1
|
Algera M, van Driel W, Slangen B, Kruitwagen R, Wouters M, Ten Cate A, Aalders A, van der Kolk A, Kruse A, Jong AVHD, van de Swaluw A, Visschers B, Buis C, Gerestein C, Smeets C, Boll D, van de Laar R, Ngo D, Davelaar E, Ooms E, van Dorst E, Schmeink C, van Es E, Roes E, Ten Cate F, Rijcken F, Dunné FRV, Fons G, Jansen G, Verhoeve H, Nagel H, Keizer H, Smedts H, Ebisch I, van de Lande J, Louwers J, Briet J, De Waard J, Diepstraten J, Vollebergh J, Van der Avoort I, Van Dijk J, Lange J, Mens J, Gaarenstroom K, Overmars K, De Vries L, Hofman L, Bartelink L, Huisman M, Verbruggen M, Vos M, Huisman M, Kleppe M, van den Hende M, van der Aa M, Wust M, Baas M, Engelen M, Scheers E, Moonen-Delarue M, Tjiong M, Leffers N, Reesink N, Timmers P, Kolk P, Vencken P, Yigit R, Smit R, Westenberg S, Coppus S, Stam T, Schukken T, van Baal W, Minderhoud-Bassie W, Van der Plas-Koning Y, van Ham M. Impact of the COVID-19-pandemic on patients with gynecological malignancies undergoing surgery: A Dutch population-based study using data from the 'Dutch Gynecological Oncology Audit'. Gynecol Oncol 2022; 165:330-338. [PMID: 35221132 PMCID: PMC8860632 DOI: 10.1016/j.ygyno.2022.02.013] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The COVID-19-pandemic caused drastic healthcare changes worldwide. To date, the impact of these changes on gynecological cancer healthcare is relatively unknown. This study aimed to assess the impact of the COVID-19-pandemic on surgical gynecological-oncology healthcare. METHODS This population-based cohort study included all surgical procedures with curative intent for gynecological malignancies, registered in the Dutch Gynecological Oncology Audit, in 2018-2020. Four periods were identified based on COVID-19 hospital admission rates: 'Pre-COVID-19', 'First wave', 'Interim period', and 'Second wave'. Surgical volume, perioperative care processes, and postoperative outcomes from 2020 were compared with 2018-2019. RESULTS A total of 11,488 surgical procedures were analyzed. For cervical cancer, surgical volume decreased by 17.2% in 2020 compared to 2018-2019 (mean 2018-2019: n = 542.5, 2020: n = 449). At nadir (interim period), only 51% of the expected cervical cancer procedures were performed. For ovarian, vulvar, and endometrial cancer, volumes remained stable. Patients with advanced-stage ovarian cancer more frequently received neoadjuvant chemotherapy in 2020 compared to 2018-2019 (67.7% (n = 432) vs. 61.8% (n = 783), p = 0.011). Median time to first treatment was significantly shorter in all four malignancies in 2020. For vulvar and endometrial cancer, the length of hospital stay was significantly shorter in 2020. No significant differences in complicated course and 30-day-mortality were observed. CONCLUSIONS The COVID-19-pandemic impacted surgical gynecological-oncology healthcare: in 2020, surgical volume for cervical cancer dropped considerably, waiting time was significantly shorter for all malignancies, while neoadjuvant chemotherapy administration for advanced-stage ovarian cancer increased. The safety of perioperative healthcare was not negatively impacted by the pandemic, as complications and 30-day-mortality remained stable.
Collapse
Affiliation(s)
- M.D. Algera
- Maastricht University Medical Center (MUMC), Department of Obstetrics and Gynecology, Maastricht, the Netherlands,GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands,Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands,Corresponding author at: Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands
| | - W.J. van Driel
- Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Department of Gynecology, Amsterdam, the Netherlands
| | - B.F.M. Slangen
- Maastricht University Medical Center (MUMC), Department of Obstetrics and Gynecology, Maastricht, the Netherlands,GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - R.F.P.M. Kruitwagen
- Maastricht University Medical Center (MUMC), Department of Obstetrics and Gynecology, Maastricht, the Netherlands,GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - M.W.J.M. Wouters
- Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands,Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands,Leiden University Medical Center, Leiden, the Netherlands
| | - the participants of the Dutch Gynecological Oncology Collaborator groupBaalbergenA.1Ten CateA.D.2AaldersA.L.3van der KolkA.4KruseA.J.5JongA.M.L.D. Van Haaften-de6van de SwaluwA.M.G.7VisschersB.A.J.T.8BuisC.C.N.9GeresteinC.G.1017SmeetsC.M.W.H.11BollD.12van de LaarR.13NgoD.H.14DavelaarE.15OomsE.A.16van DorstE.B.L.17SchmeinkC.E.18van EsE.J.M.19RoesE.M.20Ten CateF.A.21RijckenF.E.M.22DunnéF.M.R. Rosier-van23FonsG.24JansenG.H.25VerhoeveH.R.26NagelH.T.C.27KeizerH.H.28SmedtsH.P.M.29EbischI.M.W.30van de LandeJ.2LouwersJ.A.31BrietJ.32De WaardJ.33DiepstratenJ.4VolleberghJ.H.A.34Van der AvoortI.A.M.35Van DijkJ.E.W.36LangeJ.G.37MensJ.W.M.20GaarenstroomK.N.69OvermarsK.38De VriesL.C.39HofmanL.N.40BartelinkL.R.41HuismanM.A.42VerbruggenM.B.43VosM.C.44HuismanM.45KleppeM.46van den HendeM.47van der AaM.48WustM.D.49BaasM.I.50EngelenM.J.A.51ScheersE.C.A.H.52Moonen-DelarueM.W.G.53TjiongM.Y.54LeffersN.55ReesinkN.56TimmersP.J.57KolkP.58VenckenP.M.L.H.59YigitR.60SmitR.A.61WestenbergS.M.62CoppusS.F.P.J.63StamT.C.27SchukkenT.K.64van BaalW.M.65Minderhoud-BassieW.66Van der Plas-KoningY.W.C.M.67van HamM.A.P..C.68Reinier de Graaf Groep, Delft, the NetherlandsSpaarne Gasthuis, Haarlem, the NetherlandsRijnstate Ziekenhuis, Arnhem, the NetherlandsStichting Olijf, the NetherlandsIsala Klinieken, Zwolle, the NetherlandsHagaZiekenhuis, The Hague, the NetherlandsDijklander Ziekenhuis, Hoorn, the NetherlandsStichting Zorgsaam Zeeuws Vlaanderen, Terneuzen, the NetherlandsNij Smellinghe, Drachten, the NetherlandsMeander Medisch Centrum, Amersfoort, the NetherlandsSlingeland Ziekenhuis, Doetinchem, the NetherlandsCatharina Ziekenhuis, Eindhoven, the NetherlandsVieCuri Medisch Centrum, Venlo, the NetherlandsElkerliek Ziekenhuis, Helmond, the NetherlandsLangeland Ziekenhuis, Zoetermeer, the NetherlandsRode Kruis Ziekenhuis, Beverwijk, the NetherlandsUniversity Medical Center Utrecht, Utrecht, the NetherlandsSint Anna Ziekenhuis, Geldrop, the NetherlandsSint Jansgasthuis, Weert, the NetherlandsErasmus Medical Center Cancer Institute, Rotterdam, the NetherlandsBovenij Ziekenhuis, Amsterdam, the NetherlandsAlrijne Zorggroep, Leiderdorp, the NetherlandsTer Gooi Ziekenhuis, Hilversum, the NetherlandsAcademic Medical Center, Amsterdam, the NetherlandsTjongerschans Ziekenhuis, Heereveen, the NetherlandsOnze Lieve Vrouwe Gasthuis, Amsterdam, the NetherlandsHaaglanden Medical Center, the Hague, the NetherlandsMedisch Centrum Leeuwarden, Leeuwarden, the NetherlandsAmphia Ziekenhuis, Breda, the NetherlandsCanisius Wilhelmina ziekenhuis, Nijmegen, the NetherlandsDiakonessenhuis, Utrecht, the NetherlandsZiekenhuisgroep Twente, Almelo, the NetherlandsFranciscus Gasthuis & Vlietland, Rotterdam, the NetherlandsBernhoven Ziekenhuis, Uden, the NetherlandsIkazia Ziekenhuis, Rotterdam, the NetherlandsStreekziekenhuis Koningin Beatrix, Winterswijk, the NetherlandsSint Antonius Ziekenhuis, Nieuwengein, the NetherlandsAmstelland Ziekenhuis, Amstelveen, the NetherlandsTreant Zorggroep, Hoogeveen, the NetherlandsAlbert Schweitzer Ziekenhuis, Dordrecht, the NetherlandsGelderse Vallei, Ede, the NetherlandsDeventer Ziekenhuis, Deventer, the NetherlandsZaans Medisch Centrum, Zaandam, the NetherlandsElisabeth- TweeSteden Ziekenhuis, Tilburg, the NetherlandsGelre Ziekenhuis, Apeldoorn, the NetherlandsMartini Ziekenhuis, Groningen, the NetherlandsIJsselland Ziekenhuis, Capelle aan de IJssel, the NetherlandsNetherlands Comprehensive Cancer Organisation (NCCN), the NetherlandsSaxenburgh Medisch Centrum, Hardenberg, the NetherlandsZiekenhuis Rivierenland, Tiel, the NetherlandsZuyderland Medisch Centrum, Heerlen, the NetherlandsWilhelmina Ziekenhuis, Assen, the NetherlandsLaurentius Ziekenhuis, Roermond, the NetherlandsVrije Universiteit Medisch Centrum, Amsterdam, the NetherlandsOmmelander Ziekenhuis, Scheemda, the NetherlandsMedisch Centrum Twente, Enschede, the NetherlandsMaasstad Ziekenhuis, Rotterdam, the NetherlandsGroene Hart Ziekenhuis, Gouda, the NetherlandsBravis Ziekenhuis, Roosendaal, the NetherlandsUniversity Medical Center Groningen, Groningen, the NetherlandsJeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, the NetherlandsNoordwest Ziekenhuisgroep, Alkmaar, the NetherlandsMaxima Medisch Centrum, Veldhoven, the NetherlandsAntonius Ziekenhuis, Sneek, the NetherlandsFlevoziekenhuis, Almere, the NetherlandsSint Jansdal Ziekenhuis, Harderwijk, the NetherlandsAdmiraal de Ruyter Ziekenhuis, Vlissingen, the NetherlandsRadboud University Medical Center, Nijmegen, the NetherlandsLeiden University Medical Center, Leiden, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Paijens ST, Vledder A, Loiero D, Duiker EW, Bart J, Hendriks AM, Jalving M, Workel HH, Hollema H, Werner N, Plat A, Wisman GBA, Yigit R, Arts H, Kruse AJ, de Lange N, Koelzer VH, de Bruyn M, Nijman HW. Prognostic image-based quantification of CD8CD103 T cell subsets in high-grade serous ovarian cancer patients. Oncoimmunology 2021; 10:1935104. [PMID: 34123576 PMCID: PMC8183551 DOI: 10.1080/2162402x.2021.1935104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022] Open
Abstract
CD103-positive tissue resident memory-like CD8+ T cells (CD8CD103 TRM) are associated with improved prognosis across malignancies, including high-grade serous ovarian cancer (HGSOC). However, whether quantification of CD8, CD103 or both is required to improve existing survival prediction and whether all HGSOC patients or only specific subgroups of patients benefit from infiltration, remains unclear. To address this question, we applied image-based quantification of CD8 and CD103 multiplex immunohistochemistry in the intratumoral and stromal compartments of 268 advanced-stage HGSOC patients from two independent clinical institutions. Infiltration of CD8CD103 immune cell subsets was independent of clinicopathological factors. Our results suggest CD8CD103 TRM quantification as a superior method for prognostication compared to single CD8 or CD103 quantification. A survival benefit of CD8CD103 TRM was observed only in patients treated with primary cytoreductive surgery. Moreover, survival benefit in this group was limited to patients with no macroscopic tumor lesions after surgery. This approach provides novel insights into prognostic stratification of HGSOC patients and may contribute to personalized treatment strategies in the future.
Collapse
Affiliation(s)
- S. T. Paijens
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. Vledder
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D. Loiero
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - E. W. Duiker
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J. Bart
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. M. Hendriks
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M. Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. H. Workel
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - N. Werner
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. Plat
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G. B. A. Wisman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R. Yigit
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. Arts
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. J. Kruse
- Department of Obstetrics and Gynecology, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - N.M. de Lange
- Department of Obstetrics and Gynecology, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - V. H. Koelzer
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - M. de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. W. Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|