeling is associated with a more aggressive phenotype of cervical cancer and inferior survival. Targeting desmoplasia, especially in advanced disease when surgical treatment is not feasible, might be a promising treatment approach in the future.
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Affiliation(s)
- Benjamin Wolf
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Lars-Christian Horn
- University of Leipzig, Division of Breast, Gynecologic and Perinatal Pathology, Leipzig, Germany
| | - Michael Höckel
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
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Lia M, Horn LC, Sodeikat P, Höckel M, Aktas B, Wolf B. The diagnostic value of core needle biopsy in cervical cancer: A retrospective analysis. PLoS One 2022; 17:e0262257. [PMID: 34986187 PMCID: PMC8730459 DOI: 10.1371/journal.pone.0262257] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Cervical carcinoma is a major cause of morbidity and mortality among women worldwide. Histological subtype, lymphovascular space invasion and tumor grade could have a prognostic and predictive value for patients’ outcome and the knowledge of these histologic characteristics may influence clinical decision making. However, studies evaluating the diagnostic value of various biopsy techniques regarding these parameters of cervical cancer are scarce. We reviewed 318 cases of cervical carcinoma with available pathology reports from preoperative core needle biopsy (CNB) assessment and from final postoperative evaluation of the hysterectomy specimen. Setting the postoperative comprehensive pathological evaluation as reference, we analysed CNB assessment of histological tumor characteristics. In addition, we performed multivariable logistic regression to identify factors influencing the accuracy in identifying LVSI and tumor grade. CNB was highly accurate in discriminating histological subtype. Sensitivity and specificity were 98.8% and 89% for squamous cell carcinoma, 92.9% and 96.6% for adenocarcinoma, 33.3% and 100% in adenosquamous carcinoma respectively. Neuroendocrine carcinoma was always recognized correctly. The accuracy of the prediction of LVSI was 61.9% and was positively influenced by tumor size in preoperative magnetic resonance imaging and negatively influenced by strong peritumoral inflammation. High tumor grade (G3) was diagnosed accurately in 73.9% of cases and was influenced by histological tumor type. In conclusion, CNB is an accurate sampling technique for histological classification of cervical cancer and represents a reasonable alternative to other biopsy techniques.
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Affiliation(s)
- Massimiliano Lia
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Lars-Christian Horn
- Division of Gynecologic, Breast and Perinatal Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Paulina Sodeikat
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Michael Höckel
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Benjamin Wolf
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
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Sodeikat P, Lia M, Martin M, Horn LC, Höckel M, Aktas B, Wolf B. The Importance of Clinical Examination under General Anesthesia: Improving Parametrial Assessment in Cervical Cancer Patients. Cancers (Basel) 2021; 13:cancers13122961. [PMID: 34199156 PMCID: PMC8231542 DOI: 10.3390/cancers13122961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary In most cases, the treatment strategy (radiation or surgery) in cervical cancer patients depends on whether the parametrium shows tumor involvement. Traditionally, clinical pelvic examination under general anesthesia (EUA) has been used to determine whether tumor spread into the parametrium is present. During the recent decade, however, magnetic resonance imaging (MRI) has been increasingly used to determine whether parametrial tumor extension is present, and several studies have indicated that MRI might be superior to EUA. In this study, we demonstrate that EUA still plays an important role in pre-therapeutic evaluation of cervical cancer patients, and that display of MR images in the operating room (augmented EUA) achieves superior results in predicting parametrial tumor spread when comparted to MRI alone, especially in larger tumors. Best predictive results were observed in cases when radiologists and gynecological oncologists agreed on parametrial status, highlighting the importance of interdisciplinary patient assessment. Abstract Background: Parametrial tumor involvement is an important prognostic factor in cervical cancer and is used to guide management. Here, we investigate the diagnostic value of clinical examination under general anesthesia (EUA) and magnetic resonance imaging (MRI) in determining parametrial tumor spread. Methods: Post-operative pathological findings of 400 patients with primary cervical cancer were compared to the respective MRI data and the results from EUA. The gynecological oncologist had access to the MR images during clinical assessment (augmented EUA, aEUA). Results: Pathologically proven parametrial tumor invasion was present in 165 (41%) patients. aEUA exhibited a higher accuracy than MRI alone (83% vs. 76%; McNemar’s odds ratio [OR] = 2.0, 95%CI 1.25–3.27, p = 0.003). Although accuracy was not affected by tumor size in aEUA, MRI was associated with a lower accuracy in tumors ≥2.5 cm (OR for a correct diagnosis compared to smaller tumors 0.22, p < 0.001). There was also a decrease in specificity when evaluating parametrial invasion by MRI in tumors ≥2.5 cm in diameter (p < 0.0001) compared to smaller tumors (< 2.5 cm). Body mass index had no influence on performance of either method. Conclusions: aEUA has the potential to increase the diagnostic accuracy of MRI in determining parametrial tumor involvement in cervical cancer patients.
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Affiliation(s)
- Paulina Sodeikat
- Department of Gynecology, Leipzig University Medical Center, D-04103 Leipzig, Germany; (P.S.); (M.L.); (M.H.); (B.A.)
| | - Massimiliano Lia
- Department of Gynecology, Leipzig University Medical Center, D-04103 Leipzig, Germany; (P.S.); (M.L.); (M.H.); (B.A.)
| | - Mireille Martin
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, D-04103 Leipzig, Germany;
| | - Lars-Christian Horn
- Division of Gynecologic, Breast, and Perinatal Pathology, Leipzig University Medical Center, D-04103 Leipzig, Germany;
| | - Michael Höckel
- Department of Gynecology, Leipzig University Medical Center, D-04103 Leipzig, Germany; (P.S.); (M.L.); (M.H.); (B.A.)
| | - Bahriye Aktas
- Department of Gynecology, Leipzig University Medical Center, D-04103 Leipzig, Germany; (P.S.); (M.L.); (M.H.); (B.A.)
| | - Benjamin Wolf
- Department of Gynecology, Leipzig University Medical Center, D-04103 Leipzig, Germany; (P.S.); (M.L.); (M.H.); (B.A.)
- Correspondence: ; Tel.: +49-341-97-23459
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Lia M, Horn LC, Sodeikat P, Höckel M, Aktas B, Wolf B. The diagnostic value of core needle biopsy in cervical cancer: A retrospective analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e17512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17512 Background: The aim of this retrospective study was to evaluate the accuracy, sensitivity, specificity, and predictive values of preoperative core needle biopsy (CNB) assessment of histological characteristics in primary cervical cancer. Methods: We reviewed 318 cases of primary cervical carcinoma with available pathology reports from preoperative CNB assessment and from final postoperative evaluation of the hysterectomy specimen. Setting the postoperative comprehensive pathological evaluation as reference, we analysed CNB assessment of histological tumor characteristics. In addition, we performed multivariable logistic regression to identify factors influencing the accuracy in identifying lymphovascular space invasion (LVSI) and tumor grade. Results: CNB was highly accurate in discriminating histological subtype. Sensitivity and specificity were 98.8% and 89% for squamous cell carcinoma (SCC), 92.9% and 96.6% for adenocarcinoma (AC), 33.3% and 100% in adenosquamous carcinoma respectively. Neuroendocrine carcinoma was always recognized correctly. The accuracy of the prediction of lymphovascular space invasion (LVSI) was 61.9% and was positively influenced by tumor size in preoperative MRI and negatively influenced by strong peritumoral inflammation. High tumor grade was diagnosed accurately in 73.9% of cases and was influenced by histological tumor type. Conclusions: CNB is an accurate sampling technique for histological classification of cervical cancer and represents a reasonable alternative to other biopsy techniques. Factors such as peritumoral inflammation, tumor size or tumor subtype may influence the accuracy of histologic Evaluation and should be taken into account when interpreting the results.
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Affiliation(s)
- Massimiliano Lia
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Lars-Christian Horn
- University of Leipzig, Division of Breast, Gynecologic and Perinatal Pathology, Leipzig, Germany
| | - Paulina Sodeikat
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Michael Höckel
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Bahriye Aktas
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Benjamin Wolf
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
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Wolf B, Sodeikat P, Lia M, Martin M, Horn LC, Höckel M, Aktas B. Parametrial evaluation in cervical cancer by magnetic resonance imaging and clinical examination: Analysis of data from the prospective Leipzig School MMR study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5525 Parametrial evaluation in cervical cancer by magnetic resonance imaging and clinical examination Background: In cervical cancer patients, assessment of parametrial tumor extension is important for staging and treatment planning. The 2019 cervical cancer guideline published by the Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) for the first time includes recommendations for usage of magnetic resonance imaging (MRI) in this setting. However, valid data regarding the accuracy of this method, especially in patients with advanced disease, are sparce. The objective of this investigation was to compare the accuracy of parametrial assessment in cervical cancer patients using MRI and clinical examination under general anesthesia. Methods: A retrospective cohort study based on data from the prospective monocentric observational Leipzig School Mesometrial Resection study was conducted. Cervical cancer patients staged FIGO IB1 to FIGO IVA who underwent primary surgery between 1999 and 2017 were included. Data from pathological specimen of these patients was compared to the MRI findings and the results from clinical examination under general anesthesia. The gynecological oncologist had access to the MR images during clinical assessment. We calculated sensitivities, specificities, and predictive values for both examination methods. We performed logistic regression modelling to determine factors influencing the accuracy of either method. Results: 400 women were included. Pathologically proven parametrial tumor invasion was present in 165 (41%) patients. Examination under anesthesia augmented by intraoperative display of MR images exhibited a higher accuracy (83%) as compared to MRI alone (76%; McNemar’s odds ratio = 2.0, 95%CI 1.25 – 3.27, p = 0.003). While accuracy was not affected by tumor size in clinical examination, MRI was associated with a significant drop in accuracy in tumors ≥ 2.5 cm (univariable logistic regression, OR for a correct diagnosis compared to smaller tumors 0.22, p < 0.001). This association remained significant in a multivariable model. There was also a significant decrease in specificity when evaluating parametrial invasion by MRI in tumors ≥ 2.5 cm in diameter (p < 0.0001). Body mass index had no influence on performance of either method. Accuracy was significantly higher when test results were concordant (OR 7.5 and 6.0 on univariable and multivariable regression modelling, respectively, p < 0.0001 in both cases). Conclusions: Clinical evaluation of the parametrium by pelvic examination under anesthesia in conjunction with intraoperative presentation of MR images leads to more accurate staging in cervical cancer patients as compared to magnetic resonance imaging alone. Clinical examination should therefore remain an integral part of parametrial assessment in cervical cancer patients.
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Affiliation(s)
- Benjamin Wolf
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Paulina Sodeikat
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Massimiliano Lia
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Mireille Martin
- University of Leipzig Medical Center, Department of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - Lars-Christian Horn
- University of Leipzig, Division of Breast, Gynecologic and Perinatal Pathology, Leipzig, Germany
| | - Michael Höckel
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
| | - Bahriye Aktas
- University of Leipzig Medical Center, Department of Gynecology, Leipzig, Germany
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Trott S, Höckel M, Dornhöfer N, Geue K, Aktas B, Wolf B. Quality of life and associated factors after surgical treatment of vulvar cancer by vulvar field resection (VFR). Arch Gynecol Obstet 2020; 302:191-201. [PMID: 32430759 PMCID: PMC7266857 DOI: 10.1007/s00404-020-05584-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
Purpose To investigate patient-reported quality of life (QoL) and associated factors in vulvar cancer patients treated surgically by vulvar field resection (VFR) without adjuvant radiation. Methods We retrospectively evaluated patient-reported QoL as part of the prospective monocentric VFR trial using the 30-item European Organization for Research and Treatment of Cancer quality-of-life questionnaire (EORTC QLQ-C30) supplemented by a question assessing sexual activity. All patients had been treated by VFR and no participant had received adjuvant radiotherapy. The gynecologic cancer lymphedema questionnaire (GCLQ) was used to determine the presence of lymphedema. Structured telephone interviews were conducted to assess postoperative sequelae and long-term complications. Results Forty-three VFR patients (median age 63 years) were available for QoL assessment. Thirty-eight (88%) had received inguinal lymph-node dissection in addition to VFR. Mean global QoL (global health status) rating among all patients was 66.1 (± 25.5) on a scale from 0 to 100 with higher scores indicating better QoL. Higher GCLQ scores were significantly associated with lower global QoL scores (Spearman's rank correlation ρ =− 0.7, p < 0.0001). The presence of preoperative co-morbidities and postoperative wound-healing complications were also linked to reduced QoL (p < 0.01 for both). In a multivariable regression model, there was a significant interaction between preoperative co-morbidities and wound-healing complications with regard to global QoL (p < 0.05). Conclusion Overall, VFR patients exhibit good quality of life postoperatively. The presence of lymphedema, wound-healing complications, and preoperative morbidities were associated with reduced QoL. Prospective longitudinal studies have to confirm our findings in the future. Electronic supplementary material The online version of this article (10.1007/s00404-020-05584-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophia Trott
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Michael Höckel
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Nadja Dornhöfer
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Kristina Geue
- Division of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Bahriye Aktas
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Benjamin Wolf
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
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10
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Wolf B, Espig O, Stolzenburg JU, Horn LC, Aktas B, Höckel M. Preservation of the mesureter to reduce urinary complications: analysis of data from the observational Leipzig School MMR study. BJOG 2020; 127:859-865. [PMID: 32037645 DOI: 10.1111/1471-0528.16167] [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] [Accepted: 01/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer. DESIGN Retrospective cohort study with historic control. SETTING Single tertiary academic centre. POPULATION Women older than 18 with primary cervical cancer staged FIGO IB1-IIB enrolled in the prospective Leipzig School MMR study and underwent total mesometrial resection (TMMR) without adjuvant radiation. METHOD We retrospectively analysed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014-06/2017). We compared this group with the previous 100 consecutive TMMRs, which were performed before the introduction of mesureteral preservation (control group, 09/2010-01/2014). MAIN OUTCOME MEASURES The occurrence of urological and specifically ureteral complications. RESULTS Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation versus 3% with mesureteral preservation, P = 0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re-operations (7% versus none, P = 0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero-vaginal fistulas. CONCLUSION The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries that carry a high risk of ureteral damage. TWEETABLE ABSTRACT Surgical preservation of the mesureter in cervical cancer patients was associated with a reduction in urinary complications.
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Affiliation(s)
- B Wolf
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
| | - O Espig
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - J-U Stolzenburg
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - L-C Horn
- Division of Gynaecologic, Breast, and Perinatal Pathology, University Hospital Leipzig, Leipzig, Germany
| | - B Aktas
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
| | - M Höckel
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
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11
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Brausi M, Hoskin P, Andritsch E, Banks I, Beishon M, Boyle H, Colecchia M, Delgado-Bolton R, Höckel M, Leonard K, Lövey J, Maroto P, Mastris K, Medeiros R, Naredi P, Oyen R, de Reijke T, Selby P, Saarto T, Valdagni R, Costa A, Poortmans P. ECCO Essential Requirements for Quality Cancer Care: Prostate cancer. Crit Rev Oncol Hematol 2020; 148:102861. [PMID: 32151466 DOI: 10.1016/j.critrevonc.2019.102861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey. PROSTATE CANCER Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Maurizio Brausi
- European Association of Urology; Department of Urology, B. Ramazzini Hospital, Carpi-Modena, Italy
| | - Peter Hoskin
- European Society for Radiotherapy and Oncology (ESTRO); Mount Vernon Cancer Centre; University of Manchester, Manchester, United Kingdom
| | - Elisabeth Andritsch
- International Psycho-Oncology Society (IPOS); Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum, Belgium
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Helen Boyle
- International Society of Geriatric Oncology (SIOG); Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | - Maurizio Colecchia
- European Society of Pathology (ESP); Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Delgado-Bolton
- European Association for Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Michael Höckel
- European Society of Oncology Pharmacy (ESOP); Kliniken Kassel, Gesundheit Nordhessen Holding, Kassel, Germany
| | - Kay Leonard
- European Oncology Nursing Society (EONS); Saint Luke's Radiation Oncology Centre, St James's Hospital, Dublin, Ireland
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Pablo Maroto
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ken Mastris
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Uomo
| | - Rui Medeiros
- Association of European Cancer Leagues (ECL); Portuguese Cancer League, Instituto Portugues de Oncologia, Porto, Portugal
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Raymond Oyen
- European Society of Radiology (ESR); Department of Radiology, KU Leuven, Leuven, Belgium
| | - Theo de Reijke
- European Society of Surgical Oncology (ESSO); Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, University of Leeds; St James' University Hospital, Leeds, United Kingdom
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Riccardo Valdagni
- European School of Oncology (ESO); Prostate Cancer Programme and Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Kubitschke H, Wolf B, Morawetz E, Horn LC, Aktas B, Behn U, Höckel M, Käs J. Roadmap to Local Tumour Growth: Insights from Cervical Cancer. Sci Rep 2019; 9:12768. [PMID: 31484955 PMCID: PMC6726627 DOI: 10.1038/s41598-019-49182-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 08/21/2019] [Indexed: 12/25/2022] Open
Abstract
Wide tumour excision is currently the standard approach to surgical treatment of solid cancers including carcinomas of the lower genital tract. This strategy is based on the premise that tumours exhibit isotropic growth potential. We reviewed and analysed local tumour spreading patterns in 518 patients with cancer of the uterine cervix who underwent surgical tumour resection. Based on data obtained from pathological examination of the surgical specimen, we applied computational modelling techniques to simulate local tumour spread in order to identify parameters influencing preferred infiltration patterns and used area-proportional Euler diagrams to detect and confirm ordered patterns of tumour spread. Some anatomical structures, e.g. tissues of the urinary bladder, were significantly more likely to be infiltrated than other structures, e.g. the ureter and the rectum. Computational models assuming isotropic growth could not explain these infiltration patterns. Introducing ontogenetic distance of a tissue relative to the uterine cervix as a parameter led to accurate predictions of the clinically observed infiltration likelihoods. The clinical data indicates that successive infiltration likelihoods of ontogenetically distant tissues are nearly perfect subsets of ontogenetically closer tissues. The prevailing assumption of isotropic tumour extension has significant shortcomings in the case of cervical cancer. Rather, cervical cancer spread seems to follow ontogenetically defined trajectories.
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Affiliation(s)
- Hans Kubitschke
- Peter Debye Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
| | - Benjamin Wolf
- Department of Gynecology, Women's and Children's Centre, University Hospital Leipzig, Leipzig, Germany.,Leipzig School of Radical Pelvic Surgery, Leipzig University, Leipzig, Germany
| | - Erik Morawetz
- Peter Debye Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany
| | - Lars-Christian Horn
- Division of Gynecologic, Breast and Perinatal Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Bahriye Aktas
- Department of Gynecology, Women's and Children's Centre, University Hospital Leipzig, Leipzig, Germany.,Leipzig School of Radical Pelvic Surgery, Leipzig University, Leipzig, Germany
| | - Ulrich Behn
- Institute of Theoretical Physics, Leipzig University, Leipzig, Germany
| | - Michael Höckel
- Department of Gynecology, Women's and Children's Centre, University Hospital Leipzig, Leipzig, Germany.,Leipzig School of Radical Pelvic Surgery, Leipzig University, Leipzig, Germany
| | - Josef Käs
- Peter Debye Institute for Soft Matter Physics, Leipzig University, Leipzig, Germany.
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13
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Höckel M, Wolf B, Schmidt K, Mende M, Aktas B, Kimmig R, Dornhöfer N, Horn LC. Surgical resection based on ontogenetic cancer field theory for cervical cancer: mature results from a single-centre, prospective, observational, cohort study. Lancet Oncol 2019; 20:1316-1326. [PMID: 31383547 DOI: 10.1016/s1470-2045(19)30389-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous findings from our centre suggest that carcinoma of the cervix propagates within ontogenetic cancer fields, tissue compartments defined by staged morphogenesis. We aimed to determine whether surgical treatment that accounts for stage-associated, ontogenetic cancer fields and their associated lymphoid tissues results in locoregional tumour control without the need for adjuvant radiotherapy. METHODS We did the final clinical and histopathological evaluation of data from, the single-centre, observational, cohort study, the Leipzig School Mesometrial Resection Study. Patients of any age with stage IB1, IB2, IIA1, IIA2, or IIB cervical cancer (according to 2009 International Federation of Gynecology and Obstetrics [FIGO]) had total mesometrial resection or extended mesometrial resection and therapeutic lymph node dissection, done on the basis of ontogenetic cancer fields. We defined sentinel node, first-line, second-line, and third-line lymph node regions as progressive regional cancer fields. Primary outcomes were disease-specific survival and recurrence-free survival, and treatment-related morbidity (assessed with the Franco-Italian glossary). Applying Cox proportional hazard models, ontogenetic local (T) and regional (N) tumour staging was compared with pathological T and N staging. This trial is registered with the German Clinical Trials Register, number DRKS00015171. FINDINGS Between Oct 16, 1999, and June 27, 2017, 523 patients were treated per protocol and followed up for a median of 61·8 months (IQR 49·3-94·8). In 495 patients with cervical cancer treated with cancer field surgery, 5-year disease-specific survival was 89·4% (95% CI 86·5-92·4) and recurrence-free survival was 83·1% (79·7-86·6). In the per-protocol population of 523 patients, treatment-related morbidity comprised 112 (21%) grade 2 and 15 (3%) grade 3 complications. The most common moderate and severe treatment-related complications and sequelae were wound dehiscence (17 [3%]), hydronephrosis (17 [3%]), bowel obstruction (26 [5%]), and lymph oedema (33 [6%]). One patient (<1%), who received total mesometrial resection, died from postoperative brain infarction. INTERPRETATION Total or extended mesometrial resection with therapeutic lymph node dissection based on ontogenetic cancer fields results in good survival outcomes of patients with cervical cancer in our institution, but needs to be investigated further in multicentre trials. FUNDING Leipzig School of Radical Pelvic Surgery, University of Leipzig Medical School, and the Gynecologic Oncology Research Foundation.
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Affiliation(s)
- Michael Höckel
- Leipzig School of Radical Pelvic Surgery, University of Leipzig, Leipzig, Germany; Department of Gynecology and Obstetrics, University of Essen, Essen, Germany; Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany.
| | - Benjamin Wolf
- Department of Gynecology and Obstetrics, University of Leipzig, Leipzig, Germany
| | - Katja Schmidt
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Meinhard Mende
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University of Leipzig, Leipzig, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University of Essen, Essen, Germany
| | - Nadja Dornhöfer
- Department of Gynecology and Obstetrics, University of Leipzig, Leipzig, Germany
| | - Lars-Christian Horn
- Division of Breast, Gynecological and Perinatal Pathology, University of Leipzig, Leipzig, Germany
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Trott S, Dornhöfer N, Höckel M, Aktas B, Wolf B. Lebensqualität nach operativer Behandlung des Vulvakarzinoms mittels Vulvafeldresektion und anatomischer Rekonstruktion. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- S Trott
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - N Dornhöfer
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - M Höckel
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - B Aktas
- Gynäkologie Universitätsfrauenklinik Leipzig
| | - B Wolf
- Gynäkologie Universitätsfrauenklinik Leipzig
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15
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Lia M, Wolf B, Horn LC, Höckel M, Aktas B. Die Aussagekraft der core-needle-Biopsie beim Zervixkarzinom. Eine retrospektive Analyse. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Lia
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig
| | - B Wolf
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig
| | - LC Horn
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig
| | - M Höckel
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig
| | - B Aktas
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig
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16
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Wolf B, Sodeikat P, Borte G, Horn LC, Höckel M, Aktas B. Präoperative Evaluation des Parametriums beim Zervixkarzinom. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- B Wolf
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig
| | - P Sodeikat
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig
| | - G Borte
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig
| | - LC Horn
- Institut für Pathologie, Universitätsklinikum Leipzig
| | - M Höckel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig
| | - B Aktas
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Leipzig
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Abstract
Local spread patterns of malignant tumors follow permissive tissue territories, i.e., cancer fields, as shown for cervical and vulvar carcinoma. The cancer fields are associated in reverse order to the mature derivatives of the morphogenetic fields instrumental in the stepwise development of the tissue from which the tumor arose. This suggests that cancer progression may be linked to morphogenesis by inversion of the cellular bauplan sequence. Successive attractor transitions caused by proliferation-associated constraints of topobiological information processing are proposed for both morphogenesis and cancer. In morphogenesis these transitions sequentially activate bauplans with increasing complexity at decreasing plasticity restricting the permissive territories of the progenitor cell populations. Somatic mutations leading to cell proliferation in domains normally reserved for differentiation trigger the inverse cascade of bauplan changes that increase topobiological plasticity at decreased complexity and stepwise enlarge the permissive territory of neoplastic cells consistent with the clinical manifestations of cancer. The order provided by the sequence of attractor transitions and the defined topography of the permissive territories can be exploited for more accurate tumor staging and for locoregional tumor treatment either by surgery or radiotherapy with higher curative potential.
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Affiliation(s)
- Michael Höckel
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany.,Leipzig School of Radical Pelvic Surgery, University of Leipzig, Leipzig, Germany.,Department of Gynecology and Obstetrics, University of Essen, Essen, Germany
| | - Ulrich Behn
- Faculty of Physics and Earth Sciences, Institute of Theoretical Physics, University of Leipzig, Leipzig, Germany
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Weydandt L, Horn LC, Borte G, Höckel M, Aktas B. Fulminantes Zervix Karzinom Rezidiv 6 Wochen nach TMMR mit klinischer Komplettremission auf Cisplatin, Paclitaxel und Bevacizumab. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- L Weydandt
- Universitätsklinikum Leipzig, Frauenheilkunde, Leipzig, Deutschland
| | - LC Horn
- Universitätsklinikum Leipzig, Institut für Pathologie, Leipzig, Deutschland
| | - G Borte
- Universitätsklinikum Leipzig, Diagnostische Radiologie, Leipzig, Deutschland
| | - M Höckel
- Universitätsklinikum Leipzig, Frauenheilkunde, Leipzig, Deutschland
| | - B Aktas
- Universitätsklinikum Leipzig, Frauenheilkunde, Leipzig, Deutschland
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Höckel M, Trott S, Dornhöfer N, Horn LC, Hentschel B, Wolf B. Vulvar field resection based on ontogenetic cancer field theory for surgical treatment of vulvar carcinoma: a single-centre, single-group, prospective trial. Lancet Oncol 2018. [PMID: 29530664 DOI: 10.1016/s1470-2045(18)30109-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The incidence of vulvar cancer is increasing, but surgical treatment-the current standard of care-often leads to unsatisfactory outcomes, especially in patients with node-positive disease. Preliminary results at our centre showed that locoregional spread of vulvar carcinoma occurs within tissue domains defined by stepwise embryonic and fetal development (ontogenetic cancer fields and associated lymph node regions). We propose that clinical translation of these insights into practice could improve outcomes of surgical treatment of vulvar cancer. METHODS We did a single-centre prospective trial at the University of Leipzig's Cancer Center. Eligible patients were aged 18 years or older, had ontogenetic stage 1-3b histologically proven primary carcinoma of the vulva, and had not undergone previous surgical or radiotherapy treatment for vulvar cancer or any other major perineal or pelvic disease. In view of staged morphogenesis of the vulva from the cloacal membrane endoderm at Carnegie stage 11 to adulthood, we defined the tissue domains of tumour spread according to the theory of ontogenetic cancer fields. On the basis of ontogenetic staging, patients were treated locally with partial, total, or extended vulvar field resection; regionally with therapeutic inguinopelvic lymph node dissection; and anatomical reconstruction without adjuvant radiotherapy. The primary endpoints were recurrence-free survival, disease-specific survival, and early postoperative complications. Analysis of tumour spread and early postoperative surgical complications was done by intention to treat (ie, all patients were included), whereas outcome analyses were done per protocol. This ongoing trial is registered with the German Clinical Trials Register, number DRKS00013358. FINDINGS Between March 1, 2009, and June 8, 2017, 97 consecutive patients were included in the study, of whom 94 were treated per protocol with vulvar field resection, therapeutic inguinopelvic lymph node dissection, and anatomical reconstruction without adjuvant radiotherapy. 46 patients had moderate or severe postoperative complications, especially infectious perineal and inguinal wound dehiscence. 3-year recurrence-free survival in all patients was 85·1% (95% CI 76·9-93·3), and 3-year disease-specific survival was 86·0% (78·2-93·8). INTERPRETATION Our results support the theory of ontogenetic cancer fields for vulvar carcinoma, accord with our previous findings in cervical cancer, and suggest the general applicability of the theory. Application of the concept of cancer field resection could improve outcomes in patients with vulvar carcinoma, but needs to be investigated further in multicentre randomised controlled trials. FUNDING Leipzig School of Radical Pelvic Surgery and Gynecologic Oncology Research Foundation.
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Affiliation(s)
- Michael Höckel
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany; Leipzig School of Radical Pelvic Surgery, University of Leipzig, Leipzig, Germany.
| | - Sophia Trott
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany
| | - Nadja Dornhöfer
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany
| | - Lars-Christian Horn
- Division of Breast, Gynecological and Perinatal Pathology, Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Benjamin Wolf
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany
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Wolf B, Ganzer R, Stolzenburg JU, Hentschel B, Horn LC, Höckel M. Extended mesometrial resection (EMMR): Surgical approach to the treatment of locally advanced cervical cancer based on the theory of ontogenetic cancer fields. Gynecol Oncol 2017; 146:292-298. [PMID: 28526168 DOI: 10.1016/j.ygyno.2017.05.007] [Citation(s) in RCA: 14] [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: 03/08/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Based on ontogenetic-anatomic considerations, we have introduced total mesometrial resection (TMMR) and laterally extended endopelvic resection (LEER) as surgical treatments for patients with cancer of the uterine cervix FIGO stages I B1 - IV A. For a subset of patients with locally advanced disease we have sought to develop an operative strategy characterized by the resection of additional tissue at risk for tumor infiltration as compared to TMMR, but less than in LEER, preserving the urinary bladder function. METHODS We conducted a prospective single center study to evaluate the feasibility of extended mesometrial resection (EMMR) and therapeutic lymph node dissection as a surgical treatment approach for patients with cervical cancer fixed to the urinary bladder and/or its mesenteries as determined by intraoperative evaluation. None of the patients received postoperative adjuvant radiotherapy. RESULTS 48 consecutive patients were accrued into the trial. Median tumor size was 5cm, and 85% of all patients were found to have lymph node metastases. Complete tumor resection (R0) was achieved in all cases. Recurrence free survival at 5years was 54.1% (95% CI 38.3-69.9). The overall survival rate was 62.6% (95% CI 45.6-79.6) at 5years. Perioperative morbidity represented by grade II and III complications (determined by the Franco-Italian glossary) occurred in 25% and 15% of patients, respectively. CONCLUSION We demonstrate in this study the feasibility of EMMR as a surgical treatment approach for patients with locally advanced cervical cancer and regional lymph node invasion without the necessity for postoperative adjuvant radiation.
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Affiliation(s)
- Benjamin Wolf
- Department of Gynecology, Leipzig University Hospital, Leipzig, Germany
| | - Roman Ganzer
- Department of Urology, Leipzig University Hospital, Leipzig, Germany
| | | | - Bettina Hentschel
- Institute for Medical Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | | | - Michael Höckel
- Department of Gynecology, Leipzig University Hospital, Leipzig, Germany.
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Wolf B, Wiersbicki D, Wolfskämpf T, Höckel M, Steinke H. Die PAS-Reaktion zur Darstellung der ontogenetischen Kompartimentgrenzen in pelvinen Großflächenschnitten: eine neue Methode. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1601496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- B Wolf
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
| | | | | | - M Höckel
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
| | - H Steinke
- Institut für Anatomie, Universität Leipzig
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Wolf B, Horn LC, Höckel M. Risikostratifizierung von FIGO II B Zervixkarzinomen mittels ontogenetischem Tumorstaging. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1601503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- B Wolf
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
| | - LC Horn
- Institut für Pathologie, Universität Leipzig
| | - M Höckel
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
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Wolf B, Eckardt T, Höckel M. Adjuvante Chemotherapie nach TMMR/EMMR beim Zervixkarzinom mit Lymphknotenmetastasen. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1601504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- B Wolf
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
| | - T Eckardt
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
| | - M Höckel
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
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Wolf B, Ganzer R, Stolzenburg JU, Hentschel B, Horn LC, Höckel M. Die erweiterte mesometriale Resektion (EMMR): ein operatives Verfahren zur Behandlung des lokal fortgeschrittenen Zervixkarzinoms. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1601501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- B Wolf
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
| | - R Ganzer
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Urologie
| | - JU Stolzenburg
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Urologie
| | - B Hentschel
- Institut für Statistik und medizinische Epidemiologie (IMISE), Universität Leipzig
| | - LC Horn
- Institut für Pathologie, Universität Leipzig
| | - M Höckel
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gynäkologie
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Wolf B, Horn LC, Höckel M. Anogenital lichen sclerosus: Change of tissue position as pathogenetic factor. Gynecol Oncol Rep 2017; 20:73-74. [PMID: 28349117 PMCID: PMC5357701 DOI: 10.1016/j.gore.2017.03.003] [Citation(s) in RCA: 7] [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: 01/31/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 11/26/2022] Open
Abstract
•Lichen sclerosus in females primarily involves the hairless anogenital skin.•Skin tissue outside this area is constitutionally not at risk for lichen sclerosus.•Transplantation into the vulvar field may turn skin susceptible to lichen sclerosus.•Tissue inherent positional information might affect lichen sclerosus susceptibility.
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Affiliation(s)
- Benjamin Wolf
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Germany
| | | | - Michael Höckel
- Department of Obstetrics and Gynecology, Leipzig University Hospital, Germany
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Höckel M, Wolf B, Hentschel B, Horn LC. Surgical treatment and histopathological assessment of advanced cervicovaginal carcinoma: A prospective study and retrospective analysis. Eur J Cancer 2017; 70:99-110. [DOI: 10.1016/j.ejca.2016.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 11/25/2022]
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Abstract
Cancer patients and the application of pharmaceutical care: 1) Patients with chronic illnesses receive multiple benefits from pharmaceutical care. 2) The pharmaceutical care of the cancer patient must be co-ordinated with the physician. 3) The cancer care-providing pharmacist should acquire psychological competency. 4) The pharmacist sets up and maintains for the patient a drug therapy record and a drug application plan. Cancer patients require our attention and our professional knowledge in many respects. On the one hand, there is the centralized aseptic preparation of chemotherapy drugs with respective individual requirements, on the other hand there is the monitoring of therapy, pharmacoeconomics, reducing the risk of chemotherapy errors and safe drug handling. All of these require our professional commitment. In order to provide care to cancer patients in community pharmacies, it is essential to establish a structural procedure. Individualized counselling and personal care of the patient is a part of pharmaceutical services. Development of a constructive and relevant relationship between patient and pharmacist must be cultivated and begins with the issue of the first prescription. Possibly the patient could still frequent his regular pharmacy and use the special pharmacy only for oncology therapy. In the near future, with patient authorization, an exchange of medication-related data between hospital and community pharmacy will also be possible. We consider a possible German concept for oncology out-patients.
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Affiliation(s)
- Michael Höckel
- Allgemeines Krankenhaus Harburg, Pharmacy, Service-center Aponova, Hamburg, Germany
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Exner M, Kühn A, Stumpp P, Höckel M, Horn LC, Kahn T, Brandmaier P. Value of diffusion-weighted MRI in diagnosis of uterine cervical cancer: a prospective study evaluating the benefits of DWI compared to conventional MR sequences in a 3T environment. Acta Radiol 2016; 57:869-77. [PMID: 26329683 DOI: 10.1177/0284185115602146] [Citation(s) in RCA: 34] [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] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/21/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Imaging of cervical carcinoma remains challenging as local infiltration of surrounding tissues cannot always be discriminated safely. New imaging techniques, like diffusion-weighted imaging (DWI) have emerged, which could lead to a more sensitive tumor detection. PURPOSE To evaluate the benefits of DWI for determination of size, local infiltration, and tumor grading, in patients with primary and recurrent cervical cancer. MATERIAL AND METHODS In this prospective, study we enrolled 50 patients with primary (n = 35) and recurrent (n = 15) tumors. All patients underwent 3T magnetic resonance imaging (MRI) including conventional (e.g. T1/T2 ± fs ± contrast) sequences and DWI (b-values of 0, 50, 400, 800 s/mm(2)). All images were analyzed by three readers with different experience levels (1, 3, 6 years), who compared image quality, tumor delineation, dimensions, local infiltration, lymph node involvement, and quantified ADC values compared to the histopathological grading. RESULTS Additional use of DWI resulted in significantly better (P < 0.001) tumor delineation for the least experienced reader, but not for experienced readers. Tumor dimensions were assessed almost equally (P > 0.05) in conventional sequences and DWI. Use of DWI led to an increase in sensitivity of infiltrated adjacent tissue (from 86% to 90%) and detection of lymph node metastases (from 47% to 67%). Quantitative assessment of carcinomas showed lower ADC values (P < 0.001) with significant inverse correlations between different grading levels. CONCLUSION Our study demonstrates the overall benefits using DWI in 3T MRI resulting in a higher reader confidence, sensitivity of tissue infiltration, and tumor-grading for cervical cancer.
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Affiliation(s)
- Marc Exner
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Axel Kühn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Michael Höckel
- Department of Gynaecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | | | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Philipp Brandmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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Brandmaier P, Purz S, Bremicker K, Höckel M, Barthel H, Kluge R, Kahn T, Sabri O, Stumpp P. Simultaneous [18F]FDG-PET/MRI: Correlation of Apparent Diffusion Coefficient (ADC) and Standardized Uptake Value (SUV) in Primary and Recurrent Cervical Cancer. PLoS One 2015; 10:e0141684. [PMID: 26551527 PMCID: PMC4638340 DOI: 10.1371/journal.pone.0141684] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 04/07/2015] [Accepted: 10/12/2015] [Indexed: 01/18/2023] Open
Abstract
Objectives Previous non–simultaneous PET/MR studies have shown heterogeneous results about the correlation between standardized uptake values (SUVs) and apparent diffusion coefficients (ADCs). The aim of this study was to investigate correlations in patients with primary and recurrent tumors using a simultaneous PET/MRI system which could lead to a better understanding of tumor biology and might play a role in early response assessment. Methods We included 31 patients with histologically confirmed primary (n = 14) or recurrent cervical cancer (n = 17) who underwent simultaneous whole-body 18F-FDG-PET/MRI comprising DWI. Image analysis was performed by a radiologist and a nuclear physician who identified tumor margins and quantified ADC and SUV. Pearson correlations were calculated to investigate the association between ADC and SUV. Results 92 lesions were detected. We found a significant inverse correlation between SUVmax and ADCmin (r = -0.532, p = 0.05) in primary tumors as well as in primary metastases (r = -0.362, p = 0.05) and between SUVmean and ADCmin (r = -0.403, p = 0.03). In recurrent local tumors we found correlations for SUVmax and ADCmin (r = -0.747, p = 0.002) and SUVmean and ADCmin (r = -0.773, p = 0.001). Associations for recurrent metastases were not significant (p>0.05). Conclusions Our study demonstrates the feasibility of fast and reliable measurement of SUV and ADC with simultaneous PET/MRI. In patients with cervical cancer we found significant inverse correlations for SUV and ADC which could play a major role for further tumor characterization and therapy decisions.
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Affiliation(s)
- P. Brandmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - S. Purz
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - K. Bremicker
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - M. Höckel
- Department of Gynecology and Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - H. Barthel
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - R. Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - T. Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - O. Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - P. Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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Bornmann K, Stepan H, Geigenmüller F, Höckel M. Modernes Management eines fortgeschrittenen Cervixkarzinoms in der Schwangerschaft. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Haag EM, Höckel M, Höhn AK, Horn LC. Clinicopathologic analysis and p16 expression in surgically treated primary vaginal carcinoma. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Eckey C, Höhn AK, Höckel M, Scherling R, Hentschel B, Horn LC. Epithelial-mesenchymal transition (EMT) in vulvar cancer with and without inguinal lymph node metastases. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Höckel M, Hentschel B, Horn LC. Association between developmental steps in the organogenesis of the uterine cervix and locoregional progression of cervical cancer: a prospective clinicopathological analysis. Lancet Oncol 2014; 15:445-56. [DOI: 10.1016/s1470-2045(14)70060-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Höckel M, Horn LC. The puzzle of close surgical margins is not puzzling. Gynecol Oncol 2013; 130:224-5. [DOI: 10.1016/j.ygyno.2013.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/18/2013] [Accepted: 03/19/2013] [Indexed: 10/27/2022]
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Mayer A, Höckel M, Schlischewsky N, Schmidberger H, Horn LC, Vaupel P. Lacking hypoxia-mediated downregulation of E-cadherin in cancers of the uterine cervix. Br J Cancer 2013; 108:402-8. [PMID: 23322209 PMCID: PMC3566820 DOI: 10.1038/bjc.2012.570] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Experimental studies have established a causal connection between tumour hypoxia, hypoxia-associated proteome changes and downregulation of E-cadherin, the final common pathway of epithelial-to-mesenchymal transition (EMT). Our study aimed at elucidating the interrelationship of these processes in cancers of the uterine cervix in vivo. Methods: Tumour oxygenation was assessed in 48 squamous cell carcinomas (SCC) of the uterine cervix using polarographic needle electrodes. The expression pattern of E-cadherin was investigated by immunohistochemistry and western blotting, and was compared with that of the hypoxia-inducible proteins glucose transporter (GLUT)-1 and carbonic anhydrase (CA) IX in biopsy specimens of the oxygenation measurement tracks. Results: The majority of cervical cancers (52%) were E-cadherin positive, with a complete absence of the antigen in only 10% of the tumours. No correlation was found between the level of E-cadherin expression and the oxygenation status (mean pO2, median pO2 and hypoxic fractions). In patients showing partial expression of E-cadherin (38%), staining was not preferentially diminished in GLUT-1- or CA IX-positive areas, and loss of E-cadherin occurred independently of tumour cell scattering. Conclusion: Our data provide no evidence in favour of a hypoxia-induced EMT as a mechanistic basis of cervical cancer invasiveness.
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Affiliation(s)
- A Mayer
- Department of Radiooncology and Radiotherapy, University Medical Center, Mainz, Germany.
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Höckel M, Einenkel J, Horn LC. Paraaortic lymphatic spread in cervical cancer. Gynecol Oncol 2012; 127:677; author reply 677-8. [PMID: 22863871 DOI: 10.1016/j.ygyno.2012.07.122] [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] [Received: 06/27/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
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Höckel M. Comment on: Response to the Letter to the Editor by M. Höckel et al.: Laterally extended parametrectomy in node-positive early stage cervical cancer: Right direction, wrong track, by L. Ungar, Z. Novak, and L. Palfalvi. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Höckel M, Wilmer A, Jaehde U. [Fatigue in cancer patients]. Med Monatsschr Pharm 2012; 35:172-182. [PMID: 22624351] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Fatigue is characterized by persistent tiredness or exhaustion and besides the anorexia-nausea-emesis syndrome one of the most frequent adverse events of cancer treatment. There is a large variety of causes and symptoms. Various non-pharmacologic and pharmacologic interventions can help to ameliorate the symptoms and to improve patient's quality of life. For the effective management of fatigue a systematic approach of the multiprofessional team is required. Last but not least, the pharmacist can contribute to support cancer patients suffering from fatigue.
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Affiliation(s)
- Michael Höckel
- Pharmazeutisches Institut, Klinische Pharmazie, Universität Bonn, An der Immenburg 4, 53121 Bonn
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Höckel M, Horn LC, Einenkel J. Laterally extended parametrectomy in nodal positive early stage cervical cancer: Right direction, wrong track. Gynecol Oncol 2012; 125:765-6; author reply 766-7; discussion 767. [PMID: 22209774 DOI: 10.1016/j.ygyno.2011.12.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 12/21/2011] [Indexed: 11/29/2022]
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Abstract
The pathophysiologic process of local tumor spread is regarded as an isotropic infiltration of microscopic extensions of the malignant lesion irrespective of tissue boundaries. By contrast, the ontogenetic compartment theory states that malignant solid tumors are locally confined, for a relatively long phase during their natural course, to a permissive compartment derived from a common primordium in embryonic development. Tumor permeation is isotropic within the permissive ontogenetic compartment, but it is suppressed at the compartment borders. The validity of the ontogenetic compartment theory has been shown for cancer of the rectum and of the female lower genital tract. It is hypothesized that ontogenetic compartment resection, the translation of the theory into cancer surgery, holds a great potential to improve oncologic treatment results.
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Affiliation(s)
- Michael Höckel
- Department of Gynecology, Women’s & Children’s Center, University of Leipzig, Liebigstrasse 20a, 04103 Leipzig, Germany
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Höckel M, Horn LC, Tetsch E, Einenkel J. Pattern analysis of regional spread and therapeutic lymph node dissection in cervical cancer based on ontogenetic anatomy. Gynecol Oncol 2011; 125:168-74. [PMID: 22155677 DOI: 10.1016/j.ygyno.2011.12.419] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 11/25/2011] [Accepted: 12/01/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In cervical cancer lymph node dissection is applied for regional tumor staging. Up to now, the use of (chemo)radiation in the nodal positive patient has prevented the exact pattern analysis of regional tumor spread and the evaluation of the therapeutic role of lymph node dissection. New surgical techniques founded on ontogenetic instead of functional anatomy for the treatment of cervical cancer dispensing with adjuvant radiotherapy offer the possibility to accurately determine the topography of regional lymph node metastases which is the prerequisite for optimized diagnostic and therapeutic lymph node dissection. METHODS Patients with cervical cancer FIGO stages IB-IIB were treated with total mesometrial resection (TMMR) and lymph node dissection after exposing the ontogenetic visceroparietal compartments of the female pelvis. Resected lymph nodes were allocated to regions topographically defined by the embryonic development of the iliac, lumbar and mesenteric lymph systems prior to histopathological assessment. RESULTS 71 of 305 treated patients had lymph node metastases. Topographic distribution of these metastases at primary surgery and analysis of pelvic failures showed a spatial pattern related to the ontogenesis of the abdominopelvic lymphatic system. Five-year locoregional tumor control probability was 96% (95% CI: 94-98) for the whole group and 87% (95% CI: 77-97) for nodal positive patients. CONCLUSIONS The pattern of regional spread in cervical cancer can be comprehended and predicted from ontogenetic lymphatic compartments. In patients with early cervical cancer lymph node dissection based on ontogenetic anatomy achieves high regional tumor control without adjuvant radiation.
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Affiliation(s)
- Michael Höckel
- Department of Gynecology, University of Leipzig, Leipzig, Germany.
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Horn LC, Kellner C, Scherling R, Höckel M, Einenkel J. Ultrastaging for micrometastases in para-aortic lymph nodes in patients with carcinoma of the uterine cervix. Gynecol Oncol 2011; 124:374-5; author reply 375-6. [PMID: 22040833 DOI: 10.1016/j.ygyno.2011.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/06/2011] [Indexed: 12/30/2022]
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Höckel M, Horn LC. Three-dimensional classification of radical hysterectomy: new saddle for an old horse. Gynecol Oncol 2011; 124:173-4; author reply 174-5. [PMID: 21945307 DOI: 10.1016/j.ygyno.2011.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 08/26/2011] [Indexed: 11/29/2022]
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Mayer A, Höckel M, Horn LC, Schmidberger H, Vaupel P. GLUT-1 staining of squamous cell carcinomas of the uterine cervix identifies a novel element of invasion. Int J Oncol 2011; 38:145-150. [PMID: 21109935] [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: 05/30/2023] Open
Abstract
Perturbation of the normal tissue architecture in solid malignant tumors is perceived to be the consequence of actively migrating cancer cells which invade the adjacent normal host tissue. The opposite, invasion of cancer cell clusters by a vascularized stroma, has not been considered. The latter process should, however, be expected to occur since the hypoxic cores of tumor cell aggregates, under the control of HIF-1, are known to secrete cytokines (e.g., bFGF, VEGF) which attract fibroblasts and induce blood vessel formation. In this study, the expression of glucose transporter (GLUT)-1, a major HIF-1 target gene, was examined in 51 squamous cell carcinomas of the uterine cervix by immunohistochemistry to identify the localization of hypoxic tumor cell areas. The relationship of the expression pattern of GLUT-1 with the localization and morphology of the tumor stroma was analyzed. We identified three recurrent histological signs which represent strong evidence in favor of an invasion of solid tumor masses by actively migrating stromal cells. According to our findings, the histological structure of squamous cell carcinomas of the uterine cervix may in part result from the interplay between the inherent tendency of neoplastic epithelial cells to expand in the form of coherent aggregates and the fragmentation of these aggregates by invading, finger- or wedge-like stromal protrusions which carry new blood vessels, driven by gradients of hypoxia-induced pro-angiogenic, pro-migratory and growth-promoting molecules emanating from the hypoxic core.
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Affiliation(s)
- Arnulf Mayer
- Department of Radiooncology and Radiotherapy, University Medical Center, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Zenger M, Glaesmer H, Höckel M, Hinz A. Pessimism predicts anxiety, depression and quality of life in female cancer patients. Jpn J Clin Oncol 2010; 41:87-94. [PMID: 20819835 DOI: 10.1093/jjco/hyq168] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the predictive value of optimism/pessimism for anxiety, depression and health-related quality of life in female cancer patients, quantified with and without controlling the corresponding base level. METHODS A total of 97 women with breast cancer and other gynaecological cancer completed the Life Orientation Test, the Hospital Anxiety and Depression Scale and the Health Survey SF-8 at three time points: during their stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). RESULTS The degree of self-assessed pessimism at T1 was significantly associated with anxiety, depression and health-related quality of life at T3. After controlling for the base levels of anxiety, depression and health-related quality of life, only the predictive value of pessimism remained significant and substantial. CONCLUSIONS Especially, women with a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered health-related quality of life in the course of the disease. The results indicate that it seems to be more important not to be pessimistic than to be optimistic.
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Affiliation(s)
- Markus Zenger
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany.
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Abstract
The established gynecological cancer operations are based on functional anatomy derived from the mature organism and on a model of radial progressive tumor permeation. Surgical treatment aims to resect the tumor with a metrically defined radial margin of tissue microscopically free of neoplastic or dysplastic disease. However, despite adequate surgical performance local tumor relapses still occur. In the presence of histopathological risk factors adjuvant radiation is therefore recommended which increases treatment-related morbidity. The Leipzig School of Radical Pelvic Surgery has developed new gynecological cancer operations from a different perspective on anatomy and local tumor spread. Tissue mapping is deduced by following the organism's development from the stage of tissue deposition to maturity (ontogenetic anatomy) to define permissive compartments for cancer permeation. The variants of mesometrial resection (TMMR, PMMR) and vulva field resection (VFR) achieve very high (>95%) local control rates in stages I and II cancer of the lower and middle female genital tract without adjuvant radiation. Laterally extended endopelvic resection (LEER) provides sustained tumor control even in locally advanced and recurrent disease as well as cancer of the distal vagina.
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Affiliation(s)
- M Höckel
- Frauen- und Kinderzentrum, Universitätsfrauenklinik, Liebigstraße 20a, 04103, Leipzig, Deutschland.
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49
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Hinz A, Krauss O, Hauss JP, Höckel M, Kortmann RD, Stolzenburg JU, Schwarz R. Anxiety and depression in cancer patients compared with the general population. Eur J Cancer Care (Engl) 2009; 19:522-9. [PMID: 20030697 DOI: 10.1111/j.1365-2354.2009.01088.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The objective of this study was to compare the prevalence of anxiety and depression in cancer patients with the prevalence found in the general population, using the Hospital Anxiety and Depression Scale (HADS). Participants were 1529 cancer patients treated between 2002 and 2004 in Germany and 2037 persons from the German general population. In the cancer patients, the risk of psychiatric distress was nearly twice that of the general population. While for older age groups (61 years and above) there were only small differences between cancer patients and the general population, the differences in both scales were high for young persons. There were differences between the HADS mean scores of the patients with different tumour localisations, with high values for brain cancer and low scores for prostate cancer. The influence of the tumour stage on anxiety and depression was weak. However, depression scores of patients with a survival time less than 1 year were elevated. The results show that large sample sizes are necessary to evaluate the psychological situation of cancer patients, and that age and gender differences must be taken into account when several samples are compared.
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Affiliation(s)
- A Hinz
- Department of Medical Psychology, University of Leipzig, Leipzig, Germany.
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50
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Horn LC, Meinel A, Hentschel B, Leo C, Höckel M. sFTL-1 (soluble fms-like tyrosine kinase 1), intratumoral microvessel density and oxygenation in carcinoma of the uterine cervix. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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