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Tulchiner G, Staudacher N, Fritz J, Hackl M, Pichler M, Seles M, Shariat SF, D'Andrea D, Gust K, Albrecht W, Grubmüller K, Madersbacher S, Graf S, Lusuardi L, Augustin H, Berger A, Loidl W, Horninger W, Pichler R. Seasonal Variations in the Diagnosis of Testicular Germ Cell Tumors: A National Cancer Registry Study in Austria. Cancers (Basel) 2021; 13:cancers13215377. [PMID: 34771540 PMCID: PMC8582382 DOI: 10.3390/cancers13215377] [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: 09/23/2021] [Revised: 10/11/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Seasonal variations in cancer diagnosis could already be demonstrated in prostate and breast cancer. The reasons for this observed seasonal pattern are still unclear. The health care system or other determinants such as the protective function of vitamin D3 in carcinogenesis could be assumed as one explanation. Testicular germ cell tumors are the most common developed malignancy among young men. The aim of our study was to investigate, for the first time, the seasonal variations in the clinical diagnosis of testicular germ cell tumors. We have been able to confirm that the frequency of monthly newly diagnosed cases of testicular cell tumors in Austria has a strong seasonality, with a significant reduction in the tumor incidence during the summer months and an increase during the winter months. Abstract We conducted a retrospective National Cancer Registry study in Austria to assess a possible seasonal variation in the clinical diagnosis of testicular germ cell tumors (TGCT). In total, 3615 testicular cancer diagnoses were identified during an 11-year period from 2008 to 2018. Rate ratios for the monthly number of TGCT diagnoses, as well as of seasons and half-years, were assessed using a quasi-Poisson model. We identified, for the first time, a statistically significant seasonal trend (p < 0.001) in the frequency of monthly newly diagnosed cases of TGCT. In detail, clear seasonal variations with a reduction in the tumor incidence during the summer months (Apr–Sep) and an increase during the winter months (Oct–Mar) were observed (p < 0.001). Focusing on seasonality, the incidence during the months of Oct–Dec (p = 0.008) and Jan–Mar (p < 0.001) was significantly higher compared to the months of Jul–Sep, respectively. Regarding histopathological features, there is a predominating incidence in the winter months compared to summer months, mainly concerning pure seminomas (p < 0.001), but not the non-seminoma or mixed TGCT groups. In conclusion, the incidence of TGCT diagnoses in Austria has a strong seasonal pattern, with the highest rate during the winter months. These findings may be explained by a delay of self-referral during the summer months. However, the hypothetical influence of vitamin D3 in testicular carcinogenesis underlying seasonal changes in TGCT diagnosis should be the focus of further research.
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Affiliation(s)
- Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Nina Staudacher
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schöpfstraße 41, 6020 Innsbruck, Austria
| | - Monika Hackl
- Austrian National Cancer Registry, Statistics Austria, 1110 Vienna, Austria
| | - Martin Pichler
- Research Unit of Non-Coding RNAs and Genome Editing in Cancer, Comprehensive Cancer Center Graz, Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Maximilian Seles
- Department of Urology, Medical University of Graz, 8036 Graz, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Kilian Gust
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter Albrecht
- Department of Urology, Austria and Public Health Agency of Lower Austria, 2130 Mistelbach, Austria
| | - Karl Grubmüller
- Department of Urology and Andrology, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Stephan Madersbacher
- Department of Urology and Andrology, Kaiser-Franz-Josef Spital, 1100 Vienna, Austria
| | - Sebastian Graf
- Department of Urology, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Herbert Augustin
- Department of Urology, General Hospital of the City of Klagenfurt, 9020 Klagenfurt, Austria
| | - Andreas Berger
- Department of Urology, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Wolfgang Loidl
- Department of Urology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Kafka M, Wöll E, Brunhuber T, Gruber L, Tulchiner G, Staudacher N, Horninger W, Pichler R. A presumed extragonadal germ cell tumor that turned out to be a gastric cancer-a case report. Transl Androl Urol 2021; 10:2528-2533. [PMID: 34295739 PMCID: PMC8261445 DOI: 10.21037/tau-21-150] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
A solely retroperitoneal mass in males in combination with elevated serum Alpha-Fetoprotein (AFP) and beta-human choriogonadotropin (β-HCG) levels is highly indicative of a metastatic testicular cancer. Although testicular cancers are rare, they represent the most common diagnosed cancer in males between 14 and 40 years. However, in cases without evidence of a primary testicular tumor, the rare diagnosis of a retroperitoneal extragonadal germ cell tumor (EGCT) must be assumed. Here, we describe the first published case of a 66-year-old man presenting with this typical clinical picture and the diagnosis of an AFP and β-HCG producing advanced gastric cancer with retroperitoneal lymph node metastases mimicking a primary retroperitoneal EGCT. The final diagnosis was only made by gastroscopy performed after a CT-guided retroperitoneal lymph node biopsy revealed an adenocarcinoma, suggesting an upper gastrointestinal tract primary origin. However, a specific initial anamnesis and also in the primary staging, including a full-body CT-scan there was no hint for another primary tumor. Only the slightly unusual extension of the retroperitoneal mass up to the ligamentum hepatoduodenale and the pylorus, as well as the atypical age made us question our initial diagnosis. This extraordinary case is of special clinical interest to all practising physicians and once again highlights the importance of keeping rare differential diagnosis such as AFP-producing gastrointestinal tumors in mind.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Thomas Brunhuber
- Laboratory of Pathology, Dr. Obrist and Dr. Brunhuber OG, Zams, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gennadi Tulchiner
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nina Staudacher
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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Tulchiner G, Brunner A, Schmidinger M, Staudacher N, Orme J, Horninger W, Thurnher M, Culig Z, Pichler R. CMTM6 expression as a potential biomarker for immunotherapy in metastatic renal cell carcinoma. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00926-x] [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: 11/30/2022]
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Tulchiner G, Staudacher N, Fritz J, Radmayr C, Culig Z, Horninger W, Pichler R. The "COVID-19 Pandemic Gap" and Its Influence on Oncologic Outcomes of Bladder Cancer. Cancers (Basel) 2021; 13:cancers13081754. [PMID: 33916962 PMCID: PMC8067623 DOI: 10.3390/cancers13081754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/17/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary The COVID-19 pandemic has had a major impact on the entire healthcare system, resulting in severe restrictions of nonemergency clinical services, as well as in the clinical practice of uro-oncology. We performed a retrospective analysis to evaluate outcomes of the COVID-19 pandemic resulting from delayed diagnosis, staging, and treatment of bladder cancer. We showed that the COVID-19 pandemic led to a deferred oncological diagnosis and treatment of bladder cancer. More attention is required to avoid adverse outcomes, with increased rates of advanced and aggressive tumors in patients with primary bladder cancer. Moreover, timely treatment is compulsory in those patients. Abstract Coronavirus-19 (COVID-19)-induced effects on deferred diagnosis and treatment of bladder cancer (BC) patients are currently not clarified. The aim of this study was to evaluate outcomes of the COVID-19 pandemic by considering its effects on tumor stage and grade, and to create feasible clinical triage decisions. A retrospective single-center analysis of all patients who underwent diagnostic and surgical procedures due to BC, during January 2019 and December 2020, was performed. Due to COVID-19 lockdowns, significantly fewer (diagnostic and therapeutic) endoscopic procedures were performed in the first 6 months of 2020 compared to 2019 (p = 0.002). In patients with a primary diagnosis of BC, a significant increase of high-grade tumors (p < 0.001), as well as advanced tumor stages (p = 0.014), were noticed during 2020 in comparison to 2019. On the contrary, patients with recurrent BC undergoing risk-adapted surveillance, depending on previous tumor histology, showed no adverse outcomes regarding tumor stage and grade when comparing the pre COVID-19 era with 2020. Thus, more awareness in clinical urologic practice is mandatory to avoid adverse consequences, with increased rates of advanced and aggressive tumors in patients with primary BC. In recurrent BC, an individual risk stratification in order to avoid worse outcomes during the COVID-19 pandemic seems to be justified.
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Affiliation(s)
- Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Nina Staudacher
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schoepfstraße 41, 6020 Innsbruck, Austria;
| | - Christian Radmayr
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Zoran Culig
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
- Correspondence: ; Tel.: +43-512-504-24811; Fax: +43-512-504-28365
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Tulchiner G, Pichler R, Ulmer H, Staudacher N, Lindner AK, Brunner A, Zelger B, Steinkohl F, Aigner F, Horninger W, Thurnher M. Sex-specific hormone changes during immunotherapy and its influence on survival in metastatic renal cell carcinoma. Cancer Immunol Immunother 2021; 70:2805-2817. [PMID: 33646368 PMCID: PMC8423679 DOI: 10.1007/s00262-021-02882-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
Renal cell carcinoma (RCC) is a highly vascularized and immunogenic tumor, being an ideal candidate for checkpoint blockade-based immunotherapy. Accordingly, checkpoint inhibitors have demonstrated clinical efficacy in patients with metastatic RCC (mRCC). Sex-specific differences in cancer immunotherapy may be explained by the interaction of sex hormone signaling, genetic and environmental factors, affecting the innate and adaptive immune response in men and women in different ways. The aim of this prospective study was to monitor for the first time changes in sex hormones including luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio and 17-ß-estradiol (E2) in 22 mRCC patients (12 male and 10 female) receiving nivolumab therapy. In contrast to female patients, male patients showed a significant increase in E2 (p = 0.006) and LH/FSH ratio (p = 0.013) from the beginning of nivolumab therapy to week 12 of follow-up. Moreover, survival analysis revealed a significant negative association between LH/FSH ratio and progression-free survival (PFS) (p = 0.022) as well as between therapy response (p = 0.009) in males compared to females at interim evaluation (week 6/8). Our findings may therefore be the first reference to sex hormone changes during immunotherapy.
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Affiliation(s)
- Gennadi Tulchiner
- Department of Urology & Immunotherapy Unit, Medical University Innsbruck, Anichstrasse 35 and Innrain 66a, 6020, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology & Immunotherapy Unit, Medical University Innsbruck, Anichstrasse 35 and Innrain 66a, 6020, Innsbruck, Austria.
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Schoepfstraße 41, 6020, Innsbruck, Austria
| | - Nina Staudacher
- Department of Urology & Immunotherapy Unit, Medical University Innsbruck, Anichstrasse 35 and Innrain 66a, 6020, Innsbruck, Austria
| | - Andrea Katharina Lindner
- Department of Urology & Immunotherapy Unit, Medical University Innsbruck, Anichstrasse 35 and Innrain 66a, 6020, Innsbruck, Austria
| | - Andrea Brunner
- Department of Pathology, Medical University Innsbruck, Muellerstraße 44, 6020, Innsbruck, Austria
| | - Bettina Zelger
- Department of Pathology, Medical University Innsbruck, Muellerstraße 44, 6020, Innsbruck, Austria
| | - Fabian Steinkohl
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology & Immunotherapy Unit, Medical University Innsbruck, Anichstrasse 35 and Innrain 66a, 6020, Innsbruck, Austria
| | - Martin Thurnher
- Department of Urology & Immunotherapy Unit, Medical University Innsbruck, Anichstrasse 35 and Innrain 66a, 6020, Innsbruck, Austria.
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Tulchiner G, Brunner A, Schmidinger M, Staudacher N, Orme JJ, Thurnher M, Horninger W, Culig Z, Pichler R. CMTM6 expression as a potential biomarker for immunotherapy in metastatic renal cell carcinoma. BJU Int 2021; 128:29-32. [PMID: 33455021 PMCID: PMC8359430 DOI: 10.1111/bju.15341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Brunner
- Department of Pathology, Neuropathology and Molecular Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Manuela Schmidinger
- Clinical Division of Oncology, Department of Medicine I and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Nina Staudacher
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jacob J Orme
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Martin Thurnher
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Zoran Culig
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
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Rehaber P, Staudacher N, Seckler R, Bülow R, Overath P, Jaenicke R. Stability and reconstitution of the soluble variant surface glycoprotein (sVSG) from Trypanosoma brucei. Biochemistry 1990; 29:8217-23. [PMID: 2252884 DOI: 10.1021/bi00488a004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Soluble variant surface glycoprotein (sVSG) is the form of the coat protein of Trypanosoma brucei released by cleavage of its lipid anchor. As shown by ultracentrifugal analysis, the protein of the variant clone MITat 1.2 is a stable dimer of (117 +/- 6)-kDa molecular mass. Its quaternary structure remains unaltered in the concentration range from 0.01 to approximately 50 mg/mL. Further extrapolation to the in situ concentration on the cell surface points to no significant protein association beyond the dimer, because after correction for solution viscosity sedimentation velocity is independent of the protein concentration. The sedimentation constant, s20,w = 5.1 X 10(-13) s, together with the particle weight confirms the high anisotropy of the dimer. Circular dichroism and fluorescence spectra show the typical properties of an alpha-helical protein (51% alpha-helix) with fluorophores buried in the hydrophobic interior of the protein. Denaturation at extremes of pH leads to the monomer still maintaining a relatively compact structure. Increased concentrations of urea and guanidine hydrochloride cause randomization with cooperative transitions at 1.7 and 0.7 M, respectively. The yield of reconstitution of the denatured protein reaches 87% under optimum conditions. The final product is indistinguishable from the native protein in its spectral, hydrodynamic, and immunochemical properties. Immunological analysis included polyclonal antibodies as well as monoclonal antibodies raised against epitopes in the surface of the complete trypanosome, as well as cryptic epitopes exposed only on sVSG in solution. The kinetics of reconstitution involve sequential uni-bimolecular processes, corresponding to consecutive folding and subunit association. About 38% of the fluorescence of the native protein is recovered within the mixing time (secondary structure formation).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Rehaber
- Institut für Biophysik und Physikalische Biochemie, Universität Regensburg, West Germany
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