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Dubinski D, Won SY, Trnovec S, Behmanesh B, Baumgarten P, Dinc N, Konczalla J, Chan A, Bernstock JD, Freiman TM, Gessler F. Leveraging artificial intelligence in neurosurgery-unveiling ChatGPT for neurosurgical discharge summaries and operative reports. Acta Neurochir (Wien) 2024; 166:38. [PMID: 38277081 PMCID: PMC10817836 DOI: 10.1007/s00701-024-05908-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE Chat generative pre-trained transformer (GPT) is a novel large pre-trained natural language processing software that can enable scientific writing amongst a litany of other features. Given this, there is a growing interest in exploring the use of ChatGPT models as a modality to facilitate/assist in the provision of clinical care. METHODS We investigated the time taken for the composition of neurosurgical discharge summaries and operative reports at a major University hospital. In so doing, we compared currently employed speech recognition software (i.e., SpeaKING) vs novel ChatGPT for three distinct neurosurgical diseases: chronic subdural hematoma, spinal decompression, and craniotomy. Furthermore, factual correctness was analyzed for the abovementioned diseases. RESULTS The composition of neurosurgical discharge summaries and operative reports with the assistance of ChatGPT leads to a statistically significant time reduction across all three diseases/report types: p < 0.001 for chronic subdural hematoma, p < 0.001 for decompression of spinal stenosis, and p < 0.001 for craniotomy and tumor resection. However, despite a high degree of factual correctness, the preparation of a surgical report for craniotomy proved to be significantly lower (p = 0.002). CONCLUSION ChatGPT assisted in the writing of discharge summaries and operative reports as evidenced by an impressive reduction in time spent as compared to standard speech recognition software. While promising, the optimal use cases and ethics of AI-generated medical writing remain to be fully elucidated and must be further explored in future studies.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany.
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Svorad Trnovec
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Schiller University Jena, Jena, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital, Schiller University Jena, Jena, Germany
| | - Juergen Konczalla
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Alvin Chan
- David H. Koch Institute for Integrated Cancer Research, MIT, Cambridge, MA, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas M Freiman
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
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Neef V, König S, Becker H, Dubinski D, Flinspach A, Raimann FJ, Weber K, Ronellenfitsch MW, Konczalla J, Hattingen E, Czabanka M, Senft C, Zacharowski K, Baumgarten P. Red blood cell transfusion in patients undergoing elective primary glioblastoma resection. Blood Transfus 2024:BloodTransfus.613. [PMID: 38315541 DOI: 10.2450/bloodtransfus.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/27/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Red blood cell (RBC) transfusion in patients undergoing major elective cranial surgery is associated with increased postoperative morbidity and mortality. This study aims to identify the clinical outcome of transfused glioblastoma patients undergoing primary surgical tumor resection and identify risk factors for RBC transfusion. MATERIAL AND METHODS Between 2009 and 2019, 406 patients underwent elective primary glioblastoma resection. For multivariate analysis to assess risk factors for RBC transfusion, logistic regression was conducted. The impact of RBC transfusion on overall survival was assessed using Kaplan-Meier analysis. RESULTS In total, 36 (8.9%) patients received RBC transfusion. Preoperative anemia rate was significantly higher in transfused patients compared to patients without RBC transfusion (33.3 vs 6.5%; p<0.0001). Postoperative complications as well as hospital length of stay (LOS) (p<0.0001) were significantly increased in transfused patients compared to non-transfused patients. After multivariate analysis, risk factors for RBC transfusion were preoperative anemia (p<0.0001), intraoperative blood loss (p<0.0001), female gender (p=0.0056) and radiation (p=0.0064). Kaplan-Meier curves revealed that RBC transfusion and being elderly (age ≥75 years) were relevant for overall survival. DISCUSSION RBC transfusion is associated with increased postoperative morbidity and mortality in patients undergoing elective primary glioblastoma resection. Preoperative anemia and intraoperative blood loss are major risk factors for RBC transfusion. Preoperative anemia management and blood conservation strategies are crucial in patients undergoing elective primary glioblastoma resection.
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Affiliation(s)
- Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Sven König
- Goethe University Frankfurt, Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Hendrik Becker
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Daniel Dubinski
- Goethe University Frankfurt, Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Armin Flinspach
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Florian J Raimann
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Katharina Weber
- Goethe University Frankfurt, Neurological Institute, Edinger Institute, Neuropathology, Frankfurt, Germany
| | - Michael W Ronellenfitsch
- Goethe University Frankfurt, Neurological Institute, Edinger Institute, Neuropathology, Frankfurt, Germany
| | - Juergen Konczalla
- Goethe University Frankfurt, Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Elke Hattingen
- Goethe University Frankfurt, Department of Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marcus Czabanka
- Goethe University Frankfurt, Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Senft
- Friedrich Schiller University Jena, Department of Neurosurgery, University Hospital Jena, Jena, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Peter Baumgarten
- Goethe University Frankfurt, Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
- Friedrich Schiller University Jena, Department of Neurosurgery, University Hospital Jena, Jena, Germany
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Dubinski D, Won SY, Meyer-Wilmes J, Trnovec S, Rafaelian A, Behmanesh B, Cantré D, Baumgarten P, Dinc N, Konczalla J, Wittstock M, Bernstock JD, Freiman TM, Gessler F. Frailty in Traumatic Brain Injury-The Significance of Temporal Muscle Thickness. J Clin Med 2023; 12:7625. [PMID: 38137693 PMCID: PMC10743381 DOI: 10.3390/jcm12247625] [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: 10/27/2023] [Revised: 11/23/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Temporal muscle thickness (TMT) on cranial CT scans has recently been identified as a prognostic imaging parameter for assessing a patient's baseline frailty. Here, we analyzed whether TMT correlates with Traumatic brain injury (TBI) severity and whether it can be used to predict outcome(s) after TBI. METHODS We analyzed the radiological and clinical data sets of 193 patients with TBI who were admitted to our institution and correlated the radiological data with clinical outcomes after stratification for TMT. RESULTS Our analyses showed a significant association between high TMT and increased risk for intracranial hemorrhage (p = 0.0135) but improved mRS at 6 months (p = 0.001) as compared to patients with low TMT. Congruent with such findings, a lower TMT was associated with falls and reduced outcomes at 6 months (p < 0.0001 and p < 0.0001). CONCLUSION High TMT was robustly associated with head trauma sequelae but was also associated with good clinical outcomes in TBI patients. These findings consolidate the significance of TMT as an objective marker of frailty in TBI patients; such measurements may ultimately be leveraged as prognostic indicators.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
| | - Jonas Meyer-Wilmes
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
| | - Svorad Trnovec
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
| | - Artem Rafaelian
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medicine Rostock, 18057 Rostock, Germany;
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Schiller University Jena, 07747 Jena, Germany; (P.B.); (N.D.)
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital, Schiller University Jena, 07747 Jena, Germany; (P.B.); (N.D.)
| | - Juergen Konczalla
- Department of Neurosurgery, Goethe-University Hospital, 60596 Frankfurt am Main, Germany;
| | - Matthias Wittstock
- Department of Neurology, University Medicine Rostock, 18057 Rostock, Germany;
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Thomas M. Freiman
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
| | - Florian Gessler
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany; (S.-Y.W.); (J.M.-W.); (S.T.); (A.R.); (B.B.); (T.M.F.); (F.G.)
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Baumgarten P, Prange G, Kamp MA, Monden D, Neef V, Schwarzer F, Dubinski D, Dinc N, Weber KJ, Czabanka M, Hattingen E, Ronellenfitsch MW, Steinbach JP, Senft C. Treatment of very elderly glioblastoma patients ≥ 75 years of age: whom to treat. J Neurooncol 2023; 165:509-515. [PMID: 38032426 PMCID: PMC10752837 DOI: 10.1007/s11060-023-04518-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE The prognosis of patients ≥ 75 years suffering from glioblastoma is poor. Novel therapies are usually reserved for patients ≤ 70 years. In an aging population, treatment of very elderly patients remains a challenge. METHODS Between 2010 and 2018, a total of 977 glioblastoma patients were treated at our institution. Of these, 143 patients were ≥ 75 years at diagnosis. Primary procedure was surgical resection or biopsy followed by adjuvant treatment, whenever possible. We retrospectively investigated overall survival (OS) and potential prognostic factors influencing survival, including Karnofsky Performance Status (KPS), surgical therapy, adjuvant therapy as well as MGMT promotor status. RESULTS In very elderly patients, median age was 79 years (range: 75-110). Biopsy only was performed in 104 patients; resection was performed in 39 patients. Median OS for the entire cohort was 5.9 months. Univariate analysis showed that KPS at presentation (≥ 70 vs. ≤60), surgery vs. biopsy, adjuvant chemotherapy and adjuvant radiotherapy were significantly associated with OS (6 vs. 3, p < 0.0111; 12 vs. 4, p = 0.0011; 11 vs. 4, p = 0.0003 and 10 vs. 1.5 months, p < 0.0001, respectively). Multivariate analysis confirmed adjuvant radiotherapy (p < 0.0001) and chemotherapy (p = 0.0002) as independent factors influencing OS. CONCLUSION For very elderly patients, the natural course of disease without treatment is devastating. These patients benefit from multimodal treatment including adjuvant radiotherapy and chemotherapy. A beneficial effect of resection has not been demonstrated. Treatment options and outcomes should be thoughtfully discussed before treatment decisions are made.
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Affiliation(s)
- Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany.
| | - Georg Prange
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Centre for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Campus Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Daniel Monden
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Franziska Schwarzer
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Katharina J Weber
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt, Germany
- University Cancer Center (UCT), Goethe University Hospital, Frankfurt, Germany
| | - Markus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael W Ronellenfitsch
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Joachim P Steinbach
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany
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Kamp MA, von Sass C, Januzi D, Dibué M, Libourius K, Lawson McLean AC, Baumgarten P, Lawson McLean A, Dinc N, Senft CA. Frequency of social burden and underage children in neuro-oncological patients. J Cancer Res Clin Oncol 2023; 149:15911-15922. [PMID: 37679652 PMCID: PMC10620259 DOI: 10.1007/s00432-023-05338-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Brain tumours can cause significant burden for patients and their families, including physical, psychological, and social challenges. This burden can be particularly difficult for patients with malignant brain tumours and those with underage children. However, the frequency of social burden among neuro-oncological patients and the proportion of patients with underaged children is currently unknown. The aim of this retrospective study is to determine the frequency of social and family dysfunction among neuro-oncological patients, the percentage of such patients who have underage children, and to assess their associated burden. METHODS During a 22-month period, all brain tumour patients were asked to complete a short questionnaire that included epidemiological data, the EORTC-qlq-C30 and -BN20 questionnaire, and the distress thermometer. Data were collected and analysed using Prism 9 for macOS (version 9, GraphPad Prism). RESULTS Our analysis included 881 brain tumour patients, of which 540 were female. Median age was 61 years (ranging from 16 to 88 years). Of all patients, 228 suffered from malignant intracranial tumours. More than half of all patients and more than 65% of patients with malignant tumours reported that their illness or medical treatment interfered with their social activities and family life. Almost 30% of patients reported moderate or severe complaints. About 27% of all patients (and 31% of patients with malignancies) expressed moderate or major concerns that their family life could be disrupted. Among the patients with malignancies, 83.5% of patients had a total of 318 children at the time of tumour diagnosis, with a mean age of 33 ± 0.9. Of these patients with malignancies, 38 (17.9%) had a total of 56 underage children at the time of tumour diagnosis, and currently have 53 underage children. Patients with minor children had more financial worries but less interference of their disease with social activities, less psycho-oncological distress, and a more positive outlook into the future (each, p < 0.0001). They evaluated their general health status and quality of life in the week prior to their current appointment significantly better (each p < 0.0001). CONCLUSION Our study found that 17.9% of patients with malignant brain tumours have underage children. However, having underage children may actually be a positive resource for these patients, as they show lower distress values and better quality of life.
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Affiliation(s)
- Marcel A Kamp
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
| | - Christiane von Sass
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Donjetë Januzi
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Maxine Dibué
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Katharina Libourius
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Anna C Lawson McLean
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Peter Baumgarten
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Aaron Lawson McLean
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nazife Dinc
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christian A Senft
- Centre of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Dubinski D, Won SY, Mattes I, Trnovec S, Behmanesh B, Cantré D, Baumgarten P, Dinc N, Konczalla J, Wittstock M, Freiman TM, Gessler F. Frailty in cerebellar ischemic stroke-The significance of temporal muscle thickness. Front Neurol 2023; 14:1193685. [PMID: 37822528 PMCID: PMC10562580 DOI: 10.3389/fneur.2023.1193685] [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: 03/28/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
While comprising only 2% of all ischemic strokes, cerebellar strokes are responsible for substantial morbidity and mortality due to their subtle initial presentation and the morbidity of posterior fossa swelling. Furthermore, low temporal muscle thickness (TMT) has recently been identified as a prognostic imaging parameter to assess patient frailty and outcome. We analyzed radiological and clinical data sets of 282 patients with cerebellar ischemic stroke. Our analysis showed a significant association between low TMT, reduced NIHSS and mRS at discharge (p = 0.035, p = 0.004), and reduced mRS at 12 months (p = 0.001). TMT may be used as a prognostic imaging marker and objective tool to assess outcomes in patients with cerebellar ischemic stroke.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Isabell Mattes
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Svorad Trnovec
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medicine Rostock, Rostock, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Schiller University Jena, Jena, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital, Schiller University Jena, Jena, Germany
| | - Juergen Konczalla
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany
| | | | - Thomas M. Freiman
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
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Busse LC, Dubinski D, Gessler F, Dinc N, Konczalla J, Czabanka M, Senft C, Freiman TM, Baumgarten P. Retrospective comparison of long-term functionality and revision rate of two different shunt valves in pediatric and adult patients. Acta Neurochir (Wien) 2023; 165:2541-2549. [PMID: 37528210 PMCID: PMC10477094 DOI: 10.1007/s00701-023-05719-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/01/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE The most frequent therapy of hydrocephalus is implantation of ventriculoperitoneal shunts for diverting cerebrospinal into the peritoneal cavity. We compared two adjustable valves, proGAV and proGAV 2.0, for complications resulting in revision surgery. METHODS Four hundred patients undergoing primary shunt implantation between 2014 and 2020 were analyzed for overall revision rate, 1-year revision rate, and revision-free survival observing patient age, sex, etiology of hydrocephalus, implantation site, prior diversion of cerebrospinal fluid, and cause of revision. RESULTS All data were available of all 400 patients (female/male 208/192). Overall, 99 patients underwent revision surgery after primary implantation. proGAV valve was implanted in 283 patients, and proGAV 2.0 valves were implanted in 117 patients. There was no significant difference between the two shunt valves concerning revision rate (p = 0.8069), 1-year revision rate (p = 0.9077), revision-free survival (p = 0.6921), and overall survival (p = 0.3232). Regarding 1-year revision rate, we observed no significant difference between the two shunt valves in pediatric patients (40.7% vs 27.6%; p = 0.2247). Revision operation had to be performed more frequently in pediatric patients (46.6% vs 24.8%; p = 0.0093) with a significant higher number of total revisions with proGAV than proGAV 2.0 (33 of 59 implanted shunts [55.9%] vs. 8 of 29 implanted shunts [27.6%]; p = 0.0110) most likely due to longer follow-up in the proGAV-group. For this reason, we clearly put emphasis on analyzing results regarding 1-year revision rate. CONCLUSION According to the target variables we analyzed, aside from lifetime revision rate in pediatric patients, there is no significant difference between the two shunt valves.
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Affiliation(s)
- Lewin-Caspar Busse
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany.
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8
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Dubinski D, Won SY, Behmanesh B, Cantré D, Mattes I, Trnovec S, Baumgarten P, Schuss P, Freiman TM, Gessler F. Significance of Temporal Muscle Thickness in Chronic Subdural Hematoma. J Clin Med 2022; 11:jcm11216456. [PMID: 36362682 PMCID: PMC9654786 DOI: 10.3390/jcm11216456] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Reduced temporal muscle thickness (TMT) was verified as an independent negative prognostic parameter for outcome in brain tumor patients. Independent thereof, chronic subdural hematoma (CSDH) is a neurosurgical condition with high recurrence rates and unreliable risk models for poor outcome. Since sarcopenia was associated with poor outcome, we investigated the possible role of TMT and the clinical course of CSDH patients. Methods: This investigation is a single-center retrospective study on patients with CSDH. We analyzed the radiological and clinical data sets of 171 patients with surgically treated CSDH at a University Hospital from 2017 to 2020. Results: Our analysis showed a significant association between low-volume TMT and increased hematoma volume (p < 0.001), poor outcome at discharge (p < 0.001), and reduced performance status at 3 months (p < 0.002). Conclusion: TMT may represent an objective prognostic parameter and assist the identification of vulnerable CSDH patients.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany
- Correspondence: ; Tel.: +49-381-494-6439
| | - Sae-Yeon Won
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Isabell Mattes
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Svorad Trnovec
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Schiller University Jena, 07747 Jena, Germany
| | - Patrick Schuss
- Department of Neurosurgery, Unfallkrankenhaus Berlin, 12683 Berlin, Germany
| | - Thomas M. Freiman
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Florian Gessler
- Department of Neurosurgery, Rostock University Medical Center, 18057 Rostock, Germany
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9
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Dubinski D, Won SY, Trnovec S, Gounko K, Baumgarten P, Warnke P, Cantré D, Behmanesh B, Bernstock JD, Freiman TM, Gessler F, Sola S. Recurrence of chronic subdural hematoma due to low-grade infection. Front Neurol 2022; 13:1012255. [PMID: 36212639 PMCID: PMC9539083 DOI: 10.3389/fneur.2022.1012255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the high incidence and multitudes of operative techniques, the risk factors for chronic subdural hematoma (CSDH) recurrence are still under debate and a universal consensus on the pathophysiology is lacking. We hypothesized that clinically inapparent, a low-grade infection could be responsible for CSDH recurrence. This investigation is a single-center prospective observational study including patients with recurrent CSDH. In total, 44 patients with CSDH recurrence received an intraoperative swab-based microbiological test. The intraoperative swab revealed an inapparent low-grade hematoma infection in 29% of the recurrent CSDH cases. The majority (69%) of the identified germs belonged to the staphylococcus genus. We therefore, propose a novel potential pathophysiology for CSDH recurrence.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
- *Correspondence: Daniel Dubinski
| | - Sae-Yeon Won
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Svorad Trnovec
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Kseniya Gounko
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Schiller University Jena, Jena, Germany
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas M. Freiman
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Florian Gessler
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Steffen Sola
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
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10
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Neef V, Baumgarten P, Noone S, Piekarski F, Triphaus C, Kleinerüschkamp A, Helmer P, Messroghli L, Zacharowski K, Choorapoikayil S, Meybohm P. The impact of timing of intravenous iron supplementation on preoperative haemoglobin in patients scheduled for major surgery. Blood Transfus 2022; 20:188-197. [PMID: 34059194 PMCID: PMC9068360 DOI: 10.2450/2021.0058-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anaemia is frequent and an independent risk factor for morbidity and mortality in patients undergoing surgery. Iron deficiency (ID) is the main cause for anaemia and can be corrected by intravenous (IV) iron. The aim of this study was to investigate the timing of preoperative IV iron supplementation on preoperative haemoglobin (Hb) level. MATERIALS AND METHODS Surgical patients were screened for the presence of anaemia and ID from November 2015 to January 2020. In case of ID or iron deficiency anaemia (IDA), patients received IV iron supplementation. The timing of IV iron supplementation on preoperative Hb level was analysed by days and time frames clustered by 5 days before surgery. RESULTS In total, 404 patients with IV iron supplementation were analysed. In all patients, IV iron was administered with a median (interquartile range [IQR]) of 3.0 (1.0; 9.0) days before surgery. Preoperative Hb level increased steadily starting from 6 days (0.13 [±1.2] g/dL) until 16 days before surgery (1.75 [±1.1] g/dL). Group comparison revealed a median preoperative Hb change of -0.2 (-0.5; 0.2) g/dL for days 1-5, 0.2 (0.0; 0.7) g/dL for days 6-10, 0.7 (0.2; 1.1) g/dL for days 11-15, 0.7 (0.2; 1.8) g/dL for days 16-20, 0.9 (0.3; 1.7) g/dL for days 21-25, 1.5 (0.4; 2.6) g/dL for days 26-30, and 0.6 (0.0; 1.7) g/dL for >31 days. Three patients received multiple administrations of IV iron which resulted in an increase in Hb of >4 g/dL. DISCUSSION Supplementation of IV iron to increase Hb concentration preoperatively may be most effective if administered at least ten days before surgery.
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Affiliation(s)
- Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital, Friedrich Schiller University Jena, Germany
| | - Stephanie Noone
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Florian Piekarski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Chris Triphaus
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Adina Kleinerüschkamp
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Philipp Helmer
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Leila Messroghli
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Suma Choorapoikayil
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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11
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Schmitt E, Meybohm P, Neef V, Baumgarten P, Bayer A, Choorapoikayil S, Friederich P, Friedrich J, Geisen C, Güresir E, Grünewald M, Gutjahr M, Helmer P, Herrmann E, Müller M, Narita D, Raadts A, Schwendner K, Seifried E, Stark P, Steinbicker AU, Thoma J, Velten M, Weigt H, Wiesenack C, Wittmann M, Zacharowski K, Piekarski F. Preoperative anaemia and red blood cell transfusion in patients with aneurysmal subarachnoid and intracerebral haemorrhage - a multicentre subanalysis of the German PBM Network Registry. Acta Neurochir (Wien) 2022; 164:985-999. [PMID: 35220460 PMCID: PMC8967742 DOI: 10.1007/s00701-022-05144-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/11/2022] [Indexed: 11/07/2022]
Abstract
Purpose Anaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period. Methods This multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Results A total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3% in aSAH and 40.9% in ICH. RBC transfusion rates were 29.9% in aSAH and 29.3% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications. Conclusions Preoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Trial registration ClinicalTrials.gov, NCT02147795, https://clinicaltrials.gov/ct2/show/NCT02147795 Supplementary Information The online version contains supplementary material available at 10.1007/s00701-022-05144-7.
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12
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Urban H, Steidl E, Hattingen E, Filipski K, Meissner M, Sebastian M, Koch A, Strzelczyk A, Forster MT, Baumgarten P, Ronellenfitsch MW, Steinbach JP, Voss M. Immune Checkpoint Inhibitor-Induced Cerebral Pseudoprogression: Patterns and Categorization. Front Immunol 2022; 12:798811. [PMID: 35046955 PMCID: PMC8761630 DOI: 10.3389/fimmu.2021.798811] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
Background The inclusion of immune checkpoint inhibitors (ICIs) in therapeutic algorithms has led to significant survival benefits in patients with various metastatic cancers. Concurrently, an increasing number of neurological immune related adverse events (IRAE) has been observed. In this retrospective analysis, we examine the ICI-induced incidence of cerebral pseudoprogression and propose a classification system. Methods We screened our hospital information system to identify patients with any in-house ICI treatment for any tumor disease during the years 2007-2019. All patients with cerebral MR imaging (cMRI) of sufficient diagnostic quality were included. cMRIs were retrospectively analyzed according to immunotherapy response assessment for neuro-oncology (iRANO) criteria. Results We identified 12 cases of cerebral pseudoprogression in 123 patients treated with ICIs and sufficient MRI. These patients were receiving ICI therapy for lung cancer (n=5), malignant melanoma (n=4), glioblastoma (n=1), hepatocellular carcinoma (n=1) or lymphoma (n=1) when cerebral pseudoprogression was detected. Median time from the start of ICI treatment to pseudoprogression was 5 months. All but one patient developed neurological symptoms. Three different patterns of cerebral pseudoprogression could be distinguished: new or increasing contrast-enhancing lesions, new or increasing T2 predominant lesions and cerebral vasculitis type pattern. Conclusion Cerebral pseudoprogression followed three distinct patterns and was detectable in 3.2% of all patients during ICI treatment and in 9.75% of the patients with sufficient brain imaging follow up. The fact that all but one of the affected patients developed neurological symptoms, which would be classified as progressive disease according to iRANO criteria, mandates vigilance in the diagnosis and treatment of ICI-induced cerebral lesions.
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Affiliation(s)
- Hans Urban
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany
| | - Eike Steidl
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Elke Hattingen
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany.,Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Katharina Filipski
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany.,Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Martin Sebastian
- Department of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Agnes Koch
- Department of Thoracic Surgery, Agaplesion Markuskrankenhaus, Frankfurt/Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (Cepter), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Marie-Thérèse Forster
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany.,Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Peter Baumgarten
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Michael W Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (Cepter), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany
| | - Martin Voss
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany
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13
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Dubinski D, Won SY, Behmanesh B, Dosch M, Puchinin V, Baumgarten P, Bernstock JD, Voss M, Schuss P, Konczalla J, Czabanka M, Freiman TM, Gessler F. Therapeutic Anticoagulation Impacts MR Morphologic Recurrence Patterns in Glioblastoma-A Matched-Pair Analysis. J Clin Med 2022; 11:422. [PMID: 35054114 PMCID: PMC8778000 DOI: 10.3390/jcm11020422] [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: 12/10/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) patients are at particularly high risk for thrombotic complications. In the event of a postoperative pulmonary embolism, therapeutic anticoagulation (tAC) is indispensable. The impact of therapeutic anticoagulation on recurrence pattern in GBM is currently unknown. METHODS We conducted a matched-pair cohort analysis of 57 GBM patients with or without tAC that were matched for age, sex, gross total resection and MGMT methylation status in a ratio of 1:2. Patients' characteristics and clinical course were evaluated using medical charts. MRI characteristics were evaluated by two independent authors blinded to the AC status. RESULTS The morphologic MRI appearance in first GBM recurrence showed a significantly higher presence of multifocal, midline crossing and sharp demarcated GBM recurrence patterns in patients with therapeutic tAC compared to the matched control group. Although statistically non-significant, the therapeutic tAC cohort showed increased survival. CONCLUSION Therapeutic anticoagulation induced significant morphologic changes in GBM recurrences. The underlying pathophysiology is discussed in this article but remains to be further elucidated.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
- Department of Neurosurgery, University Medicine Rostock, 18055 Rostock, Germany; (T.M.F.); (F.G.)
| | - Sae-Yeon Won
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
- Department of Neurosurgery, University Medicine Rostock, 18055 Rostock, Germany; (T.M.F.); (F.G.)
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
- Department of Neurosurgery, University Medicine Rostock, 18055 Rostock, Germany; (T.M.F.); (F.G.)
| | - Max Dosch
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
| | - Viktoria Puchinin
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
| | - Joshua D. Bernstock
- Department of Neurosurgery, Birgham and Women’s, Harvard Medical School, Boston, MA 02115, USA;
| | - Martin Voss
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, 18055 Frankfurt, Germany;
| | - Patrick Schuss
- Department of Neurosurgery, Unfallkrankenhaus Berlin, 12683 Berlin, Germany;
| | - Jürgen Konczalla
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital, Goethe University, 60528 Frankfurt, Germany; (S.-Y.W.); (B.B.); (M.D.); (V.P.); (P.B.); (J.K.); (M.C.)
| | - Thomas M. Freiman
- Department of Neurosurgery, University Medicine Rostock, 18055 Rostock, Germany; (T.M.F.); (F.G.)
| | - Florian Gessler
- Department of Neurosurgery, University Medicine Rostock, 18055 Rostock, Germany; (T.M.F.); (F.G.)
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14
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Maas SLN, Stichel D, Hielscher T, Sievers P, Berghoff AS, Schrimpf D, Sill M, Euskirchen P, Blume C, Patel A, Dogan H, Reuss D, Dohmen H, Stein M, Reinhardt A, Suwala AK, Wefers AK, Baumgarten P, Ricklefs F, Rushing EJ, Bewerunge-Hudler M, Ketter R, Schittenhelm J, Jaunmuktane Z, Leu S, Greenway FEA, Bridges LR, Jones T, Grady C, Serrano J, Golfinos J, Sen C, Mawrin C, Jungk C, Hänggi D, Westphal M, Lamszus K, Etminan N, Jungwirth G, Herold-Mende C, Unterberg A, Harter PN, Wirsching HG, Neidert MC, Ratliff M, Platten M, Snuderl M, Aldape KD, Brandner S, Hench J, Frank S, Pfister SM, Jones DTW, Reifenberger G, Acker T, Wick W, Weller M, Preusser M, von Deimling A, Sahm F. Integrated Molecular-Morphologic Meningioma Classification: A Multicenter Retrospective Analysis, Retrospectively and Prospectively Validated. J Clin Oncol 2021; 39:3839-3852. [PMID: 34618539 PMCID: PMC8713596 DOI: 10.1200/jco.21.00784] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [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
PURPOSE Meningiomas are the most frequent primary intracranial tumors. Patient outcome varies widely from benign to highly aggressive, ultimately fatal courses. Reliable identification of risk of progression for individual patients is of pivotal importance. However, only biomarkers for highly aggressive tumors are established (CDKN2A/B and TERT), whereas no molecularly based stratification exists for the broad spectrum of patients with low- and intermediate-risk meningioma. METHODS DNA methylation data and copy-number information were generated for 3,031 meningiomas (2,868 patients), and mutation data for 858 samples. DNA methylation subgroups, copy-number variations (CNVs), mutations, and WHO grading were analyzed. Prediction power for outcome was assessed in a retrospective cohort of 514 patients, validated on a retrospective cohort of 184, and on a prospective cohort of 287 multicenter cases. RESULTS Both CNV- and methylation family-based subgrouping independently resulted in increased prediction accuracy of risk of recurrence compared with the WHO classification (c-indexes WHO 2016, CNV, and methylation family 0.699, 0.706, and 0.721, respectively). Merging all risk stratification approaches into an integrated molecular-morphologic score resulted in further substantial increase in accuracy (c-index 0.744). This integrated score consistently provided superior accuracy in all three cohorts, significantly outperforming WHO grading (c-index difference P = .005). Besides the overall stratification advantage, the integrated score separates more precisely for risk of progression at the diagnostically challenging interface of WHO grade 1 and grade 2 tumors (hazard ratio 4.34 [2.48-7.57] and 3.34 [1.28-8.72] retrospective and prospective validation cohorts, respectively). CONCLUSION Merging these layers of histologic and molecular data into an integrated, three-tiered score significantly improves the precision in meningioma stratification. Implementation into diagnostic routine informs clinical decision making for patients with meningioma on the basis of robust outcome prediction.
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Affiliation(s)
- Sybren L N Maas
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Damian Stichel
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Sievers
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna S Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Daniel Schrimpf
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Philipp Euskirchen
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Blume
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Areeba Patel
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Helin Dogan
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hildegard Dohmen
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany
| | - Marco Stein
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany.,Department of Neurosurgery, University Hospital Gießen, Giessen, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Abigail K Suwala
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Franz Ricklefs
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabeth J Rushing
- Department of Neuropathology, University Hospital Zurich, Zürich, Switzerland
| | | | - Ralf Ketter
- Department of Neurosurgery, University Hospital Homburg, Homburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, United Kingdom.,Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Severina Leu
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Fay E A Greenway
- Department of Neurosurgery, St George's Hospital, London, United Kingdom
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's Hospital, London, United Kingdom
| | - Timothy Jones
- Department of Neurosurgery, St George's Hospital, London, United Kingdom
| | - Conor Grady
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | | | - John Golfinos
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | - Christian Mawrin
- Department of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Gerhard Jungwirth
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Exp. Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI) and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Heidelberg, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Miriam Ratliff
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University, Heidelberg, Germany
| | - Matija Snuderl
- Department of Pathology, NYU Grossman School of Medicine, New York, NY
| | | | - Sebastian Brandner
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, United Kingdom.,Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jürgen Hench
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stephan Frank
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University Medical Faculty, Düsseldorf, Germany.,German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany
| | - Till Acker
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
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15
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Marquardt G, Quick-Weller J, Tritt S, Baumgarten P, Senft C, Seifert V. Two-step staged resection of giant olfactory groove meningiomas. Acta Neurochir (Wien) 2021; 163:3425-3431. [PMID: 34373942 PMCID: PMC8599346 DOI: 10.1007/s00701-021-04910-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/10/2021] [Indexed: 12/05/2022]
Abstract
Background The surgical treatment of giant olfactory groove meningiomas (OGMs) with marked perilesional brain oedema is still a surgical challenge. After tumour resection, increase of brain oedema may occur causing dramatic neurological deterioration and even death of the patient. The objective of this paper is to describe surgical features of a two-step staged resection of these tumours performed to counter increase of postoperative brain oedema. Methods This two-step staged resection procedure was carried out in a consecutive series of 19 patients harbouring giant OGMs. As first step, a bifrontal craniectomy was performed followed by a right-sided interhemispherical approach. About 80% of the tumour mass was resected leaving behind a shell-shaped tumour remnant. In the second step, carried out after the patients’ recovery from the first surgery and decline of oedema, the remaining part of the tumour was removed completely followed by duro- and cranioplasty. Results Ten patients recovered quickly from first surgery and the second operation was performed after a mean of 12.4 days. In eight patients, the second operation was carried out later between day 25 and 68 due to surgery-related complications, development of a trigeminal zoster, or to a persisting frontal brain oedema. Mean follow-up was 49.3 months and all but one patient had a good outcome regardless of surgery-related complications. Conclusions Our results suggest that a two-step staged resection of giant OGMs minimizes the increase of postoperative brain oedema as far as possible and translates into lower morbidity and mortality.
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Affiliation(s)
- Gerhard Marquardt
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Johanna Quick-Weller
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Stephanie Tritt
- Department of Neuroradiology, Goethe - University, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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16
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Maas S, Stichel D, Hielscher T, Sievers P, Berghoff A, Schrimpf D, Sill M, Euskirchen P, Reuss D, Dohmen H, Stein M, Baumgarten P, Ricklefs F, Rushing E, Bewerunge-Hudler M, Ketter R, Schittenhelm J, Jaunmuktane Z, Leu S, Grady C, Serrano J, Golfinos J, Sen C, Mawrin C, Jungk C, Hänggi D, Westphal M, Lamszus K, Etminan N, Unterberg A, Harter P, Wirsching HG, Neidert MC, Ratliff M, Platten M, Snuderl M, Aldape K, Brandner S, Hench J, Frank S, Pfister S, Jones D, Reifenberger G, Acker T, Wick W, Weller M, Preusser M, von Deimling A, Sahm F. PATH-39. INTEGRATED MOLECULAR-MORPHOLOGICAL MENINGIOMA CLASSIFICATION: A MULTICENTER RETROSPECTIVE ANALYSIS, RETRO- AND PROSPECTIVELY VALIDATED. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
PURPOSE
Meningiomas are the most frequent primary intracranial tumors. Patient outcome varies widely from cases with benign to highly aggressive, ultimately fatal courses. Reliable identification of risk of progression for the individual patient is of pivotal importance in clinical management. However, only biomarkers for highly aggressive tumors are established at present (CDKN2A/B and TERT), while no molecularly-based stratification exists for the broad spectrum of low- and intermediate-risk meningioma patients.
PATIENTS AND METHODS
DNA methylation data and copy-number information were generated for 3,031 meningiomas of 2,868 individual patients, with mutation data for 858 samples. DNA methylation subgroups, copy-number variations (CNV), mutations and WHO grading were comparatively analyzed. Prediction power for outcome of these parameters was assessed in an initial retrospective cohort of 514 patients, and validated on a retrospective cohort of 184, and on a prospective cohort of 287 multi-center cases, respectively.
RESULTS
Both CNV and methylation family- (MF)-based subgrouping independently resulted in an increase in prediction accuracy of risk of recurrence compared to the WHO classification (c-indexes WHO 2016, CNV, and MF 0.699, 0.706 and 0.721, respectively). Merging all independently powerful risk stratification approaches into an integrated molecular-morphological score resulted in a further, substantial increase in accuracy (c-index 0.744). This integrated score consistently provided superior accuracy in all three cohorts, significantly outperforming WHO grading (c-index difference p=0.005). Besides the overall stratification advantage, the integrated score separates more precisely for risk of progression at the diagnostically challenging interface of WHO grade 1 and grade 2 tumors (HR 4.56 [2.97;7.00], 4.34 [2.48;7.57] and 3.34 [1.28; 8.72] for discovery, retrospective, and prospective validation cohort, respectively).
CONCLUSIONS
Merging these layers of histological and molecular data into an integrated, three-tiered score significantly improves the precision in meningioma stratification. Implementation into diagnostic routine informs clinical decision-making for meningioma patients on the basis of robust outcome prediction.
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Affiliation(s)
- Sybren Maas
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Damian Stichel
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Hielscher
- Dept. of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Sievers
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniel Schrimpf
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Sill
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | | | - David Reuss
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hildegard Dohmen
- Dept. of Neuropathology, University Hospital Gießen, Gießen, Germany
| | - Marco Stein
- Dept. of Neurosurgery, University Hospital Giessen, Germany, Gießen, Germany
| | - Peter Baumgarten
- Dept. of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Franz Ricklefs
- Dept. of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Elizabeth Rushing
- Dept. of Neuropathology, University Hospital Zurich, Zürich, Switzerland
| | | | - Ralf Ketter
- Dept. of Neurosurgery, University Hospital Homburg, Homburg, Germany
| | - Jens Schittenhelm
- Eberhard-Karls University Tübingen, Department of Neuropathology, Tübingen, Germany
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, University College London, London, United Kingdom
| | - Severina Leu
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Conor Grady
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | | | - John Golfinos
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | - Christian Mawrin
- Dept. of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine Jungk
- Dept. of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Hänggi
- Dept. of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nima Etminan
- Dept. of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Andreas Unterberg
- Division of Experimental Neurosurgery, Department of Neurosurgery, Ruprechts-Karls-University Heidelberg, Heidelberg, Germany
| | - Patrick Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Frankfurt, Germany
| | - Hans-Georg Wirsching
- Dept. of Neurology, University Hospital and University of Zurich, Zürich, Switzerland
| | | | - Miriam Ratliff
- Dept. of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matija Snuderl
- Department of Pathology at NYU Grossman School of Medicine, New York City, NY, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
| | - Jürgen Hench
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stephan Frank
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stefan Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - David Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
| | - Till Acker
- Dept. of Neuropathology, University Hospital Gießen, Gießen, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Dept. of Medicine, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
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17
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Neef V, König S, Monden D, Dubinski D, Benesch A, Raimann FJ, Piekarski F, Ronellenfitsch MW, Harter PN, Senft C, Meybohm P, Hattingen E, Zacharowski K, Seifert V, Baumgarten P. Clinical Outcome and Risk Factors of Red Blood Cell Transfusion in Patients Undergoing Elective Primary Meningioma Resection. Cancers (Basel) 2021; 13:cancers13143601. [PMID: 34298814 PMCID: PMC8307823 DOI: 10.3390/cancers13143601] [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: 04/25/2021] [Revised: 06/24/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary The transfusion of red blood cells (RBC) in patients undergoing major elective cranial surgery is associated with increased morbidity and mortality. This study sought to identify the clinical outcome of RBC transfusions in skull base and non-skull base meningioma patients including the identification of risk factors for RBC transfusion. Data underline that preoperative anaemia rate was significantly higher in transfused patients (17.7%) compared to patients without RBC transfusion (6.2%). We could further show that RBC transfusion was associated with increased postoperative complications and increased hospital length of stay. After multivariate analyses, risk factors for RBC transfusion were preoperative American Society of Anaesthesiologists (ASA) physical status score, tumor size, surgical time, and intraoperative blood loss. We concluded that blood loss due to large tumors or localization near large vessels are the main triggers for RBC transfusion in meningioma patients paired with a potential preselection that masks the effect of preoperative anaemia in multivariate analysis. So far, this has not been investigated in a large cohort (n = 423) of skull base and non-skull base meningioma patients. Abstract Transfusion of red blood cells (RBC) in patients undergoing major elective cranial surgery is associated with increased morbidity, mortality and prolonged hospital length of stay (LOS). This retrospective single center study aims to identify the clinical outcome of RBC transfusions on skull base and non-skull base meningioma patients including the identification of risk factors for RBC transfusion. Between October 2009 and October 2016, 423 patients underwent primary meningioma resection. Of these, 68 (16.1%) received RBC transfusion and 355 (83.9%) did not receive RBC units. Preoperative anaemia rate was significantly higher in transfused patients (17.7%) compared to patients without RBC transfusion (6.2%; p = 0.0015). In transfused patients, postoperative complications as well as hospital LOS was significantly higher (p < 0.0001) compared to non-transfused patients. After multivariate analyses, risk factors for RBC transfusion were preoperative American Society of Anaesthesiologists (ASA) physical status score (p = 0.0247), tumor size (p = 0.0006), surgical time (p = 0.0018) and intraoperative blood loss (p < 0.0001). Kaplan-Meier curves revealed significant influence on overall survival by preoperative anaemia, RBC transfusion, smoking, cardiovascular disease, preoperative KPS ≤ 60% and age (elderly ≥ 75 years). We concluded that blood loss due to large tumors or localization near large vessels are the main triggers for RBC transfusion in meningioma patients paired with a potential preselection that masks the effect of preoperative anaemia in multivariate analysis. Further studies evaluating the impact of preoperative anaemia management for reduction of RBC transfusion are needed to improve the clinical outcome of meningioma patients.
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Affiliation(s)
- Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany; (V.N.); (A.B.); (F.J.R.); (F.P.); (P.M.); (K.Z.)
| | - Sven König
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.K.); (D.M.); (D.D.); (C.S.); (V.S.)
| | - Daniel Monden
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.K.); (D.M.); (D.D.); (C.S.); (V.S.)
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.K.); (D.M.); (D.D.); (C.S.); (V.S.)
| | - Anika Benesch
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany; (V.N.); (A.B.); (F.J.R.); (F.P.); (P.M.); (K.Z.)
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.K.); (D.M.); (D.D.); (C.S.); (V.S.)
| | - Florian J. Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany; (V.N.); (A.B.); (F.J.R.); (F.P.); (P.M.); (K.Z.)
| | - Florian Piekarski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany; (V.N.); (A.B.); (F.J.R.); (F.P.); (P.M.); (K.Z.)
| | - Michael W. Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany;
| | - Patrick N. Harter
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany;
| | - Christian Senft
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.K.); (D.M.); (D.D.); (C.S.); (V.S.)
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany; (V.N.); (A.B.); (F.J.R.); (F.P.); (P.M.); (K.Z.)
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany;
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany; (V.N.); (A.B.); (F.J.R.); (F.P.); (P.M.); (K.Z.)
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.K.); (D.M.); (D.D.); (C.S.); (V.S.)
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.K.); (D.M.); (D.D.); (C.S.); (V.S.)
- Correspondence: ; Tel.: +49-(0)3641-9323011
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18
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Kamp MA, Malzkorn B, von Sass C, DiMeco F, Hadjipanayis CG, Senft C, Rapp M, Gepfner-Tuma I, Fountas K, Krieg SM, Neukirchen M, Florian IȘ, Schnell O, Mijderwijk HJ, Perin A, Baumgarten P, van Lieshout JH, Thon N, Renovanz M, Kahlert U, Spoor JKH, Hänggi D, McLean AL, Mäurer M, Sarrubbo S, Freyschlag CF, Schmidt NO, Vergani F, Jungk C, Stein M, Forster MT, Weinberg JS, Sinclair J, Belykh E, Bello L, Mandonnet E, Moiyadi A, Sabel M. Proposed definition of competencies for surgical neuro-oncology training. J Neurooncol 2021; 153:121-131. [PMID: 33881726 PMCID: PMC8131302 DOI: 10.1007/s11060-021-03750-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/26/2021] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this work is to define competencies and entrustable professional activities (EPAs) to be imparted within the framework of surgical neuro-oncological residency and fellowship training as well as the education of medical students. Improved and specific training in surgical neuro-oncology promotes neuro-oncological expertise, quality of surgical neuro-oncological treatment and may also contribute to further development of neuro-oncological techniques and treatment protocols. Specific curricula for a surgical neuro-oncologic education have not yet been established. METHODS We used a consensus-building approach to propose skills, competencies and EPAs to be imparted within the framework of surgical neuro-oncological training. We developed competencies and EPAs suitable for training in surgical neuro-oncology. RESULT In total, 70 competencies and 8 EPAs for training in surgical neuro-oncology were proposed. EPAs were defined for the management of the deteriorating patient, the management of patients with the diagnosis of a brain tumour, tumour-based resections, function-based surgical resections of brain tumours, the postoperative management of patients, the collaboration as a member of an interdisciplinary and/or -professional team and finally for the care of palliative and dying patients and their families. CONCLUSIONS AND RELEVANCE The present work should subsequently initiate a discussion about the proposed competencies and EPAs and, together with the following discussion, contribute to the creation of new training concepts in surgical neuro-oncology.
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Affiliation(s)
- Marcel A Kamp
- Department of Neurosurgery, Centre of Neuro-Oncology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Centre of Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Bastian Malzkorn
- Medical Education, Office of the Deanery of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christiane von Sass
- Department of Neurosurgery, Centre of Neuro-Oncology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Centre of Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Francesco DiMeco
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurological Surgery, Istituto Nazionale Neurologico "C. Besta", Milan, Italy
| | - Constantinos G Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, USA
- Brain Tumor Nanotechnology Laboratory, Tisch Cancer Institute, New York, USA
| | - Christian Senft
- Department of Neurosurgery, Centre of Neuro-Oncology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Marion Rapp
- Centre of Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Irina Gepfner-Tuma
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Konstantinos Fountas
- Department of Neurosurgery, University Hospital of Larissa, Larissa, Thessaly, Greece
- Medical School, University of Thessaly, Thessaly, Greece
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Martin Neukirchen
- Interdisciplinary Centre for Palliative Care, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Anesthesiology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ioan Ștefan Florian
- Department of Neurosurgery, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Department of Neurosurgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Oliver Schnell
- Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Hendrik-Jan Mijderwijk
- Centre of Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Alessandro Perin
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurological Surgery, Istituto Nazionale Neurologico "C. Besta", Milan, Italy
| | - Peter Baumgarten
- Department of Neurosurgery, Centre of Neuro-Oncology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Jasper H van Lieshout
- Centre of Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Niklas Thon
- Neurosurgical Clinic, University of Munich (LMU), Campus Grosshadern, Munich, Germany
| | - Miriam Renovanz
- Department of Neurology & Neuro-Oncology, University Hospital Tuebingen, Tuebingen, Germany
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulf Kahlert
- Division of Preclinical Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jochem K H Spoor
- Departments of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Daniel Hänggi
- Centre of Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Aaron Lawson McLean
- Department of Neurosurgery, Centre of Neuro-Oncology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthias Mäurer
- Department of Radiation Oncology, Jena University Hospital, Jena, Germany
| | - Silvio Sarrubbo
- Department of Neurosurgery, Structural and Functional Connectivity Lab Project, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | | | - Nils O Schmidt
- Department of Neurosurgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Christine Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig University Giessen, Giessen, Germany
| | | | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Sinclair
- Department of Neurosurgery, The Ottawa Hospital Civic Campus, Ottawa, ON, Canada
| | - Evgenii Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers, NJ, USA
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | | | - Aliasgar Moiyadi
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Michael Sabel
- Centre of Neuro-Oncology, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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19
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Keil VC, Gielen GH, Pintea B, Baumgarten P, Datsi A, Hittatiya K, Simon M, Hattingen E. DCE-MRI in Glioma, Infiltration Zone and Healthy Brain to Assess Angiogenesis: A Biopsy Study. Clin Neuroradiol 2021; 31:1049-1058. [PMID: 33900414 PMCID: PMC8648693 DOI: 10.1007/s00062-021-01015-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/22/2021] [Indexed: 12/29/2022]
Abstract
Purpose To explore the focal predictability of vascular growth factor expression and neovascularization using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in glioma. Methods 120 brain biopsies were taken in vital tumor, infiltration zone and normal brain tissue of 30 glioma patients: 17 IDH(isocitrate dehydrogenase)-wildtype glioblastoma (GBM), 1 IDH-wildtype astrocytoma °III (together prognostic group 1), 3 IDH-mutated GBM (group 2), 3 anaplastic astrocytomas IDH-mutated (group 3), 4 anaplastic oligodendrogliomas and 2 low-grade oligodendrogliomas (together prognostic group 4). A mixed linear model evaluated the predictabilities of microvessel density (MVD), vascular area ratio (VAR), mean vessel size (MVS), vascular endothelial growth factor and receptors (VEGF-A, VEGFR‑2) and vascular endothelial-protein tyrosine phosphatase (VE-PTP) expression from Tofts model kinetic and model-free curve parameters. Results All kinetic parameters were associated with VEGF‑A (all p < 0.001) expression. Ktrans, kep and ve were associated with VAR (p = 0.006, 0.004 and 0.01, respectively) and MVS (p = 0.0001, 0.02 and 0.003, respectively) but not MVD (p = 0.84, 0.74 and 0.73, respectively). Prognostic groups differed in Ktrans (p = 0.007) and ve (p = 0.004) values measured in the infiltration zone. Despite significant differences of VAR, MVS, VEGF‑A, VEGFR‑2, and VE-PTP in vital tumor tissue and the infiltration zone (p = 0.0001 for all), there was no significant difference between kinetic parameters measured in these zones. Conclusion The DCE-MRI kinetic parameters show correlations with microvascular parameters in vital tissue and also reveal blood-brain barrier abnormalities in the infiltration zones adequate to differentiate glioma prognostic groups. Supplementary Information The online version of this article (10.1007/s00062-021-01015-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vera C Keil
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Department of Radiology, Amsterdam University Medical Center, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Gerrit H Gielen
- Department of Neuropathology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital BG Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,Institute of Neuropathology (Edinger Institute), University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Angeliki Datsi
- ITZ, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Kanishka Hittatiya
- Center for Pathology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Neurosurgery, Ev. Krankenhaus Bielefeld, Haus Gilead I, Burgsteig 13, 33617, Bielefeld, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Neuroradiology, University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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20
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Dubinski D, Won SY, Voss M, Keil F, Miesbach W, Behmanesh B, Dosch M, Baumgarten P, Bernstock JD, Seifert V, Freiman TM, Gessler F. Direct oral anticoagulants vs. low-molecular-weight heparin for pulmonary embolism in patients with glioblastoma. Neurosurg Rev 2021; 45:451-457. [PMID: 33900495 PMCID: PMC8827361 DOI: 10.1007/s10143-021-01539-9] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/03/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
Glioblastoma (GBM) is a cancer type with high thrombogenic potential and GBM patients are therefore at a particularly high risk for thrombotic events. To date, only limited data on anticoagulation management after pulmonary embolism (PE) in GBM is available and the sporadic use of DOACs remains off-label. A retrospective cohort analysis of patients with GBM and postoperative, thoracic CT scan confirmed PE was performed. Clinical course, follow-up at 6 and 12 months and the overall survival (OS) were evaluated using medical charts and neuroradiological data. Out of 584 GBM patients, 8% suffered from postoperative PE. Out of these, 30% received direct oral anticoagulants (DOACs) and 70% low-molecular-weight heparin (LMWH) for therapeutic anticoagulation. There was no significant difference in major intracranial hemorrhage (ICH), re-thrombosis, or re-embolism between the two cohorts. Although statistically non-significant, a tendency to reduced mRS at 6 and 12 months was observed in the LMWH cohort. Furthermore, patients receiving DOACs had a statistical benefit in OS. In our analysis, DOACs showed a satisfactory safety profile in terms of major ICH, re-thrombosis, and re-embolism compared to LMWH in GBM patients with postoperative PE. Prospective, randomized trials are urgent to evaluate DOACs for therapeutic anticoagulation in GBM patients with PE.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany.
| | - Sae-Yeon Won
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany
| | - Martin Voss
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - Fee Keil
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt, Germany
| | - Wolfgang Miesbach
- Department of Hemostaseology and Transfusion Medicine, University Hospital, DRK-Blutspendedienst Baden-Württemberg-Hessen gGmbH, Frankfurt, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany
| | - Max Dosch
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany
| | - Joshua D Bernstock
- Department of Neurosurgery, Birgham and Women's, Harvard Medical School, Boston, MA, USA
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Hospital, Goethe University, Schleusenweg 2-16, 60598, Frankfurt, Germany
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21
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Wirsik NM, Ehlers J, Mäder L, Ilina EI, Blank AE, Grote A, Feuerhake F, Baumgarten P, Devraj K, Harter PN, Mittelbronn M, Naumann U. TGF-β activates pericytes via induction of the epithelial-to-mesenchymal transition protein SLUG in glioblastoma. Neuropathol Appl Neurobiol 2021; 47:768-780. [PMID: 33780024 DOI: 10.1111/nan.12714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/22/2021] [Accepted: 03/13/2021] [Indexed: 12/19/2022]
Abstract
AIMS In primary central nervous system tumours, epithelial-to-mesenchymal transition (EMT) gene expression is associated with increased malignancy. However, it has also been shown that EMT factors in gliomas are almost exclusively expressed by glioma vessel-associated pericytes (GA-Peris). In this study, we aimed to identify the mechanism of EMT in GA-Peris and its impact on angiogenic processes. METHODS In glioma patients, vascular density and the expression of the pericytic markers platelet derived growth factor receptor (PDGFR)-β and smooth muscle actin (αSMA) were examined in relation to the expression of the EMT transcription factor SLUG and were correlated with survival of patients with glioblastoma (GBM). Functional mechanisms of SLUG regulation and the effects on primary human brain vascular pericytes (HBVP) were studied in vitro by measuring proliferation, cell motility and growth characteristics. RESULTS The number of PDGFR-β- and αSMA-positive pericytes did not change with increased malignancy nor showed an association with the survival of GBM patients. However, SLUG-expressing pericytes displayed considerable morphological changes in GBM-associated vessels, and TGF-β induced SLUG upregulation led to enhanced proliferation, motility and altered growth patterns in HBVP. Downregulation of SLUG or addition of a TGF-β antagonising antibody abolished these effects. CONCLUSIONS We provide evidence that in GA-Peris, elevated SLUG expression is mediated by TGF-β, a cytokine secreted by most glioma cells, indicating that the latter actively modulate neovascularisation not only by modulating endothelial cells, but also by influencing pericytes. This process might be responsible for the formation of an unstructured tumour vasculature as well as for the breakdown of the blood-brain barrier in GBM.
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Affiliation(s)
- Naita M Wirsik
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,General-, Visceral- and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jakob Ehlers
- Laboratory of Molecular Neuro-Oncology, Department of Vascular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Lisa Mäder
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,Department of Neurology, Klinikum Darmstadt, Darmstadt, Germany
| | - Elena I Ilina
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,Luxembourg Centre of Neuropathology (LCNP), Luxembourg, Luxembourg.,Department of Oncology (DONC), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
| | - Anna-Eva Blank
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,Pediatric Cardiology, University Hospital of Giessen, Gießen, Germany
| | - Anne Grote
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Friedrich Feuerhake
- Institute for Pathology, Hannover Medical School, Hannover, Germany.,Institute for Neuropathology, University Clinic Freiburg, Freiburg, Germany
| | - Peter Baumgarten
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,Department of Neurosurgery, Goethe University, Frankfurt/Main, Germany
| | - Kavi Devraj
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Patrick N Harter
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany
| | - Michel Mittelbronn
- Edinger Institute (Neurological Institute), Goethe University Hospital, Frankfurt/Main, Germany.,Luxembourg Centre of Neuropathology (LCNP), Luxembourg, Luxembourg.,Department of Oncology (DONC), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg, Luxembourg.,National Center of Pathology (NCP), Laboratoire Nationale de Santé (LNS), Luxembourg, Luxembourg
| | - Ulrike Naumann
- Laboratory of Molecular Neuro-Oncology, Department of Vascular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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22
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Dubinski D, Won SY, Rauch M, Behmanesh B, Ngassam LDC, Baumgarten P, Senft C, Harter PN, Bernstock JD, Freiman TM, Seifert V, Gessler F. Association of Isocitrate Dehydrogenase (IDH) Status With Edema to Tumor Ratio and Its Correlation With Immune Infiltration in Glioblastoma. Front Immunol 2021; 12:627650. [PMID: 33868245 PMCID: PMC8044904 DOI: 10.3389/fimmu.2021.627650] [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: 11/09/2020] [Accepted: 03/09/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose The extent of preoperative peritumoral edema in glioblastoma (GBM) has been negatively correlated with patient outcome. As several ongoing studies are investigating T-cell based immunotherapy in GBM, we conducted this study to assess whether peritumoral edema with potentially increased intracranial pressure, disrupted tissue homeostasis and reduced local blood flow has influence on immune infiltration and affects survival. Methods A volumetric analysis of preoperative imaging (gadolinium enhanced T1 weighted MRI sequences for tumor size and T2 weighted sequences for extent of edema (including the infiltrative zone, gliosis etc.) was conducted in 144 patients using the Brainlab® software. Immunohistochemical staining was analyzed for lymphocytic- (CD 3+) and myelocytic (CD15+) tumor infiltration. A retrospective analysis of patient-, surgical-, and molecular characteristics was performed using medical records. Results The edema to tumor ratio was neither associated with progression-free nor overall survival (p=0.90, p=0.74). However, GBM patients displaying IDH-1 wildtype had significantly higher edema to tumor ratio than patients displaying an IDH-1 mutation (p=0.01). Immunohistopathological analysis did not show significant differences in lymphocytic or myelocytic tumor infiltration (p=0.78, p=0.74) between these groups. Conclusion In our cohort, edema to tumor ratio had no significant correlation with immune infiltration and outcome. However, patients with an IDH-1wildtype GBM had a significantly higher edema to tumor ratio compared to their IDH-1 mutated peer group. Further studies are necessary to elucidate the underlying mechanisms.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Maximilian Rauch
- Institute of Neuroradiology, Goethe University, Frankfurt, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Lionel D C Ngassam
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt, Germany
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas M Freiman
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
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23
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Bernatz S, Monden D, Gessler F, Radic T, Hattingen E, Senft C, Seifert V, Ronellenfitsch MW, Plate KH, Harter PN, Baumgarten P. Influence of VEGF-A, VEGFR-1-3, and neuropilin 1-2 on progression-free: and overall survival in WHO grade II and III meningioma patients. J Mol Histol 2021; 52:233-243. [PMID: 33528717 PMCID: PMC8012320 DOI: 10.1007/s10735-020-09940-2] [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: 06/24/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022]
Abstract
Higher grade meningiomas tend to recur. We aimed to evaluate protein levels of vascular endothelial growth factor (VEGF)-A with the VEGF-receptors 1-3 and the co-receptors Neuropilin (NRP)-1 and -2 in WHO grade II and III meningiomas to elucidate the rationale for targeted treatments. We investigated 232 specimens of 147 patients suffering from cranial meningioma, including recurrent tumors. Immunohistochemistry for VEGF-A, VEGFR-1-3, and NRP-1/-2 was performed on tissue micro arrays. We applied a semiquantitative score (staining intensity x frequency). VEGF-A, VEGFR-1-3, and NRP-1 were heterogeneously expressed. NRP-2 was mainly absent. We demonstrated a significant increase of VEGF-A levels on tumor cells in WHO grade III meningiomas (p = 0.0098). We found a positive correlation between expression levels of VEGF-A and VEGFR-1 on tumor cells and vessels (p < 0.0001). In addition, there was a positive correlation of VEGF-A and VEGFR-3 expression on tumor vessels (p = 0.0034). VEGFR-2 expression was positively associated with progression-free survival (p = 0.0340). VEGF-A on tumor cells was negatively correlated with overall survival (p = 0.0084). The VEGF-A-driven system of tumor angiogenesis might still present a suitable target for adjuvant therapy in malignant meningioma disease. However, its role in malignant tumor progression may not be as crucial as expected. The value of comprehensive testing of the ligand and all receptors prior to administration of anti-angiogenic therapy needs to be evaluated in clinical trials.
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Affiliation(s)
- Simon Bernatz
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Daniel Monden
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Tijana Radic
- Institute of Clinical Neuroanatomy, Goethe-University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Michael W Ronellenfitsch
- Department of Neuro-Oncology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Karl H Plate
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI), Goethe-University, Frankfurt, Germany.,German Cancer Consortium (DKTK), Partner site Frankfurt/Mainz, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
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24
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Baumgarten P, Sarlak M, Monden D, Spyrantis A, Bernatz S, Gessler F, Dubinski D, Hattingen E, Marquardt G, Strzelczyk A, Rosenow F, Harter PN, Seifert V, Freiman TM. Early and Late Postoperative Seizures in Meningioma Patients and Prediction by a Recent Scoring System. Cancers (Basel) 2021; 13:cancers13030450. [PMID: 33504023 PMCID: PMC7865990 DOI: 10.3390/cancers13030450] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Seizures are among the most common symptoms of meningioma patients even after surgery. This study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified version of a score to predict postoperative seizures on an independent cohort. The data underline that there are distinct factors identifying patients with a high risk of postoperative seizures following meningioma surgery which has been already shown before. We could further show that the high proportion of 43% of postoperative seizures occur as late seizures which are more dangerous because they may happen out of hospital. The modified STAMPE2 score could predict postoperative seizures when reaching very high scores but was not generally transferable to our independent cohort. Abstract Seizures are among the most common symptoms of meningioma. This retrospective study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified STAMPE2 score. In 556 patients who underwent meningioma surgery, we correlated different risk factors with the occurrence of postoperative seizures. A modified STAMPE2 score was applied. Risk factors for preoperative seizures were edema (p = 0.039) and temporal location (p = 0.038). For postoperative seizures preoperative tumor size (p < 0.001), sensomotory deficit (p = 0.004) and sphenoid wing location (p = 0.032) were independent risk factors. In terms of postoperative status epilepticus; sphenoid wing location (p = 0.022), tumor volume (p = 0.045) and preoperative seizures (p < 0.001) were independent risk factors. Postoperative seizures lead to a KPS deterioration and thus an impaired quality of life (p < 0.001). Late seizures occurred in 43% of patients with postoperative seizures. The small sub-cohort of patients (2.7%) with a STAMPE2 score of more than six points had a significantly increased risk for seizures (p < 0.001, total risk 70%). We concluded that besides distinct risk factors, high scores of the modified STAMPE2 score could estimate the risk of postoperative seizures. However, it seems not transferable to our cohort
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Affiliation(s)
- Peter Baumgarten
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
- Correspondence: ; Tel.: +49-(0)69-6301-5295
| | - Mana Sarlak
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Daniel Monden
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Andrea Spyrantis
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Simon Bernatz
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.B.); (P.N.H.)
| | - Florian Gessler
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany;
| | - Gerhard Marquardt
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (A.S.); (F.R.)
- Department of Neurology, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (A.S.); (F.R.)
- Department of Neurology, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
| | - Patrick N. Harter
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (S.B.); (P.N.H.)
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
- German Cancer Consortium (DKTK) Partner Site Frankfurt/Mainz, 60528 Frankfurt am Main, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), 60528 Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
| | - Thomas M. Freiman
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (M.S.); (D.M.); (A.S.); (F.G.); (D.D.); (G.M.); (V.S.); (T.M.F.)
- Epilepsy Center Frankfurt Rhine-Main, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany; (A.S.); (F.R.)
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
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25
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Dubinski D, Won SY, Miesbach W, Keil F, Behmanesh B, Baumgarten P, Raimann FJ, Bernstock JD, Senft C, Seifert V, Freiman TM, Gessler F. Direct oral anticoagulants for therapeutic anticoagulation in postoperative pulmonary embolism after meningioma resection. J Clin Neurosci 2020; 81:265-269. [PMID: 33222927 DOI: 10.1016/j.jocn.2020.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acute postoperative pulmonary embolism (PE) is a dreaded complication with severe mortality rates. Brain tumor patients are at the highest risk for postoperative PE. The juxtaposition of low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) in the treatment of postoperative PE in meningioma patients is largely unexplored. PATIENTS/METHODS This is a single center observational analysis of meningioma patients who underwent neurosurgical resection with a thoracic CT scan confirmation of postoperative PE. The treatment modality, clinical course and outcome were investigated. RESULTS Of 538 meningioma patients operated, 30 (6%) developed acute postoperative PE. After diagnosis, these patients received different long-term anticoagulation regimes. No significant difference in postoperative hemorrhage (p < 0.56), re-operation rate (p < 0.70) or Karnofsky performance scale (KPS) at 3 (p < 0.34) and 12 months (p = 1) were identified, when compared according to the different anticoagulation regimes. CONCLUSION DOACs were not associated with elevated risk for hemorrhage, recurrent thrombosis or poor outcome when compared with traditional anticoagulation regimes. Prospective randomized trials are necessary to verify the non-inferiority of DOACs for long-term anticoagulation in postoperative pulmonary embolism after meningioma resection.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany.
| | - Sae-Yeon Won
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Wolfgang Miesbach
- Department of Hemostaseology and Transfusion Medicine, University Hospital, Frankfurt, Germany; DRK-Blutspendedienst Baden-Württemberg-Hessen gGmbH, Frankfurt, Germany; Department of Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - Fee Keil
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Florian J Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Joshua D Bernstock
- Department of Neurosurgery, Birgham and Women's, Harvard Medical School, Boston, MA, USA
| | - Christian Senft
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany
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26
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Braun Y, Filipski K, Bernatz S, Baumgarten P, Roller B, Zinke J, Zeiner PS, Ilina E, Senft C, Ronellenfitsch MW, Plate KH, Bähr O, Hattingen E, Steinbach JP, Mittelbronn M, Harter PN. Linking epigenetic signature and metabolic phenotype in IDH mutant and IDH wildtype diffuse glioma. Neuropathol Appl Neurobiol 2020; 47:379-393. [PMID: 33080075 DOI: 10.1111/nan.12669] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/23/2020] [Accepted: 10/14/2020] [Indexed: 01/17/2023]
Abstract
AIMS Changes in metabolism are known to contribute to tumour phenotypes. If and how metabolic alterations in brain tumours contribute to patient outcome is still poorly understood. Epigenetics impact metabolism and mitochondrial function. The aim of this study is a characterisation of metabolic features in molecular subgroups of isocitrate dehydrogenase mutant (IDHmut) and isocitrate dehydrogenase wildtype (IDHwt) gliomas. METHODS We employed DNA methylation pattern analyses with a special focus on metabolic genes, large-scale metabolism panel immunohistochemistry (IHC), qPCR-based determination of mitochondrial DNA copy number and immune cell content using IHC and deconvolution of DNA methylation data. We analysed molecularly characterised gliomas (n = 57) for in depth DNA methylation, a cohort of primary and recurrent gliomas (n = 22) for mitochondrial copy number and validated these results in a large glioma cohort (n = 293). Finally, we investigated the potential of metabolic markers in Bevacizumab (Bev)-treated gliomas (n = 29). RESULTS DNA methylation patterns of metabolic genes successfully distinguished the molecular subtypes of IDHmut and IDHwt gliomas. Promoter methylation of lactate dehydrogenase A negatively correlated with protein expression and was associated with IDHmut gliomas. Mitochondrial DNA copy number was increased in IDHmut tumours and did not change in recurrent tumours. Hierarchical clustering based on metabolism panel IHC revealed distinct subclasses of IDHmut and IDHwt gliomas with an impact on patient outcome. Further quantification of these markers allowed for the prediction of survival under anti-angiogenic therapy. CONCLUSION A mitochondrial signature was associated with increased survival in all analyses, which could indicate tumour subgroups with specific metabolic vulnerabilities.
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Affiliation(s)
- Yannick Braun
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Katharina Filipski
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Frankfurt, Germany.,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Simon Bernatz
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Peter Baumgarten
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,Department of Neurosurgery, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Bastian Roller
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Jenny Zinke
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Pia S Zeiner
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,Dr. Senckenberg Institute for Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Elena Ilina
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Michael W Ronellenfitsch
- German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Frankfurt, Germany.,German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Dr. Senckenberg Institute for Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt, Germany
| | - Karl H Plate
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Frankfurt, Germany.,German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute for Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Elke Hattingen
- Frankfurt Cancer Institute (FCI), Frankfurt, Germany.,Department of Neuroradiology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Joachim P Steinbach
- German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Frankfurt, Germany.,German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Dr. Senckenberg Institute for Neurooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,Luxembourg Centre of Neuropathology (LCNP), Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg.,National Centre of Pathology (NCP), Laboratoire national de santé (LNS), Luxembourg.,Department of Oncology (DONC), Luxembourg Institute of Health (LIH), Luxembourg
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany.,German Cancer Consortium (DKTK) partner site Frankfurt/Mainz, Frankfurt, Germany.,German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt, Germany
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27
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Braczynski AK, Gfroerer S, Beschorner R, Harter PN, Baumgarten P, Rolle U, Mittelbronn M. Cholinergic innervation and ganglion cell distribution in Hirschsprung's disease. BMC Pediatr 2020; 20:399. [PMID: 32838761 PMCID: PMC7445925 DOI: 10.1186/s12887-020-02299-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background The diagnostic gold standard of Hirschsprung’s disease (HD) is based on the histopathological assessment of colorectal biopsies. Although data on cholinergic innervation and ganglion cell (GC) distribution exist, only few studies have examined these two key features together. We assessed the pattern of cholinergic innervation and the amount of GCs in colorectal specimens of 14 HD patients. Methods We established a semi-quantitative score for cholinergic innervation using acetylcholinesterase (AChE) enzyme histochemistry and quantitatively analyzed the number of GCs via NADH tetrazolium reductase (NADH) enzyme histochemistry. We examined both the entire length of the resected specimens as well as defined areas of the transition zone of both pathological and healthy appearing segment. Results High AChE score values were associated with absence of GCs, and AChE scores were inversely correlated with the number of GCs. Nevertheless, we observed several cases in which one of the two features revealed a normal distribution pattern, whereas the other still displayed pathological features. Conclusions Our data support the need for transmural colon biopsies, to enable the best evaluation of both cholinergic innervation and GCs for a reliable assessment of HD.
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Affiliation(s)
- Anne K Braczynski
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Physical Biology, Heinrich-Heine University, Düsseldorf, Germany.,Institute of Biological Information Processing (IBI-7: Structural Biochemistry, Forschungszentrum Jülich, Jülich, Germany.,Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany
| | - Stefan Gfroerer
- Department of Pediatric Surgery, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Rudi Beschorner
- Institute of Pathology and Neuropathology, Eberhard-Karls University, Tuebingen, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany
| | - Peter Baumgarten
- Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany.,Department of Neurosurgery, Goethe University, Frankfurt, Germany
| | - Udo Rolle
- Department of Pediatric Surgery, University of Frankfurt am Main, Frankfurt, Germany.,University Children's Hospital, Goethe University, Frankfurt, Germany
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany. .,Department of Oncology (DONC), Luxembourg Institute of Health (LIH), Strassen, Luxembourg. .,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg City, Luxembourg. .,National Center of Pathology (NCP), Laboratoire national de santé (LNS), 1, Rue Louis Rech, L-3555, Dudelange, Luxembourg. .,Luxembourg Center of Neuropathology (LCNP), 1, Rue Louis Rech, L-3555, Dudelange, Luxembourg.
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28
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Nassiri F, Mamatjan Y, Suppiah S, Badhiwala JH, Mansouri S, Karimi S, Saarela O, Poisson L, Gepfner-Tuma I, Schittenhelm J, Ng HK, Noushmehr H, Harter P, Baumgarten P, Weller M, Preusser M, Herold-Mende C, Tatagiba M, Tabatabai G, Sahm F, von Deimling A, Zadeh G, Aldape KD. DNA methylation profiling to predict recurrence risk in meningioma: development and validation of a nomogram to optimize clinical management. Neuro Oncol 2020; 21:901-910. [PMID: 31158293 DOI: 10.1093/neuonc/noz061] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Variability in standard-of-care classifications precludes accurate predictions of early tumor recurrence for individual patients with meningioma, limiting the appropriate selection of patients who would benefit from adjuvant radiotherapy to delay recurrence. We aimed to develop an individualized prediction model of early recurrence risk combining clinical and molecular factors in meningioma. METHODS DNA methylation profiles of clinically annotated tumor samples across multiple institutions were used to develop a methylome model of 5-year recurrence-free survival (RFS). Subsequently, a 5-year meningioma recurrence score was generated using a nomogram that integrated the methylome model with established prognostic clinical factors. Performance of both models was evaluated and compared with standard-of-care models using multiple independent cohorts. RESULTS The methylome-based predictor of 5-year RFS performed favorably compared with a grade-based predictor when tested using the 3 validation cohorts (ΔAUC = 0.10, 95% CI: 0.03-0.018) and was independently associated with RFS after adjusting for histopathologic grade, extent of resection, and burden of copy number alterations (hazard ratio 3.6, 95% CI: 1.8-7.2, P < 0.001). A nomogram combining the methylome predictor with clinical factors demonstrated greater discrimination than a nomogram using clinical factors alone in 2 independent validation cohorts (ΔAUC = 0.25, 95% CI: 0.22-0.27) and resulted in 2 groups with distinct recurrence patterns (hazard ratio 7.7, 95% CI: 5.3-11.1, P < 0.001) with clinical implications. CONCLUSIONS The models developed and validated in this study provide important prognostic information not captured by previously established clinical and molecular factors which could be used to individualize decisions regarding postoperative therapeutic interventions, in particular whether to treat patients with adjuvant radiotherapy versus observation alone.
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Affiliation(s)
- Farshad Nassiri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Yasin Mamatjan
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Suganth Suppiah
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jetan H Badhiwala
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sheila Mansouri
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shirin Karimi
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laila Poisson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Irina Gepfner-Tuma
- Interdisciplinary Division of Neuro-Oncology, Hertie Institute for Clinical Brain Research & Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Houtan Noushmehr
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Patrick Harter
- Edinger Institute (Institute of Neurology), Goethe-University, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center CNS Unit, Medical University of Vienna, Vienna, Austria
| | | | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Hertie Institute for Clinical Brain Research & Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Kenneth D Aldape
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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29
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Gessler F, Bernstock JD, Braczynski A, Lescher S, Baumgarten P, Harter PN, Mittelbronn M, Wu T, Seifert V, Senft C. Surgery for Glioblastoma in Light of Molecular Markers: Impact of Resection and MGMT Promoter Methylation in Newly Diagnosed IDH-1 Wild-Type Glioblastomas. Neurosurgery 2020; 84:190-197. [PMID: 29617848 DOI: 10.1093/neuros/nyy049] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies addressing the influence of surgery on the outcome of patients with glioblastomas (GBM) have not addressed molecular markers. The value of surgery versus the tumor's major biological markers remains unclear. OBJECTIVE We investigate the extent of resection as a prognosticator for patients with newly diagnosed primary GBM with the incorporation of molecular diagnostics as per the updated WHO 2016 diagnostic criteria for GBM. METHODS Patients with newly diagnosed GBM who underwent resection were prospectively included within a database. We analyzed patients with newly diagnosed GBM and excluded patients who presented with IDH1 R132H mutations. Gross total resection (GTR) was defined as complete removal of enhancing disease. RESULTS One hundred seventy-five patients were included within the analysis. One hundred four patients (59.4%) had GTR, 71 patients (40.6%) had subtotal or partial resection. Eighty patients (45.7%) displayed O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, 95 patients (54.3%) showed no MGMT promoter methylation. In Cox regression analysis, MGMT promoter methylation (hazard ratio [HR] 1.55; 95% confidence interval [CI], 1.01-2.19; P = .0133) and GTR (HR 1.48; 95% CI, 1.06-2.07; P = .0206) were significantly associated with favorable progression-free survival. MGMT promoter methylation (HR 2.13; 95% CI, 1.45-3.12; P = .0001) and GTR (HR 1.81; 95% CI, 1.24-2.63; P = .002) were associated with favorable overall survival (OS). Of other risk factors analyzed, age (>60 vs ≤ 60 yr) was significantly associated with progression-free survival (HR 1.60; 95% CI, 1.14-2.24; P = .006) and OS (HR 2.19; 95% CI, 1.51-3.19; P < .0001). CONCLUSION GTR and MGMT promoter methylation are independent prognosticators for improved overall and progression-free survival in a homogeneous cohort of newly diagnosed patients with IDH wild-type glioblastoma.
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Affiliation(s)
- Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Joshua D Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, Maryland
| | - Anne Braczynski
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Stephanie Lescher
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.,Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Tianxia Wu
- Clinical trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, Maryland
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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30
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Baumgarten P, Prange G, Harter P, Forster MT, Wagner M, Steinbach J, Seifert V, Senft C. INNV-22. TO TREAT OR NOT TO TREAT – TREATMENT OUTCOMES OF VERY ELDERLY GLIOBLASTOMA PATIENTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVE
The prognosis especially of older patients with glioblastoma is poor. Novel therapies are usually reserved for patients ≤65 years. As the population is growing older, the challenge remains as to how very elderly patients ≥75 years should be treated. Only limited outcome data exist for this patient subgroup.
METHODS
Between 2010 and 2018 we treated a total of 977 patients with glioblastoma at our institution. Of these, 144 patients were ≥75 years at diagnosis. The primary procedure was surgery or biopsy followed by adjuvant treatment, if possible. We retrospectively investigated progression-free and overall survival (OS) and looked at potential prognostic factors influencing survival, including Karnofsky performance score (KPS), surgical therapy, adjuvant therapy as well as MGMT promoter methylation status.
RESULTS
In our very elderly cohort, the median age was 79 years (range: 75–110). Biopsy only was performed in 108 patients, resection was performed in 36 patients. Median OS for the entire cohort was 5.9 months. Patients without adjuvant treatment fared worse than patients receiving either radiotherapy and/or chemotherapy (1.2 vs. 8.4 months, p< 0.001). Multivariate analysis showed that KPS at presentation (≥70 vs. ≤60), surgery vs. biopsy, and MGMT status (methylated vs. non-methylated) were significantly associated with OS (6.3 vs. 3.9 months, p=0.002; 12.6 vs. 4.9 months, p=0.003; and 10.5 vs. 5.0 months, p=0.009, respectively).
CONCLUSION
For patients with glioblastoma ≥75 years, the natural course of the disease is devastating, and there is a negative treatment bias in these patients. Very elderly patients, too, benefit from multimodal treatment including microsurgical tumor removal. Treatment options and outcomes should be thoughtfully discussed with patients before treatment decisions are made.
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Affiliation(s)
| | - Georg Prange
- University Hospital Frankfurt, Frankfurt, Germany
| | - Patrick Harter
- Edinger-Instiute, Goehte University Medical School, Frankfurt, Germany
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31
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Forster MT, Baumgarten P, Gessler F, Maurer G, Senft C, Hattingen E, Seifert V, Harter PN, Franz K. Influence of pregnancy on glioma patients. Acta Neurochir (Wien) 2019; 161:535-543. [PMID: 30693372 DOI: 10.1007/s00701-019-03823-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/30/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Data about the influence of pregnancy on progression-free survival and overall survival of glioma patients are sparse and controversial. We aimed at providing further evidence on this relation. METHODS The course of 18 glioma patients giving birth to 23 children after tumor surgery was reviewed and compared to the course of 18 nulliparous female patients matched for tumor diagnosis including molecular markers, extent of resection, and tumor location. RESULTS Tumor pathology was astrocytoma, oligodendroglioma, and ependymoma in 9, 6, and 3 patients, respectively. Time interval between tumor resection and delivery was 5.3 ± 4.4 years. All newborns were healthy after uneventful deliveries. Tumor progression was diagnosed before pregnancy in 4 patients and during pregnancy in 1 patient, and 4 patients displayed progressive disease 31.0 ± 11 months after delivery. Three of these latter patients underwent second surgery, whereas resection of recurrent tumor had been performed in 2 women before pregnancy. Among nulliparous patients, 9 women suffered from tumor progression, resulting in re-operation in 7 patients and/or further adjuvant treatment in 6 cases. Progression-free survival did not differ between patients with and patients without children (p = 0.4). Moreover, in both groups, median overall survival was not reached after a mean follow-up period of 9.7 ± 5.7 years in glioma patients who gave birth to a child and 8.9 ± 4.2 years in nulliparous glioma patients. CONCLUSION Pregnancy does not seem to influence the clinical course of glioma patients. Likewise, glioma seems not to have an impact on delivered children's health.
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Affiliation(s)
- Marie-Therese Forster
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Gabriele Maurer
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt, Germany
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Patrick N Harter
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt, Germany
- Institute of Neurology (Edinger-Institute), Goethe University Hospital, Heinrich-Hoffmann-Straße 7, 60528, Frankfurt am Main, Germany
- German Cancer Research Center DKFZ Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Kea Franz
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- University Cancer Center Frankfurt (UCT), Goethe University Hospital, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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32
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Zeiner PS, Preusse C, Golebiewska A, Zinke J, Iriondo A, Muller A, Kaoma T, Filipski K, Müller-Eschner M, Bernatz S, Blank AE, Baumgarten P, Ilina E, Grote A, Hansmann ML, Verhoff MA, Franz K, Feuerhake F, Steinbach JP, Wischhusen J, Stenzel W, Niclou SP, Harter PN, Mittelbronn M. Distribution and prognostic impact of microglia/macrophage subpopulations in gliomas. Brain Pathol 2019; 29:513-529. [PMID: 30506802 PMCID: PMC6849857 DOI: 10.1111/bpa.12690] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [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: 08/06/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
While the central nervous system is considered an immunoprivileged site and brain tumors display immunosuppressive features, both innate and adaptive immune responses affect glioblastoma (GBM) growth and treatment resistance. However, the impact of the major immune cell population in gliomas, represented by glioma‐associated microglia/macrophages (GAMs), on patients’ clinical course is still unclear. Thus, we aimed at assessing the immunohistochemical expression of selected microglia and macrophage markers in 344 gliomas (including gliomas from WHO grade I–IV). Furthermore, we analyzed a cohort of 241 IDH1R132H‐non‐mutant GBM patients for association of GAM subtypes and patient overall survival. Phenotypical properties of GAMs, isolated from high‐grade astrocytomas by CD11b‐based magnetic cell sorting, were analyzed by immunocytochemistry, mRNA microarray, qRT‐PCR and bioinformatic analyses. A higher amount of CD68‐, CD163‐ and CD206‐positive GAMs in the vital tumor core was associated with beneficial patient survival. The mRNA expression profile of GAMs displayed an upregulation of factors that are considered as pro‐inflammatory M1 (eg, CCL2, CCL3L3, CCL4, PTGS2) and anti‐inflammatory M2 polarization markers (eg, MRC1, LGMN, CD163, IL10, MSR1), the latter rather being associated with phagocytic functions in the GBM microenvironment. In summary, we present evidence that human GBMs contain mixed M1/M2‐like polarized GAMs and that the levels of different GAM subpopulations in the tumor core are positively associated with overall survival of patients with IDH1R132H‐non‐mutant GBMs.
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Affiliation(s)
- Pia S Zeiner
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Corinna Preusse
- Department of Neuropathology, Charité Berlin, Berlin, Germany
| | - Anna Golebiewska
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (LIH), Luxembourg
| | - Jenny Zinke
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ane Iriondo
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Arnaud Muller
- Department of Oncology, Luxembourg Institute of Health (LIH), Luxembourg
| | - Tony Kaoma
- Department of Oncology, Luxembourg Institute of Health (LIH), Luxembourg
| | - Katharina Filipski
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Monika Müller-Eschner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simon Bernatz
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anna-Eva Blank
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elena Ilina
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (LIH), Luxembourg.,Luxembourg Centre of Neuropathology (LCNP), Luxembourg
| | - Anne Grote
- Institute of Pathology and Neuropathology, Medical University Hannover, Hannover, Germany
| | - Martin L Hansmann
- Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kea Franz
- Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Friedrich Feuerhake
- Institute of Pathology and Neuropathology, Medical University Hannover, Hannover, Germany.,Institute of Neuropathology, University Clinic Freiburg, Freiburg, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe University Frankfurt, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Wischhusen
- Department of Gynecology, University of Wuerzburg, Wuerzburg, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité Berlin, Berlin, Germany
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (LIH), Luxembourg.,KG Jebsen Brain Tumour Research Center, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Patrick N Harter
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michel Mittelbronn
- Edinger Institute, Institute of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany.,NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (LIH), Luxembourg.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Luxembourg Centre of Neuropathology (LCNP), Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg.,Laboratoire national de santé (LNS), Dudelange, Luxembourg
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33
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Sievers P, Stichel D, Hielscher T, Schrimpf D, Reinhardt A, Wefers AK, Reuss D, Jones DTW, Bewerunge-Hudler M, Hartmann C, Baumgarten P, Wirsching HG, Winther-Kristensen B, Brokinkel B, Ketter R, Idoate Gastearena MA, Lamszus K, Seiz-Rosenhagen M, Mawrin C, Harter PN, Felsberg J, Hänggi D, Herold-Mende C, Berghoff AS, Weller M, Pfister SM, Wick W, Reifenberger G, Preusser M, von Deimling A, Sahm F. Chordoid meningiomas can be sub-stratified into prognostically distinct DNA methylation classes and are enriched for heterozygous deletions of chromosomal arm 2p. Acta Neuropathol 2018; 136:975-978. [PMID: 30382370 DOI: 10.1007/s00401-018-1924-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Peter Baumgarten
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bjarne Winther-Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Ralf Ketter
- Department of Neurosurgery, University Hospital Saarland, Homburg, Saar, Germany
| | | | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christian Mawrin
- Department of Neuropathology, University Magdeburg, Magdeburg, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
| | - Jörg Felsberg
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Sophie Berghoff
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.
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34
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Nassiri F, Mamatjan Y, Suppiah S, Badhiwala J, Mansouri S, Karimi S, Harter P, Baumgarten P, Weller M, Preusser M, Herold-Mende C, Sahm F, von Deimling A, Zadeh G, Aldape K. MNGI-05. DEVELOPMENT AND VALIDATION OF A DNA METHYLOME-BASED PREDICTOR OF MENINGIOMA RECURRENCE AND MENINGIOMA RECURRENCE SCORE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Farshad Nassiri
- Division of Neurosurgery & MacFeeters-Hamilton Center for Neuro-Oncology, University Health Network, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Yasin Mamatjan
- MacFeeters Hamilton center for neuro-oncology research, Prince Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Suganth Suppiah
- Division of Neurosurgery & MacFeeters-Hamilton Center for Neuro-Oncology, University Health Network, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Jetan Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sheila Mansouri
- MacFeeters-Hamilton Center for Neuro-Oncology, University Health Network, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Shirin Karimi
- MacFeeters-Hamilton Center for Neuro-Oncology, University Health Network, Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Christel Herold-Mende
- Division of Neurosurgical Research, Heidelberg University, Germany, Heidelberg, Germany
| | - Felix Sahm
- University of Heidelberg and DKFZ, Heidelberg, Germany
| | | | - Gelareh Zadeh
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kenneth Aldape
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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35
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Katz LM, Hielscher T, Liechty B, Silverman J, Zagzag D, Sen R, Wu P, Golfinos J, Reuss D, Neidert M, Wirsching HG, Baumgarten P, Herold-Mende C, Wick W, Harter P, Weller M, von Deimling A, Snuderl M, Sen C, Sahm F. MNGI-14. LOSS OF HISTONE H3K27me3 IDENTIFIES A SUBSET OF MENINGIOMAS WITH INCREASED RISK OF RECURRENCE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leah M Katz
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | | | - Benjamin Liechty
- Langone Hospital, Department of Pathology, Division of Neuropathology, NYC, NY, USA
| | - Joshua Silverman
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | - David Zagzag
- Langone Hospital, Department of Pathology, Division of Neuropathology, NYC, NY, USA
| | - Rajeev Sen
- NYU Langone Hospital, Department of Neurosurgery, NYC, NY, USA
| | - Peter Wu
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | - John Golfinos
- NYU Langone Hospital, Department of Neurosurgery, NYC, NY, USA
| | - David Reuss
- Department of Neuropathology University Hospital Heidelberg, and Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany, Heidelberg, Germany
| | - Marian Neidert
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Christel Herold-Mende
- Div. of Experimental Neurosurgery, Dept. of Neurosurgery, University Hospital Heidelberg, Heidelberg
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany and Department of Neurology and Neurooncology Program. National Center for Tumor Diseases, Heidelberg University H, Heidelberg, Germany
| | - Patrick Harter
- Neurological Institute (Edinger Institute), Goethe University Frankfurt, Frankfurt am Main, Germany and German Cancer Consortium (DKTK), Partner site Frankfurt/Mainz, Germany; German Cancer Research Center (DKFZ), Heidelberg, Frankfurt, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Matija Snuderl
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
| | - Chandra Sen
- NYU Langone Hospital, Department of Neurosurgery, NYC, NY, USA
| | - Felix Sahm
- University of Heidelberg and DKFZ, Heidelberg, Germany
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36
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Forster M, Baumgarten P, Gessler F, Maurer G, Senft C, Hattingen E, Seifert V, Harter P, Franz K. P01.063 Influence of Pregnancy on Glioma Patients. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Forster
- Goethe University, Frankfurt, Germany
| | | | - F Gessler
- Goethe University, Frankfurt, Germany
| | - G Maurer
- Goethe University, Frankfurt, Germany
| | - C Senft
- Goethe University, Frankfurt, Germany
| | | | - V Seifert
- Goethe University, Frankfurt, Germany
| | - P Harter
- Goethe University, Frankfurt, Germany
| | - K Franz
- Goethe University, Frankfurt, Germany
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37
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Nassiri F, Mamatjan Y, Suppiah S, Badhiwala J, Mansouri S, Karimi S, Harter P, Baumgarten P, Weller M, Preusser M, Herold-Mende C, Sahm F, von Deimling A, Zadeh G, Aldape K. OS3.6 Development and validation of a DNA methylome-based predictor of meningioma recurrence and meningioma recurrence score. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Nassiri
- University of Toronto, Toronto, ON, Canada
| | - Y Mamatjan
- University of Toronto, Toronto, ON, Canada
| | - S Suppiah
- University of Toronto, Toronto, ON, Canada
| | | | - S Mansouri
- University of Toronto, Toronto, ON, Canada
| | - S Karimi
- University of Toronto, Toronto, ON, Canada
| | - P Harter
- University of Frankfurt, Frankfurt, Germany
| | | | - M Weller
- Univeristy Hospital Zurich, Zurich, Switzerl
| | - M Preusser
- Medical University of Vienna, Vienna, Austria
| | | | - F Sahm
- University of Heidelberg, Heidelberg, Germany
| | | | - G Zadeh
- University of Toronto, Toronto, ON, Canada
| | - K Aldape
- National Institute of Health, Bethesda, MD, United States
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38
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Katz LM, Hielscher T, Liechty B, Silverman J, Zagzag D, Sen R, Wu P, Golfinos JG, Reuss D, Neidert MC, Wirsching HG, Baumgarten P, Herold-Mende C, Wick W, Harter PN, Weller M, von Deimling A, Snuderl M, Sen C, Sahm F. Loss of histone H3K27me3 identifies a subset of meningiomas with increased risk of recurrence. Acta Neuropathol 2018; 135:955-963. [PMID: 29627952 DOI: 10.1007/s00401-018-1844-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 11/25/2022]
Abstract
Epigenetic patterns on the level of DNA methylation have already been shown to separate clinically relevant subgroups of meningiomas. We here set out to identify potential prognostic implications of epigenetic modification on the level of histones with focus on H3K27 trimethylation (H3K27me3). H3K27me3 was assessed by immunohistochemistry on 232 meningiomas from 232 patients. In 194 cases, trimethylation was detected in tumor cells. In 25 cases, staining was limited to vessels while all tumor cells were negative. Finally, 13 cases yielded equivocal staining patterns. Reduced abundance of H3K27me3 in cases with staining limited to vessels was confirmed by mass spectrometry on a subset of cases. Lack of staining for H3K27me3 in all tumor cells was significantly associated with more rapid progression (p = 0.009). In line, H3K27me3-negative cases were associated with a DNA methylation pattern of the more aggressive types among the recently introduced DNA methylation groups. Also, NF2 and SUFU mutations were enriched among cases with complete lack of H3K27me3 staining in tumor cells (p < 0.0001 and p = 0.029, respectively). H3K27me3 staining pattern added significant prognostic insight into WHO grade II cases and in the compound subset of WHO grade I and II cases (p = 0.04 and p = 0.007, respectively). However, it did not further stratify within WHO grade III cases. Collectively, these data indicate that epigenetic modifications beyond DNA methylation are involved in the aggressiveness of meningioma. It also suggests that H3K27me3 immunohistochemistry might be a useful adjunct in meningioma diagnostics, particularly for cases with WHO grade II histology or at the borderline between WHO grade I and II.
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Affiliation(s)
- Leah M Katz
- Department of Radiation Oncology, NYU Langone Hospital, New York, NY, USA
| | - Thomas Hielscher
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benjamin Liechty
- Division of Neuropathology, Department of Pathology, NYU Langone Hospital, New York, NY, USA
| | - Joshua Silverman
- Department of Radiation Oncology, NYU Langone Hospital, New York, NY, USA
| | - David Zagzag
- Division of Neuropathology, Department of Pathology, NYU Langone Hospital, New York, NY, USA
| | - Rajeev Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, NY, USA
| | - Peter Wu
- Department of Radiation Oncology, NYU Langone Hospital, New York, NY, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Hospital, New York, NY, USA
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), Goethe University Frankfurt, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site, Frankfurt/Mainz, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matija Snuderl
- Division of Neuropathology, Department of Pathology, NYU Langone Hospital, New York, NY, USA
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, NY, USA
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, 69120, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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39
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Baumgarten P, Quick-Weller J, Gessler F, Wagner M, Tichy J, Forster MT, Foerch C, Seifert V, Mittelbronn M, Senft C. Pre- and early postoperative GFAP serum levels in glioma and brain metastases. J Neurooncol 2018; 139:541-546. [PMID: 29797180 DOI: 10.1007/s11060-018-2898-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/19/2017] [Accepted: 05/13/2018] [Indexed: 11/25/2022]
Abstract
SUBJECT To date there is no established tumor marker for the clinical follow-up of glioblastoma, WHO grade IV, (GBM) which constitutes the most frequent and malignant primary brain tumor. However, since there is promising data that the serum glial fibrillary acidic protein (sGFAP) may serve as a biomarker for glial brain tumors, this prospective study aimed at evaluating the diagnostic relevance of perioperative changes in sGFAP levels for the assessment of residual glial tumor tissue in patients undergoing surgery of intracerebral tumors. METHODS Serum GFAP was measured using an electrochemiluminometric immunoassay (ElecsysR GFAP prototype test, Roche Diagnostics, Penzberg/Germany) in 32 prospectively recruited patients between September 2009 and August 2010. Twenty-five were diagnosed with glioma and seven with brain metastases (BM). We assessed sGFAP levels prior to and at different time points during the early postoperative phase until patient discharge. RESULTS There were only significant differences in the pre-operative sGFAP levels of patients with gliomas compared to BM (0.18 vs. 0.08 µg/l; p = 0.0198, Welch's t-Test). Even though there was an increase of sGFAP after surgery, there were no significant differences between glioma and BM patients at any other time point. Peak sGFAP levels where reached on postoperative day 1 followed by a slight decrease, but not reaching pre-operative levels until postop day 7. There was no significant correlation between postoperative glioma tumor volume and sGFAP levels in univariate analyses. CONCLUSION According to our data sGFAP does not appear to be suitable to detect residual glioma tissue in the acute postoperative phase.
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Affiliation(s)
- Peter Baumgarten
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528, Frankfurt am Main, Germany.
| | - Johanna Quick-Weller
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528, Frankfurt am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528, Frankfurt am Main, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Julia Tichy
- Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marie-Therese Forster
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528, Frankfurt am Main, Germany
| | - Michel Mittelbronn
- Edinger Institute, Goethe University Frankfurt, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Laboratoire National de Santé (LNS), Dudelange, Luxembourg
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg
- Luxembourg Centre of Neuropathology (LCNP), Dudelange, Luxembourg
| | - Christian Senft
- Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528, Frankfurt am Main, Germany
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40
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Mäder L, Blank AE, Capper D, Jansong J, Baumgarten P, Wirsik NM, Zachskorn C, Ehlers J, Seifert M, Klink B, Liebner S, Niclou S, Naumann U, Harter PN, Mittelbronn M. Pericytes/vessel-associated mural cells (VAMCs) are the major source of key epithelial-mesenchymal transition (EMT) factors SLUG and TWIST in human glioma. Oncotarget 2018; 9:24041-24053. [PMID: 29844871 PMCID: PMC5963615 DOI: 10.18632/oncotarget.25275] [Citation(s) in RCA: 6] [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: 02/21/2017] [Accepted: 04/03/2018] [Indexed: 11/25/2022] Open
Abstract
Epithelial-to-mesenchymal transition (EMT) is supposed to be responsible for increased invasion and metastases in epithelial cancer cells. The activation of EMT genes has further been proposed to be important in the process of malignant transformation of primary CNS tumors. Since the cellular source and clinical impact of EMT factors in primary CNS tumors still remain unclear, we aimed at deciphering their distribution in vivo and clinico-pathological relevance in human gliomas. We investigated 350 glioma patients for the expression of the key EMT factors SLUG and TWIST by immunohistochemistry and immunofluorescence related to morpho-genetic alterations such as EGFR-amplification, IDH-1 (R132H) mutation and 1p/19q LOH. Furthermore, transcriptional cluster and survival analyses were performed. Our data illustrate that SLUG and TWIST are overexpressed in gliomas showing vascular proliferation such as pilocytic astrocytomas and glioblastomas. EMT factors are exclusively expressed by non-neoplastic pericytes/vessel-associated mural cells (VAMCs). They are not associated with patient survival but correlate with pericytic/VAMC genes in glioblastoma cluster analysis. In summary, the upregulation of EMT genes in pilocytic astrocytomas and glioblastomas reflects the level of activation of pericytes/VAMCs in newly formed blood vessels. Our results underscore that the negative prognostic potential of the EMT signature in the group of diffuse gliomas of WHO grade II-IV does most likely not derive from glioma cells but rather reflects the degree of proliferating mural cells thereby constituting a potential target for future alternative treatment approaches.
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Affiliation(s)
- Lisa Mäder
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany
| | - Anna E Blank
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany
| | - David Capper
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
| | - Janina Jansong
- Laboratory of Molecular Neuro-Oncology, Department of Vascular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Peter Baumgarten
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany
| | - Naita M Wirsik
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany
| | - Cornelia Zachskorn
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jakob Ehlers
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany.,Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Michael Seifert
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Institute for Medical Informatics and Biometry (IMB), Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Barbara Klink
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Stefan Liebner
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany
| | - Simone Niclou
- NORLUX Neuro-Oncology Laboratory, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Ulrike Naumann
- Laboratory of Molecular Neuro-Oncology, Department of Vascular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Patrick N Harter
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michel Mittelbronn
- Edinger Institute (Neurological Institute), Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,NORLUX Neuro-Oncology Laboratory, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.,Luxembourg Centre of Neuropathology (LCNP), Dudelange, Luxembourg.,Laboratoire National de Santé (LNS), Dudelange, Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
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41
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Barz A, Noack A, Baumgarten P, Seifert V, Forster MT. Motor Cortex Reorganization in Patients with Glioma Assessed by Repeated Navigated Transcranial Magnetic Stimulation-A Longitudinal Study. World Neurosurg 2018; 112:e442-e453. [PMID: 29360588 DOI: 10.1016/j.wneu.2018.01.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/06/2018] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Evidence for cerebral reorganization after resection of low-grade glioma has mainly been obtained by serial intraoperative cerebral mapping. Noninvasively collected data on cortical plasticity in tumor patients over a surgery-free period are still scarce. The present study therefore aimed at evaluating motor cortex reorganization by navigated transcranial magnetic stimulation (nTMS) in patients after perirolandic glioma surgery. METHODS nTMS was performed preoperatively and postoperatively in 20 patients, separated by 26.1 ± 24.8 months. Further nTMS mapping was conducted in 14 patients, resulting in a total follow-up period of 46.3 ± 25.4 months. Centers of gravity (CoGs) were calculated for every muscle representation area, and Euclidian distances between CoGs over time were defined. Results were compared with data from 12 healthy individuals, who underwent motor cortex mapping by nTMS in 2 sessions. RESULTS Preoperatively and postoperatively pooled CoGs from the area of the dominant abductor pollicis brevis muscle and of the nondominant leg area differed significantly compared with healthy individuals (P < 0.05). Most remarkably, during the ensuing follow-up period, a reorganization of all representation areas was observed in 3 patients, and a significant shift of hand representation areas was identified in further 3 patients. Complete functional recovery of postoperative motor deficits was exclusively associated with cortical reorganization. CONCLUSIONS Despite the low potential of remodeling within the somatosensory region, long-term reorganization of cortical motor function can be observed. nTMS is best suited for a noninvasive evaluation of this reorganization.
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Affiliation(s)
- Anne Barz
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Anika Noack
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany; University Cancer Center Frankfurt (UCT), Goethe University Hospital, Frankfurt, Germany
| | - Marie-Therese Forster
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany; University Cancer Center Frankfurt (UCT), Goethe University Hospital, Frankfurt, Germany.
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42
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Jennewein L, Ronellenfitsch MW, Antonietti P, Ilina EI, Jung J, Stadel D, Flohr LM, Zinke J, von Renesse J, Drott U, Baumgarten P, Braczynski AK, Penski C, Burger MC, Theurillat JP, Steinbach JP, Plate KH, Dikic I, Fulda S, Brandts C, Kögel D, Behrends C, Harter PN, Mittelbronn M. Diagnostic and clinical relevance of the autophago-lysosomal network in human gliomas. Oncotarget 2018; 7:20016-32. [PMID: 26956048 PMCID: PMC4991435 DOI: 10.18632/oncotarget.7910] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/15/2016] [Indexed: 12/19/2022] Open
Abstract
Recently, the conserved intracellular digestion mechanism ‘autophagy’ has been considered to be involved in early tumorigenesis and its blockade proposed as an alternative treatment approach. However, there is an ongoing debate about whether blocking autophagy has positive or negative effects in tumor cells. Since there is only poor data about the clinico-pathological relevance of autophagy in gliomas in vivo, we first established a cell culture based platform for the in vivo detection of the autophago-lysosomal components. We then investigated key autophagosomal (LC3B, p62, BAG3, Beclin1) and lysosomal (CTSB, LAMP2) molecules in 350 gliomas using immunohistochemistry, immunofluorescence, immunoblotting and qPCR. Autophagy was induced pharmacologically or by altering oxygen and nutrient levels. Our results show that autophagy is enhanced in astrocytomas as compared to normal CNS tissue, but largely independent from the WHO grade and patient survival. A strong upregulation of LC3B, p62, LAMP2 and CTSB was detected in perinecrotic areas in glioblastomas suggesting micro-environmental changes as a driver of autophagy induction in gliomas. Furthermore, glucose restriction induced autophagy in a concentration-dependent manner while hypoxia or amino acid starvation had considerably lesser effects. Apoptosis and autophagy were separately induced in glioma cells both in vitro and in vivo. In conclusion, our findings indicate that autophagy in gliomas is rather driven by micro-environmental changes than by primary glioma-intrinsic features thus challenging the concept of exploitation of the autophago-lysosomal network (ALN) as a treatment approach in gliomas.
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Affiliation(s)
- Lukas Jennewein
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Michael W Ronellenfitsch
- Senckenberg Institute of Neurooncology, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Antonietti
- Experimental Neurosurgery, Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany
| | - Elena I Ilina
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Jennifer Jung
- Institute of Biochemistry II, Goethe University, Frankfurt am Main, Germany
| | - Daniela Stadel
- Institute of Biochemistry II, Goethe University, Frankfurt am Main, Germany
| | - Lisa-Marie Flohr
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Jenny Zinke
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Janusz von Renesse
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Ulrich Drott
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany.,Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany
| | - Anne K Braczynski
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany
| | - Cornelia Penski
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael C Burger
- Senckenberg Institute of Neurooncology, Goethe University, Frankfurt am Main, Germany
| | | | - Joachim P Steinbach
- Senckenberg Institute of Neurooncology, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karl-Heinz Plate
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ivan Dikic
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Biochemistry II, Goethe University, Frankfurt am Main, Germany
| | - Simone Fulda
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute for Experimental Cancer Research in Pediatrics, Goethe University, Frankfurt am Main, Germany
| | - Christian Brandts
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Medicine, Hematology/Oncology, Goethe University, Frankfurt am Main, Germany
| | - Donat Kögel
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Experimental Neurosurgery, Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany
| | - Christian Behrends
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Biochemistry II, Goethe University, Frankfurt am Main, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger Institute), Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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43
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Gessler F, Baumgarten P, Harter P, Baehr O, Franz K, Forster MT, Bink A, Seifert V, Senft C. SURG-08. RESECTION OF CONTRAST ENHANCING TISSUE PROLONGS OVERALL SURVIVAL IN GLIOMAS – SECONDARY ENDPOINT ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL ON INTRAOPERATIVE MRI USE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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44
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Gessler F, Braczynski A, Tritt S, Baumgarten P, Harter P, Bernstock J, Wu T, Mittelbronn M, Seifert V, Senft C. 316 Extent of Resection and MGMT Promotor Methylation Status are Independent Risk Factors in IDH1_R132H Wild-type Primary Glioblastomas. Neurosurgery 2017. [DOI: 10.1093/neuros/nyx417.316] [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: 11/13/2022] Open
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45
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Bernstock JD, Ye D, Gessler FA, Lee YJ, Peruzzotti-Jametti L, Baumgarten P, Johnson KR, Maric D, Yang W, Kögel D, Pluchino S, Hallenbeck JM. Topotecan is a potent inhibitor of SUMOylation in glioblastoma multiforme and alters both cellular replication and metabolic programming. Sci Rep 2017; 7:7425. [PMID: 28785061 PMCID: PMC5547153 DOI: 10.1038/s41598-017-07631-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/28/2017] [Indexed: 12/30/2022] Open
Abstract
Protein SUMOylation is a dynamic post-translational modification shown to be involved in a diverse set of physiologic processes throughout the cell. SUMOylation has also been shown to play a role in the pathobiology of myriad cancers, one of which is glioblastoma multiforme (GBM). As such, the clinical significance and therapeutic utility offered via the selective control of global SUMOylation is readily apparent. There are, however, relatively few known/effective inhibitors of global SUMO-conjugation. Herein we describe the identification of topotecan as a novel inhibitor of global SUMOylation. We also provide evidence that inhibition of SUMOylation by topotecan is associated with reduced levels of CDK6 and HIF-1α, as well as pronounced changes in cell cycle progression and cellular metabolism, thereby highlighting its putative role as an adjuvant therapy in defined GBM patient populations.
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Affiliation(s)
- Joshua D Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA. .,Wellcome Trust-Medical Research Council Stem Cell Institute, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Daniel Ye
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Florian A Gessler
- Wellcome Trust-Medical Research Council Stem Cell Institute, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of Neurosurgery, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Yang-Ja Lee
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Luca Peruzzotti-Jametti
- Wellcome Trust-Medical Research Council Stem Cell Institute, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter Baumgarten
- Edinger Institute, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Kory R Johnson
- Bioinformatics Section, Information Technology & Bioinformatics Program, Division of Intramural Research (DIR), (NINDS/NIH), Bethesda, MD, USA
| | - Dragan Maric
- Flow Cytometry Core Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NINDS/NIH), Bethesda, MD, USA
| | - Wei Yang
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Donat Kögel
- Department of Neurosurgery, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Stefano Pluchino
- Wellcome Trust-Medical Research Council Stem Cell Institute, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John M Hallenbeck
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Gessler F, Baumgarten P, Bernstock JD, Harter P, Lescher S, Senft C, Seifert V, Marquardt G, Weise L. Assessment of molecular markers demonstrates concordance between samples acquired via stereotactic biopsy and open craniotomy in both anaplastic astrocytomas and glioblastomas. J Neurooncol 2017; 133:399-407. [PMID: 28508327 DOI: 10.1007/s11060-017-2448-2] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
The classification, treatment and prognosis of high-grade gliomas has been shown to correlate with the expression of molecular markers (e.g. MGMT promotor methylation and IDH1 mutations). Acquisition of tumor samples may be obtained via stereotactic biopsy or open craniotomy. Between the years 2009 and 2013, 22 patients initially diagnosed with HGGs via stereotactic biopsy, that ultimately underwent open craniotomy for resection of their tumor were prospectively included in an institutional glioma database. MGMT promotor analysis was performed using methylation-specific (MS)-PCR and IDH1R132H mutation analysis was performed using immunohistochemistry. Three patients (13.7%) exhibited IDH1R132H mutations in samples obtained via stereotactic biopsy. Tissue derived from stereotaxic biopsy was demonstrated to have MGMT promotor methylation in ten patients (45.5%), while a non-methylated MGMT promotor was demonstrated in ten patients (45.5%); inconclusive results were obtained for the remaining two patients (9%) within our cohort. The initial histologic grading, IDH1R132H mutation and MGMT promotor methylation results were confirmed using samples obtained during open craniotomy in all but one patient; here inconclusive MGMT promotor analysis was obtained in contrast to that which was obtained via stereotactic biopsy. Tumor samples acquired via stereotactic biopsy provide accurate information with regard to clinically relevant molecular markers that have been shown to impact patient care decisions. The profile of markers analyzed in our cohort was nearly concordant between those samples obtained via stereotactic biopsy or open craniotomy thereby suggesting that clinical decisions may be based on the molecular profile of the tumor samples obtained via stereotactic biopsy.
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Affiliation(s)
- Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany.
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany.,Institute of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe-University, Heinrich-Hoffmann-Straße 7, 60528, Frankfurt, Germany
| | - Joshua D Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Patrick Harter
- Institute of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe-University, Heinrich-Hoffmann-Straße 7, 60528, Frankfurt, Germany
| | - Stephanie Lescher
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Lutz Weise
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany
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47
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Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S, Okonechnikov K, Koelsche C, Reuss DE, Capper D, Sturm D, Wirsching HG, Berghoff AS, Baumgarten P, Kratz A, Huang K, Wefers AK, Hovestadt V, Sill M, Ellis HP, Kurian KM, Okuducu AF, Jungk C, Drueschler K, Schick M, Bewerunge-Hudler M, Mawrin C, Seiz-Rosenhagen M, Ketter R, Simon M, Westphal M, Lamszus K, Becker A, Koch A, Schittenhelm J, Rushing EJ, Collins VP, Brehmer S, Chavez L, Platten M, Hänggi D, Unterberg A, Paulus W, Wick W, Pfister SM, Mittelbronn M, Preusser M, Herold-Mende C, Weller M, von Deimling A. DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 2017; 18:682-694. [PMID: 28314689 DOI: 10.1016/s1470-2045(17)30155-9] [Citation(s) in RCA: 497] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The WHO classification of brain tumours describes 15 subtypes of meningioma. Nine of these subtypes are allotted to WHO grade I, and three each to grade II and grade III. Grading is based solely on histology, with an absence of molecular markers. Although the existing classification and grading approach is of prognostic value, it harbours shortcomings such as ill-defined parameters for subtypes and grading criteria prone to arbitrary judgment. In this study, we aimed for a comprehensive characterisation of the entire molecular genetic landscape of meningioma to identify biologically and clinically relevant subgroups. METHODS In this multicentre, retrospective analysis, we investigated genome-wide DNA methylation patterns of meningiomas from ten European academic neuro-oncology centres to identify distinct methylation classes of meningiomas. The methylation classes were further characterised by DNA copy number analysis, mutational profiling, and RNA sequencing. Methylation classes were analysed for progression-free survival outcomes by the Kaplan-Meier method. The DNA methylation-based and WHO classification schema were compared using the Brier prediction score, analysed in an independent cohort with WHO grading, progression-free survival, and disease-specific survival data available, collected at the Medical University Vienna (Vienna, Austria), assessing methylation patterns with an alternative methylation chip. FINDINGS We retrospectively collected 497 meningiomas along with 309 samples of other extra-axial skull tumours that might histologically mimic meningioma variants. Unsupervised clustering of DNA methylation data clearly segregated all meningiomas from other skull tumours. We generated genome-wide DNA methylation profiles from all 497 meningioma samples. DNA methylation profiling distinguished six distinct clinically relevant methylation classes associated with typical mutational, cytogenetic, and gene expression patterns. Compared with WHO grading, classification by individual and combined methylation classes more accurately identifies patients at high risk of disease progression in tumours with WHO grade I histology, and patients at lower risk of recurrence among WHO grade II tumours (p=0·0096) from the Brier prediction test). We validated this finding in our independent cohort of 140 patients with meningioma. INTERPRETATION DNA methylation-based meningioma classification captures clinically more homogenous groups and has a higher power for predicting tumour recurrence and prognosis than the WHO classification. The approach presented here is potentially very useful for stratifying meningioma patients to observation-only or adjuvant treatment groups. We consider methylation-based tumour classification highly relevant for the future diagnosis and treatment of meningioma. FUNDING German Cancer Aid, Else Kröner-Fresenius Foundation, and DKFZ/Heidelberg Institute of Personalized Oncology/Precision Oncology Program.
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Affiliation(s)
- Felix Sahm
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Damian Stichel
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Schefzyk
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Konstantin Okonechnikov
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Koelsche
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Haematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Peter Baumgarten
- Neurological Institute (Edinger-Institute), Goethe University, Frankfurt, Germany
| | - Annekathrin Kratz
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristin Huang
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hayley P Ellis
- Brain Tumour Research Group, Institute of Clinical Neurosciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Kathreena M Kurian
- Brain Tumour Research Group, Institute of Clinical Neurosciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Ali Fuat Okuducu
- Department of Pathology, University Hospital Nürnberg, Nürnberg, Germany
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Matthias Schick
- Genomics and Proteomics Core Facility, Micro-Array Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, Micro-Array Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | | | - Ralf Ketter
- Department of Neurosurgery, Saarland University, Homburg, Germany
| | - Matthias Simon
- Department of Neurosurgery, Evangelische Krankenhaus Bielefeld, Bielefeld, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Albert Becker
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Arend Koch
- Department of Neuropathology, Charité Medical University, Berlin, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Elisabeth J Rushing
- Department of Neuropathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - V Peter Collins
- Department of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - Stefanie Brehmer
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Lukas Chavez
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Platten
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany; Neurology Clinic, University Hospital Mannheim, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Haematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger-Institute), Goethe University, Frankfurt, Germany
| | - Matthias Preusser
- Department of Medicine I, CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | | | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Quick-Weller J, Koch F, Dinc N, Lescher S, Baumgarten P, Harter P, Scheerer F, Sader R, Seifert V, Marquardt G, Freiman T. Intracranial Ameloblastoma Arising from the Maxilla: An Interdisciplinary Surgical Approach. J Neurol Surg A Cent Eur Neurosurg 2016; 78:582-587. [PMID: 28038480 DOI: 10.1055/s-0036-1594236] [Citation(s) in RCA: 3] [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: 10/20/2022]
Abstract
Background Ameloblastomas are a rare tumor entity accounting for only 10% of all odontogenic tumors. They mostly originate from the mandible. Only a few cases are known to grow aggressively and to invade the orbit, nasal cavity, or even the brain. Patient and Methods/Case Report We present the case of a 57-year-old patient who was admitted with a huge tumor involving the nasal cavity, the left maxilla, and the anterior fossa. Histologic diagnosis was made by biopsy. A combined two-stage neurosurgical maxillofacial approach was planned. First the intracranial tumor mass was removed using bifrontal trepanation. A duraplasty was sewn in to cover the brain. In the second procedure, a combined bifrontal and midfacial approach was used by craniofacial plastic surgeons and neurosurgeons. A perisinusoidal tumor mass and retropharyngeal tumor mass was removed up to the skull base. The left orbit was completely exenterated, and a fibular bone-muscle graft was used for palatal, orbital, and facial reconstruction. The facial vein and artery were carefully prepared to feed the bone-muscle graft by end-to-end anastomoses. Conclusion Ameloblastomas are very rare slow-growing tumors that show a tendency to recur. They are responsible for only 1% of all oral tumors. Their growth can be enormous, and they can extend into sinusoidal cavities, the orbit, and the brain. Complex and extensive palliative surgery can ease the concerns of these patients and prolong their survival.
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Affiliation(s)
| | - Felix Koch
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Nazife Dinc
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Stephanie Lescher
- Institute for Neuroradiology, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Patrick Harter
- Edinger Institute, Neurological Institute, Goethe-University Frankfurt, Frankfurt, Germany
| | - Friedrich Scheerer
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Thomas Freiman
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
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Brawanski N, Baumgarten P, Konczalla J, Seifert V, Senft C. Cerebral foreign body granuloma in brain triggering generalized seizures without obvious craniocerebral injury: A case report and review of the literature. Surg Neurol Int 2016; 7:S775-S778. [PMID: 27920935 PMCID: PMC5122819 DOI: 10.4103/2152-7806.193924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/28/2016] [Indexed: 11/13/2022] Open
Abstract
Background: Intracerebral foreign body granuloma is rarely reported. We present the case of a male patient with a cerebral foreign body granuloma. Case Description: Initial admission of a 67-year-old male patient was after an aphasia followed by secondary generalized seizures. Cranial computed tomography (CCT) showed a metal-dense, wedge-shaped foreign body in the range of the frontal sinus on the left side, breaking through the frontal sinus, and creating a connection to the frontal cerebral lobe. The patient did not report previous trauma or accident. A concomitant inflammatory response could not be excluded in CCT imaging. In clinical examination, the patient showed no sensorimotor deficit. Operative resection and dural reconstruction was performed. Several tiny, metal-like foreign-body fragments and one stone-like body could be detected and removed. Histopathological examination showed an intracerebral granuloma with areas of acute granulocytic inflammatory reaction. Conclusion: Cerebral foreign body granuloma is a rare entity without initially provoking clinical symptoms, and causing clinical symptoms even years after the initial event. In most reported cases, wooden or metallic bodies are reported. In addition, hemostatic materials and non-resorbable cotton sheets can cause intracerebral granuloma. There is a high risk of infection with a high mortality rate in case of an existent intracranial abscess. In case of first presentation of seizures, a foreign body should be kept in mind if a traumatic injury cannot be reported. Therefore, possible foreign bodies provoking clinical symptoms such as seizures should always be radiologically excluded, and if present and operatively accessible, removal should be done as soon as possible.
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Affiliation(s)
- Nina Brawanski
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany; Edinger- Institut of Neuropathology, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany
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50
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Quick-Weller J, Lescher S, Baumgarten P, Dinc N, Bruder M, Weise L, Seifert V, Marquardt G. Stereotactic Biopsy of Pineal Lesions. World Neurosurg 2016; 96:124-128. [DOI: 10.1016/j.wneu.2016.04.130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/28/2016] [Accepted: 04/30/2016] [Indexed: 11/26/2022]
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