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Brandl A, Lundon D, Lorenzon L, Schrage Y, Caballero C, Holmberg CJ, Santrac N, Smith H, Vasileva-Slaveva M, Montagna G, Bonci EA, Sgarbura O, Sayyed R, Ben-Yaacov A, Herrera Kok JH, Suppan I, Kaul P, Sochorova D, Vassos N, Carrico M, Mohan H, Ceelen W, Arends J, Sandrucci S. Current practice in assessment and management of malnutrition in surgical oncology practice - An ESSO-EYSAC snapshot analysis. Eur J Surg Oncol 2024; 50:106953. [PMID: 37429796 DOI: 10.1016/j.ejso.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Malnutrition is common in patients suffering from malignant diseases and has a major impact on patient outcomes. Prevention and early detection are crucial for effective treatment. This study aimed to investigate current international practice in the assessment and management of malnutrition in surgical oncology departments. MATERIAL AND METHODS The survey was designed by European Society of Surgical Oncology (ESSO) and ESSO Young Surgeons and Alumni Club (EYSAC) Research Academy as an online questionnaire with 41 questions addressing three main areas: participant demographics, malnutrition assessment, and perioperative nutritional standards. The survey was distributed from October to November 2021 via emails, social media and the ESSO website to surgical networks focussing on surgical oncologists. Results were collected and analysed by an independent team. RESULTS A total of 156 participants from 39 different countries answered the survey, reflecting a response rate of 1.4%. Surgeons reported treating a mean of 22.4 patients per month. 38% of all patients treated in surgical oncology departments were routinely screened for malnutrition. 52% of patients were perceived as being at risk for malnutrition. The most used screening tool was the "Malnutrition Universal Screening Tool" (MUST). 68% of participants agreed that the surgeon is responsible for assessing preoperative nutritional status. 49% of patients were routinely seen by dieticians. In cases of severe malnutrition, 56% considered postponing the operation. CONCLUSIONS The reported rate of malnutrition screening by surgical oncologists is lower than expected (38%). This indicates a need for improved awareness of malnutrition in surgical oncology, and nutritional screening.
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Affiliation(s)
- Andreas Brandl
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany.
| | - Dara Lundon
- Mount Sinai Department of Urology, New York, United States
| | - Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Carl Jacob Holmberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Nada Santrac
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Henry Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Denmark
| | | | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduard-Alexandru Bonci
- Surgical Oncology and Gynecologic Oncology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Olivia Sgarbura
- Department of Surgical Oncology, Institut du Cancer Montpellier, University of Montpellier, France
| | - Raza Sayyed
- Department of Surgical Oncology, Patel Hospital, Karachi, Pakistan
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Ina Suppan
- Breast Center, Department of Gynaecology, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - Pallvi Kaul
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Dana Sochorova
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marta Carrico
- Nutrition Department - Champalimaud Foundation, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Helen Mohan
- Peter MacCallum Cancer Centre in Melbourne, Australia
| | - Wim Ceelen
- Department of GI Surgery and Cancer Research Institute Ghent (CRIG), Ghent University Hospital, Belgium
| | - Jann Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Hess T, Maj C, Gehlen J, Borisov O, Haas SL, Gockel I, Vieth M, Piessen G, Alakus H, Vashist Y, Pereira C, Knapp M, Schüller V, Quaas A, Grabsch HI, Trautmann J, Malecka-Wojciesko E, Mokrowiecka A, Speller J, Mayr A, Schröder J, Hillmer AM, Heider D, Lordick F, Pérez-Aísa Á, Campo R, Espinel J, Geijo F, Thomson C, Bujanda L, Sopeña F, Lanas Á, Pellisé M, Pauligk C, Goetze TO, Zelck C, Reingruber J, Hassanin E, Elbe P, Alsabeah S, Lindblad M, Nilsson M, Kreuser N, Thieme R, Tavano F, Pastorino R, Arzani D, Persiani R, Jung JO, Nienhüser H, Ott K, Schumann RR, Kumpf O, Burock S, Arndt V, Jakubowska A, Ławniczak M, Moreno V, Martín V, Kogevinas M, Pollán M, Dąbrowska J, Salas A, Cussenot O, Boland-Auge A, Daian D, Deleuze JF, Salvi E, Teder-Laving M, Tomasello G, Ratti M, Senti C, De Re V, Steffan A, Hölscher AH, Messerle K, Bruns CJ, Sīviņš A, Bogdanova I, Skieceviciene J, Arstikyte J, Moehler M, Lang H, Grimminger PP, Kruschewski M, Vassos N, Schildberg C, Lingohr P, Ridwelski K, Lippert H, Fricker N, Krawitz P, Hoffmann P, Nöthen MM, Veits L, Izbicki JR, Mostowska A, Martinón-Torres F, Cusi D, Adolfsson R, Cancel-Tassin G, Höblinger A, Rodermann E, Ludwig M, Keller G, Metspalu A, Brenner H, Heller J, Neef M, Schepke M, Dumoulin FL, Hamann L, Cannizzaro R, Ghidini M, Plaßmann D, Geppert M, Malfertheiner P, Glehen O, Skoczylas T, Majewski M, Lubiński J, Palmieri O, Boccia S, Latiano A, Aragones N, Schmidt T, Dinis-Ribeiro M, Medeiros R, Al-Batran SE, Leja M, Kupcinskas J, García-González MA, Venerito M, Schumacher J. Corrigendum to "Dissecting the genetic heterogeneity of gastric cancer". EBioMedicine 2023; 94:104709. [PMID: 37480624 PMCID: PMC10393529 DOI: 10.1016/j.ebiom.2023.104709] [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: 07/24/2023] Open
Affiliation(s)
- Timo Hess
- Institute of Human Genetics, University of Marburg, Marburg, Germany; Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Carlo Maj
- Institute of Human Genetics, University of Marburg, Marburg, Germany; Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Jan Gehlen
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Oleg Borisov
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Stephan L Haas
- Department of Upper GI Diseases, Karolinska University Hospital and Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Michael Vieth
- Institute for Pathology, Friedrich-Alexander-University Erlangen-Nuernberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, Lille, France
| | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany
| | - Yogesh Vashist
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany; Centre for Surgical Oncology, Medias Klinikum Burghausen, Burghausen, Germany
| | - Carina Pereira
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Institute of Oncology of Porto (IPO Porto), 4200-072 Porto, Portugal; Porto Comprehensive Cancer Center & RISE @ CI-IPO, University of Porto, 4200-450, Porto, Portugal
| | - Michael Knapp
- Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), Medical Faculty, University of Bonn, Bonn, Germany
| | - Vitalia Schüller
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Alexander Quaas
- Institute of Pathology, University Hospital Cologne, Medical Faculty, University of Cologne, Germany
| | - Heike I Grabsch
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands; Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Jessica Trautmann
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | | | - Anna Mokrowiecka
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Jan Speller
- Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), Medical Faculty, University of Bonn, Bonn, Germany
| | - Andreas Mayr
- Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), Medical Faculty, University of Bonn, Bonn, Germany
| | - Julia Schröder
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Axel M Hillmer
- Institute of Pathology, University Hospital Cologne, Medical Faculty, University of Cologne, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | | | - Rafael Campo
- Department of Gastroenterology, Hospital Parc Tauli, Sabadell, Spain
| | - Jesús Espinel
- Department of Gastroenterology, Complejo Hospitalario, León, Spain
| | - Fernando Geijo
- Department of Gastroenterology, Hospital Clínico Universitario, Salamanca, Spain
| | - Concha Thomson
- Department of Gastroenterology, Hospital Obispo Polanco, Teruel, Spain
| | - Luis Bujanda
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Federico Sopeña
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ángel Lanas
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - María Pellisé
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Claudia Pauligk
- Krankenhaus Nordwest, University Cancer Center, Frankfurt, Germany; Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten Oliver Goetze
- Krankenhaus Nordwest, University Cancer Center, Frankfurt, Germany; Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Carolin Zelck
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Julian Reingruber
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Emadeldin Hassanin
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Peter Elbe
- Department of Upper GI Diseases, Karolinska University Hospital and Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Alsabeah
- Department of Upper GI Diseases, Karolinska University Hospital and Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lindblad
- Department of Upper GI Diseases, Karolinska University Hospital and Division of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Department of Upper GI Diseases, Karolinska University Hospital and Division of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Nicole Kreuser
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Francesca Tavano
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Dario Arzani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Persiani
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Jin-On Jung
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Katja Ott
- Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Ralf R Schumann
- Institute of Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Oliver Kumpf
- Department of Anaesthesiology and operative Intensive care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susen Burock
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Poland; Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University in Szczecin, Poland
| | - Małgorzta Ławniczak
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, Poland
| | - Victor Moreno
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Barcelona, Spain; Colorectal Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Vicente Martín
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; The Research Group in Gene - Environment and Health Interactions (GIIGAS)/Institute of Biomedicine (IBIOMED), Universidad de Leon, Leon, Spain; Department of Biomedical Sciences, Faculty of Health Sciences, Area of Preventive Medicine and Public Health, Universidad de Leon, Leon, Spain
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Campus Del Mar, Barcelona, Spain; IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain
| | - Marina Pollán
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Justyna Dąbrowska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poland
| | - Antonio Salas
- Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; GenPoB Research Group, Instituto de Investigación Sanitaria (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Olivier Cussenot
- CeRePP, Paris, France; GRC n°5 Predictive Onco-Urology, Tenon Hospital, Sorbonne University, Paris, France
| | - Anne Boland-Auge
- University Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, Evry, France
| | - Delphine Daian
- University Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, Evry, France
| | - Jean-Francois Deleuze
- University Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, Evry, France
| | - Erika Salvi
- Neuroalgology Unit Fondazione IRCCS, Instituto Neurologico 'Carlo Besta' Milan, Milan, Italy
| | - Maris Teder-Laving
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Gianluca Tomasello
- Medical Oncology Unit, ASST of Cremona, Cremona, Italy; Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Chiara Senti
- Medical Oncology Unit, ASST of Cremona, Cremona, Italy; Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Valli De Re
- Unit of Immunopathologia e Biomarcatori Oncologici/Bio-proteomics facility, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Agostino Steffan
- Unit of Immunopathologia e Biomarcatori Oncologici, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Arnulf H Hölscher
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany
| | - Katharina Messerle
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany
| | | | - Armands Sīviņš
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga East University Hospital, Riga, Latvia
| | - Inga Bogdanova
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga East University Hospital, Riga, Latvia
| | - Jurgita Skieceviciene
- Gastroenterology Department and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justina Arstikyte
- Gastroenterology Department and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Markus Moehler
- Department of Medicine I, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Martin Kruschewski
- Department of General and Visceral Surgery, Klinikum Frankfurt (Oder), Germany
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Claus Schildberg
- Department of General Surgery, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Karsten Ridwelski
- Department of General and Visceral Surgery, Klinikum Magdeburg GmbH, Magdeburg, Germany
| | - Hans Lippert
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Nadine Fricker
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Peter Krawitz
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Lothar Veits
- Institute for Pathology, Friedrich-Alexander-University Erlangen-Nuernberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Adrianna Mostowska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poland
| | - Federico Martinón-Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain; Pediatrics Department, Translational Pediatrics and Infectious Diseases Section, Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Spain; Genetics, Vaccines, Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniele Cusi
- Institute of Biomedical Technologies, National Research Council of Italy, Milan, Italy; Bio4Dreams-Business, Nursery for Life Sciences, Milan, Italy
| | - Rolf Adolfsson
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Geraldine Cancel-Tassin
- CeRePP, Paris, France; GRC n°5 Predictive Onco-Urology, Tenon Hospital, Sorbonne University, Paris, France
| | - Aksana Höblinger
- Department of Internal Medicine I, Community Hospital Mittelrhein, Koblenz, Germany
| | - Ernst Rodermann
- Association of Medical Practices in Hematology and Internal Oncology, Troisdorf, Germany
| | - Monika Ludwig
- Association for Oncological Studies (Gefos), Dortmund, Germany
| | - Gisela Keller
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Andres Metspalu
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joerg Heller
- Department of Gastroenterology, Marienhaus Hospital Ahrweiler, Ahrweiler, Germany
| | - Markus Neef
- Department of Gastroenterology, Helios Hospital Siegburg, Siegburg, Germany
| | - Michael Schepke
- Department of Gastroenterology, Helios Hospital Siegburg, Siegburg, Germany
| | | | - Lutz Hamann
- Institute of Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Renato Cannizzaro
- Unit of Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michele Ghidini
- Medical Oncology Unit, ASST of Cremona, Cremona, Italy; Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany; Department of Internal Medicine II, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France
| | - Tomasz Skoczylas
- 2nd Department of General Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Majewski
- 2nd Department of General Surgery, Medical University of Lublin, Lublin, Poland
| | - Jan Lubiński
- Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Poland
| | - Orazio Palmieri
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Stefania Boccia
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Latiano
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Nuria Aragones
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mário Dinis-Ribeiro
- Porto Comprehensive Cancer Center & RISE @ CI-IPO, University of Porto, 4200-450, Porto, Portugal; Gastroenterology Department, Portuguese Institute of Oncology of Porto, 4200-072 Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Institute of Oncology of Porto (IPO Porto), 4200-072 Porto, Portugal; Research Department of the Portuguese League Against Cancer-North (LPCC-NRNorte), 4200-177 Porto, Portugal
| | - Salah-Eddin Al-Batran
- Krankenhaus Nordwest, University Cancer Center, Frankfurt, Germany; Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga East University Hospital, Riga, Latvia; Digestive Diseases Centre GASTRO, Riga, Latvia
| | - Juozas Kupcinskas
- Gastroenterology Department and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - María A García-González
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
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3
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Noh S, Nessim C, Keung EZ, Roland CL, Strauss D, Sivarajah G, Fiore M, Biasoni D, Cioffi SPB, Mehtsun W, Cananzi FCM, Sicoli F, Quagliuolo V, Chen J, Luo C, Gladdy RA, Swallow C, Johnston W, Ford SJ, Evenden C, Tirotta F, Almond M, Nguyen L, Rutkowski P, Krotewicz M, Pennacchioli E, Cardona K, Gamboa A, Hompes D, Renard M, Kollár A, Ryser CO, Vassos N, Raut CP, Fairweather M, Krakorova DA, Quildrian S, Perhavec A, Nizri E, Farma JM, Greco SH, Vincenzi B, Lopez JAG, Solerdecoll MS, Iwata S, Fukushima S, Kim T, Tolomeo F, Snow H, Howlett-Jansen Y, Tzanis D, Nikulin M, Gronchi A, Sicklick JK. Retrospective Analysis of Retroperitoneal-Abdominal-Pelvic Ganglioneuromas: An International Study by the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg 2023; 278:267-273. [PMID: 35866666 PMCID: PMC10191524 DOI: 10.1097/sla.0000000000005625] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The Transatlantic Australasian Retroperitoneal Sarcoma Working Group conducted a retrospective study on the disease course and clinical management of ganglioneuromas. BACKGROUND Ganglioneuromas are rare tumors derived from neural crest cells. Data on these tumors remain limited to case reports and single-institution case series. METHODS Patients of all ages with pathologically confirmed primary retroperitoneal, intra-abdominal, and pelvic ganglioneuromas between January 1, 2000, and January 1, 2020, were included. We examined demographic, clinicopathologic, and radiologic characteristics, as well as clinical management. RESULTS Overall, 328 patients from 29 institutions were included. The median age at diagnosis was 37 years with 59.1% of patients being female. Symptomatic presentation comprised 40.9% of cases, and tumors were often located in the extra-adrenal retroperitoneum (67.1%). At baseline, the median maximum tumor diameter was 7.2 cm. One hundred sixteen (35.4%) patients underwent active surveillance, whereas 212 (64.6%) patients underwent resection with 74.5% of operative cases achieving an R0/R1 resection. Serial tumor evaluations showed that malignant transformation to neuroblastoma was rare (0.9%, N=3). Tumors undergoing surveillance had a median follow-up of 1.9 years, with 92.2% of ganglioneuromas stable in size. With a median follow-up of 3.0 years for resected tumors, 84.4% of patients were disease free after resections, whereas recurrences were observed in 4 (1.9%) patients. CONCLUSIONS Most ganglioneuromas have indolent disease courses and rarely transform to neuroblastoma. Thus, active surveillance may be appropriate for benign and asymptomatic tumors particularly when the risks of surgery outweigh the benefits. For symptomatic or growing tumors, resection may be curative.
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Affiliation(s)
- Sangkyu Noh
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, CA 92093-0987, USA
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA
| | - Carolyn Nessim
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Surgery, Ottawa, Ontario, Canada
| | - Emily Z. Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L. Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dirk Strauss
- Department of Surgical Oncology, Royal Marsden Hospital, London, UK
| | | | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Winta Mehtsun
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, CA 92093-0987, USA
| | - Ferdinando Carlo Maria Cananzi
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Federico Sicoli
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Jun Chen
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, China, 102206
| | - Chenghua Luo
- Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, China, 102206
| | - Rebecca A. Gladdy
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Carol Swallow
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Wendy Johnston
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Samuel J. Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Caroline Evenden
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Fabio Tirotta
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Laura Nguyen
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Surgery, Ottawa, Ontario, Canada
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcoma and Rare Tumors, IRCCS, European Institute of Oncology, Milan, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Adriana Gamboa
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - Marleen Renard
- Department of Paediatric Oncology, University Hospitals, Leuven, Belgium
| | - Attila Kollár
- Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph O. Ryser
- Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikolaos Vassos
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Chandrajit P. Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Sergio Quildrian
- Sarcoma and Melanoma Unit, General Surgery Department, Buenos Aires British Hospital, Buenos Aires, Argentina
- Sarcoma and Melanoma Unit, Angel H Roffo Institute of Oncology, University of Buenos Aires, Buenos Aires, Argentina
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1105, Ljubljana, Slovenia
| | - Eran Nizri
- Surgical Oncology Unit, Department of Surgery A, The Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeffrey M. Farma
- Fox Chase Cancer Center, Department of Surgical Oncology, 333 Cottman Ave, Philadelphia, PA 19111, USA
| | - Stephanie H. Greco
- Fox Chase Cancer Center, Department of Surgical Oncology, 333 Cottman Ave, Philadelphia, PA 19111, USA
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - José Antonio González Lopez
- Unidad de Mama y Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Mireia Solans Solerdecoll
- Unidad de Mama y Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Shintaro Iwata
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Suguru Fukushima
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Teresa Kim
- Department of Surgery, University of Washington, Seattle
| | - Francesco Tolomeo
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Hayden Snow
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ynez Howlett-Jansen
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Maxim Nikulin
- N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia, Moscow, Russia
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jason K. Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, CA 92093-0987, USA
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4
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Reijers SJM, Davies E, Grünhagen DJ, Fiore M, Honore C, Rastrelli M, Vassos N, Podleska LE, Niethard M, Jakob J, Perhavec A, Duarte C, González F, Deroose JP, Stas M, Boecxstaens V, Schrage Y, Snow H, Algarra SM, Said HM, Ortega DYG, Martin K, Mattsson J, Djafarrian R, Di Lorenzo G, Colombo C, Gronchi A, Matter M, Verhoef C, Bagge RO, Hohenberger P, Hayes AJ, van Houdt WJ. Variation in response rates to isolated limb perfusion in different soft-tissue tumour subtypes: an international multi-centre study. Eur J Cancer 2023; 190:112949. [PMID: 37453241 DOI: 10.1016/j.ejca.2023.112949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/11/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the response rates of different extremity soft-tissue sarcoma subtypes (eSTS) after isolated limb perfusion (ILP), based on an international multi-centre study. MATERIALS AND METHODS The retrospective cohort comprised eSTS patients from 17 specialised ILP centres that underwent melphalan-based ILP, with or without recombinant human tumour necrosis factor (rhTNFα) (TM-ILP and M-ILP, respectively). Response was measured on imaging (magnetic resonance imaging) and/or clinical response, for which M-ILPs were excluded. RESULTS A total of 1109 eSTS patients were included. The three most common histological subtypes were undifferentiated pleomorphic sarcoma (17%, n = 184), synovial sarcoma (16%, n = 175) and myxofibrosarcoma (8%, n = 87). rhTNFα was used in 93% (TM-ILP) and resulted in a significantly better overall response rate (ORR, p = 0.031) and complete responses (CR, p < 0.001) in comparison to M-ILP, without significant differences among histological subgroups. The ORR of TM-ILP was 68%, including 17% CR. Also, 80% showed progressive disease. Significantly higher response rates were shown for Kaposi sarcoma (KS) with 42% CR and 96% ORR (both p < 0.001), and significantly higher CR rates for angiosarcoma (AS, 45%, p < 0.001) and clear cell sarcoma (CCS, 31%, p = 0.049). ILP was followed by resection ≤ 6 months in 80% of the patients. The overall limb salvage rate was 88%, without significant differences among histological subgroups, but was significantly higher for ILP responders compared to non-responders (93% versus 76%, p < 0.001). CONCLUSION ILP resulted in high response and LRS among all eSTS subtypes, however, with significant differences between subtypes with most promising results for KS, AS and CCS.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Emma Davies
- Department of Surgical Oncology, Royal Marsden Hospital, 203 Fulham Rd., SW3 6JJ London, UK.
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Charles Honore
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
| | - Marco Rastrelli
- Department of Surgery Oncology and Gastroenterology, University of Padova, Via VIII Febbraio, 2, 35122 Padua, Italy; Department of Surgical Oncology, Istituto Oncologico Veneto (IOV), Via Gattamelata, 64, 35128 Padua, Italy.
| | - Nikolaos Vassos
- Division of Surgical Oncology, Mannheim University Medical Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Lars E Podleska
- Department of Orthopaedic Oncology and Soft Tissue Sarcoma, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany.
| | - Maya Niethard
- Department of Surgical Oncology, Helios Klinikum Berlin-Buch, Schwanebecker Ch 50, 13125 Berlin, Germany; Department of Orthopedic Surgery, University Medicine Greifswald, Fleischmannstraße 6, 17489 Greifswald, Germany.
| | - Jens Jakob
- Department of Orthopaedic Oncology and Soft Tissue Sarcoma, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany.
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
| | - Carlos Duarte
- Department of Surgical Oncology, Instituto Nacional de Cancerología, Cl. 1 #9-85, Bogota, Colombia.
| | - Felipe González
- Department of Surgical Oncology, Instituto Nacional de Cancerología, Cl. 1 #9-85, Bogota, Colombia.
| | - Jan P Deroose
- Department of Surgical Oncology, Martini Ziekenhuis, Van Swietenplein 1, 9728 NT Groningen, the Netherlands.
| | - Marguerite Stas
- Department of Surgical Oncology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Veerle Boecxstaens
- Department of Surgical Oncology, Universitair Ziekenhuis Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Hayden Snow
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000. Australia.
| | - Salvador Martín Algarra
- Department of Medical Oncology, Clínica Universidad de Navarra, Av. de Pío XII, 36, 31008 Pamplona, Spain.
| | - Hector Martinez Said
- Department of Surgical Oncology, National Cancer Institute Mexico, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, 14080 Mexico City, Mexico.
| | - Dorian Yarih Garcia Ortega
- Department of Surgical Oncology, National Cancer Institute Mexico, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, 14080 Mexico City, Mexico.
| | - Karla Martin
- Department of Surgical Oncology, National Cancer Institute Mexico, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, 14080 Mexico City, Mexico.
| | - Jan Mattsson
- Department of Surgery, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Medicinaregatan 3, 413 90 Gothenburg, Sweden.
| | - Reza Djafarrian
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Giorgia Di Lorenzo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.
| | - Maurice Matter
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Blå stråket 5, 413 45 Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Medicinaregatan 3, 413 90 Gothenburg, Sweden.
| | - Peter Hohenberger
- Division of Surgical Oncology, Mannheim University Medical Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Andrew J Hayes
- Department of Surgical Oncology, Royal Marsden Hospital, 203 Fulham Rd., SW3 6JJ London, UK.
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
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5
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Hess T, Maj C, Gehlen J, Borisov O, Haas SL, Gockel I, Vieth M, Piessen G, Alakus H, Vashist Y, Pereira C, Knapp M, Schüller V, Quaas A, Grabsch HI, Trautmann J, Malecka-Wojciesko E, Mokrowiecka A, Speller J, Mayr A, Schröder J, Hillmer AM, Heider D, Lordick F, Pérez-Aísa Á, Campo R, Espinel J, Geijo F, Thomson C, Bujanda L, Sopeña F, Lanas Á, Pellisé M, Pauligk C, Goetze TO, Zelck C, Reingruber J, Hassanin E, Elbe P, Alsabeah S, Lindblad M, Nilsson M, Kreuser N, Thieme R, Tavano F, Pastorino R, Arzani D, Persiani R, Jung JO, Nienhüser H, Ott K, Schumann RR, Kumpf O, Burock S, Arndt V, Jakubowska A, Ławniczak M, Moreno V, Martín V, Kogevinas M, Pollán M, Dąbrowska J, Salas A, Cussenot O, Boland-Auge A, Daian D, Deleuze JF, Salvi E, Teder-Laving M, Tomasello G, Ratti M, Senti C, De Re V, Steffan A, Hölscher AH, Messerle K, Bruns CJ, Sīviņš A, Bogdanova I, Skieceviciene J, Arstikyte J, Moehler M, Lang H, Grimminger PP, Kruschewski M, Vassos N, Schildberg C, Lingohr P, Ridwelski K, Lippert H, Fricker N, Krawitz P, Hoffmann P, Nöthen MM, Veits L, Izbicki JR, Mostowska A, Martinón-Torres F, Cusi D, Adolfsson R, Cancel-Tassin G, Höblinger A, Rodermann E, Ludwig M, Keller G, Metspalu A, Brenner H, Heller J, Neef M, Schepke M, Dumoulin FL, Hamann L, Cannizzaro R, Ghidini M, Plaßmann D, Geppert M, Malfertheiner P, Gehlen O, Skoczylas T, Majewski M, Lubiński J, Palmieri O, Boccia S, Latiano A, Aragones N, Schmidt T, Dinis-Ribeiro M, Medeiros R, Al-Batran SE, Leja M, Kupcinskas J, García-González MA, Venerito M, Schumacher J. Dissecting the genetic heterogeneity of gastric cancer. EBioMedicine 2023; 92:104616. [PMID: 37209533 DOI: 10.1016/j.ebiom.2023.104616] [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: 12/21/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is clinically heterogenous according to location (cardia/non-cardia) and histopathology (diffuse/intestinal). We aimed to characterize the genetic risk architecture of GC according to its subtypes. Another aim was to examine whether cardia GC and oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett's oesophagus (BO), which are all located at the gastro-oesophageal junction (GOJ), share polygenic risk architecture. METHODS We did a meta-analysis of ten European genome-wide association studies (GWAS) of GC and its subtypes. All patients had a histopathologically confirmed diagnosis of gastric adenocarcinoma. For the identification of risk genes among GWAS loci we did a transcriptome-wide association study (TWAS) and expression quantitative trait locus (eQTL) study from gastric corpus and antrum mucosa. To test whether cardia GC and OAC/BO share genetic aetiology we also used a European GWAS sample with OAC/BO. FINDINGS Our GWAS consisting of 5816 patients and 10,999 controls highlights the genetic heterogeneity of GC according to its subtypes. We newly identified two and replicated five GC risk loci, all of them with subtype-specific association. The gastric transcriptome data consisting of 361 corpus and 342 antrum mucosa samples revealed that an upregulated expression of MUC1, ANKRD50, PTGER4, and PSCA are plausible GC-pathomechanisms at four GWAS loci. At another risk locus, we found that the blood-group 0 exerts protective effects for non-cardia and diffuse GC, while blood-group A increases risk for both GC subtypes. Furthermore, our GWAS on cardia GC and OAC/BO (10,279 patients, 16,527 controls) showed that both cancer entities share genetic aetiology at the polygenic level and identified two new risk loci on the single-marker level. INTERPRETATION Our findings show that the pathophysiology of GC is genetically heterogenous according to location and histopathology. Moreover, our findings point to common molecular mechanisms underlying cardia GC and OAC/BO. FUNDING German Research Foundation (DFG).
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Affiliation(s)
- Timo Hess
- Institute of Human Genetics, University of Marburg, Marburg, Germany; Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Carlo Maj
- Institute of Human Genetics, University of Marburg, Marburg, Germany; Medical Faculty, Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Jan Gehlen
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Oleg Borisov
- Medical Faculty, Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Stephan L Haas
- Department of Upper GI Diseases, Karolinska Institutet, Karolinska University Hospital and Unit of Gastroenterology and Rheumatology, Stockholm, Sweden
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Michael Vieth
- Institute for Pathology, Friedrich-Alexander-University Erlangen-Nuernberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, Lille, France
| | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany
| | - Yogesh Vashist
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany; Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Carina Pereira
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Institute of Oncology of Porto (IPO Porto), Porto 4200-072, Portugal; Porto Comprehensive Cancer Center & RISE @ CI-IPO, University of Porto, Porto 4200-450, Portugal
| | - Michael Knapp
- Medical Faculty, Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany
| | - Vitalia Schüller
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Alexander Quaas
- Medical Faculty, Institute of Pathology, University Hospital Cologne, University of Cologne, Germany
| | - Heike I Grabsch
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands; Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Jessica Trautmann
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | | | - Anna Mokrowiecka
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Jan Speller
- Medical Faculty, Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany
| | - Andreas Mayr
- Medical Faculty, Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany
| | - Julia Schröder
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Axel M Hillmer
- Medical Faculty, Institute of Pathology, University Hospital Cologne, University of Cologne, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | | | - Rafael Campo
- Department of Gastroenterology, Hospital Parc Tauli, Sabadell, Spain
| | - Jesús Espinel
- Department of Gastroenterology, Complejo Hospitalario, León, Spain
| | - Fernando Geijo
- Department of Gastroenterology, Hospital Clínico Universitario, Salamanca, Spain
| | - Concha Thomson
- Department of Gastroenterology, Hospital Obispo Polanco, Teruel, Spain
| | - Luis Bujanda
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Federico Sopeña
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ángel Lanas
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - María Pellisé
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Department of Gastroenterology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Claudia Pauligk
- Krankenhaus Nordwest, University Cancer Center, Frankfurt, Germany; Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten Oliver Goetze
- Krankenhaus Nordwest, University Cancer Center, Frankfurt, Germany; Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Carolin Zelck
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Julian Reingruber
- Institute of Human Genetics, University of Marburg, Marburg, Germany
| | - Emadeldin Hassanin
- Medical Faculty, Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter Elbe
- Department of Upper GI Diseases, Karolinska Institutet, Karolinska University Hospital and Unit of Gastroenterology and Rheumatology, Stockholm, Sweden
| | - Sandra Alsabeah
- Department of Upper GI Diseases, Karolinska Institutet, Karolinska University Hospital and Unit of Gastroenterology and Rheumatology, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Upper GI Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery, Department of Upper GI Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Nicole Kreuser
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Francesca Tavano
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Dario Arzani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Persiani
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Jin-On Jung
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Katja Ott
- Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Ralf R Schumann
- Institute of Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Oliver Kumpf
- Department of Anaesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susen Burock
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Poland; Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University in Szczecin, Poland
| | - Małgorzta Ławniczak
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, Poland
| | - Victor Moreno
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Barcelona, Spain; Colorectal Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Faculty of Medicine, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Vicente Martín
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; The Research Group in Gene - Environment and Health Interactions (GIIGAS)/Institute of Biomedicine (IBIOMED), Universidad de Leon, Leon, Spain; Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de Leon, Leon, Spain
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Campus Del Mar, Barcelona, Spain; IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain
| | - Marina Pollán
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Justyna Dąbrowska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poland
| | - Antonio Salas
- Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; GenPoB Research Group, Instituto de Investigación Sanitaria (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Olivier Cussenot
- CeRePP, Paris, France; GRC n°5 Predictive Onco-Urology, Tenon Hospital, Sorbonne University, Paris, France
| | - Anne Boland-Auge
- Centre National de Recherche en Génomique Humaine, CEA, University Paris-Saclay, Evry, France
| | - Delphine Daian
- Centre National de Recherche en Génomique Humaine, CEA, University Paris-Saclay, Evry, France
| | - Jean-Francois Deleuze
- Centre National de Recherche en Génomique Humaine, CEA, University Paris-Saclay, Evry, France
| | - Erika Salvi
- Neuroalgology Unit Fondazione IRCCS, Instituto Neurologico 'Carlo Besta' Milan, Milan, Italy
| | - Maris Teder-Laving
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Gianluca Tomasello
- Medical Oncology Unit, ASST of Cremona, Cremona, Italy; Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Chiara Senti
- Medical Oncology Unit, ASST of Cremona, Cremona, Italy; Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Valli De Re
- Unit of Immunopathologia e Biomarcatori Oncologici/Bio-proteomics Facility, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Agostino Steffan
- Unit of Immunopathologia e Biomarcatori Oncologici, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Arnulf H Hölscher
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany
| | - Katharina Messerle
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany
| | | | - Armands Sīviņš
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga East University Hospital, Riga, Latvia
| | - Inga Bogdanova
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga East University Hospital, Riga, Latvia
| | - Jurgita Skieceviciene
- Gastroenterology Department and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justina Arstikyte
- Gastroenterology Department and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Markus Moehler
- Department of Medicine I, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Martin Kruschewski
- Department of General and Visceral Surgery, Klinikum Frankfurt (Oder), Germany
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Claus Schildberg
- Department of General Surgery, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg, Brandenburg, Germany
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Karsten Ridwelski
- Department of General and Visceral Surgery, Klinikum Magdeburg GmbH, Magdeburg, Germany
| | - Hans Lippert
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Nadine Fricker
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Peter Krawitz
- Medical Faculty, Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Lothar Veits
- Institute for Pathology, Friedrich-Alexander-University Erlangen-Nuernberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Adrianna Mostowska
- Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poland
| | - Federico Martinón-Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain; Department of Pediatrics, Translational Pediatrics and Infectious Diseases Section, Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Spain; Genetics, Vaccines, Infectious Diseases and Pediatrics Research Group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniele Cusi
- Institute of Biomedical Technologies, National Research Council of Italy, Milan, Italy; Bio4Dreams-Business, Nursery for Life Sciences, Milan, Italy
| | - Rolf Adolfsson
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Geraldine Cancel-Tassin
- CeRePP, Paris, France; GRC n°5 Predictive Onco-Urology, Tenon Hospital, Sorbonne University, Paris, France
| | - Aksana Höblinger
- Department of Internal Medicine I, Community Hospital Mittelrhein, Koblenz, Germany
| | - Ernst Rodermann
- Association of Medical Practices in Hematology and Internal Oncology, Troisdorf, Germany
| | - Monika Ludwig
- Association for Oncological Studies (Gefos), Dortmund, Germany
| | - Gisela Keller
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Andres Metspalu
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joerg Heller
- Department of Gastroenterology, Marienhaus Hospital Ahrweiler, Ahrweiler, Germany
| | - Markus Neef
- Department of Gastroenterology, Helios Hospital Siegburg, Siegburg, Germany
| | - Michael Schepke
- Department of Gastroenterology, Helios Hospital Siegburg, Siegburg, Germany
| | | | - Lutz Hamann
- Institute of Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Renato Cannizzaro
- Unit of Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Michele Ghidini
- Medical Oncology Unit, ASST of Cremona, Cremona, Italy; Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany; Department of Internal Medicine II, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Olivier Gehlen
- Department of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France
| | - Tomasz Skoczylas
- 2nd Department of General Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Majewski
- 2nd Department of General Surgery, Medical University of Lublin, Lublin, Poland
| | - Jan Lubiński
- Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Poland
| | - Orazio Palmieri
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Stefania Boccia
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Latiano
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Nuria Aragones
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública e CIBERESP), Spain; Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Cologne, Germany; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mário Dinis-Ribeiro
- Porto Comprehensive Cancer Center & RISE @ CI-IPO, University of Porto, Porto 4200-450, Portugal; Gastroenterology Department, Portuguese Institute of Oncology of Porto, Porto 4200-072, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, IPO Porto Research Center (CI-IPOP), Portuguese Institute of Oncology of Porto (IPO Porto), Porto 4200-072, Portugal; Research Department of the Portuguese League Against Cancer-North (LPCC-NRNorte), Porto 4200-177, Portugal
| | - Salah-Eddin Al-Batran
- Krankenhaus Nordwest, University Cancer Center, Frankfurt, Germany; Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga East University Hospital, Riga, Latvia; Digestive Diseases Centre GASTRO, Riga, Latvia
| | - Juozas Kupcinskas
- Gastroenterology Department and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - María A García-González
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
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Stolze T, Franke S, Haybaeck J, Moehler M, Grimminger PP, Lang H, Roth W, Gockel I, Kreuser N, Bläker H, Wittekind C, Lordick F, Vieth M, Veits L, Waidmann O, Lingohr P, Peitz U, Schildberg C, Kruschewski M, Vassos N, Goni E, Bruns CJ, Ridwelski K, Wolff S, Lippert H, Schumacher J, Malfertheiner P, Venerito M. Mismatch repair deficiency, chemotherapy and survival for resectable gastric cancer: an observational study from the German staR cohort and a meta-analysis. J Cancer Res Clin Oncol 2023; 149:1007-1017. [PMID: 35211781 PMCID: PMC9984318 DOI: 10.1007/s00432-022-03953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE In a post hoc analysis of the MAGIC trial, patients with curatively resected gastric cancer (GC) and mismatch repair (MMR) deficiency (MMRd) had better median overall survival (OS) when treated with surgery alone but worse median OS when treated with additional chemotherapy. Further data are required to corroborate these findings. METHODS Between April 2013 and December 2018, 458 patients with curatively resected GC, including cancers of the esophagogastric junction Siewert type II and III, were identified in the German centers of the staR consortium. Tumor sections were assessed for expression of MLH1, MSH2, MSH6 and PMS2 by immunohistochemistry. The association between MMR status and survival was assessed. Similar studies published up to January 2021 were then identified in a MEDLINE search for a meta-analysis. RESULTS MMR-status and survival data were available for 223 patients (median age 66 years, 62.8% male), 23 patients were MMRd (10.3%). After matching for baseline clinical characteristics, median OS was not reached in any subgroup. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd and MMRp had a HR of 0.67 (95% CI 0.13-3.37, P = 0.63) and 1.44 (95% CI 0.66-3.13, P = 0.36), respectively. The meta-analysis included pooled data from 385 patients. Compared to perioperative chemotherapy, patients receiving surgery alone with MMRd had an improved OS with a HR of 0.36 (95% CI 0.14-0.91, P = 0.03), whereas those with MMRp had a HR of 1.18 (95% CI 0.89-1.58, P = 0.26). CONCLUSION Our data support a positive prognostic effect for MMRd in GC patients treated with surgery only and a differentially negative prognostic effect in patients treated with perioperative chemotherapy. MMR status determined by preoperative biopsies may be used as a predictive biomarker to select patients for perioperative chemotherapy in curatively resectable GC.
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Affiliation(s)
- T Stolze
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany
| | - S Franke
- Institute of Pathology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany
| | - J Haybaeck
- Institute of Pathology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany.,Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria.,Diagnostic and Research Center for Molecular BioMedicine, Institute of Pathology, Medical University Graz, Graz, Austria
| | - M Moehler
- Department of Internal Medicine I, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - H Lang
- Department of General, Visceral and Transplant Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - W Roth
- Institute of Pathology, University Hospital Mainz, Mainz, Germany
| | - I Gockel
- Department of Medicine II and University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - N Kreuser
- Department of Medicine II and University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - H Bläker
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - C Wittekind
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - F Lordick
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - M Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - L Veits
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - O Waidmann
- Department of Internal Medicine 1, Main Area Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Cancer Center, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - U Peitz
- Department of Gastroenterology, Raphaelshospital, Münster, Germany
| | - C Schildberg
- Department of General and Visceral Surgery, Brandenburg, University Hospital of Visceral Surgery, Brandenburg, Germany
| | - M Kruschewski
- Department of General and Visceral Surgery, Hospital Frankfurt (Oder), Frankfurt (Oder), Germany
| | - N Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - E Goni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - C J Bruns
- Department of General, Tumor and Transplantation Surgery, University Hospital Cologne, Köln, Germany
| | - K Ridwelski
- Department of General and Visceral Surgery, Municipal Hospital, Magdeburg, Germany.,AN-Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - S Wolff
- Department of General, Visceral, Vascular and Transplantation Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - H Lippert
- AN-Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Department of General, Visceral, Vascular and Transplantation Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - J Schumacher
- Human Genetics Center, Philipps University of Marburg, Marburg, Germany
| | - P Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany.,Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, Magdeburg, Germany. .,Department of Gastroenterology, Hepatology and Infectious Diseases, Medizinische Fakultät der Otto-Von-Guericke-Universität, Leipziger Straße 66, 39120, Magdeburg, Germany.
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Vassos N, Faust E, Sandra-Petrescu F, Roessner E, Hohenberger P. The use of human acellular dermal matrix (hADM) for thoracic wall reconstruction in sarcoma patients. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.193] [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: 02/23/2023]
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Kokkali S, Kyriazoglou A, Mangou E, Economopoulou P, Panousieris M, Psyrri A, Ardavanis A, Vassos N, Boukovinas I. Real-World Data on Cabozantinib in Advanced Osteosarcoma and Ewing Sarcoma Patients: A Study from the Hellenic Group of Sarcoma and Rare Cancers. J Clin Med 2023; 12:jcm12031119. [PMID: 36769769 PMCID: PMC9918141 DOI: 10.3390/jcm12031119] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Advanced osteosarcomas (OSs) and Ewing sarcomas (ESs) tend to have poor prognosis with limited therapeutic options beyond first-line therapy. Aberrant angiogenesis and MET signaling play an important role in preclinical models. The anti-angiogenic drug cabozantinib was tested in a phase 2 trial of advanced OS and ES and was associated with clinical benefits. We retrospectively analyzed the off-label use of cabozantinib in adult patients with advanced OS and ES/primitive neuroectodermal tumors (PNETs) in three centers of the Hellenic Group of Sarcoma and Rare Cancers (HGSRC). Between April 2019 and January 2022, 16 patients started taking 60 mg of cabozantinib for advanced bone sarcoma or PNET. Median age at cabozantinib initiation was 31 years (17-83). All patients had received peri-operative chemotherapy for primary sarcoma and between 0 and 4 lines of treatment (median; 2.5) for advanced disease. The most common adverse effects included fatigue, anorexia, hypertransaminasemia, weight loss, and diarrhea. One toxic death was noted (cerebral hemorrhage). Dose reduction to 40 mg was required in 31.3% of the patients. No objective response was noted, and 9/16 patients exhibited stable disease outcomes. Progression-free survival varied from 1 to 8 (median; 5) months. Our study demonstrates that cabozantinib has antitumor activity in this population. In the real-life setting, we observed similar adverse events as in the CABONE study and in other neoplasms.
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Affiliation(s)
- Stefania Kokkali
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
- Medical Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-2132089511
| | - Anastasios Kyriazoglou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Elpida Mangou
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Panagiota Economopoulou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Michail Panousieris
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Amanda Psyrri
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Alexandros Ardavanis
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Nikolaos Vassos
- Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Ioannis Boukovinas
- Department of Medical Oncology, Bioclinic Hospital, 54622 Thessaloniki, Greece
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9
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Khan M, Wilkerson H, Vassos N, Hannay JA, Thway K, Messiou C, Hayes AJ, Strauss DC, Smith MJ. Oncologic outcomes of surgically managed primary pelvic soft tissue sarcoma; tumour biology or surgical constraints of the true pelvis? Eur J Surg Oncol 2022; 49:941-949. [PMID: 36566120 DOI: 10.1016/j.ejso.2022.12.005] [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: 10/11/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pelvic soft tissue sarcomas are rare. Potentially curative resection remains challenging due to anatomical constraints of true pelvis and tumour spread through various anatomical hiatus. We sought to review the oncological outcomes of surgically managed cases at our centre and determine whether outcomes differ for patients with localised (limited to pelvis) versus extensive disease (with extra-pelvic extension). METHODS Sixty-seven patients who underwent surgical resection with curative intent at the centre for primary, non-metastatic, WHO intermediate to high-grade soft tissue sarcoma of the true pelvis from January 2012 through January 2020 were analysed. Establishment of the extent of disease was made by review of pre-treatment imaging and surgical notes. Oncologic endpoints examined were resection margin, recurrence rate, disease-free and overall survival. RESULTS Rates of complete oncological resection and disease control were similar for tumours with localised or extensive disease. On logistic regression analysis, tumour grade, and a negative resection margin (R0) correlated with the risk of recurrence (p=<0.05). On further multinomial analysis, R0 resection was associated with improved local control, but not metastatic relapse (p = 0.003). 5-year local recurrence-free and distant metastasis-free survival were 61.3% and 67.1%, respectively. Five and 10-year overall survival were 64% and 36%, respectively. Age >50 years and high tumour grade were associated with a worse outcome (p < 0.05). CONCLUSIONS When potentially curative surgery is performed for pelvic sarcoma, disease-extent does not influence oncologic outcomes. While a complete oncologic resection determines the risk of local recurrence, tumour grade and metastatic relapse remain primary prognostic determinants for overall survival.
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Affiliation(s)
- Misbah Khan
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom
| | | | - Nikolaos Vassos
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom
| | | | - Khin Thway
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Christina Messiou
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Andrew J Hayes
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Dirk Cornelius Strauss
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Myles Jf Smith
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom.
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10
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Weigl H, Hohenberger P, Marx A, Vassos N, Jakob J, Galata C. Accuracy and Safety of Ultrasound-Guided Core Needle Biopsy of Soft Tissue Tumors in an Outpatient Setting: A Sarcoma Center Analysis of 392 Consecutive Patients. Cancers (Basel) 2021; 13:cancers13225659. [PMID: 34830814 PMCID: PMC8616355 DOI: 10.3390/cancers13225659] [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: 09/13/2021] [Revised: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary In patients with unclear soft tissue lesions, treatment planning largely depends on histology. Core needle biopsy is the diagnostic standard in these cases. The aim of this retrospective study was to investigate accuracy and safety of ultrasound guided core needle biopsy at a tertiary referral center. We show that ultrasound guided biopsy was feasible as a one stop shop procedure in an outpatient setting in 87.6% of the cases. The rate of conclusive biopsies was 88.5%. After surgical resection, the dignity, tumor type and histopathological grading of the biopsy matched one of the resection specimens in 97.2%, 92.7% and 92.5% of the cases, respectively. Major complications occurred in 0.8% of the cases. With this study, we confirm that ultrasound guided core needle biopsy is safe, effective and can be performed at the first outpatient presentation to speed up the diagnostic and therapeutic cascade in sarcoma patients. Abstract Background: The aim of this study was to investigate diagnostic accuracy, safety and histologic results of ultrasound guided core needle biopsy (CNB) in patients with soft tissue lesions (STL) at a tertiary referral center. Methods: A retrospective analysis of all consecutive patients undergoing ultrasound guided CNB for STL at our sarcoma outpatient service between January 2015 and August 2020 was performed. Results: A total of 392 patients were identified. Main histologic entities were sarcomas, lipomas and desmoid tumors. Biopsy was performed in an outpatient setting in 87.6% of the cases. Conclusive biopsies were obtained in 88.5% of the cases. In patients who underwent surgical resection after CNB, the concordance of dignity, tumor entity and histopathological grading between biopsy and resection specimen were 97.2%, 92.7% and 92.5% respectively. The risk of inconclusive CNB was highest in intraabdominal or retroperitoneal tumors (19.5%) and lowest in lesions at the lower extremity (4.4%). Major complications after CNB occurred in three cases (0.8%). No case of biopsy tract seeding was observed during the study period. Conclusions: Ultrasound guided CNB for STL at first presentation in a dedicated surgical outpatient setting is a safe procedure and yields a high diagnostic accuracy.
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Affiliation(s)
- Helene Weigl
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.W.); (N.V.); (J.J.); (C.G.)
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- Correspondence:
| | - Alexander Marx
- Institute of Pathology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Nikolaos Vassos
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.W.); (N.V.); (J.J.); (C.G.)
| | - Jens Jakob
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.W.); (N.V.); (J.J.); (C.G.)
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Christian Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.W.); (N.V.); (J.J.); (C.G.)
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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11
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Franck C, Zimmermann N, Goni E, Lippert H, Ridwelski K, Kruschewski M, Kreuser N, Lingohr P, Schildberg C, Vassos N, Waidmann O, Peitz U, Lang H, Grmminger PP, Bruns C, Veits L, Vieth M, Moehler M, Lordick F, Gockel I, Schumacher J, Malfertheiner P, Venerito M. Different Prevalence of Alarm, Dyspeptic and Reflux Symptoms in Patients with Cardia and Non-cardia Gastric Cancer. J Gastrointestin Liver Dis 2021; 30:431-437. [PMID: 34752588 DOI: 10.15403/jgld-3795] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Symptoms of patients with gastric cancer (GC) are often unspecific and differences in symptoms between patients with cardia and non-cardia GC have been poorly investigated. We aimed to characterize symptoms of patients with cardia and non-cardia GC. METHODS Patients with cardia (Siewert type II and III) and non-cardia GC were recruited in the German multicenter cohort of the Gastric Cancer Research (staR) study between 2013 and 2017. Alarm, dyspeptic and reflux symptoms at the time of presentation were documented using a self-administered questionnaire. RESULTS A completed self-administered questionnaire was available for 568/759 recruited patients (132 cardia GC, 436 non-cardia GC, male 61%, mean age 64 years). Dyspeptic symptoms were more common in patients with non-cardia GC (69.0 vs. 54.5%, p=0.0024). Cardia GC patients reported more frequently alarm symptoms (69.7 vs. 44.7%, p<0.0001), and were more likely to have Union for International Cancer Control (UICC) stage III-IV (54.1vs. 38.9%, p=0.0034). Especially, dysphagia and weight loss were more common in patients with cardia GC (49.2 vs. 6.4 %, p<0.0001 and 37.1 vs. 25.7%, p=0.02, respectively). No differences between the two groups were observed with respect to reflux symptoms. Patients with alarm symptoms were more likely to have UICC stage III-IV at presentation (69.4 vs. 42.9%, p<0.0001). CONCLUSIONS In clinical practice the symptom pattern at presentation may serve as a hint for tumor localization. Despite the fact that they are common in the general population, dyspeptic symptoms offer a chance for earlier GC detection. Thus, in patients with dyspeptic symptoms who fail empiric approaches, endoscopy should not be delayed.
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Affiliation(s)
- Caspar Franck
- Deptartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Nadja Zimmermann
- Deptartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Elisabetta Goni
- Department of Internal Medicine II, Ludwig Maximilians University Hospital, Munich, Germany
| | - Hans Lippert
- Department of General, Visceral, Vascular and Transplantation Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | | | - Martin Kruschewski
- Department for General, Visceral und Thoracic surgery, Frankfurt (Oder) Municipal Hospital, Frankfurt (Oder), Germany
| | - Nicole Kreuser
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Claus Schildberg
- Department of General Surgery, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Center, University Heidelberg, Mannheim, Germany
| | - Oliver Waidmann
- Department of Gastroenterology and Hepatology, University Hospital of Frankfurt a. Main, Frankfurt, Germany
| | - Ulrich Peitz
- Department of Gastroenterology, Raphaelsklinik Muenster, Muenster, Germany
| | - Hauke Lang
- Department of Gastroenterology, Raphaelsklinik Muenster, Muenster, Germany
| | - Peter P Grmminger
- Department of Surgery, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christiane Bruns
- Deparment of General, Visceral, Tumor and Transplantation Surgery, University Hospital Cologne, Cologne, Germany
| | - Lothar Veits
- Institute of Pathology, University of Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Michael Vieth
- Institute of Pathology, University of Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Markus Moehler
- First Medical Clinic and Policlinic, University Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg; 2) Department of Internal Medicine II, Ludwig Maximilians University Hospital, Munich, Germany
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12
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Rauch M, Agaimy A, Semrau S, Willner A, Ott O, Fietkau R, Hohenberger W, Croner RS, Grützmann R, Fechner K, Vassos N. Long-Term Follow-Up of Patients Receiving Neoadjuvant Treatment Modalties for Soft Tissue Sarcomas of the Extremities. Cancers (Basel) 2021; 13:cancers13205244. [PMID: 34680391 PMCID: PMC8534061 DOI: 10.3390/cancers13205244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/03/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neoadjuvant treatment modalities in soft tissue sarcoma (STS) of the extremities have become more popular in recent years, but because of the rarity and heterogeneity of STS, there are yet few studies on the long-term impact of neoadjuvant treatment modalities, especially in terms of neoadjuvant radiochemotherapy. METHODS The study enrolled 136 patients with primary STS of the extremities who underwent surgery with curative intent or neoadjuvant therapy, followed by surgery in a 15-year period. Neoadjuvant treatment consisted of radiotherapy (RT) with 60 Gy and in most cases simultaneous chemotherapy (CTx) with ifosfamide (1.5 g/m2/d, d1-5, q28) and doxorubicine (50 mg/m2/d, d3, q28). We investigated the clinical, (post)-operative and histopathological data and the oncological follow-up as well. The median follow-up period was 82 months (range 6-202). RESULTS A total of 136 patients (M:F = 73:63) with a mean age of 62 years (range; 21-93) was observed. Seventy-four patients (54.4%) received neoadjuvant therapy (NT), 62 patients (45.6%) received primary surgery (PS). When receiving NT, patients with high-risk STS had a lower risk to develop distant metastasis (p = 0.025). Age, histological type, tumor size and surgical margins (R0 vs. R1) had no influence on any survival rates. There was an association between NT and the occurrence of postoperative complications (p = 0.001). The 5-year local recurrence free survival (LRFS), metastasis free survival (MFS), disease free survival (DFS) and overall survival (OS) rate of the whole cohort was 89.9%, 77.0%, 70.6% and 72.6%; whereas the 5-year LRFS, MFS, DFS and OS rate was 90.5%, 67.2%, 64.1% and 62.8% for the NT group and 89.5%, 88.3%. 78.4% and 83.8% for the PS group. CONCLUSIONS Multimodal treatment strategies in patients with STS of extremities lead to excellent oncological outcomes. Patients with high-risk STS had a significantly better MFS when receiving NT than patients with low-risk STS. NT was associated with a higher probability of postoperative but well-manageable complications.
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Affiliation(s)
- Miriam Rauch
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Sabine Semrau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Alexander Willner
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Oliver Ott
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
| | - Roland S. Croner
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany;
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
| | - Katja Fechner
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
- Mannheim University Medical Center, Division of Surgical Oncology, Department of Surgery, University of Heidelberg, 68167 Mannheim, Germany
- Correspondence: ; Tel.: +49-621-383-3921; Fax: +49-621-383-1479
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13
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Vassos N, Perrakis A, Hohenberger W, Croner RS. Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST). J Clin Med 2021; 10:jcm10194459. [PMID: 34640476 PMCID: PMC8509470 DOI: 10.3390/jcm10194459] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. METHODS We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12-140). RESULTS A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42-77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5-13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. CONCLUSION The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.
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Affiliation(s)
- Nikolaos Vassos
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-621-383-3921; Fax: +49-621-383-1479
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
| | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Roland S. Croner
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
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14
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Callegaro D, Barretta F, Swallow CJ, Strauss DC, Bonvalot S, Honorè C, Stoeckle E, van Coevorden F, Haas R, Rutkowski P, Schrage Y, Fairweather M, Conti L, Vassos N, Gladdy RA, Ng D, van Houdt WJ, Miceli R, Raut CP, Gronchi A. Longitudinal prognostication in retroperitoneal sarcoma survivors: Development and external validation of two dynamic nomograms. Eur J Cancer 2021; 157:291-300. [PMID: 34555648 DOI: 10.1016/j.ejca.2021.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to create and validate dynamic nomograms to predict overall survival (OS) and disease-free survival (DFS) at different time points during follow-up in patients who had undergone resection of primary retroperitoneal sarcoma (RPS). METHODS Patients with primary RPS operated upon between 2002 and 2017 at four and six referral centres comprised the development and external validation cohorts, respectively. Landmark analysis and multivariable Cox models were used to develop dynamic nomograms. Variables were selected using two backward procedures based on the Akaike information criterion. The prediction window was fixed at 5 years. Nomogram performances were tested in terms of calibration and discrimination on the development and validation cohorts. RESULTS Development and validation cohorts totalled 1357 and 487 patients (OS analysis), and 1309 and 452 patients (DFS analysis), respectively. The final OS model included age, landmark time (TLM), tumour grade, completeness of resection and occurrence of local/distant recurrence. The final DFS model included TLM, histologic subtype, tumour size, tumour grade, multifocality and the interaction terms between TLM and size, grade and multifocality. For OS, Harrell C indices were higher than 0.7 in both cohorts, indicating very good discriminative capability. For DFS, Harrell C indices were between 0.64 and 0.72 in the development cohort and 0.62 and 0.68 in the validation cohort. Calibration plots showed good agreement between predicted and observed outcomes. CONCLUSION Validated nomograms are available to predict the 5-year OS and DFS probability at different time points throughout the first 5 years of follow-up in RPS survivors.
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Affiliation(s)
- Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Francesco Barretta
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dirk C Strauss
- Department of General Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Sylvie Bonvalot
- Department of Surgery, Institute Curie, PSL University, Paris, France
| | - Charles Honorè
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | | | - Frits van Coevorden
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rick Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Yvonne Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lorenzo Conti
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nikolaos Vassos
- Department of General Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Rebecca A Gladdy
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Deanna Ng
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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15
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Bdeir M, Vassos N, Darwich A, Weis CA, Gravius S, Renker E. [Solitary locoregional metastasis of an undifferentiated pleomorphic sarcoma in the M. quadratus femoris]. Orthopade 2021; 50:489-492. [PMID: 33733296 PMCID: PMC8189966 DOI: 10.1007/s00132-021-04093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
Das undifferenzierte pleomorphe Sarkom („undifferentiated pleomorphic sarcoma“ [UPS]) gehört zur Gruppe der Weichteilsarkome und macht fast 10 % aller Weichteilsarkome aus. Der Fall eines 49-jährigen Patienten wird vorgestellt, bei dem die kompartmentorientierte Resektion eines primären UPS im linken Musculus gluteus maximus mit adjuvanter Radiotherapie (60 Gy) durchgeführt wurde. Im Rahmen der Tumornachsorge (3 Jahre später) wurde eine lokoregionäre Metastase an einer ungewöhnlichen Lokalisation im M. quadratus femoris festgestellt, welche mittels einer In-toto-Resektion mit intraoperativer Radiotherapie (10 Gy) behandelt wurde. Der intra- und postoperative Verlauf gestalten sich komplikationslos ohne neurologische Defizite. Im Rahmen der Nachtuntersuchung 6 Monate postoperativ war der Patient tumor- und beschwerdefrei.
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Affiliation(s)
- Mohamad Bdeir
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Nikolaos Vassos
- Chirurgische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Ali Darwich
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Cleo-Aron Weis
- Pathologisches Institut, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Sascha Gravius
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Eva Renker
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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16
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Callegaro D, Raut CP, Ng D, Strauss DC, Honoré C, Stoeckle E, Bonvalot S, Haas RL, Vassos N, Conti L, Gladdy RA, Fairweather M, van Houdt W, Schrage Y, van Coevorden F, Rutkowski P, Miceli R, Gronchi A, Swallow CJ. Has the Outcome for Patients Who Undergo Resection of Primary Retroperitoneal Sarcoma Changed Over Time? A Study of Time Trends During the Past 15 years. Ann Surg Oncol 2020; 28:1700-1709. [PMID: 33073340 DOI: 10.1245/s10434-020-09065-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to investigate changes in treatment strategy and outcome for patients with primary retroperitoneal sarcoma (RPS) undergoing resection at referral centers during a recent period. METHODS The study enrolled consecutive adult patients with primary non-metastatic RPS who underwent resection with curative intent between 2002 and 2017 at 10 referral centers. The patients were grouped into three periods according to date of surgery: t1 (2002-2006), t2 (2007-2011), and t3 (2012-2017). Five-year overall survival (OS), disease-specific survival (DSS), and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were calculated. Multivariable analyses for OS and DSS were performed. RESULTS The study included 1942 patients. The median follow-up period after resection varied from 130 months (interquartile range [IQR], 124-141 months) in t1 to 37 months (IQR, 35-39 months) in t3. The 5-year OS was 61.2% (95% confidence interval [CI], 56.4-66.3%) in t1, 67.0% (95 CI, 63.2-71.0%) in t2, and 71.9% (95% CI, 67.7-76.1%) in t3. The rate of macroscopically incomplete resection (R2) was 7.1% in t1 versus 4.7% in t3 (p = 0.066). The median number of resected organs increased over time (p < 0.001). In the multivariable analysis resection during t3 was associated with better OS and DSS. The 90-day postoperative mortality improved over time (4.3% in t1 to 2.3% in t3; p = 0.031). The 5-year CCI of LR and DM did not change significantly over time. CONCLUSIONS The long-term survival of patients who underwent resection for primary RPS has increased during the past 15 years. This increased survival is attributable to better patient selection for resection, quality of surgery, and perioperative patient management.
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Affiliation(s)
- Dario Callegaro
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chandrajit P Raut
- Department of Surgery, Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Deanna Ng
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dirk C Strauss
- Sarcoma Unit, Department of General Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Charles Honoré
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | | | | | - Rick L Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nikolaos Vassos
- Sarcoma Unit, Department of General Surgery, Royal Marsden NHS Foundation Trust, London, UK.,Division of Surgical Oncology, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lorenzo Conti
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rebecca A Gladdy
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mark Fairweather
- Department of Surgery, Dana-Farber Cancer Institute, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Winan van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Yvonne Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits van Coevorden
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada.
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17
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Vassos N, Perrakis A, Schmid A, Croner RS, Gruetzmann R, Agaimy A. Diffuse Neuromatosis of Intrahepatic and Extrahepatic Bile Ducts as a Rare Cause of Jaundice. Visc Med 2020; 37:226-232. [PMID: 34250082 DOI: 10.1159/000510486] [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: 05/10/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neuroma of the biliary tree is extremely rare with no more than 100 cases reported so far. They mostly present with obstructive jaundice and have been commonly described after surgery or abdominal trauma. Although involvement of the extrahepatic bile duct is far more common, occurrence in the intrahepatic ducts has not so far been reported. Case Report We describe 3 cases of diffuse biliary tree neuroma affecting 3 females aged 53-68 years. None had a history of neurofibromatosis type1. All presented with progressive obstructive jaundice with no evidence of gallstones. A history of previous surgery was noted in 2 patients. Initial impression on clinical and imaging examination was highly suspicious for bile duct carcinoma in 2 patients. Histology showed diffuse neuromatous proliferation replacing and thickening the bile duct walls. The third patient had concurrent neuroma and recurrent cholangiocarcinoma causing great clinical confusion as initial biopsy showed only benign neuroma, but CA 19-9 was steadily increasing, necessitating a second biopsy which then confirmed recurrent carcinoma. Conclusion This uncommon cause of long-distance bile duct stenosis and progressive jaundice should be included in the differential diagnosis of bile duct neoplasms, in particular when there is a previous surgical history in this abdominal region.
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Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany.,Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | | | - Axel Schmid
- Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Gruetzmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany
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18
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Vassos N, Brunner M, Perrakis A, Göhl J, Grützmann R, Hohenberger W, Croner RS. Oncological outcome after hyperthermic isolated limb perfusion for primarily unresectable versus locally recurrent soft tissue sarcoma of extremities. Surg Oncol 2020; 35:162-168. [PMID: 32882523 DOI: 10.1016/j.suronc.2020.08.010] [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: 04/22/2020] [Revised: 07/08/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The management of locally advanced extremity soft tissue sarcomas, particularly in terms of a limb salvage strategy, represents a challenge, especially in recurrent tumors. In the context of a patient-tailored multimodal therapy, hyperthermic isolated limb perfusion (ILP) is a promising limb-saving treatment option. We report the outcome of patients with primarily irresectable and locally recurrent soft tissue sarcoma (STS) treated by ILP. PATIENTS AND METHODS Data about patient demographics, clinical und histopathological characteristics, tumor response, morbidity and oncological outcome of all patients with STS, who underwent an ILP at our institution in a 10-year period, were retrospectively detected and analyzed. RESULTS The cohort comprised 30 patients. Two patients were treated with ILP for palliative tumor control, 13 patients because of a local recurrent soft tissue sarcoma (rSTS) and 15 patients because of primarily unresectable soft tissue sarcoma (puSTS). 25 of the 28 patients with curative intention received surgery after ILP (11 pts with rSTS and 14 pts with puSTS). Histopathologically we observed complete response in 6 patients (24%) and partial responses in 19 patients (76%) with a significant better remission in patients with puSTS (p = 0,043). Limb salvage rate was 75%. Mean follow-up was 69 months [range 13-142 months]. Seven (7/11; 64%) patients with rSTS and one (1/14; 7%) patient with puSTS developed local recurrence after ILP and surgery, whereas eight (8/13; 62%) rSTS patients and seven (7/15; 47%) puSTS patients developed distant metastasis. During follow-up, eight patients (28.5%) died of disease (5/13; 38%) rSTS and 3/15 (20%) puSTS. ILP in the group of previously irradiated sarcoma patients (n = 13) resulted in a limb salvage rate of 69% and was not associated in an increased risk for adverse events. DISCUSSION ILP for advanced extremity STS is a treatment option for both puSTS and rSTS resulting in good local control and should be considered in multimodal management. ILP is also a good option for patients after radiation history.
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Affiliation(s)
- N Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany; Department of Surgery, University Hospital Erlangen, Erlangen, Germany.
| | - M Brunner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - A Perrakis
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - J Göhl
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - W Hohenberger
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
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19
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Lochner J, Menge F, Vassos N, Hohenberger P, Kasper B. Prognosis of Patients with Metastatic Soft Tissue Sarcoma: Advances in Recent Years. Oncol Res Treat 2020; 43:613-619. [PMID: 32854101 DOI: 10.1159/000509519] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 04/22/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the prognosis of patients with metastatic soft tissue sarcomas (STS) and to define prognostic indicators for overall survival (OS). METHODS All patients who were treated at the Sarcoma Unit at the Mannheim University Medical Center between 2010 and 2016 and who developed metastatic disease deriving from a STS were included in this retrospective analysis. OS was investigated using data from clinical records and German registry offices. Clinical and pathological characteristics were recorded and analyzed. RESULTS A total number of 212 patients developed metastatic disease from STS during that period. Median OS after first documentation of metastatic disease was 24 months (95% CI 21-33). 1-, 2-, and 5-year OS rates were 70.0% (95% CI 64-77), 49.9% (95% CI 43-58), and 24.8% (95% CI 19-33), respectively. In multivariate analysis, significant predictors for mortality appeared to be gender, age, location and size of the primary tumor, histology, and disease-free interval. CONCLUSION Being treated in a high-volume STS reference center in Germany, patients with metastatic disease could demonstrate an increased OS compared to former analyses. These data can be used as a benchmark for upcoming studies and highlight that further research on treatment strategies in this rare disease is urgently needed.
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Affiliation(s)
- Jakob Lochner
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Franka Menge
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Nikolaos Vassos
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Peter Hohenberger
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany,
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20
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Augustin M, Wilhelm M, Reichert B, Siegler GM, Dreier J, Rottmann M, Blos M, Kalisch A, Dressler S, Stein H, Koehler J, Papadopoulos T, Meyer C, Hohenberger P, Jakob J, Vassos N, Grehn C, Albrecht C. Radiochemotherapy with gemcitabine as radiosensitizer in patients with soft tissue sarcoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23559 Background: Radiation therapy is an essential backbone of the management of patients (pts.) with soft tissue sarcoma (STS) as part of a multimodal curative or palliative treatment. Concurrent external-beam radiation therapy (EBRT) and chemotherapy with doxorubicin (doxo) and ifosfamide (ifo) may be indicated as well, but is associated with relevant toxicity. Gemcitabine (gem) is a known radiosensitizer and has shown activity in STS. The purpose of this study was to evaluate the efficacy and toxicity of concurrent EBRT and gemcitabine. Methods: A single center, retrospective analysis of 12 patients (pts) with STS treated with concurrent EBRT and gemcitabine from Nov 2017 to Dez 2019 in a neoadjuvant (6 pts) or palliative setting (6 pts). Gemcitabine (gem) was administered with 150-300mg/m2 once weekly for the duration of the EBRT (50 Gy in 25 fractions over 5 weeks). In the neoadjuvant treated group, 4 pts had undifferentiated pleomorphic sarcoma (UPS) G3, 1 leiomyosarcoma (LMS) G2 and 1 retroperitoneal G1 liposarcoma (LPS). The pts. were either not eligible for a neoadjuvant systemic treatment with doxo/ifo or received the EBRT/gem treatment in addition to it. Results: 5/6 pts. with neoadjuvant EBRT/gem had R0 resection and 1/6pt. R1. The IUCC stage was IIIB in 5/6 pts and IB in 1/6 pt. The tumor regression grade (TRG) was > 99% in 3/4 pts. with UPS G3 (75%) and 80% in 1/4 pt. with UPS G3. The TRG for the G2 LMS and for the G1 LPS was 20%. All pts treated in palliative setting had high grade sarcoma and responded to the treatment with partial remission, the 6 months’ local control rate was 83% (5/6 pts) for symptomatic fast growing lesions, 1/6 pt. being in PR at 4 months follow up. The combination treatment was well tolerated with reversible skin toxicity CTCAE grade I. As expected transient thrombocytopenia was observed without limiting effect on the planned EBRT. Conclusions: The combination therapy of EBRT and gemcitabine as sensitizer in pts. with STS is feasible und well tolerated. The treatment is an option for patients not eligible for neoadjuvant systemic treatment with doxo/ifo and in the palliative setting as well. It might be more potent than radiation only in achieving tumor regression and local control for high grade STS.
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Affiliation(s)
- Marinela Augustin
- Paracelsus Medical University, Klinikum Nuernberg, Department of Hematology and Oncology, Nuremberg, Germany
| | - Martin Wilhelm
- Paracelsus Medical University, Department of Hematology and Oncology, Nuremberg, Germany
| | - Bert Reichert
- Paracelsus Medical University, Klinikum Nuernberg, Department of Plastic Surgery, Nuremberg, Germany
| | - Gabriele Margareta Siegler
- Paracelsus Medical University, Klinikum Nuernberg, Department of Hematology and Oncology, Nuremberg, Germany
| | | | - Michael Rottmann
- Paracelsus Medical University, Klinikum Nuernberg, Department of Hematology and Oncology, Nuremberg, Germany
| | - Martin Blos
- Parcelsus Medical University, Klinikum Nuernberg, Department of Hematology and Oncology, Nuremberg, Germany
| | - Alexander Kalisch
- Paracelsus Medical University, Klinikum Nurnberg, Department of Hematology and Oncology, Nuremberg, Germany
| | - Sabine Dressler
- Parcelsus Medical University, Klinikum Nuernberg, Department of Hematology and Oncology, Nuremberg, Germany
| | - Hubert Stein
- Paracelsus Medical University, Klinikum Nuernberg, Department of Surgery, Nuremberg, Germany
| | - Jens Koehler
- Paracelsus Medical University, Klinikum Nuernberg, Department of Surgery, Nuremberg, Germany
| | - Thomas Papadopoulos
- Paracelsus Medical University Nuremberg General Hospital Department of Pathology, Nuremberg, Germany
| | - Christian Meyer
- Paracelsus Medical University Nuremberg General Hospital Department of Pathology, Nuremberg, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Jens Jakob
- Georg-August-University Goettingen, Department of Surgery, Goettingen, Germany
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Centre, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | | | - Clemens Albrecht
- Paracelsus Medical University, Radiation Oncology Clinic, Nuremberg, Germany
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21
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Weigl H, Janssen S, Vassos N, Hohenberger P, Simeonova-Chergou A, Wenz F, Haubenreisser H, Jakob J. Fusion imaging to evaluate the radiographic anatomical relationship between primary tumors and local recurrences in retroperitoneal soft tissue sarcoma. Surg Oncol 2020; 34:109-112. [PMID: 32891314 DOI: 10.1016/j.suronc.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Local recurrence (LR) of retroperitoneal soft tissue sarcoma (RPS) is a common and life-threatening event. The evaluation of the exact anatomical patterns of local recurrence might help to improve local treatment in RPS. METHODS Of our local database we extracted ten patients with LR of RPS with axial MRI and/or CT datasets of the primary tumor (PT) and the LR. Using the Osirix DICOM viewer Version v.3.9.4 64-bit (Pixmeo, Geneva, Switzerland) we performed a three-step fusion algorithm consisting of: a) 3-point co-registration of the axial datasets depicting the PT and the LR using three abdominal landmarks b) re-orientation of the datasets and c) image fusion. We evaluated the feasibility of this technique with regard to categorizing the localization of LR as within or distant from the PT. RESULTS Fusion imaging was feasible in seven out of ten patients. In the other three patients anatomical shifting of organs after surgery led to a relevant mismatch of anatomical landmarks and impeded interpretation of the fused images. In five of seven patients with successful fusion imaging, local recurrences were located within the anatomical borders of the primary tumor, in two out of seven patients local recurrences were distant to the primary. CONCLUSIONS Fusion imaging of primary tumors and local recurrences is feasible in most patients with RPS. Most local recurrences occurred within the anatomical localization of the primary tumor. For further investigations validation of the technique in larger patient cohorts is required.
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Affiliation(s)
- Helene Weigl
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sonja Janssen
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; Division of Surgical Oncology & Thoracic Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anna Simeonova-Chergou
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Frederik Wenz
- University Medical Center Freiburg, Freiburg, Germany
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Jens Jakob
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany.
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22
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Weise F, Vieth M, Reinhold D, Haybaeck J, Goni E, Lippert H, Ridwelski K, Lingohr P, Schildberg C, Vassos N, Kruschewski M, Krasniuk I, Grimminger PP, Waidmann O, Peitz U, Veits L, Kreuser N, Lang H, Bruns C, Moehler M, Lordick F, Gockel I, Schumacher J, Malfertheiner P, Venerito M. Gastric cancer in autoimmune gastritis: A case-control study from the German centers of the staR project on gastric cancer research. United European Gastroenterol J 2019; 8:175-184. [PMID: 32213076 PMCID: PMC7079279 DOI: 10.1177/2050640619891580] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives Patients with autoimmune gastritis (AIG) are reported to have an increased
risk of developing gastric cancer (GC). In this study, we assess the
characteristics and outcomes of GC patients with AIG in a multicenter
case-control study. Methods Between April 2013 and May 2017, patients with GC, including cancers of the
esophagogastric junction (EGJ) Siewert type II and III, were recruited.
Patients with histological characteristics of AIG were identified and
matched in a 1:2 fashion for age and gender to GC patients with no AIG.
Presenting symptoms were documented using a self-administered
questionnaire. Results Histological assessment of gastric mucosa was available for 572/759 GC
patients. Overall, 28 (4.9%) of GC patients had AIG (67 ± 9 years,
female-to-male ratio 1.3:1). In patients with AIG, GC was more likely to be
localized in the proximal (i.e. EGJ, fundus, corpus) stomach (odds ratio
(OR) 2.7, 95% confidence interval (CI) 1.0–7.1). In GC patients with AIG,
pernicious anemia was the leading clinical sign (OR 22.0, 95% CI 2.6–187.2),
and the most common indication for esophagogastroduodenoscopy (OR 29.0, 95%
CI 7.2–116.4). GC patients with AIG were more likely to present without
distant metastases (OR 6.2, 95% CI 1.3–28.8) and to be treated with curative
intention (OR 3.0, 95% CI 1.0–9.0). The five-year survival rates with 95% CI
in GC patients with and with no AIG were 84.7% (83.8–85.6) and 53.5%
(50.9–56.1), respectively (OR 0.25, 95% CI 0.08–0.75,
p = 0.001). Conclusions Pernicious anemia leads to earlier diagnosis of GC in AIG patients and
contributes significantly to a better clinical outcome.
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Affiliation(s)
- Friederike Weise
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Dirk Reinhold
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Johannes Haybaeck
- Department of Pathology, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Institute of Pathology, Medical University of Graz, Graz, Austria.,Department of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabetta Goni
- Department of Internal Medicine II, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Hans Lippert
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Karsten Ridwelski
- Department of General and Visceral Surgery, Klinikum Magdeburg GmbH, Magdeburg, Germany
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Claus Schildberg
- Department of General and Visceral Surgery, Pius Klinikum, University Hospital of Visceral Surgery, Oldenburg, Germany
| | - Nikolaos Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Kruschewski
- Department of General and Visceral Surgery, Klinikum Frankfurt (Oder), Germany
| | - Iurii Krasniuk
- Department of General, Visceral and Thoracic Surgery, Städtisches Klinikum Solingen GmbH, Solingen, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Oliver Waidmann
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ulrich Peitz
- Department of Gastroenterology, Raphaelsklinik, Münster, Germany
| | - Lothar Veits
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Nicole Kreuser
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Christiane Bruns
- Department of General, Visceral and Tumor Surgery, University Hospital Cologne, Cologne, Germany
| | - Markus Moehler
- Department of Internal Medicine I, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Department of Internal Medicine II, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
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23
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Götzl R, Sterzinger S, Semrau S, Vassos N, Hohenberger W, Grützmann R, Agaimy A, Arkudas A, Horch RE, Beier JP. Patient's quality of life after surgery and radiotherapy for extremity soft tissue sarcoma - a retrospective single-center study over ten years. Health Qual Life Outcomes 2019; 17:170. [PMID: 31703704 PMCID: PMC6842193 DOI: 10.1186/s12955-019-1236-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023] Open
Abstract
Background and objectives The purpose of this study is to analyze major complication rates and different aspects of health-related quality of life (HRQoL) in extremity soft tissue sarcoma (STS) patients treated with or without radio (chemo) therapy and surgery. Methods We performed a retrospective analysis of all patients who underwent Extremity STS excision from 2004 to 2014 (182 patients included). Patients’ data were collected from patients’ records. HRQoL was assessed by using EORTC QLQ-C30. Results A total of 182 patients underwent sarcoma resection. After neoadjuvant radiochemotherapy (RCT), the major-complication rate amounted to 28% (vs. 7%, no radiotherapy, p < 0.001). Major-complication rates after adjuvant radiotherapy (RT) occurred in 8% (vs. 7%, no radiotherapy, p = 0.265). Comparison QoL scores between treating with neoadjuvant RCT or without RT revealed significant worse scores with neoadjuvant RCT. Further stratification of disease control of these patients showed significant reduced scores in the group of disease-free patients with neoadjuvant RCT compared to irradiated disease-free patients. Discussion To date, there have only been a few investigations of QoL in STS. Retrospective study on quality of life have limitations, like a lack of baseline evaluation of QoL. Patient candidated to radiation therapy could have had worse QoL baseline due to more advanced disease. Disease status of the patients who answered the questionnaires could have been an influence of QoL and we could show reduced scores in the group of disease-free patients with neoadjuvant RCT, but not for the patients with recurrence or metastasis, so it is very hard to discriminate whether radiation therapy could really have an impact or not. Conclusion This study might assist in further improving the understanding of QoL in STS patients and may animate for prospective studies examining the oncological therapies impact on HRQoL.
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Affiliation(s)
- Rebekka Götzl
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany. .,Present Address: Department of Plastic Surgery, Hand and Burn Surgery, University Hospital of Aachen, RWTH University of Aachen, Aachen, Germany.
| | - Sebastian Sterzinger
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Werner Hohenberger
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Justus P Beier
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Present Address: Department of Plastic Surgery, Hand and Burn Surgery, University Hospital of Aachen, RWTH University of Aachen, Aachen, Germany
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Perrakis A, Vassos N, Weber K, Matzel KE, Papadopoulos K, Koukis G, Perrakis E, Croner RS, Hohenberger W. Introduction of complete mesocolic excision with central vascular ligation as standardized surgical treatment for colon cancer in Greece. Results of a pilot study and bi-institutional cooperation. Arch Med Sci 2019; 15:1269-1277. [PMID: 31572473 PMCID: PMC6764310 DOI: 10.5114/aoms.2018.80040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/28/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Complete mesocolic excision (CME) is generally accepted as state of the art in colon cancer surgery. However, the long-term impact of CME has not been systematically examined. Therefore cohort studies might be a possible way to clarify any differences between conventional resections and CME. Following bilateral cooperation between the Department of Surgery/University Hospital of Erlangen and the 1st Surgical Department of the General Hospital of Nikaia/Piraeus, including teaching activities for introduction of CME, a cohort study was performed, considering surgical quality criteria and clinical outcome. MATERIAL AND METHODS All patients with colon carcinomas (CME group, n = 31) referred to the 1st Surgical Department of General Hospital, Nikaia/Piraeus, Greece for surgery from January 2012 to December 2013 were prospectively analyzed and compared with patients who underwent conventional surgery for colon cancer between January 2008 and December 2011 (non-CME group, n = 35). Patients' follow-up was at least 48 months. RESULTS There were significantly better results in terms of lymph node yield (CME group: 29.6 vs. non-CME group: 17.85; p < 0.001) and lymph node ratio (LNR) (CME group: 0.12 vs. non-CME group: 0.24; p < 0.001) and recurrence-free survival in favor of the CME group (CME group: n = 0 vs. non-CME group: n = 5) without any increase in surgical morbidity (CME group: n = 6 vs. non-CME group: n = 11; p = 0.10). CONCLUSIONS Complete mesocolic excision appears to offer a superior oncological result without any increase of postoperative morbidity and mortality. Furthermore, CME represents a surgical technique which can be established in a surgical department after previous teaching without increasing the postoperative complication rate.
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Affiliation(s)
- Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Klaus Weber
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Klaus E. Matzel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Georgios Koukis
- 1 Surgical Department, General Hospital of Piraeus/Nikaia, Piraeus/Nikaia, Greece
| | - Evangelos Perrakis
- 1 Surgical Department, General Hospital of Piraeus/Nikaia, Piraeus/Nikaia, Greece
| | - Roland S. Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
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25
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Wiesmueller F, Agaimy A, Perrakis A, Arkudas A, Horch RE, Grützmann R, Vassos N. Dermatofibrosarcoma protuberans: surgical management of a challenging mesenchymal tumor. World J Surg Oncol 2019; 17:90. [PMID: 31138233 PMCID: PMC6540534 DOI: 10.1186/s12957-019-1627-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade malignant mesenchymal tumor of the soft tissue, characterized by slow infiltrative growth and common local recurrence, with rare distant metastases. Patients and methods We present a retrospective study of nineteen patients who were diagnosed with DFSP and operated at our institution in > 10-year period. We examined the clinicopathological parameters with special emphasis on the margin status regarding the clinical outcome and the follow-up. Results A total of eight cases underwent re-excision at our institution following primary excision or incisional biopsy performed at a different institution. Seven cases received excision after incisional biopsy at our institution. Four patients developed recurrent disease following primary excision with histological R0 margins at other institutions and received re-excision at our institution. All excisions at our institution resulted in R0 margins with no recurrence recorded at last follow-up (6 to 175; mean 84 months). The mean margin for those who received resection at our institution was 1.67 cm. Negative margins upon primary excision were achieved using a mean margin width of 2.04 cm. Most common tumor localization was the trunk (10 cases). Conclusion Awareness of this rare entity is important for a prompt diagnosis and a proper management of the disease. The greatest clinical challenge in the management of DFSP is achieving local control. Complete excision of the tumor with surgical margin widths of at least 2 cm is recommended.
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Affiliation(s)
- Felix Wiesmueller
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.,Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany. .,Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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Heinrichs SKM, Hess T, Becker J, Hamann L, Vashist YK, Butterbach K, Schmidt T, Alakus H, Krasniuk I, Höblinger A, Lingohr P, Ludwig M, Hagel AF, Schildberg CW, Veits L, Gyvyte U, Weise K, Schüller V, Böhmer AC, Schröder J, Gehlen J, Kreuser N, Hofer S, Lang H, Lordick F, Malfertheiner P, Moehler M, Pech O, Vassos N, Rodermann E, Izbicki JR, Kruschewski M, Ott K, Schumann RR, Vieth M, Mangold E, Gasenko E, Kupcinskas L, Brenner H, Grimminger P, Bujanda L, Sopeña F, Espinel J, Thomson C, Pérez-Aísa Á, Campo R, Geijo F, Collette D, Bruns C, Messerle K, Gockel I, Nöthen MM, Lippert H, Ridwelski K, Lanas A, Keller G, Knapp M, Leja M, Kupcinskas J, García-González MA, Venerito M, Schumacher J. Evidence for PTGER4, PSCA, and MBOAT7 as risk genes for gastric cancer on the genome and transcriptome level. Cancer Med 2018; 7:5057-5065. [PMID: 30191681 PMCID: PMC6198243 DOI: 10.1002/cam4.1719] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022] Open
Abstract
Genetic associations between variants on chromosome 5p13 and 8q24 and gastric cancer (GC) have been previously reported in the Asian population. We aimed to replicate these findings and to characterize the associations at the genome and transcriptome level. We performed a fine‐mapping association study in 1926 GC patients and 2012 controls of European descent using high dense SNP marker sets on both chromosomal regions. Next, we performed expression quantitative trait locus (eQTL) analyses using gastric transcriptome data from 143 individuals focusing on the GC associated variants. On chromosome 5p13 the strongest association was observed at rs6872282 (P = 2.53 × 10−04) and on chromosome 8q24 at rs2585176 (P = 1.09 × 10−09). On chromosome 5p13 we found cis‐eQTL effects with an upregulation of PTGER4 expression in GC risk allele carrier (P = 9.27 × 10−11). On chromosome 8q24 we observed cis‐eQTL effects with an upregulation of PSCA expression in GC risk allele carrier (P = 2.17 × 10−47). In addition, we found trans‐eQTL effects for the same variants on 8q24 with a downregulation of MBOAT7 expression in GC risk allele carrier (P = 3.11 × 10−09). In summary, we confirmed and refined the previously reported GC associations at both chromosomal regions. Our data point to shared etiological factors between Asians and Europeans. Furthermore, our data imply an upregulated expression of PTGER4 and PSCA as well as a downregulated expression of MBOAT7 in gastric tissue as risk‐conferring GC pathomechanisms.
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Affiliation(s)
- Sophie K M Heinrichs
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Timo Hess
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Jessica Becker
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Lutz Hamann
- Institute for Microbiology and Hygiene, Charité University Medical Center Berlin, Berlin, Germany
| | - Yogesh K Vashist
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja Butterbach
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hakan Alakus
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Iurii Krasniuk
- Department of General and Visceral Surgery, Municipal Hospital Solingen, Solingen, Germany
| | - Aksana Höblinger
- Department of Internal Medicine I, Community Hospital Mittelrhein, Koblenz, Germany
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Bonn, Germany
| | - Monika Ludwig
- Association for Oncological Studies (Gefos), Dortmund, Germany
| | - Alexander F Hagel
- Department of Medicine I, Gastroenterology and Interventional Endoscopy, University of Erlangen, Erlangen, Germany
| | | | - Lothar Veits
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Ugne Gyvyte
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katharina Weise
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Vitalia Schüller
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany.,Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Anne C Böhmer
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Julia Schröder
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Jan Gehlen
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Nicole Kreuser
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Hofer
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Hospital of Leipzig, Leipzig, Germany
| | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Markus Moehler
- First Medical Clinic and Policlinic, University Medical Center, University of Mainz, Mainz, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen, Erlangen, Germany
| | - Ernst Rodermann
- Association of Medical Practices in Hematology and Internal Oncology, Troisdorf, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Kruschewski
- Department of General and Visceral Surgery, Hospital Frankfurt Oder, Frankfurt Oder, Germany
| | - Katja Ott
- Department of General, Visceral and Thorax Surgery, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Ralf R Schumann
- Institute for Microbiology and Hygiene, Charité University Medical Center Berlin, Berlin, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Elisabeth Mangold
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Evita Gasenko
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | - Limas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Luis Bujanda
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Federico Sopeña
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jesús Espinel
- Department of Gastroenterology, Complejo Hospitalario, León, Spain
| | - Concha Thomson
- Department of Gastroenterology, Hospital Obispo Polanco, Teruel, Spain
| | | | - Rafael Campo
- Department of Gastroenterology, Hospital Parc Tauli, Sabadell, Spain
| | - Fernando Geijo
- Department of Gastroenterology, Hospital Clínico Universitario, Salamanca, Spain
| | - Daniela Collette
- Association of Medical Practices in Hematology and Oncology, Dortmund, Germany
| | - Christiane Bruns
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Katharina Messerle
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Hans Lippert
- An-Institute for Quality Control in Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Karsten Ridwelski
- An-Institute for Quality Control in Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Department of Surgery, Hospital Magdeburg, Magdeburg, Germany
| | - Angel Lanas
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Gisela Keller
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Michael Knapp
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | - Juozas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Maria A García-González
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.,Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Johannes Schumacher
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany.,Center of Human Genetics, University Hospital Marburg, Marburg, Germany
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Mekras A, Krenn V, Perrakis A, Croner RS, Kalles V, Atamer C, Grützmann R, Vassos N. Gastrointestinal schwannomas: a rare but important differential diagnosis of mesenchymal tumors of gastrointestinal tract. BMC Surg 2018; 18:47. [PMID: 30045739 PMCID: PMC6060462 DOI: 10.1186/s12893-018-0379-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 07/21/2017] [Accepted: 07/12/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Schwannomas of gastrointestinal tract are rare, mostly benign and notably different neoplasms from conventional schwannomas that arise in soft tissue or the central nervous system. These tumors are of clinical importance since they should always be considered in the differential diagnosis of submucosal lesions of gastrointestinal tract. METHODS Seven patients with a pathologically proven gastrointestinal schwannoma were identified in our series of mesenchymal tumors and reviewed retrospectively. Clinicopathological and immunohistochemical parameters along with the follow-up results were analysed. RESULTS The series included two males and five females, with a mean age 69 years (range, 39-81). Most patients were asymptomatic on presentation, except for two patients with abdominal pain. In the other cases (n = 5), the tumor was an incidental finding during other medical, imaging or surgical procedures. The tumors were located in the stomach (n = 4) and in the small intestine (n = 3) with an average size of 29 mm (range, 12-70). A preoperative diagnosis was achieved only in one case with a CT-guided core biopsy. Otherwise the clinical, intraoperative, endoscopic or radiological findings were unspecific. Patients with gastric tumor underwent either laparoscopic (n = 2) or open (n = 2) gastric wedge resection of the tumor; in the cases of intestinal tumor (n = 3) a segmentectomy was performed. Pathological examination revealed solid homogenous tumors, which were highly cellular and composed of spindle cells with positive staining for S100 protein, and confirmed the diagnosis of schwannoma. All tumors were negative for c-Kit, smooth muscle actin, desmin and DOG-1 and showed very low proliferation index. There were negative resection margins and no malignant variants were recognized. At an average follow-up of 60 months (range, 24-185) all patients were free of disease with no signs of recurrence or metastases and acceptable gastrointestinal function. CONCLUSIONS Schwannomas are rare, slow-growing and mostly asymptomatic gastrointestinal mesenchymal tumors. They are difficult to be diagnosed preoperatively as endoscopic and radiological findings are nonspecific but histological and immunohistochemical features are of paramount importance to differentiate between benign and malignant schwannomas, or other spindle cell sarcomas. The treatment of choice is complete surgical excision without a conclusive preoperative diagnosis, and the long-term outcome is excellent as these lesions are mostly benign.
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Affiliation(s)
- Alexandros Mekras
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Vasileios Kalles
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Cem Atamer
- Department of Surgery, S. Elisabeth Hospital, Bernkastel/Wittlich, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
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Perrakis A, Vassos N, Grützmann R, Croner RS. What is Changing in Indications and Treatment of Focal Nodular Hyperplasia of the Liver. Is There Any Place for Surgery? Ann Hepatol 2017; 16:333-341. [PMID: 28425402 DOI: 10.5604/16652681.1235475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Focal nodular hyperplasia (FNH) is a common benign liver tumor, which occurs in the vast majority of the cases in young women. FNH represents a polyclonal lesion characterized by local vascular abnormalities and is a truly benign lesion without any potential for malignant transformation. A retrospective single institution analysis of 227 FNH patients, treated from 1990 to 2016 and a review of studies reporting surgical therapy of overall 293 patients with FNH was performed. Indications for resection with a focus on diagnostic workup, patient selection, surgical mode and operative mortality and morbidity have been analysed. Ninety three patients underwent elective hepatectomy and 134 patients observation alone, where median follow-up was 107 months. Postoperative complications were recorded in 14 patients, 92% of patients reported an improvement with respect to their symptoms. Overall among 293 patients underwent surgery in the series, included to this review, there was a morbidity of 13%, where median follow-up was 53 months. Systematic follow-up remains the gold standard in asymptomatic patients with FNH. However elective surgery should be considered in symptomatic patients, in those with marked enlargement and in case of uncertainty of diagnosis. Surgery for FNH is a safe procedure with low morbidity and very good long term results as far as quality of life after surgery is concerned and surely an integral part of the modern management of FNH.
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Affiliation(s)
- Aristotelis Perrakis
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr. Erlangen, Germany
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Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Perrakis E, Perrakis A. Incarcerated recurrent inguinal hernia containing an acute appendicitis (Amyand hernia): an extremely rare surgical situation. Arch Med Sci 2017; 13:702-704. [PMID: 28507592 PMCID: PMC5420623 DOI: 10.5114/aoms.2016.60403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/31/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Mueller C, Croner R, Klein P, Grützmann R, Vassos N. Primary and recurrent sporadic desmoids: Prognostic factors influencing recurrence-free survival after complete gross resection. Int J Surg 2016; 31:63-70. [PMID: 27262879 DOI: 10.1016/j.ijsu.2016.05.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/18/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is continuing controversy over the significance of prognostic factors in sporadic desmoid-type fibromatosis (DF). Further, only limited data is available in the literature concerning second recurrence in patients with recurrent DF. The purpose of this study was to identify prognostic factors influencing recurrence-free survival (RFS) and to determine rates of local recurrence (LR) in patients with primary and recurrent DF. METHODS Fifty-three consecutive patients with DF who underwent surgery at a single institution were identified. As a result of strict exclusion criteria, a homogeneous cohort of thirty-two patients who received macroscopically complete resection was included in this study and split into a primary (PG) and recurrent disease (RG) group. Clinicopathological parameters and immunohistochemical markers were retrospectively and independently analyzed in both groups. RESULTS The local recurrence rate was 35% for the PG and 33% for the RG. The PG's calculated median time to relapse was 17 months, and the RG's was 29 months. The estimated 1-, 5-, and 8-year RFS rates for the PG were 75%, 64%, and 55% while the corresponding RFS rates for the RG were 69%, 69%, and 52%, respectively. In primary disease, extraabdominal tumor location was the only significant adverse prognostic factor associated with worse RFS (p = 0.008). Whereas in recurrent disease, age ≥40 yrs (p = 0.022) and R0 margin status (p = 0.049) correlated with a significantly better outcome. CONCLUSION Recurrence in primary and recurrent DF is characterized by different predictive factors and benefits from distinct therapeutic strategies. Immunohistochemical markers are valuable tools in the diagnosis of DF, although have limited potential in predicting the outcome.
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Affiliation(s)
- Christian Mueller
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany; Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Roland Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Peter Klein
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany.
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Perrakis A, Stirkat F, Croner RS, Vassos N, Raptis D, Yedibela S, Hohenberger W, Müller V. Prognostic and diagnostic value of procalcitonin in the post-transplant setting after liver transplantation. Arch Med Sci 2016; 12:372-9. [PMID: 27186183 PMCID: PMC4848368 DOI: 10.5114/aoms.2016.59264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess the diagnostic accuracy of procalcitonin (PCT) as a marker for complications and as a prognostic factor for mortality after liver transplantation. MATERIAL AND METHODS Liver transplant patients between January 2007 and April 2011 were prospectively included in the study. Procalcitonin serum concentration was recorded before, 6 h after reperfusion and then daily. Postoperative clinical course was prospectively analyzed from admission to discharge. Main surgical data such as operating procedure, type of reperfusion, operating and ischemic times, high urgency (HU) status and MELD score at the time of transplantation were also recorded. RESULTS Sixteen patients with initial PCT > 5 ng/ml suffered ≥ 1 complication (p = 0.03). However, there was no association between the level of the 1(st) peak PCT and the further postoperative course or the occurrence of complications. Patients in whom a 2(nd) PCT peak occurred had a significantly higher risk for a complicated course, for a complicated sepsis course and for mortality (p < 0.0001). Warm ischemic time over 58 min, operating time over 389 min and HU status were significant independent factors for a complicated postoperative course (p < 0.001, p < 0.001 and p = 0.03 respectively). CONCLUSIONS Based on our results, we believe that PCT course and the occurrence of a 2(nd) peak seem to possess important diagnostic and prognostic power in the post-transplant setting after liver transplantation.
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Affiliation(s)
| | - Falk Stirkat
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Dimitrios Raptis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Süleyman Yedibela
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Volker Müller
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
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Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Salpiggidis C, Perrakis E, Perrakis A. Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia. Arch Med Sci 2016; 12:469-72. [PMID: 27186195 PMCID: PMC4848376 DOI: 10.5114/aoms.2016.59273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | - Evangelos Perrakis
- Department of Surgery, Western Attica General Hospital, Athens, Greece
- Department of Surgery, General Hospital Nikea, Piraeus, Greece
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Vassos N, Agaimy A, Hohenberger W, Croner RS. Management of liver metastases of gastrointestinal stromal tumors (GIST). Ann Hepatol 2016; 14:531-9. [PMID: 26019040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Liver metastases (LM) are crucial prognostic manifestation of gastrointestinal stromal tumors (GIST). With the advent of tyrosine kinase inhibitors (TKI), management of metastatic GIST has radically changed. Long clinical follow-up provides an increased proportion of GIST patients with LM who are candidates for potentially curative therapy. MATERIAL AND METHODS Patients who underwent treatment for liver metastases of GIST between 2000-2009 in our department were included in the study. Mean follow-up was 84 months (range 40-145) months. In retrospective analysis we investigated clinical, macro-/microscopic and immunohistochemical criteria, surgical, interventional and TKI therapy as well. RESULTS In 87 GIST-patients we identified 25 (29%) patients with metastatic disease. Of these, 12 patients (14%) suffered from LM with a mean age of 60.5 (range, 35-75) years. Primary GIST were located at stomach (n = 4, 33%) or small intestine (n = 8, 67%); all of them expressed CD117 and/or CD34. LM were multiple (83%), distributed in both lobes (67%). They were detected synchronously with primary tumor in 33% and metachronously in 77%. All patients with liver involvement were considered to treatment with TKI. LM were resected (R0) in 4 patients (33%). In recurrent (2/4) and TKI resistant cases, interventional treatment (radiofrequency ablation) and TKI escalation were carried out. During a median follow-up of 84 months (range 30-152), 2 patients died (16.5%) for progressive disease and one patient for other reasons. Nine patients (75%) were alive. CONCLUSION Treatment of LM from GIST needs a multimodal approach. TKI-therapy is required at any case. In case of respectability, surgery must be carried out. In unresectable cases or recurrent/progressive disease, interventional treatment or TKI escalation should be considered. Therefore, these patients need to be treated in experienced centres, where multimodal approaches are established.
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Affiliation(s)
| | - Abbas Agaimy
- Institute of Pathology. University Hospital Erlangen, Germany
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Vassos N, Förtsch T, Aladashvili A, Hohenberger W, Croner RS. Repeated cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with recurrent peritoneal carcinomatosis. World J Surg Oncol 2016; 14:42. [PMID: 26912149 PMCID: PMC4765140 DOI: 10.1186/s12957-016-0804-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/17/2016] [Indexed: 02/08/2023] Open
Abstract
Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the treatment of choice for resectable peritoneal carcinomatosis (PC) and improved the survival of these patients. The situation changes if PC recurs and repeated CRS with HIPEC is considered. The patient selection and outcome of the repeated approach has not been well described. We analyzed our cohort and share the experiences. Methods Ninety-three CRS/HIPEC procedures, performed in 85 patients during the period 2001–2013, were examined in a retrospective analysis. Type of primary, ECOG status, peritoneal cancer index (PCI), completeness of cytoreduction (CC), duration of hospitalization, postoperative morbidity, mortality, and disease-free/overall survival were reviewed. Results Six patients (7 %) underwent a second CRS/HIPEC (median interval between the two procedures: 26 months, range 8–61) including two patients with mesotheliomas, one patient with ovarian adenocarcinoma, one patient with leiomyosarcoma of uterus, one patient with colon adenocarcinoma, and one patient with appendiceal adenocarcinoma. The last two patients underwent a third CRS/HIPEC, 25 and 36 months, after the second procedure. The median PCI was 14 (range, 4–26) during the first and 20 (range, 7–39) during the second CRS/HIPEC of these patients. Completeness of cytoreduction score of 0 (CC-0) was achieved in all first procedures and in 67 % of second procedures (CC-0; n = 4 and CC-1; n = 2). A CC-0 score was possible in both of the third procedures. The mean operating time was 444 min (range, 198–642) and 427 min (range, 239–617) during the first and the second procedure. Median intensive care unit (ICU) was 2 days, and hospital stay after second CRS/HIPEC was 17 days (range, 7–50). The 30-day morbidity after repeated CRS/HIPEC was 33 % (16 % for grade III–IV complications), and there was no 30-day mortality neither after the second nor after the third CRS/HIPEC. Median disease-free interval between first CRS/HIPEC and peritoneal recurrence was 17 months (range, 8–30). Median disease-free survival of 18 months (range, 4–33) was achieved after the second CRS/HIPEC. After a median follow-up of 74 months (range, 39–151), all patients are alive with disease (n = 5) or disease free (n = 1) under chemotherapy. Conclusions In experienced centers, repeated CRS/HIPEC can be performed with safety. Patient selection and correct timing is of particular importance in achieving control of the disease. Repeated CRS/HIPEC should be considered as treatment option for selected patients with recurrent PC.
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Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Thomas Förtsch
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | | | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
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Stubbe F, Agaimy A, Ott O, Lettmaier S, Vassos N, Croner R, Hohenberger W, Fietkau R, Semrau S. Effective local control of advanced soft tissue sarcoma with neoadjuvant chemoradiotherapy and surgery: A single institutional experience. Cancer Radiother 2016; 20:6-13. [DOI: 10.1016/j.canrad.2015.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/22/2015] [Accepted: 05/29/2015] [Indexed: 01/25/2023]
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Vassos N, Raptis D, Lell M, Klein P, Perrakis A, Köhler J, Croner RS, Hohenberger W, Agaimy A. Intra-abdominal localized hyaline-vascular Castleman disease: imaging characteristics and management of a rare condition. Arch Med Sci 2016; 12:227-32. [PMID: 26925142 PMCID: PMC4754385 DOI: 10.5114/aoms.2016.57600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/25/2014] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Dimitrios Raptis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Michael Lell
- Institute of Diagnostic and Interventional Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Peter Klein
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Jens Köhler
- Department of Surgery, Nuremberg Medical Center, Nuremberg, Germany
| | - Roland S. Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
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Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Salpiggidis C, Perrakis E, Perrakis A. Left-sided Gallbladder in the Era of Laparoscopic Cholecystectomy: A Single-center Experience. Am Surg 2015; 81:1249-1252. [PMID: 26736163] [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: 06/05/2023]
Abstract
The malposition of gallbladder under the liver segment III, defined as left-sided gallbladder (LSG), is an unexpected situation for the laparoscopic surgeon. The purpose of this study is to present our experience in treating patients with cholecystitis and LSG discovered incidentally during laparoscopic surgical procedure. Between 1993 and 2009, 5569 patients underwent laparoscopic cholecystectomy in our surgical department. Their records were reviewed and seven patients revealed having LSG (0.12%). Analysis parameters included demographic data, diagnostic methods, mode of surgery, and postoperative outcome. Mean follow-up was 140 months. Of the seven patients, five were women. Mean patient age was 56.7 years. All patients were referred to our department with clinical symptoms of classic cholelithiasis and the diagnosis was established in all of them during surgery. Laparoscopic cholecystectomy was successful in five patients, while in two patients, a conversion to open procedure was needed. A postoperative complication, i.e., biliary leakage was registered in one patient, which was treated successfully. Laparoscopic cholecystectomy is safe even in LSG, but the surgeon must consider the possibility for more anatomical anomalies, adjust the technique of dissection, and must not hesitate, if in doubt, to strive for conversion to open procedure to avoid serious complications.
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Velimezis G, Vassos N, Kapogiannatos G, Koronakis D, Salpiggidis C, Perrakis E, Perrakis A. Left-sided Gallbladder in the Era of Laparoscopic Cholecystectomy: A Single-center Experience. Am Surg 2015. [DOI: 10.1177/000313481508101227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The malposition of gallbladder under the liver segment III, defined as left-sided gallbladder (LSG), is an unexpected situation for the laparoscopic surgeon. The purpose of this study is to present our experience in treating patients with cholecystitis and LSG discovered incidentally during laparoscopic surgical procedure. Between 1993 and 2009, 5569 patients underwent laparoscopic cholecystectomy in our surgical department. Their records were reviewed and seven patients revealed having LSG (0.12%). Analysis parameters included demographic data, diagnostic methods, mode of surgery, and postoperative outcome. Mean follow-up was 140 months. Of the seven patients, five were women. Mean patient age was 56.7 years. All patients were referred to our department with clinical symptoms of classic cholelithiasis and the diagnosis was established in all of them during surgery. Laparoscopic cholecystectomy was successful in five patients, while in two patients, a conversion to open procedure was needed. A postoperative complication, i.e., biliary leakage was registered in one patient, which was treated successfully. Laparoscopic cholecystectomy is safe even in LSG, but the surgeon must consider the possibility for more anatomical anomalies, adjust the technique of dissection, and must not hesitate, if in doubt, to strive for conversion to open procedure to avoid serious complications.
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Affiliation(s)
- Georgios Velimezis
- Department of Surgery, Western Attica General Hospital, Athens, Greece; and
| | - Nikolaos Vassos
- Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | - Evangelos Perrakis
- Department of Surgery, Western Attica General Hospital, Athens, Greece; and
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Vassos N, Lell M, Hohenberger W, Croner R, Agaimy A. 472. Deep-seated huge hibernoma of soft tissue: A rare differential diagnosis of atypical lipomatous tumour/well differentiated liposarcoma. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.460] [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: 10/24/2022] Open
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Vassos N, Agaimy A, Hohenberger W, Croner RS. Coexistence of gastrointestinal stromal tumours (GIST) and malignant neoplasms of different origin: prognostic implications. Int J Surg 2014; 12:371-7. [PMID: 24632413 DOI: 10.1016/j.ijsu.2014.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 03/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Over the past decade, several changes occurred in diagnostics, treatment and understanding of pathogenesis of gastrointestinal stromal tumours (GIST). However, their coexistence with other malignancies of different histogenetic origin remains a challenging issue. METHODS Patients diagnosed with GIST in a 10-years period were identified retrospectively and clinical history and findings thoroughly explored for the presence of associated other malignancies. Follow up data were obtained and analysed for prognostic impact of the concurrent malignancy and/or GIST. RESULTS Thirty seven (27 males, 10 females) of 86 GIST-patients (43%) had another malignancy. Mean age was 70 years. Associated malignancies were gastrointestinal (n = 29; 69%), renal-/urological (n = 5; 12%), haematological (n = 4; 9.5%), cutaneous (n = 3; 7%) and thyroid (n = 1; 2.5%) in origin. Majority of GISTs occurred in stomach (65%) and small intestine (30.6%) and most (78%) were asymptomatic incidental findings during diagnostic or therapeutic procedures for associated malignancies. GIST size ranged from 0.1 cm to 9 cm (mean, 2.2 cm) and all of them had a low (<5/50 HPFs) or no mitotic activity. Thirty-one tumours (84%) were of no/very low/low risk and 6 were of intermediate risk. During follow-up (range 3-160 months, mean; 60 months), one patient suffered from distant metastases of GIST. Seven patients (19%) died of associated malignancies and three patients (8%) of other non-tumour-associated cause, but none died of GIST. CONCLUSION Coexistence of GIST with other malignancies is higher than previously reported and should draw attention of clinicians towards these incidental findings. Prognosis in these patients is usually determined by other malignancy and not significantly influenced by GIST. Therefore treatment algorithms should be focused on prognostically relevant malignancy.
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Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital, Erlangen, Germany.
| | - Abbas Agaimy
- Department of Pathology, University Hospital, Erlangen, Germany
| | | | - Roland S Croner
- Department of Surgery, University Hospital, Erlangen, Germany
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Vassos N, Rau T, Merkel S, Feiersinger F, Geppert CI, Stürzl M, Hohenberger W, Croner RS. Prognostic value of β1 integrin expression in colorectal liver metastases. Int J Clin Exp Pathol 2013; 7:288-300. [PMID: 24427350 PMCID: PMC3885484] [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] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/03/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED Integrins are cell surface adhesion molecules (CAM) that regulate via intercellular and cell-matrix signaling various cellular processes including wound healing, cell differentiation, division, growth, migration and metastatic dissemination. Although a correlation between carcinogenesis and changes in integrin expression, especially β1 integrin, has been reported, its role in colorectal liver metastases remains unclear. This study aimed to evaluate the expression of β1 integrin in colorectal liver metastases and to correlate the pattern of expression with clinicopathological features and to investigate the putative role of β1 integrin expression on survival of these patients. METHODS Formalin-fixed, paraffin-embedded (FFPE) tumor samples of 81 patients who were operated because of colorectal liver metastases without any neoadjuvant therapy were obtained and stained with hematoxylin and eosin (H & E). An immunohistochemical examination was performed using Dako, Peroxidase/DAB kit and a primary monoclonal β1 integrin (CD29, fibronectin receptor subunit beta; ab3167, Abcam plc). β1 integrin expression was evaluated according to the immunoreactive score of Remmele and Stegner and was related with clinicopathological features of prognostic significance and with disease-free and overall survival as well. Statistical analysis was performed using SPSS version 21.0. RESULTS β1 integrin was overexpressed in tumor cells in 37 (48%) patients and in stromal cell in 27 (33%) patients. The β1 expression was not statistically correlated with clinicopathological features of the primary tumors but it was statistically correlated (p=0.03) with the histological grading of liver metastases. Kaplan-Meier survival analysis showed that there is a tendency but no statistically significant correlation in disease-free and overall survival. CONCLUSION Considering that expression of β1 integrin in colorectal liver metastases remains controversial, specially its relation with survival of patients, we showed that the β1 expression represents a reliable prognostic factor regarding the grading of liver metastases of CRC and our findings imply that β1 integrin expression profiles may have further potential in identifying the stage of colorectal liver metastases and being a marker of prognosis in these patients.
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Affiliation(s)
| | - Tilman Rau
- Institute of Pathology, University Hospital ErlangenGermany
| | - Susanne Merkel
- Department of Surgery, University Hospital ErlangenGermany
| | | | | | - Michael Stürzl
- Division of Molecular and Experimental Surgery, University Hospital ErlangenGermany
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Vassos N, Lell M, Hohenberger W, Croner RS, Agaimy A. Deep-seated huge hibernoma of soft tissue: a rare differential diagnosis of atypical lipomatous tumor/well differentiated liposarcoma. Int J Clin Exp Pathol 2013; 6:2178-2184. [PMID: 24133596 PMCID: PMC3796240] [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] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/21/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hibernoma is a rare benign fat-forming soft tissue tumor that differentiates similar to brown fat, hence an origin from remnants of fetal brown adipose tissue has been proposed. Mainly young adults are affected, usually without significant clinical symptoms. MATERIAL AND METHODS We report on four patients with hibernomas, who were treated at our hospital during the last 10 years. The clinicopathologic and immunohistochemical features are presented and treatment and follow-up data discussed. RESULTS Patients were 2 women and 2 men aged 21-67 years (mean: 45 yrs) who presented with a slowly growing, painless mass. The anatomic location was the thigh, upper arm, lateral thoracic wall and paravertebral soft tissue. Two of them were diagnosed preoperatively through a percutaneous core needle biopsy and the other two underwent surgery because of high clinical and radiological suspicion of liposarcoma. The tumor's size ranged from 7 cm to 15.5 cm (mean: 11 cm). All were deep-seated subfascial intramuscular masses. Histologically, all four tumors were of the typical variant. All patients underwent a R0-surgical resection of the tumor and they were recurrence-free at last follow-up (mean: 47 months; range: 25-87). CONCLUSION Hibernoma may present as huge deep intramuscular soft tissue mass in adults, closely mimicking well differentiated liposarcoma and should be considered in the differential diagnosis of fatty soft tissue tumors in any location. Surgical excision is the treatment of choice. The tumor has no malignant or recurrence potential.
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Affiliation(s)
| | - Michael Lell
- Institute of Interventional Radiology, University HospitalErlangen, Germany
| | | | | | - Abbas Agaimy
- Institute of Pathology, University HospitalErlangen, Germany
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Perrakis A, Förtsch T, Del Medico A, Croner R, Vassos N, Yedibela S, Lohmüller C, Zopf S, Hohenberger W, Müller V. Liver Transplantation for Hepatitis B-Induced Liver Disease: Long-Term Outcome and Effectiveness of Antiviral Therapy for Prevention of Recurrent Hepatitis B Infection. Transplant Proc 2013; 45:1953-6. [DOI: 10.1016/j.transproceed.2012.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/19/2012] [Indexed: 01/11/2023]
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Vassos N, Agaimy A, Klein P, Hohenberger W, Croner RS. Solid-pseudopapillary neoplasm (SPN) of the pancreas: case series and literature review on an enigmatic entity. Int J Clin Exp Pathol 2013; 6:1051-1059. [PMID: 23696922 PMCID: PMC3657357] [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] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/23/2013] [Indexed: 06/02/2023]
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor which typically affects young women without significant clinical symptoms. SPN usually shows an indolent behavior and only rare cases recur and/or metastasize after complete resection. We report our experience with four cases of SPN of the pancreas. All four patients were female with an age range of 15-42 years (mean age: 24.5 years). Two patients presented with abdominal pain, one with abdominal mass and one with acute abdominal signs following blunt trauma. Tumor's size ranged from 1 to 16 cm (mean size: 5.5 cm). Two tumors were diagnosed preoperatively through percutaneous core needle biopsy and two underwent surgery without preoperative diagnosis because of high suspicion of SPN based on clinical and radiological findings. By immunohistochemistry, all cases stained strongly for vimentin, progesterone-receptor and beta-catenin (nuclear) and variably with pankeratin and neuroendocrine markers. The proliferation index (Ki-67) was <2% in all cases. After a median follow-up of 40 months (range: 24-57 months), all patients were alive with no evidence of recurrence or metastatic disease. In conclusion, SPN of the pancreas should be considered in the differential diagnosis of any solid and partly cystic pancreatic or upper abdominal mass, particularly in young females. SPN possesses a low malignant potential and complete surgical resection with clear margins is the treatment of choice. Following R0 resection, SPN has an excellent prognosis.
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MESH Headings
- Adolescent
- Adult
- Biomarkers, Tumor/analysis
- Biopsy, Needle
- Female
- Humans
- Immunohistochemistry
- Neoplasms, Cystic, Mucinous, and Serous/chemistry
- Neoplasms, Cystic, Mucinous, and Serous/classification
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreatectomy
- Pancreatic Neoplasms/chemistry
- Pancreatic Neoplasms/classification
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Pancreaticoduodenectomy
- Predictive Value of Tests
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Tumor Burden
- Young Adult
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Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital, Erlangen, Germany.
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Agaimy A, Vassos N, Croner RS. Gastrointestinal manifestations of neurofibromatosis type 1 (Recklinghausen's disease): clinicopathological spectrum with pathogenetic considerations. Int J Clin Exp Pathol 2012; 5:852-862. [PMID: 23119102 PMCID: PMC3484498] [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] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/01/2012] [Indexed: 06/01/2023]
Abstract
Neurofibromatosis type 1 (NF-1, Recklinghausen disease) is the most common hereditary multitumor syndrome with an incidence at birth of approximately 1:3000. However, the significant variation in the expression of the disease not infrequently precludes early diagnosis. As a consequence of non-familiarity with their frequency and wide clinicopathological spectrum, gastrointestinal manifestations of NF-1 are seldom thought of in routine clinical practice and might thus be significantly under-recognized. Their heterogeneous spectrum ranges from localized microscopic proliferative lesions of autonomic nerves and interstitial cells of Cajal and diffuse microscopic ganglio/neuro/fibromatosis to grossly recognizable mass-forming neurofibromas and gastrointestinal stromal tumors (GIST). Furthermore, neuroendocrine neoplasms, particularly of the periampullary duodenum seem to be quite characteristic of this disease. Based on our own experience and the available literature, this review summarizes and discusses the clinicopathological spectrum of gastrointestinal manifestations of NF-1 including putative proliferative precursor lesions with emphasis on the differential diagnostic aspects of these disorders and their molecular pathogenesis. In addition, this review underlines the great value of specific gastrointestinal findings in uncovering undiagnosed or missed NF-1 cases.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany.
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Agaimy A, Vassos N, Croner RS, Strobel D, Lell M. Hepatic angiomyolipoma: a series of six cases with emphasis on pathological-radiological correlations and unusual variants diagnosed by core needle biopsy. Int J Clin Exp Pathol 2012; 5:512-521. [PMID: 22949933 PMCID: PMC3430108] [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] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 06/29/2012] [Indexed: 06/01/2023]
Abstract
Hepatic angiomyolipoma is rare and may pose differential diagnostic difficulty, particularly if encountered in core needle biopsy. We studied 6 cases from 5 males and one female (median age, 48.6 yrs). All presented with non-specific symptoms or an incidentally discovered tumor mass. Two patients had a remote history of chemotherapy for hematological neoplasms (acute lymphoblastic leukemia and Hodgkin lymphoma respectively) and another had clear cell renal cell carcinoma and anaplastic pancreatic carcinoma diagnosed at autopsy without definable syndrome. None of the patients had evidence of the tuberous sclerosis complex or renal or other extra-renal angiomyolipoma. Three tumors were resected completely and three have been only biopsied and followed up. None of the resected cases recurred at a mean follow-up of 35 months. Histologically, tumors were classified as classical triphasic (1), lipomatous (2), epithelioid/oncocytoid (1), epithelioid trabecular (1) and myelolipoma-like (1). The adjacent liver parenchyma was normal in 3 cases, showed pigment cirrhosis in one case and mild fatty change in another case. One case had clinically diagnosed but histologically unverified cirrhosis. The initial diagnostic impression/frozen section was misleading in 5 of the cases and included vascular lesion, focal fatty change, myelolipoma, hepatocellular tumor and oncocytic neoplasm. All tumors expressed HMB45 and variably desmin. One epithelioid lesion expressed HMB45 and TFE3, but lacked desmin expression. In conclusion, hepatic angiomyolipomas are increasingly recognized as incidental findings during surveillance for cirrhosis or investigations for unrelated conditions. Awareness of their diverse morphological spectrum in liver biopsy is necessary to avoid misdiagnosis as hepatocellular carcinoma, metastatic melanoma or other malignant neoplasms.
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Affiliation(s)
- Abbas Agaimy
- Institute of pathology, University Hospital, Erlangen, Germany.
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Agaimy A, Vassos N, Wunsch PH, Hohenberger W, Hartmann A, Croner RS. Impact of serosal involvement/extramural growth on the risk of synchronous and metachronous peritoneal spread in gastrointestinal stromal tumors: proposal for a macroscopic classification of GIST. Int J Clin Exp Pathol 2012; 5:12-22. [PMID: 22295142 PMCID: PMC3267481] [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] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Peritoneal and hepatic metastases are the main routes of spread of gastrointestinal stromal tumors (GIST). However, criteria to predict the site and pattern of recurrence in individual cases are still lacking. PATIENTS We retrospectively analyzed 67 consecutive GISTs with complete gross descriptions to correlate macroscopic patterns with clinical course. Primary endpoint was the appearance of synchronous or metachronous peritoneal disease. Tumors were classified into type I (luminal/intramural) and type II (extramural) based on the macroscopic/histologic presence or absence of normal tissue between deeper tumor border and serosa, respectively. RESULTS Patients were 35 men and 32 women (mean age, 64 yrs) with gastric (n=32), small bowel (n=30) and large bowel (n=5) GISTs. Based on the above proposal, 22 tumors were classified as type I and 45 as type II. Type I tumors were predominantly gastric (18/22; P<0.001) and frequently had very low/low risk (14/22; P<0.001) whereas type II tumors were predominantly intestinal (31/45; P<0.001) and often of intermediate/high risk (36/45; P<0.001). Ten patients had synchronous peritoneal spread and 6/30 patients with a mean follow-up of 29 months developed metachronous peritoneal spread at a mean of 27 months. Tumor rupture was seen in 2 patients (3%). Thus, 16/40 patients (40%) had synchronous or metachronous peritoneal progression. Taken by gross type, peritoneal progression was seen in 15/30 type II compared to 1/10 type I tumors (p=0.032). CONCLUSION this study points to extramural growth as a predictor of peritoneal recurrence in GIST, probably as a consequence of tumor rupture or due to microscopic serosal penetration. This study aimed at alerting surgical pathologists to the importance of careful gross and microscopic assessment of resection specimen harboring GIST to allow for reliable prospective evaluation of serosal involvement as an adverse prognostic factor in GIST.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany.
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Vassos N, Agaimy A, berger WH, Croner R. 9411 POSTER Coexistence of GISTs With Other Malignancies – More Than a Simple Coincidence? Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vassos N, Agaimy A, Hohenberger W, Croner RS. Extraabdominal lymph node metastasis in gastrointestinal stromal tumors (GIST). J Gastrointest Surg 2011; 15:1232-6. [PMID: 21336495 DOI: 10.1007/s11605-011-1464-3] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 02/03/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The two principal ways of metastases in gastrointestinal stromal tumors (GISTs) are diffuse intraabdominal spread and liver metastasis whereas lymph node metastases (LNM) are extremely rare. Accordingly, nodal dissection is generally not recommended for GISTs' surgical treatment. METHODS We present two unique cases of GIST with synchronous and metachronous extraabdominal LNM, whose clinical, macro-/microscopic, and immunohistochemical criteria, surgical and neo- or adjuvant therapy were investigated in retrospective analysis. RESULTS A 76-year-old man was presented with an inguinal mass and a simultaneously detected intraabdominal mass. Pathological evaluation of the core needle biopsy from the inguinal lymph node confirmed metastatic GIST. Partial resection of the ileum and inguinal lymph node dissection (LND) showed a spindle cell GIST in the ileum with inguinal LNM. Imatinib mesylate therapy was administered, which was interrupted 2 years later because of patient's intolerance. A 35-year-old man underwent extended gastrectomy, atypical liver resection, splenectomy, and LND because of a huge gastric fundus GIST. Postoperative imatinib mesylate therapy was administered. Histology showed multiple regional lymph node metastasis. Two years later, a left hemihepatectomy was performed for liver metastases. During follow-up, new axillary LNM were detected, and a sunitinib therapy was initiated. Thereafter, he developed progressive axillary, mediastinal, hepatic, abdominal, osseous, and cutaneous metastases, and he was treated by palliative cytoreductive surgery. CONCLUSION These two cases demonstrate that extraabdominal node metastasis may rarely occur in GIST, either initially or in the setting of widespread disease. In selected cases with confirmed or suspected LNM, LND should be considered. Metachronous extraabdominal lymph node metastasis represents a late event in high-risk GISTs and cannot be controlled by drug therapy alone.
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Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital, University of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.
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