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Nieuwenhuyzen-de Boer GM, Aamran H, van den Berg CB, Willemsen S, Piek JMJ, Reesink-Peters N, Maliepaard M, van Doorn HC, Polinder S, van Beekhuizen HJ. Cytoreductive Surgery with the PlasmaJet Improved Quality-of-Life for Advanced Stage Ovarian Cancer Patients. Cancers (Basel) 2023; 15:3947. [PMID: 37568763 PMCID: PMC10416900 DOI: 10.3390/cancers15153947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Knowledge of quality-of-life after cytoreductive surgery is important to counsel patients with advanced-stage epithelial ovarian cancer prior to surgery. The aim of this study was to determine whether the use of the PlasmaJet Surgical device during cytoreductive surgery has an effect on the quality-of-life of patients with advanced epithelial ovarian cancer. METHODS Data included in this prospective observational study were derived from the PlaComOv study, in which patients with advanced epithelial ovarian cancer were randomly assigned to have cytoreductive surgery with or without adjuvant use of the PlasmaJet. Quality-of-life was measured before surgery and one, six, 12, and 24 months after surgery with three questionnaires: the EORTC QLQ-C30, QLQ-OV28, and EQ-5D-5L. RESULTS Between 2018 and 2020, 326 patients were enrolled in the trial. The overall response rate was high, with the lowest response rate at 24 months of 77%. At 6 months, quality-of-life was higher in the intervention group (95%CI 0.009; 0.081, p = 0.045). At 12 months, quality-of-life was higher in the intervention group with fewer symptoms of fatigue, appetite loss, and diarrhea (95%CI 0.6; 10,0, p = 0.027); similarly, patients in the intervention group reported a better body image (95%CI -14.2; -3.0, p = 0.003) and a higher score on the visual analog scale (95%CI 1.99; 11.15, p = 0.005). At 24 months postoperatively, no further difference was found between the two groups except for pain (95%CI -12.9; -0.8, p = 0.027) and body image (95%CI -13.808; -0.733, p = 0.029). A higher quality-of-life in the intervention group was partially explained by the mediator 'surgery outcome'. CONCLUSIONS This study demonstrated knowledge of patients' quality-of-life until two years after cytoreductive surgery. The use of the PlasmaJet Surgical device during cytoreductive surgery leads to a higher quality-of-life than conventional surgery with electrocoagulation alone. Even after adjustment for the mediator of surgical outcome, a higher quality-of-life was seen in patients who had surgery with the use of the PlasmaJet device.
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Affiliation(s)
- Gatske M. Nieuwenhuyzen-de Boer
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Hanane Aamran
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
| | - Caroline B. van den Berg
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Sten Willemsen
- Department of Epidemiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands;
- Department of Biostatistics, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Jurgen M. J. Piek
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, 5623 EJ Eindhoven, The Netherlands;
| | - Nathalie Reesink-Peters
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
| | - Marianne Maliepaard
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
| | - Helena C. van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Heleen J. van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
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Nieuwenhuyzen-de Boer GM, Hofhuis W, Reesink-Peters N, Willemsen S, Boere IA, Schoots IG, Piek JMJ, Hofman LN, Beltman JJ, van Driel WJ, Werner HMJ, Baalbergen A, van Haaften-de Jong AMLD, Dorman M, Haans L, Nedelcu I, Ewing-Graham PC, van Beekhuizen HJ. ASO Visual Abstract: The Role of Adjuvant Use of the PlasmaJet® Device During Cytoreductive Surgery for Advanced-Stage Ovarian Cancer—Results of the PlaComOv-Study, a Randomized, Controlled Trial in the Netherlands. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11820-w] [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: 11/18/2022]
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Nieuwenhuyzen-de Boer GM, Hofhuis W, Reesink-Peters N, Willemsen S, Boere IA, Schoots IG, Piek JMJ, Hofman LN, Beltman JJ, van Driel WJ, Werner HMJ, Baalbergen A, van Haaften-de Jong AMLD, Dorman M, Haans L, Nedelcu I, Ewing-Graham PC, van Beekhuizen HJ. Adjuvant Use of PlasmaJet Device During Cytoreductive Surgery for Advanced-Stage Ovarian Cancer: Results of the PlaComOv-study, a Randomized Controlled Trial in The Netherlands. Ann Surg Oncol 2022; 29:4833-4843. [PMID: 35552938 PMCID: PMC9246793 DOI: 10.1245/s10434-022-11763-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
Abstract
Objective Standard surgical treatment of advanced-stage ovarian carcinoma with electrosurgery cannot always result in complete cytoreductive surgery (CRS), especially when many small metastases are found on the mesentery and intestinal surface. We investigated whether adjuvant use of a neutral argon plasma device can help increase the complete cytoreduction rate. Patients and Methods 327 patients with FIGO stage IIIB–IV epithelial ovarian cancer (EOC) who underwent primary or interval CRS were randomized to either surgery with neutral argon plasma (PlasmaJet) (intervention) or without PlasmaJet (control group). The primary outcome was the percentage of complete CRS. The secondary outcomes were duration of surgery, blood loss, number of bowel resections and colostomies, hospitalization, 30-day morbidity, and quality of life (QoL). Results Complete CRS was achieved in 119 patients (75.8%) in the intervention group and 115 patients (67.6%) in the control group (risk difference (RD) 8.2%, 95% confidence interval (CI) –0.021 to 0.181; P = 0.131). In a per-protocol analysis excluding patients with unresectable disease, complete CRS was obtained in 85.6% in the intervention group and 71.5% in the control group (RD 14.1%, 95% CI 0.042 to 0.235; P = 0.005). Patient-reported QoL at 6 months after surgery differed between groups in favor of PlasmaJet surgery (95% CI 0.455–8.350; P = 0.029). Other secondary outcomes did not differ significantly. Conclusions Adjuvant use of PlasmaJet during CRS for advanced-stage ovarian cancer resulted in a significantly higher proportion of complete CRS in patients with resectable disease and higher QoL at 6 months after surgery. (Funded by ZonMw, Trial Register NL62035.078.17.) Trial Registration Approved by the Medical Ethics Review Board of the Erasmus University Medical Center Rotterdam, the Netherlands, NL62035.078.17 on 20-11-2017. Recruitment started on 30-1-2018. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-11763-2.
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Affiliation(s)
- G M Nieuwenhuyzen-de Boer
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - W Hofhuis
- Department of Obstetrics and Gynecology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - N Reesink-Peters
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - S Willemsen
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - I A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - I G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J M J Piek
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - L N Hofman
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - J J Beltman
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - W J van Driel
- Department of Gynecology, Center of Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H M J Werner
- Department of Obstetrics and Gynecology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A Baalbergen
- Department of Obstetrics and Gynecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - M Dorman
- Department of Obstetrics and Gynecology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - L Haans
- Department of Obstetrics and Gynecology, Haags Medical Centre, The Hague, The Netherlands
| | - I Nedelcu
- Department of Obstetrics and Gynecology, Groene Hart Hospital, Gouda, The Netherlands
| | - P C Ewing-Graham
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H J van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Reijntjes B, van Suijlichem M, Woolderink JM, Bongers MY, Reesink-Peters N, Paulsen L, van der Hurk PJ, Kraayenbrink AA, Apperloo MJA, Slangen B, Schukken T, Tummers FHMP, van Kesteren PJM, Huirne JAF, Boskamp D, Lunter G, de Bock GH, Mourits MJE. Recurrence and survival after laparoscopy versus laparotomy without lymphadenectomy in early-stage endometrial cancer: Long-term outcomes of a randomised trial. Gynecol Oncol 2021; 164:265-270. [PMID: 34955237 DOI: 10.1016/j.ygyno.2021.12.019] [Citation(s) in RCA: 13] [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: 08/03/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Laparoscopic hysterectomy is accepted worldwide as the standard treatment option for early-stage endometrial cancer. However, there are limited data on long-term survival, particularly when no lymphadenectomy is performed. We compared the survival outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH), both without lymphadenectomy, for early-stage endometrial cancer up to 5 years postoperatively. METHODS Follow-up of a multi-centre, randomised controlled trial comparing TLH and TAH, without routine lymphadenectomy, for women with stage I endometrial cancer. Enrolment was between 2007 and 2009 by 2:1 randomisation to TLH or TAH. Outcomes were disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and primary site of recurrence. Multivariable Cox regression analyses were adjusted for age, stage, grade, and radiotherapy with adjusted hazard ratios (aHR) and 95% confidence intervals (95%CI) reported. To test for significance, non-inferiority margins were defined. RESULTS In total, 279 women underwent a surgical procedure, of whom 263 (94%) had follow-up data. For the TLH (n = 175) and TAH (n = 88) groups, DFS (90.3% vs 84.1%; aHR[recurrence], 0.69; 95%CI, 0.31-1.52), OS (89.2% vs 82.8%; aHR[death], 0.60; 95%CI, 0.30-1.19), and DSS (95.0% vs 89.8%; aHR[death], 0.62; 95%CI, 0.23-1.70) were reported at 5 years. At a 10% significance level, and with a non-inferiority margin of 0.20, the null hypothesis of inferiority was rejected for all three outcomes. There were no port-site or wound metastases, and local recurrence rates were comparable. CONCLUSION Disease recurrence and 5-year survival rates were comparable between the TLH and TAH groups and comparable to studies with lymphadenectomy, supporting the widespread use of TLH without lymphadenectomy as the primary treatment for early-stage, low-grade endometrial cancer.
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Affiliation(s)
- Bianca Reijntjes
- Department of Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Mieke van Suijlichem
- Department of Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Jorien M Woolderink
- Department of Obstetrics and Gynaecology, Martini Hospital Groningen, the Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Center Veldhoven, the Netherlands
| | - Nathalie Reesink-Peters
- Department of Obstetrics and Gynaecology, Medical Spectrum Twente Enschede/Hospital Group Twente Almelo, the Netherlands
| | - Lasse Paulsen
- Department of Obstetrics and Gynaecology, Wilhelmina Hospital Assen, the Netherlands
| | - Pieter J van der Hurk
- Department of Obstetrics and Gynaecology, Nij Smellinghe Hospital Drachten, the Netherlands
| | - Arjan A Kraayenbrink
- Department of Obstetrics and Gynaecology, Rijnstate Hospital Arnhem, the Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, the Netherlands
| | - Brigitte Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, the Netherlands
| | - Tineke Schukken
- Department of Obstetrics and Gynaecology, Antonius Hospital Sneek, the Netherlands
| | | | | | - Judith A F Huirne
- Department of Gynaecology, Amsterdam University Medical Center, the Netherlands
| | - Dieuwke Boskamp
- Department of Obstetrics and Gynaecology, VieCuri Medical Center Venlo, the Netherlands
| | - Gerton Lunter
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Marian J E Mourits
- Department of Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands.
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Nieuwenhuyzen-de Boer GM, Hofhuis W, Reesink-Peters N, Ewing-Graham PC, Schoots IG, Beltman JJ, Piek JMJ, Baalbergen A, Kooi GS, van Haaften A, van Huisseling H, Haans L, Dorman M, van Beekhuizen HJ. Evaluation of effectiveness of the PlasmaJet surgical device in the treatment of advanced stage ovarian cancer (PlaComOv-study): study protocol of a randomized controlled trial in the Netherlands. BMC Cancer 2019; 19:58. [PMID: 30642296 PMCID: PMC6332622 DOI: 10.1186/s12885-019-5275-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/03/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The most important goal for survival benefit of advanced stage ovarian cancer is to surgically remove all visible tumour, because complete cytoreductive surgery (CCS) has been shown to be associated with prolonged survival. In a remarkable number of women, CCS is very challenging. Especially in women with many small metastases on the peritoneum and intestinal surface, conventional CCS with electrosurgery is not able to be "complete" in removing safely all visible tumour. In this randomized controlled trail (RCT) we investigate whether the use of the PlasmaJet Surgical Device increases the rate of CCS, and whether this indeed leads to a longer progression free and overall survival. The main research question is: does the use of the PlasmaJet Surgical Device in surgery for advanced stage ovarian cancer result in an increased number of complete cytoreductive surgeries when compared with conventional surgical techniques. Secondary study objectives are: 30-day morbidity, duration of surgery, blood loss, length of hospitalisation, Quality of Life, disease-free survival, overall survival, percentage colostomy, cost-effectiveness. METHODS The study design is a multicentre single-blinded superiority RCT in two university and nine non-university hospitals in The Netherlands. Three hundred and thirty women undergoing cytoreductive surgery for advanced stage ovarian carcinoma (FIGO Stage IIIB-IV) will be randomized into two arms: use of the PlasmaJet (intervention group) versus the use of standard surgical instruments combined with electrocoagulation (control group). The primary outcome is the rate of complete cytoreductive surgery in both groups. Secondary study objectives are: 30-day morbidity, duration of surgery, blood loss, length of hospitalisation, Quality of Life, disease-free survival, overall survival, percentage colostomy, cost-effectiveness. Quality of life will be evaluated using validated questionnaires at baseline, at 1 and 6 months after surgery and at 1, 2, 3 and 4 years after surgery. DISCUSSION We hypothesize the additional value of the use of the PlasmaJet in CCS for advanced stage epithelial ovarian cancer. More knowledge about efficacy, side effects, recurrence rates, cost effectiveness and pathology findings after using the PlasmaJet Device is advocated. This RCT may aid in this void. TRIAL REGISTRATION Dutch Trial Register NTR6624 . Registered 18 August 2017. Medical Ethical Committee approval number: NL62035.078.17 (Medical Ethical Committee Erasmus Medical Centre Rotterdam).
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Affiliation(s)
- G M Nieuwenhuyzen-de Boer
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - W Hofhuis
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - N Reesink-Peters
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - P C Ewing-Graham
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - I G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J J Beltman
- Department of Obstetrics and Gynaecology, Leids University Medical Centre, Leiden, The Netherlands
| | - J M J Piek
- Department of Obstetrics and Gynaecology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - A Baalbergen
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - G S Kooi
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A van Haaften
- Department of Obstetrics and Gynaecology, Haga Hospital, The Hague, The Netherlands
| | - H van Huisseling
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, The Netherlands
| | - L Haans
- Department of Obstetrics and Gynaecology, Haags Medical Centre, The Hague, The Netherlands
| | - M Dorman
- Department of Obstetrics and Gynaecology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - H J van Beekhuizen
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Kroese A, van der Velde M, Morssink L, Zafarmand H, Mol B, Reesink-Peters N. Authors' reply re: 'Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial'. BJOG 2017; 124:696-697. [PMID: 28224736 DOI: 10.1111/1471-0528.14500] [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] [Accepted: 11/21/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Arjanne Kroese
- Department of Obstetrics and Gynaecology, Medical Spectrum Twente, Enschede, the Netherlands
| | - Minke van der Velde
- Department of Obstetrics and Gynaecology, Medical Spectrum Twente, Enschede, the Netherlands
| | - Leonard Morssink
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Hadi Zafarmand
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Public Health, Academic Medical Centre, Amsterdam, the Netherlands
| | - Ben Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - Nathalie Reesink-Peters
- Department of Obstetrics and Gynaecology, Medical Spectrum Twente, Enschede, the Netherlands
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7
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Kroese JA, van der Velde M, Morssink LP, Zafarmand MH, Geomini P, van Kesteren PJM, Radder CM, van der Voet LF, Roovers JPWR, Graziosi GCM, van Baal WM, van Bavel J, Catshoek R, Klinkert ER, Huirne JAF, Clark TJ, Mol BWJ, Reesink-Peters N. Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial. BJOG 2016; 124:243-249. [DOI: 10.1111/1471-0528.14281] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- JA Kroese
- Department of Obstetrics and Gynaecology; Medical Spectrum Twente; Enschede the Netherlands
| | - M van der Velde
- Department of Obstetrics and Gynaecology; Medical Spectrum Twente; Enschede the Netherlands
| | - LP Morssink
- Department of Obstetrics and Gynaecology; Medical Centre Leeuwarden; Leeuwarden the Netherlands
| | - MH Zafarmand
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Public Health; Academic Medical Centre; Amsterdam the Netherlands
| | - P Geomini
- Department of Obstetrics and Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | - PJM van Kesteren
- Department of Obstetrics and Gynaecology; Onze Lieve Vrouwe Gasthuis; Amsterdam the Netherlands
| | - CM Radder
- Department of Obstetrics and Gynaecology; Saint Lucas Andreas Hospital; Amsterdam the Netherlands
| | - LF van der Voet
- Department of Obstetrics and Gynaecology; Deventer Hospital; Deventer the Netherlands
| | - JPWR Roovers
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
| | - GCM Graziosi
- Department of Obstetrics and Gynaecology; Antonius Hospital; Nieuwegein the Netherlands
| | - WM van Baal
- Department of Obstetrics and Gynaecology; Flevoziekenhuis; Almere the Netherlands
| | - J van Bavel
- Department of Obstetrics and Gynaecology; Amphia Hospital; Breda the Netherlands
| | - R Catshoek
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - ER Klinkert
- Department of Obstetrics and Gynaecology; University Medical Centre Groningen; Groningen the Netherlands
| | - JAF Huirne
- Department of Obstetrics and Gynaecology; Vrije University Medical Centre; Amsterdam the Netherlands
| | - TJ Clark
- Department of Obstetrics and Gynaecology; Birmingham Women's Hospital; Birmingham UK
| | - BWJ Mol
- The Robinson Research Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - N Reesink-Peters
- Department of Obstetrics and Gynaecology; Medical Spectrum Twente; Enschede the Netherlands
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8
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van Hanegem N, Breijer MC, Slockers SA, Zafarmand MH, Geomini PMAJ, Catshoek R, Pijnenborg JMA, van der Voet LF, Dijkhuizen FPHLJ, van Hoecke GCR, Reesink-Peters N, Veersema S, van Hooff MHA, van Kesteren PJM, Huirne JA, Opmeer BC, Bongers MY, Mol BWJ, Timmermans A. Diagnostic workup for postmenopausal bleeding: a randomised controlled trial. BJOG 2016; 124:231-240. [DOI: 10.1111/1471-0528.14126] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 12/11/2022]
Affiliation(s)
- N van Hanegem
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - MC Breijer
- Department of Obstetrics and Gynaecology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - SA Slockers
- Department of Obstetrics and Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | - MH Zafarmand
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
- Department of Public Health; Academic Medical Centre; Amsterdam the Netherlands
| | - PMAJ Geomini
- Department of Obstetrics and Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | - R Catshoek
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - JMA Pijnenborg
- Department of Obstetrics and Gynaecology; Twee Steden Hospital; Tilburg the Netherlands
| | - LF van der Voet
- Department of Obstetrics and Gynaecology; Deventer hospital; Deventer the Netherlands
| | - FPHLJ Dijkhuizen
- Department of Obstetrics and Gynaecology; Rijnstate hospital; Arnhem the Netherlands
| | - GCR van Hoecke
- Department of Obstetrics and Gynaecology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - N Reesink-Peters
- Department of Obstetrics and Gynaecology; Medical Spectrum Twente; Enschede the Netherlands
| | - S Veersema
- Department of Obstetrics and Gynaecology; St. Antonius Hospital; Nieuwegein the Netherlands
| | - MHA van Hooff
- Department of Obstetrics and Gynaecology; Sint Franciscus Gasthuis; Rotterdam the Netherlands
| | - PJM van Kesteren
- Department of Obstetrics and Gynaecology; Onze Lieve Vrouwe Gasthuis; Amsterdam the Netherlands
| | - JA Huirne
- Department of Obstetrics and Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - BC Opmeer
- Clinical Research Unit; Academic Medical Centre; Amsterdam the Netherlands
| | - MY Bongers
- Department of Obstetrics and Gynaecology; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Obstetrics and Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | - BWJ Mol
- The Robinson Research Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - A Timmermans
- Department of Obstetrics and Gynaecology; Academic Medical Centre; Amsterdam the Netherlands
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9
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Blok JL, Reesink-Peters N, Diercks GFH, Reyners AKL, Terra JB. [Vulvar basal cell carcinoma with destructive consequences]. Ned Tijdschr Geneeskd 2012; 156:A5391. [PMID: 23031244] [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
BACKGROUND Basal cell carcinoma is the most common form of skin cancer. Generally, the prognosis is relatively good and curative surgical treatment is accomplished in the great majority of patients. CASE DESCRIPTION Here we report a case that illustrates the natural course of a vulvar basal cell carcinoma. It concerns an 80-year-old woman who was diagnosed with a so-called 'giant' vulvar basal cell carcinoma causing severe destruction of the anogenital anatomy. At the time of diagnosis, haematogenous metastases were strongly suspected and curative therapy was not possible. CONCLUSION This case description illustrates that a basal cell carcinoma can transform into a 'giant' basal cell carcinoma if it is left untreated for many years. 'Giant' basal cell carcinomas carry a significantly higher risk of metastases than basal cell tumours smaller than 5 cm. In addition, 'giant' basal cell carcinoma is associated with higher morbidity and mortality rates.
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Affiliation(s)
- Janine L Blok
- Universitair Medisch Centrum Groningen, Afd. Dermatologie, Groningen, the Netherlands.
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10
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Eijsink JJH, de Bock GH, Kuiper JL, Reesink-Peters N, van Hemel BM, Hollema H, Nijman HW, Mourits MJE, van der Zee AGJ. Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ). Gynecol Oncol 2009; 113:348-51. [PMID: 19297014 DOI: 10.1016/j.ygyno.2008.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 11/07/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the compliance of HSIL patients to the national Dutch routine follow-up protocol in the first 2 years after LLETZ and to determine if based on the status of excision margins, follow-up intervals could be modified. METHODS A prospective cohort study was performed in patients, referred because of an abnormal Pap smear between 1996 and 2004 and treated for HSIL with LLETZ. The Dutch national routine follow-up protocol orders a Pap smear after 6, 12 and 24 months, respectively. Follow-up results were completed by using PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands. To assess compliance to the follow-up protocol, adequate follow-up was defined as three cervical smears taken after 6 (+/-3), 12 (+/-3) and 24 (+/-3) months, respectively. RESULTS Compliance to the first 2 years follow-up protocol declined from 86.2% to 64.8% to 51.2% for first, second and third follow-up cervical smears, respectively. Patients with involved excision margins had a three times higher overall risk of developing a subsequent HSIL after LLETZ as compared to patients with free excision margins (HR: 3.2, 95% CI=1.3-7.9, p=0.01). Risk for diagnosing HSIL during the first 12 months of follow-up for patients with free excision margins was only 1%. CONCLUSIONS Compliance to the Dutch national routine follow-up protocol in HSIL patients after LLETZ is only moderate. For HSIL patients with free excision margins after LLETZ the first cytological follow-up interval can safely be increased to 12 months.
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Affiliation(s)
- J J H Eijsink
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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11
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Hougardy BMT, Reesink-Peters N, van den Heuvel FAJ, ten Hoor KA, Hollema H, de Vries EGE, de Jong S, van der Zee AGJ. A robust ex vivo model for evaluation of induction of apoptosis by rhTRAIL in combination with proteasome inhibitor MG132 in human premalignant cervical explants. Int J Cancer 2008; 123:1457-65. [PMID: 18567003 DOI: 10.1002/ijc.23684] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Development of medical therapies for high-grade cervical intraepithelial neoplasia (CIN II/III) is hampered by the lack of CIN II/III cell lines. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induces apoptosis upon binding to its receptors DR4 or DR5. Proteasome inhibition by MG132 sensitized cervical cancer cell lines to recombinant human (rh)TRAIL. In our study, we aimed to develop an ex vivo model for CIN II/III and to investigate the apoptosis-inducing effect of rhTRAIL and/or MG132 in cervical explants from CIN II/III patients. A short-term ex vivo culture system was optimized for cervical biopsies, in which explants from normal cervix and CIN II/III lesions were exposed to either rhTRAIL (1 microg/ml), MG132 (5 microM) or the combination and compared to untreated explants for apoptosis induction. Normal cervix (n = 90) and CIN II/III (n = 24) explants could be reproducibly put in culture and kept viable for up to 7 days using a transwell membrane system. CIN II/III explants (n = 5) were highly sensitive to rhTRAIL plus MG132 (mean % apoptosis: 91 +/- 5) compared to normal cervix (n = 10) treated with rhTRAIL plus MG132 (mean % apoptosis: 24 +/- 10, p < 0.0001), while monotherapy with either rhTRAIL, MG132 or medium resulted in a mean % apoptosis <10 in both CIN II/III and normal cervix. Our ex vivo model system allows preclinical evaluation of (topical) medical therapies for CIN II/III. A strong synergistic apoptosis-inducing effect of the combination of rhTRAIL and MG132, especially in CIN II/III lesions indicates that rhTRAIL combined with proteasome inhibitors deserves exploration as medical treatment for CIN II/III.
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Affiliation(s)
- Brigitte M T Hougardy
- Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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12
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Nijhuis ER, Nijman HW, Oien KA, Bell A, ten Hoor KA, Reesink-Peters N, Boezen HM, Hollema H, van der Zee AGJ. Loss of MSH2 protein expression is a risk factor in early stage cervical cancer. J Clin Pathol 2007; 60:824-30. [PMID: 17596548 PMCID: PMC1995775 DOI: 10.1136/jcp.2005.036038] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Loss of mismatch repair (MMR) gene expression has been associated with fewer metastases and improved prognosis in various tumour types. AIMS To evaluate the predictive and prognostic significance of loss of MMR protein MSH2 in early stage cervical cancer. METHODS Specimens from 218 consecutive patients with early stage, surgically treated cervical cancer were analysed. Median age was 42 years (interquartile range 35-53). International Federation of Gynecology and Obstetrics (FIGO) stages were IB1 (57%), IB2 (25%) and IIA (18%). Histology was 70% squamous cell, 6% adenosquamous and 24% adenocarcinoma. Pelvic lymph node metastasis was present in 66 (30%) patients. Median follow-up was 5.2 years (interquartile range 2.5-7.9). Tissue microarrays (TMAs) were constructed containing three cores of paraffin-embedded tumour per case. MSH2 expression was assessed by immunohistochemistry on TMAs and full sections. RESULTS In TMAs MSH2 expression could be analysed in 184/218 (84%) tumours. Loss of MSH2 was observed in 58/184 (32%) tumours, with a moderately strong concordance between TMAs and full sections (kappa = 0.47). In tumours with loss of MSH2, pelvic lymph node metastasis and cancer invasion beyond 10 mm were more frequent (48% vs 25%, and 59% vs 37%, respectively). However, loss of MSH2 expression was not related to recurrence or survival. CONCLUSION TMAs are powerful tools for high throughput screening of biological markers for prognostic value in cervical cancer. Absence of MSH2 expression is associated with a high-risk profile in early stage cervical cancer, but does not predict lymph node status with sufficient accuracy to be used in the clinic.
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Affiliation(s)
- E R Nijhuis
- Department of Gynecological Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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13
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Nijhuis ER, Reesink-Peters N, Wisman GBA, Nijman HW, van Zanden J, Volders H, Hollema H, Suurmeijer AJH, Schuuring E, van der Zee AGJ. An overview of innovative techniques to improve cervical cancer screening. Anal Cell Pathol (Amst) 2007; 28:233-46. [PMID: 17167177 PMCID: PMC4617820 DOI: 10.1155/2006/273547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although current cytomorphology-based cervical cancer screening has reduced the incidence of cervical cancer, Papsmears
are associated with high false positive and false negative rates. This has spurred the search for new technologies to improve
current screening. New methodologies are automation of Pap-smear analysis, addition of new biological or molecular markers to
traditional cytology or using these new markers to replace the current screening method. In this overview we will summarize data
on cervical cancer epidemiology and etiology and the current cervical cancer screening approach. Available data on new screening
approaches, such as quantitative cytochemistry, detection of loss of heterozygosity (LOH) and hypermethylation analysis will
be reviewed.We discuss the potential of these approaches to replace or augment current screening. When available, data on cost–
effectiveness of certain approaches will be provided. In short, Human Papillomavirus (HPV) DNA detection stands closest to implementation
in nation-wide screening programs of all markers reviewed. However, specificity is low in women aged <35 years
and the psychological effects of knowledge of HPV positivity in absence of cervical (pre) malignant disease are important drawbacks.
In our opinion the results of large clinical trials should be awaited before proceeding to implement HPV DNA detection.
New technologies based on molecular changes associated with cervical carcinogenesis might result in comparable sensitivity,
but improved specificity. Hypermethylation analysis is likely to be more objective to identify patients with high grade squamous
intra-epithelial lesions (HSIL) or invasive cancer with a higher specificity than current cytomorphology based screening.
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Affiliation(s)
- Esther R. Nijhuis
- Department of Gynecologic OncologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Nathalie Reesink-Peters
- Department of Gynecologic OncologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - G. Bea A. Wisman
- Department of Gynecologic OncologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Hans W. Nijman
- Department of Gynecologic OncologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Jelmer van Zanden
- Department of Gynecologic OncologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Haukeline Volders
- Department of Gynecologic OncologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Harry Hollema
- Department of PathologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Albert J. H. Suurmeijer
- Department of PathologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Ed Schuuring
- Department of PathologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Ate G. J. van der Zee
- Department of Gynecologic OncologyUniversity Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
- *Ate G.J. van der Zee:
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14
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Wisman GBA, Nijhuis ER, Hoque MO, Reesink-Peters N, Koning AJ, Volders HH, Buikema HJ, Boezen HM, Hollema H, Schuuring E, Sidransky D, van der Zee AGJ. Assessment of gene promoter hypermethylation for detection of cervical neoplasia. Int J Cancer 2006; 119:1908-14. [PMID: 16736496 DOI: 10.1002/ijc.22060] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Current cervical cancer screening is based on morphological assessment of Pap smears and associated with significant false negative and false positive results. Previously, we have shown that detection of hypermethylated genes in cervical scrapings using quantitative methylation-specific PCR (QMSP) is a promising tool for identification of squamous cell cervical cancer. Aim of the present pilot-study was to evaluate presence of hypermethylated genes in cervical carcinogenesis, both in squamous cell as well as adenocarcinomas. Cervical scrapings were obtained from 30 patients diagnosed with cervical cancer (20 squamous cell carcinomas and 10 adenocarcinomas) and 19 women with histologically normal cervices. The scraped cells were used for determination of promoter hypermethylation by QMSP for 12 genes and for morphological assessment. Overall, CALCA, DAPK, ESR1, TIMP3, APC and RAR-beta2 promoters were significantly more often hypermethylated in cancers than in controls, while adenocarcinomas were more often hypermethylated above the highest control ratio for APC, TIMP3 and RASSF1A promoters. Combining 4 genes (CALCA, DAPK, ESR1 and APC) yielded a sensitivity of 89% (with all adenocarcinomas identified), equal to cytomorphology (89%) and high-risk human papilloma virus (Hr-HPV; 90%). The 4-gene QMSP proved theoretically superior to cytomorphology as well as Hr-HPV in specificity (100% vs. 83 and 68%, respectively), because cytology identified 3 controls as moderate or severe dyskaryosis and 6 controls were positive for Hr-HPV. In conclusions, QMSP of 4 gene promoters combined appears to have comparable sensitivity and potentially better specificity in comparison to "classic" cytomorphological assessment and Hr-HPV detection. QMSP holds promise as a new diagnostic tool for both squamous cell carcinoma and adenocarcinoma of the cervix.
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Affiliation(s)
- G Bea A Wisman
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
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15
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Reesink-Peters N, Hougardy BMT, van den Heuvel FAJ, Ten Hoor KA, Hollema H, Boezen HM, de Vries EGE, de Jong S, van der Zee AGJ. Death receptors and ligands in cervical carcinogenesis: an immunohistochemical study. Gynecol Oncol 2005; 96:705-13. [PMID: 15721415 DOI: 10.1016/j.ygyno.2004.10.046] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2004] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Increasing imbalance between proliferation and apoptosis is important in cervical carcinogenesis. The death ligands FasL and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induce apoptosis by binding to their cognate cell-surface death receptors Fas or death receptor (DR) 4 and DR5. This study aims to examine if changes in death ligand and death receptor expression during different stages of cervical carcinogenesis are related to an imbalance between proliferation and apoptosis. METHODS The immunohistochemical expression and localization of Fas/FasL and DR4/DR5/TRAIL were assessed in 11 normal cervices, 15 cervical intraepithelial neoplasia (CIN) grade I, 15 CIN II, 13 CIN III, and 25 (microinvasive) squamous cell cervical cancers. The number of apoptotic cells was determined by morphological criteria and the number of proliferating cells by counting Ki-67-positive cells. RESULTS A marked increase in proliferation as well as apoptosis percentage was found with increasing severity of neoplasia. In normal cervix and CIN I samples, FasL, DR4, DR5, and TRAIL staining was mainly observed in the basal/parabasal layer, whereas Fas staining was localized in the superficial, more differentiated epithelial layer. Frequency of Fas-positive staining decreased with increasing severity of CIN. In contrast, homogeneous FasL, DR4, DR5, and TRAIL expression throughout the lesions was more frequently observed in CIN III and cervical cancer. FasL, DR4, DR5, and TRAIL staining patterns were correlated, although TRAIL expression was more intense in low-grade lesions. No association was found between death receptor or ligand expression with the percentage of apoptosis or proliferation. CONCLUSION The loss of Fas and the deregulation of FasL, DR4, DR5, and TRAIL in the CIN-cervical cancer sequence suggest a possible functional role of these death ligands and receptors during cervical carcinogenesis. The frequent expression of DR4 and DR5 presents these receptors as promising targets for innovative therapy modalities in cervical cancer.
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Affiliation(s)
- N Reesink-Peters
- Department of Gynecologic Oncology, University Hospital Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
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16
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Reesink-Peters N, van der Velden J, Ten Hoor KA, Boezen HM, de Vries EGE, Schilthuis MS, Mourits MJE, Nijman HW, Aalders JG, Hollema H, Pras E, Duk JM, van der Zee AGJ. Preoperative serum squamous cell carcinoma antigen levels in clinical decision making for patients with early-stage cervical cancer. J Clin Oncol 2005; 23:1455-62. [PMID: 15735121 DOI: 10.1200/jco.2005.02.123] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To prevent morbidity associated with double modality treatment, early-stage cervical cancer patients should only be offered surgery when there is a low likelihood for adjuvant radiotherapy. We analyzed whether serum squamous cell carcinoma antigen (SCC-ag) analysis allows better preoperative identification of patients with a low likelihood for adjuvant radiotherapy than currently used clinical parameters. PATIENTS AND METHODS In a cohort study, International Federation of Gynecology and Obstetrics (FIGO) stage, tumor size, and preoperative serum SCC-ag levels, as determined by enzyme immunoassay, were related to the frequency of postoperative indications for adjuvant radiotherapy in 337 surgically treated, FIGO stage IB/IIA, squamous cell cervical cancer patients. RESULTS In patients with normal preoperative SCC-ag, 16% of IB1 and 29% of IB2/IIA had postoperative indications for adjuvant radiotherapy, in contrast to 57% of IB1 and 74% of IB2/IIA patients with elevated (> 1.9 ng/mL) serum SCC-ag (P < .001). Serum SCC-ag was the only independent predictor for a postoperative indication for radiotherapy (odds ratio, 7.1; P < .001). Furthermore, in IB1 patients that did not have indications for adjuvant radiotherapy, 15% of patients with elevated preoperative serum SCC-ag levels recurred within 2 years, compared with 1.6% of patients with normal serum SCC-ag levels (P = .02). CONCLUSION In early-stage cervical cancer, determination of serum SCC-ag levels allows more refined preoperative estimation of the likelihood for adjuvant radiotherapy than current clinical parameters, and simultaneously identifies patients at high risk for recurrence when treated with surgery only. The role of preoperative serum SCC-ag in the management of patients with early-stage cervical cancer deserves further investigation.
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Affiliation(s)
- Nathalie Reesink-Peters
- Department of Gynecological Oncology, University Hospital Groningen, 9700 RB Groningen, The Netherlands
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17
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Reesink-Peters N, Wisman GBA, Jéronimo C, Tokumaru CY, Cohen Y, Dong SM, Klip HG, Buikema HJ, Suurmeijer AJ, Hollema H, Boezen HM, Sidransky D, van der Zee AG. Detecting Cervical Cancer by Quantitative Promoter Hypermethylation Assay on Cervical Scrapings: A Feasibility Study. Mol Cancer Res 2004. [DOI: 10.1158/1541-7786.289.2.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Current morphology-based cervical cancer screening is associated with significant false-positive and false-negative results. Tumor suppressor gene hypermethylation is frequently present in cervical cancer. It is unknown whether a cervical scraping reflects the methylation status of the underlying epithelium, and it is therefore unclear whether quantitative hypermethylation specific PCR (QMSP) on cervical scrapings could be used as a future screening method augmenting the current approach. Cervical scrapings and paired fresh frozen cervical tissue samples were obtained from 53 cervical cancer patients and 45 controls. All scrapings were morphologically scored and analyzed with QMSP for the genes APC, DAPK, MGMT, and GSTP1. To adjust for DNA input, hypermethylation ratios were calculated against DNA levels of a reference gene. Hypermethylation ratios of paired fresh frozen tissue samples and scrapings of cervical cancer patients and controls were strongly related (Spearman correlation coefficient, 0.80 for APC, 0.98 for DAPK, and 0.83 for MGMT; P < 0.001). More cervical cancer patients than controls were DAPK positive (P < 0.001). When cutoff levels for ratios were defined to be above the highest ratio observed in controls, QMSP in cervical scrapings identified 32 (67%) of 48 cervical cancer patients. This feasibility study demonstrates that QMSP on cervical scrapings holds promise as a new diagnostic tool for cervical cancer. The addition of more genes specifically methylated in cervical cancer will further improve the assay.
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Affiliation(s)
| | | | - Carmen Jéronimo
- 2Department of Head and Neck Cancer Research Division, School of Medicine, John Hopkins University, Baltimore, Maryland
| | - C. Yutaka Tokumaru
- 2Department of Head and Neck Cancer Research Division, School of Medicine, John Hopkins University, Baltimore, Maryland
| | - Yoram Cohen
- 2Department of Head and Neck Cancer Research Division, School of Medicine, John Hopkins University, Baltimore, Maryland
| | - Seung Myung Dong
- 2Department of Head and Neck Cancer Research Division, School of Medicine, John Hopkins University, Baltimore, Maryland
| | | | | | | | | | - H. Marieke Boezen
- 4Epidemiology and Biostatistics, University Hospital Groningen, Groningen, The Netherlands and
| | - David Sidransky
- 2Department of Head and Neck Cancer Research Division, School of Medicine, John Hopkins University, Baltimore, Maryland
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Reesink-Peters N, Wisman GBA, Jéronimo C, Tokumaru CY, Cohen Y, Dong SM, Klip HG, Buikema HJ, Suurmeijer AJH, Hollema H, Boezen HM, Sidransky D, van der Zee AGJ. Detecting cervical cancer by quantitative promoter hypermethylation assay on cervical scrapings: a feasibility study. Mol Cancer Res 2004; 2:289-95. [PMID: 15192122] [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: 04/29/2023]
Abstract
Current morphology-based cervical cancer screening is associated with significant false-positive and false-negative results. Tumor suppressor gene hypermethylation is frequently present in cervical cancer. It is unknown whether a cervical scraping reflects the methylation status of the underlying epithelium, and it is therefore unclear whether quantitative hypermethylation specific PCR (QMSP) on cervical scrapings could be used as a future screening method augmenting the current approach. Cervical scrapings and paired fresh frozen cervical tissue samples were obtained from 53 cervical cancer patients and 45 controls. All scrapings were morphologically scored and analyzed with QMSP for the genes APC, DAPK, MGMT, and GSTP1. To adjust for DNA input, hypermethylation ratios were calculated against DNA levels of a reference gene. Hypermethylation ratios of paired fresh frozen tissue samples and scrapings of cervical cancer patients and controls were strongly related (Spearman correlation coefficient, 0.80 for APC, 0.98 for DAPK, and 0.83 for MGMT; P < 0.001). More cervical cancer patients than controls were DAPK positive (P < 0.001). When cutoff levels for ratios were defined to be above the highest ratio observed in controls, QMSP in cervical scrapings identified 32 (67%) of 48 cervical cancer patients. This feasibility study demonstrates that QMSP on cervical scrapings holds promise as a new diagnostic tool for cervical cancer. The addition of more genes specifically methylated in cervical cancer will further improve the assay.
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Affiliation(s)
- Nathalie Reesink-Peters
- Department of Gynecologic Oncology, University Hospital Groningen, P.O. Box 30,001, 9700 RB Groningen, The Netherlands
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Visser JTJ, Hoogeboom BN, Reesink-Peters N, Klip H, Hepkema B, van Velde H, van der Zee AGJ, Daemen T. HLA class I alleles and cervical neoplasia. J Infect Dis 2003; 187:1675-6. [PMID: 12721951 DOI: 10.1086/374938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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20
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Reesink-Peters N, Tokumaru Y, Dong SM, Klip HG, Buikema HJ, Suurmeijer AJ, Hollema H, Boezen M, Sidransky D, van der Zee AG. DAP-K HYPERMETHYLATION IN CERVICAL SCRAPINGS DISTINGUISHES CERVICAL CANCER CASES FROM CONTROLS. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00115] [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: 11/04/2022] Open
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21
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Reesink-Peters N, van der Velden K, Duk JM, ten Hoor KH, Boezen HM, de Bruijn HW, Hollema H, van der Zee AG. SERUM SQUAMOUS CELL CARCINOMA ANTIGEN (SCCAG) LEVELS SHOULD BE USED IN CLINICAL DECISION MAKING FOR PATIENTS WITH EARLY-STAGE CERVICAL CARCINOMA. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00016] [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: 11/04/2022] Open
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22
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Reesink-Peters N, Helder MN, Wisman GBA, Knol AJ, Koopmans S, Boezen HM, Schuuring E, Hollema H, de Vries EGE, de Jong S, van der Zee AGJ. Detection of telomerase, its components, and human papillomavirus in cervical scrapings as a tool for triage in women with cervical dysplasia. J Clin Pathol 2003; 56:31-5. [PMID: 12499429 PMCID: PMC1769855 DOI: 10.1136/jcp.56.1.31] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To examine whether the detection of either telomerase and its components or high risk human papillomavirus (HPV) are of value in predicting the presence of cervical intraepithelial neoplasia (CIN) grade II/III in women referred because of cervical cytology reports showing at most moderate dyskaryosis. METHODS Cervical scrapings of 50 women referred with cytological borderline, mild, or moderate dyskaryosis were analysed. Telomerase activity was assessed by a commercially available telomere repeat amplification protocol assay and its components human telomerase RNA (hTR) and human telomerase reverse transcriptase (hTERT) were assessed by reverse transcriptase polymerase chain reaction (PCR). HPV was detected by GP5+/6+ PCR enzyme immunosassay. Histological findings on colposcopy guided biopsies or excised cervical tissue were regarded as the final pathological diagnosis. The sensitivity and specificity for detecting CIN II/III were calculated. RESULTS Twenty eight women were diagnosed with CIN II/III. Telomerase activity was detected in none, hTR in 88%, hTERT in 23%, and high risk HPV was detected in 79% of these women. As a diagnostic test none of the described analyses combined a sensitivity of at least 90% with a specificity >or= 90%. Despite the small numbers, calculation of the 95% confidence intervals excluded a combined sensitivity and specificity of at least 90% for all of the evaluated parameters. CONCLUSIONS Neither detection of telomerase or its components, nor detection of high risk HPV seem suitable for the triage of women with borderline, mild, and moderate cytological dyskaryosis.
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Affiliation(s)
- N Reesink-Peters
- Department of Gynaecological Oncology, University Hospital Groningen, 9700 RB, Groningen, The Netherlands
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Reesink-Peters N, Burger MP, Kleter B, Quint WG, Bossuyt PM, Adriaanse AH. Using a new HPV detection system in epidemiological research: change of views on cervical dyskaryosis? Eur J Obstet Gynecol Reprod Biol 2001; 98:199-204. [PMID: 11574131 DOI: 10.1016/s0301-2115(01)00300-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED The prevalence of human papillomavirus (HPV) rises with increasing histological severity of neoplasia, more cigarettes smoked per day and higher lifetime number of sexual partners in women with cervical dyskaryosis. Recently, the highly sensitive SPF10 primers and Inno-LiPA (line probe assay) HPV prototype research assay became available for the detection and typing of HPV. BACKGROUND using this system, we challenged the previously reported findings. STUDY DESIGN the study group comprised 304 women referred because of abnormal pap smears in whom a histological diagnosis was made. Data on the lifetime number of sexual partners and smoking behaviour were obtained by questionnaire. HPV analysis was performed on cervical scrapes obtained at the enrollment visit. RESULTS oncogenic HPV was found in 288 (95%) women. A total of 86 (30%) out of these 288 women disclosed multiple types. HPV 16 occurred significantly less often in multiple infections than was expected on the basis of chance alone. The grade of neoplasia was significantly associated with the presence of oncogenic HPV, and this association depended on the presence of HPV type 16. No association was found between grade of neoplasia and the presence of multiple HPV types. Neither the lifetime number of sexual partners nor smoking were associated with oncogenic HPV, the five most frequent HPV types separately or the presence of multiple types. CONCLUSION we conclude that the association between the detection of HPV and the epidemiological risk factors, as found with the GP5/6 PCR in the past, could not be confirmed when using SPF10 PCR primers and LiPA HPV genotyping. We suggest that the number of sexual partners and smoking may be determinants of high HPV viral load rather than determinants of the presence of HPV per se.
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Affiliation(s)
- N Reesink-Peters
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Reesink-Peters N, Ossewaarde JM, Van Der Zee AG, Quint WG, Burger MP, Adriaanse AH. No association of anti-Chlamydia trachomatis antibodies and severity of cervical neoplasia. Sex Transm Infect 2001; 77:101-2. [PMID: 11287686 PMCID: PMC1744283 DOI: 10.1136/sti.77.2.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore whether the presence of Chlamydia trachomatis antibodies is associated with the severity of neoplastic lesions in women with cervical dyskaryosis. METHODS In a cross sectional study in two groups of women referred for an abnormal Papanicolaou smear (group A: 296, group B: 331 women) blood samples were analysed for antichlamydial antibodies by enzyme immunoassay. Cervical neoplasia was graded histologically. RESULTS In group A no association was found between increasing grade of CIN and the presence of antichlamydial antibodies. The proportion (93%) of women with antichlamydial antibodies was higher in 14 women with (micro)invasive carcinoma than in women with CIN (35%). As the high prevalence of antichlamydial antibodies in women with cervical carcinoma is not consistent with prevalences reported in recent literature, we analysed a second group of women in which indeed the high prevalence was not confirmed CONCLUSION Our results suggest that the presence of circulating antichlamydial antibodies is not associated with the severity of neoplastic lesions and it seems unlikely that C trachomatis has a role in the progression of cervical neoplasia.
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Affiliation(s)
- N Reesink-Peters
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, The Netherlands
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