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Zunder SM, Perez-Lopez R, de Kok BM, Raciti MV, van Pelt GW, Dienstmann R, Garcia-Ruiz A, Meijer CA, Gelderblom H, Tollenaar RA, Nuciforo P, Wasser MN, Mesker WE. Correlation of the tumour-stroma ratio with diffusion weighted MRI in rectal cancer. Eur J Radiol 2020; 133:109345. [PMID: 33120239 DOI: 10.1016/j.ejrad.2020.109345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/06/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the correlation between intratumoural stroma proportion, expressed as tumour-stroma ratio (TSR), and apparent diffusion coefficient (ADC) values in patients with rectal cancer. METHODS This multicentre retrospective study included all consecutive patients with rectal cancer, diagnostically confirmed by biopsy and MRI. The training cohort (LUMC, Netherlands) included 33 patients and the validation cohort (VHIO, Spain) 69 patients. Two observers measured the mean and minimum ADCs based on single-slice and whole-volume segmentations. The TSR was determined on diagnostic haematoxylin & eosin stained slides of rectal tumour biopsies. The correlation between TSR and ADC was assessed by Spearman correlation (rs). RESULTS The ADC values between stroma-low and stroma-high tumours were not significantly different. Intra-class correlation (ICC) demonstrated a good level of agreement for the ADC measurements, ranging from 0.84-0.86 for single slice and 0.86-0.90 for the whole-volume protocol. No correlation was observed between the TSR and ADC values, with ADCmeanrs= -0.162 (p= 0.38) and ADCminrs= 0.041 (p= 0.82) for the single-slice and rs= -0.108 (p= 0.55) and rs= 0.019 (p= 0.92) for the whole-volume measurements in the training cohort, respectively. Results from the validation cohort were consistent; ADCmeanrs= -0.022 (p= 0.86) and ADCminrs = 0.049 (p= 0.69) for the single-slice and rs= -0.064 (p= 0.59) and rs= -0.063 (p= 0.61) for the whole-volume measurements. CONCLUSIONS Reproducibility of ADC values is good. Despite positive reports on the correlation between TSR and ADC values in other tumours, this could not be confirmed for rectal cancer.
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Affiliation(s)
- Stéphanie M Zunder
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Bente M de Kok
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Maria Vittoria Raciti
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rodrigo Dienstmann
- Department of Oncology Data Science, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Alonso Garcia-Ruiz
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - C Arnoud Meijer
- Department of Radiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Paolo Nuciforo
- Department of Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Martin N Wasser
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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Tilanus-Linthorst MM, Saadatmand S, Geuzinge AH, Rutgers EJ, Mann R, de Roy van Zuidewijn DB, Zonderland HM, Tollenaar RA, Lobbes MB, Ausems MG, van 't Riet M, Hooning MJ, Mares-Engelbert I, Luiten EJ, Heijnsdijk EA, Verhoef C, Karssemeijer N, Oosterwijk JC, Obdeijn IM, de Koning HJ. Abstract P6-13-01: MRI breast cancer screening compared to mammography in women with a familial risk: A multicenter randomized controlled trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-13-01] [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: 11/16/2022]
Abstract
Abstract
Background: Screening guidelines for women with a family history of breast cancer without a known causative gene mutation differ per country. No randomized controlled trial has been performed to assess the optimal screening strategy for these women.
Methods: In twelve centers, 1355 women aged 30–55 years with a cumulative lifetime risk of ≥20% without a BRCA1/2 mutation were randomized into two arms. From January 2011 until December 2017, women in the MRI-arm received yearly MRI-screening, clinical breast examination (CBE), and mammography every other year; and in the Mx-arm yearly mammography and CBE. Outcomes were number and stage of detected breast cancers, sensitivity, specificity and positive predictive value, and stratified by screening round and by mammographic density.
Results: After on average 4.3 screening rounds per woman, in the MRI-arm (N=675) compared to the Mx-arm (N=680) more breast cancers were detected (41 versus 14, p<0.001), invasive cancers were smaller (median size 8 versus 17 mm, p=0.006) and less often node positive (20% versus 71.4%, p=0.019)(Table). In the MRI-arm, sensitivity was slightly higher (95.1% versus 92.9%, p=1), and specificity significantly lower (82% versus 90.1%, p<0.001), compared to the Mx-arm. After two rounds, specificity improved for both modalities (87.1% for MRI; 93.0% for Mx; p<0.001) and no ≥T2 tumors or interval cancers occurred in the MRI-arm. All tumors ≥T2 were in the two highest density categories. MRI detected more small invasive tumors than Mx across all density categories.
Conclusions: In real-life practice the MRI-arm detected more, relevantly smaller, and far more often node negative tumors, and also at low density in women with a familial risk for breast cancer.
Table 1Characteristics of participating women at baseline and of the detected breast cancers, according to study armParticipantsMRI-arm n=675Mx-arm n=680MRI-arm vs. Mx-arm p-valueMean age yr ± SD44.6 ± 6.244.7 ± 6.3 Premenopausal512 (76%)505 (74%) Previous Mx ≤ 2 yr536 (79 %)542 (80%) Previous Mx > 2 years ago23 ( 3%)29 ( 4%) Previous MRI ≤ 2 years ago62 ( 9%)81 (12%) Previous MRI > 2 years ago91 (14%)89 (13%) BI-RADS density category* I (entirely fat)88 (13%)92 (14%) II (scattered densities)248 (37%)229 (34%) III (heterogeneously dense)238 (35%)243 (36%) IV (extremely dense)98 (15%)102 (15%) Mean age at cancer detection49,6 ± 7.049,8 ± 4,70.74No cancer – no. (%)634 (94%)666 (98%) Invasive breast cancers – no. (%)25 (4%)7 (1%)<0.001 (noBC/inv BC/DCIS)DCIS – no. (%)16 (2%)7 (1%) Median size of invasive cancers8 mm17 mm0.006T1a/b15 (60%)1 (14%) T1c7 (28%)4 (57%)0.078 (T1a-b/T1c/≥ T2)≥ T23 (12%)2 (29%) Node pos5 (20%)5 (71%)0.019 (N+/-)Node negative20 (80%)2 (29%) DCIS grade 15 (31%)2 (29%) DCIS grade 28 (50%)4 (57%)1 (dcis gr1,2,3)DCIS grade 33 (19%)1 (14%) *Determined by radiologists, according to the fourth ACR BI-RADS edition
Citation Format: Tilanus-Linthorst MM, Saadatmand S, Geuzinge AH, Rutgers EJ, Mann R, de Roy van Zuidewijn DB, Zonderland HM, Tollenaar RA, Lobbes MB, Ausems MG, van 't Riet M, Hooning MJ, Mares-Engelbert I, Luiten EJ, Heijnsdijk EA, Verhoef C, Karssemeijer N, Oosterwijk JC, Obdeijn I-M, de Koning HJ. MRI breast cancer screening compared to mammography in women with a familial risk: A multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-13-01.
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Affiliation(s)
- MM Tilanus-Linthorst
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - S Saadatmand
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - AH Geuzinge
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - EJ Rutgers
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - R Mann
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - DB de Roy van Zuidewijn
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - HM Zonderland
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - RA Tollenaar
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - MB Lobbes
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - MG Ausems
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - M van 't Riet
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - MJ Hooning
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - I Mares-Engelbert
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - EJ Luiten
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - EA Heijnsdijk
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - C Verhoef
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - N Karssemeijer
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - JC Oosterwijk
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - I-M Obdeijn
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
| | - HJ de Koning
- Erasmus University Medical Centre, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Hospital, Nijmegen, Netherlands; Medical Centre Leeuwarden, Leeuwarden, Netherlands; Amsterdam University Medical Center, Amsterdam, Netherlands; Leiden University Medical Centre, Leiden, Netherlands; Academic Hospital, Maastricht, Maastricht, Netherlands; University Medical Centre, Utrecht, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Vlietland Ziekenhuis, Schiedam, Netherlands; Amphia Ziekenhuis, Breda, Netherlands; University Medical Centre Groningen, Groningen, Netherlands
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Ibrahim IS, Wasser MN, Wu Y, Inderson A, de Vos Tot Nederveen Cappel WH, Morreau H, Hes FJ, Veenendaal RA, Putter H, Feshtali S, van Mil AM, Gruis NA, Tollenaar RA, Bergman W, Bonsing BA, Vasen HFA. High Growth Rate of Pancreatic Ductal Adenocarcinoma in CDKN2A-p16-Leiden Mutation Carriers. Cancer Prev Res (Phila) 2018; 11:551-556. [PMID: 29991580 DOI: 10.1158/1940-6207.capr-18-0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/09/2018] [Accepted: 06/29/2018] [Indexed: 11/16/2022]
Abstract
CDKN2A-p16-Leiden mutation carriers have a 20% to 25% risk of developing pancreatic ductal adenocarcinoma (PDAC). Better understanding of the natural course of PDAC might allow the surveillance protocol to be improved. The aims of the study were to evaluate the role of cystic precursor lesions in the development of PDAC and to assess the growth rate. In 2000, a surveillance program was initiated, consisting of annual MRI in carriers of a CDKN2A-p16-Leiden mutation. The study cohort included 204 (42% male) patients. Cystic precursor lesions were found in 52 (25%) of 204 mutation carriers. Five (9.7%) of 52 mutation carriers with cystic lesions and 8 (7.0%) of 114 mutation carriers without cystic lesions developed PDAC (P = 0.56). Three of 6 patients with a cystic lesion of ≥10 mm developed PDAC. The median size of all incident PDAC detected between 9 and 12 months since the previous normal MRI was 15 mm, suggesting an annual growth rate of about 15 mm/year. In conclusion, our findings show that patients with and without a cystic lesions have a similar risk of PDAC. However, cystic precursor lesions between 10 and 20 mm increase the risk of PDAC substantially. In view of the large size of the screen-detected tumors, a shorter interval of screening might be recommended for all patients. Cancer Prev Res; 11(9); 551-6. ©2018 AACR.
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Affiliation(s)
- Isaura S Ibrahim
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Martin N Wasser
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Yinghui Wu
- Department of Radiology, West Suffolk Hospital, Bury St. Edmunds, United Kingdom
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Roeland A Veenendaal
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Shirin Feshtali
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anneke M van Mil
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Nelleke A Gruis
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilma Bergman
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
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Zunder SM, van Pelt GW, Gelderblom HJ, Mancao C, Putter H, Tollenaar RA, Mesker WE. Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer. Br J Cancer 2018; 119:164-169. [PMID: 29755119 PMCID: PMC6048031 DOI: 10.1038/s41416-018-0083-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 12/13/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022] Open
Abstract
Background The tumour–stroma ratio (TSR) has proven to be an independent prognostic factor in colon cancer. methods Haematoxylin eosin tissue slides of patients from the AVANT trial were microscopically scored for TSR and categorised as stroma -low or stroma -high. Scores were correlated to the primary and secondary endpoint disease-free survival (DFS) and overall survival (OS). Results Patients with stroma-high tumours (N = 339, 28%) had a significantly shorter DFS (p < 0.001) compared to stroma-low tumours (N = 824, 68%). In the bevacizumab-FOLFOX-4 arm, DFS was significantly shorter compared to FOLFOX-4 in stroma-low tumours, with a hazard ratio (HR) of 1.94 (95% CI 1.24–3.04; p = 0.004). In stroma-high tumours a trend for better DFS was seen in bevacizumab-FOLFOX-4 vs. FOLFOX-4 (HR 0.61 (95% CI 0.35–1.07; p = 0.08)). For bevacizumab-XELOX vs. FOLFOX-4, this was not seen (stroma-low HR 1.07 (95% CI 0.64–1.77; p = 0.80); stroma-high HR 0.78 (95% CI 0.47–1.30; p = 0.35)). OS showed the same pattern for bevacizumab-FOLFOX-4 vs. FOLFOX-4 with a HR of 2.53 (95% CI 1.36–4.71; p = 0.003) for stroma-low and HR 0.50 (95% CI 0.22–1.14; p = 0.10) for stroma-high tumours. For bevacizumab-XELOX vs. FOLFOX-4, HR 1.13 (95% CI 0.55–2.31; p = 0.74) for stroma-low tumours and HR 0.74 (95% CI 0.37–1.51; p = 0.41) for stroma-high tumours. Conclusions This exploratory analysis suggests a significantly shorter DFS and OS in stroma-low tumours with addition of bevacizumab to intravenous oxaliplatin-based chemotherapy, contrary to stroma-high tumours, where a beneficial trend is observed.
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Affiliation(s)
- Stéphanie M Zunder
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands.,Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Hans J Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Christoph Mancao
- Oncology Biomarker Development, Genentech Inc., CH-4070, Basel, Switzerland
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
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Holst S, van Pelt GW, Mesker WE, Tollenaar RA, Belo AI, van Die I, Rombouts Y, Wuhrer M. High-Throughput and High-Sensitivity Mass Spectrometry-Based N-Glycomics of Mammalian Cells. Methods Mol Biol 2017; 1503:185-196. [PMID: 27743367 DOI: 10.1007/978-1-4939-6493-2_14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The current protocols for glycomic analysis of cells often require a large quantity of material (5-20 million cells). In order to analyze the N-glycosylation from small amounts of cells (≤1 million) as obtained from, for example, primary cell lines or cell sorting, and in a higher throughput approach, we set up a robust 96-well format PVDF-membrane based N-glycan release protocol followed by linkage-specific sialic acid stabilization, cleanup, and MALDI-TOF-MS analysis. We further evaluated the influence of PNGase F incubation time on the N-glycan profile.
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Affiliation(s)
- Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Postzone S3, Postbus 9600, 2300, RC, Leiden, The Netherlands.
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Ana I Belo
- Department of Molecular Cell Biology and Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Irma van Die
- Department of Molecular Cell Biology and Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Yoann Rombouts
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Postzone S3, Postbus 9600, 2300, RC, Leiden, The Netherlands
- University Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59 000, Lille, France
| | - Manfred Wuhrer
- Division of BioAnalytical Chemistry, VU University Amsterdam, De Boelelaan 1083, Amsterdam, 1081, HV, The Netherlands
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
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6
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Heijs B, Holst S, Briaire-de Bruijn IH, van Pelt GW, de Ru AH, van Veelen PA, Drake RR, Mehta AS, Mesker WE, Tollenaar RA, Bovée JVMG, Wuhrer M, McDonnell LA. Multimodal Mass Spectrometry Imaging of N-Glycans and Proteins from the Same Tissue Section. Anal Chem 2016; 88:7745-53. [PMID: 27373711 DOI: 10.1021/acs.analchem.6b01739] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
On-tissue digestion matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) can be used to record spatially correlated molecular information from formalin-fixed, paraffin-embedded (FFPE) tissue sections. In this work, we present the in situ multimodal analysis of N-linked glycans and proteins from the same FFPE tissue section. The robustness and applicability of the method are demonstrated for several tumors, including epithelial and mesenchymal tumor types. Major analytical aspects, such as lateral diffusion of the analyte molecules and differences in measurement sensitivity due to the additional sample preparation methods, have been investigated for both N-glycans and proteolytic peptides. By combining the MSI approach with extract analysis, we were also able to assess which mass spectral peaks generated by MALDI-MSI could be assigned to unique N-glycan and peptide identities.
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Affiliation(s)
- Bram Heijs
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Arnoud H de Ru
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Peter A van Veelen
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Anand S Mehta
- Department of Microbiology and Immunology, College of Medicine, Drexel University , Philadelphia, Pennsylvania 19129, United States
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center , Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands.,Department of Pathology, Leiden University Medical Center , Leiden, The Netherlands.,Fondazione Pisana per la Scienza ONLUS , Pisa, Italy
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7
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Holst S, Heijs B, de Haan N, van Zeijl RJM, Briaire-de Bruijn IH, van Pelt GW, Mehta AS, Angel PM, Mesker WE, Tollenaar RA, Drake RR, Bovée JVMG, McDonnell LA, Wuhrer M. Linkage-Specific in Situ Sialic Acid Derivatization for N-Glycan Mass Spectrometry Imaging of Formalin-Fixed Paraffin-Embedded Tissues. Anal Chem 2016; 88:5904-13. [PMID: 27145236 DOI: 10.1021/acs.analchem.6b00819] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging is a rapidly evolving field in which mass spectrometry techniques are applied directly on tissues to characterize the spatial distribution of various molecules such as lipids, protein/peptides, and recently also N-glycans. Glycans are involved in many biological processes and several glycan changes have been associated with different kinds of cancer, making them an interesting target group to study. An important analytical challenge for the study of glycans by MALDI mass spectrometry is the labile character of sialic acid groups which are prone to in-source/postsource decay, thereby biasing the recorded glycan profile. We therefore developed a linkage-specific sialic acid derivatization by dimethylamidation and subsequent amidation and transferred this onto formalin-fixed paraffin-embedded (FFPE) tissues for MALDI imaging of N-glycans. Our results show (i) the successful stabilization of sialic acids in a linkage specific manner, thereby not only increasing the detection range, but also adding biological meaning, (ii) that no noticeable lateral diffusion is induced during to sample preparation, (iii) the potential of mass spectrometry imaging to spatially characterize the N-glycan expression within heterogeneous tissues.
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Affiliation(s)
- Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Bram Heijs
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Noortje de Haan
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - René J M van Zeijl
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Anand S Mehta
- Department of Microbiology and Immunology, Drexel University College of Medicine , 245 N. 15th Street, Philadelphia, Pennsylvania 19102, United States
| | - Peggy M Angel
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands.,Department of Pathology, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands.,Fondazione Pisana per la Scienza ONLUS, c/o Croce Rossa Italiana , via Panfilo Castaldi 2, 56121, Ospedaletto, Pisa, Italy
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
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8
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Holst S, Deuss AJM, van Pelt GW, van Vliet SJ, Garcia-Vallejo JJ, Koeleman CAM, Deelder AM, Mesker WE, Tollenaar RA, Rombouts Y, Wuhrer M. N-glycosylation Profiling of Colorectal Cancer Cell Lines Reveals Association of Fucosylation with Differentiation and Caudal Type Homebox 1 (CDX1)/Villin mRNA Expression. Mol Cell Proteomics 2015; 15:124-40. [PMID: 26537799 PMCID: PMC4762531 DOI: 10.1074/mcp.m115.051235] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 04/28/2015] [Indexed: 01/05/2023] Open
Abstract
Various cancers such as colorectal cancer (CRC) are associated with alterations in protein glycosylation. CRC cell lines are frequently used to study these (glyco)biological changes and their mechanisms. However, differences between CRC cell lines with regard to their glycosylation have hitherto been largely neglected. Here, we comprehensively characterized the N-glycan profiles of 25 different CRC cell lines, derived from primary tumors and metastatic sites, in order to investigate their potential as glycobiological tumor model systems and to reveal glycans associated with cell line phenotypes. We applied an optimized, high-throughput membrane-based enzymatic glycan release for small sample amounts. Released glycans were derivatized to stabilize and differentiate between α2,3- and α2,6-linked N-acetylneuraminic acids, followed by N-glycosylation analysis by MALDI-TOF(/TOF)-MS. Our results showed pronounced differences between the N-glycosylation patterns of CRC cell lines. CRC cell line profiles differed from tissue-derived N-glycan profiles with regard to their high-mannose N-glycan content but showed a large overlap for complex type N-glycans, supporting their use as a glycobiological cancer model system. Importantly, we could show that the high-mannose N-glycans did not only occur as intracellular precursors but were also present at the cell surface. The obtained CRC cell line N-glycan features were not clearly correlated with mRNA expression levels of glycosyltransferases, demonstrating the usefulness of performing the structural analysis of glycans. Finally, correlation of CRC cell line glycosylation features with cancer cell markers and phenotypes revealed an association between highly fucosylated glycans and CDX1 and/or villin mRNA expression that both correlate with cell differentiation. Together, our findings provide new insights into CRC-associated glycan changes and setting the basis for more in-depth experiments on glycan function and regulation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yoann Rombouts
- From the ‡Center for Proteomics and Metabolomics, ¶Department of RheumatologyLeiden University Medical Center, Leiden, The Netherlands; ‡‡Univ. Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, F 59 000 Lille, France
| | - Manfred Wuhrer
- From the ‡Center for Proteomics and Metabolomics, ‖Department of Molecular Cell Biology and Immunology and **Division of BioAnalytical Chemistry, VU University Medical Center, Amsterdam, The Netherlands;
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9
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Saadatmand S, Obdeijn IM, Rutgers EJ, Oosterwijk JC, Tollenaar RA, Woldringh GH, Bergers E, Verhoef C, Heijnsdijk EA, Hooning MJ, de Koning HJ, Tilanus-Linthorst MM. Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC). Int J Cancer 2015; 137:1729-38. [PMID: 25820931 DOI: 10.1002/ijc.29534] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 02/03/2015] [Revised: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 11/05/2022]
Abstract
Adding MRI to annual mammography screening improves early breast cancer detection in women with familial risk or BRCA1/2 mutation, but breast cancer specific metastasis free survival (MFS) remains unknown. We compared MFS of patients from the largest prospective MRI Screening Study (MRISC) with 1:1 matched controls. Controls, unscreened if<50 years, and screened with biennial mammography if ≥50 years, were matched on risk category (BRCA1, BRCA2, familial risk), year and age of diagnosis. Of 2,308 MRISC participants, breast cancer was detected in 93 (97 breast cancers), who received MRI <2 years before breast cancer diagnosis; 33 BRCA1 mutation carriers, 18 BRCA2 mutation carriers, and 42 with familial risk. MRISC patients had smaller (87% vs. 52% <T2, p < 0.001), more often node negative (69% vs. 44%, p = 0.001) tumors and received less chemotherapy (39% vs. 77%, p < 0.001) and hormonal therapy (14% vs. 47%, p < 0.001) than controls. Median follow-up time was 9 years (range 0-14). Breast cancer metastasized in 9% (8/93) of MRISC patients and in 23% (21/93) of controls (p = 0.009). MFS was better in MRISC patients overall (log-rank p = 0.008, HR 0.36, 95% CI 0.16-0.80), with familial risk (log-rank p = 0.024, HR: 0.21, 95% CI 0.04-0.95), and in BRCA1 mutation carriers (log-rank p = 0.055, HR 0.30, 95% CI 0.08-1.13). MFS remained better in MRISC patients after lead time correction (log-rank p = 0.020, HR 0.40, 95% CI 0.18-0.90). Overall survival was non-significantly better in MRISC patients (log-rank p = 0.064, HR 0.51, CI 0.24-1.06). Annual screening with MRI and mammography improves metastasis free survival in women with BRCA1 mutation or familial predisposition.
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Affiliation(s)
- Sepideh Saadatmand
- Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | - Inge-Marie Obdeijn
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Emiel J Rutgers
- Department of Surgery, the Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University Medical Center, Groningen University, Groningen, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Gwendolyn H Woldringh
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisabeth Bergers
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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10
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Hennink SD, Hofland N, Gopie JP, van der Kaa C, de Koning K, Nielsen M, Tops C, Morreau H, de Vos tot Nederveen Cappel WH, Langers AMJ, Hardwick JC, Gaarenstroom KN, Tollenaar RA, Veenendaal RA, Tibben A, Wijnen J, van Heck M, van Asperen C, Roukema AJ, Hommes DW, Hes FJ, Vasen HFA. Value-based healthcare in Lynch syndrome. Fam Cancer 2013; 12:347-54. [DOI: 10.1007/s10689-013-9655-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Saadatmand S, Heijnsdijk EA, Rutgers EJ, Hoogerbrugge N, Oosterwijk JC, Tollenaar RA, Hooning M, Obdeijn IM, de Koning HJ, Tilanus-Linthorst MM. Abstract P3-02-09: Cost-effectiveness of screening with additional MRI for women with familial risk for breast cancer without a genetic predisposition. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-02-09] [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: 11/16/2022]
Abstract
Abstract
Background: To reduce mortality risk, women with a family history of breast cancer are often screened with mammography before 50 years of age. Additional Magnetic Resonance Imaging (MRI) can improve sensitivity. MRI screening is cost-effective for BRCA1/2 mutation carriers. However, for women with a family history of breast cancer without a proven mutation cost-effectiveness is not clear. We evaluated the cost-effectiveness of additional MRI for women with a familial risk in the largest prospective MRI screening study: the Dutch MRI Screening Study (MRISC).
Materials & Methods: Between 1999 and 2007 a total of 1597 women (8370 women years at risk) between 25–70 years, with an estimated cumulative lifetime risk of 15–50% for breast cancer participated in the MRISC. Women were screened with clinical breast examination (CBE) every six months and annual mammography and MRI. We calculated the costs per detected breast cancer. In addition, MRISC data were incorporated into a micro simulation screening analysis model: MISCAN. This model simulates screening programs with different screening modalities and time intervals. Different screening schemes were evaluated and the cost per life-year gained (CLYG) estimated.
Results: Forty-seven breast cancers, including 9 Ductal Carcinoma in Situ, were detected. Screening with additional MRI leads to a cost per detected breast cancer treated of €101,962. In increasing age-cohorts the cost decreased, probably due to the higher breast cancer incidence. The cost per detected and treated breast cancer in age group 40–50 years doubled in the age group >60 years. We will demonstrate these results more extensively.
With MISCAN modeling we predicted that screening with this scheme from age 35 to 60 years reduces breast cancer mortality by 30% at a CLYG of €119,945 (3.5% discounting), compared to 21% estimated mortality reduction at €45,707 CLYG with mammography and CBE alone.
Conclusion: Screening with MRI may improve survival for women with familial risk for breast cancer, but is expensive. However, it may be cost-effective for a select group. We will discuss subgroups that may benefit from MRI screening and in which age category MRI was most effective in our study.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-09.
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Affiliation(s)
- S Saadatmand
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - EA Heijnsdijk
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - EJ Rutgers
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - N Hoogerbrugge
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - JC Oosterwijk
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - RA Tollenaar
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - M Hooning
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - I-M Obdeijn
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - HJ de Koning
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
| | - MM Tilanus-Linthorst
- Erasmus Medical Center, Rotterdam, Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; University Medical Center Groningen, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Erasmus Medical Center, Netherlands
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12
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Huijbers A, Pin E, Pierobon M, Pelt GWV, Belluco C, Silvestri A, Liotta LA, Tollenaar RA, Petricoin E, Mesker WE. Correlation of VEGFR activation within the tumor-associated stroma with an aggressive colon cancer phenotype. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e14151] [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: 11/20/2022] Open
Abstract
e14151 Background: The tumour microenvironment, and especially the stroma surrounding the tumor cells, is an important target for cancer therapy. Previous results published by our group showed that colon cancer (CC) patients with a high (>50%) intra-tumor stroma ratio had poor prognosis compared to patients with low intra-tumor stroma ratios. In order to evaluate the contribution of the underpinning signalling and molecular architecture of the tumor associated stroma (TAS) to this aggressive phenotype, we utilized laser capture microdissection (LCM) coupled to broad-scale protein pathway activation mapping using reverse phase protein microarrays (RPMA). Such analysis could identify new stromal-based targeted treatment options through the identification of activated pathways within the TAS of patients with aggressive CC. Methods: CC stage II and III tissue specimens were scored for the amount of stroma and a stroma-high and a stroma-low group were defined. Correspondent frozen tumor specimens were selected for a pilot study (n=30; 15 high and 15 low TAS) and subjected to LCM to enrich for TAS cells. RPMA was performed on the resultant lysates whereby an initial set of 30 total and phospho-proteins, known to be involved in stroma proliferation and activation, were analyzed. Results: Unsupervised hierarchical clustering analysis showed partial grouping of stroma high and stroma low samples with phosphorylation of VEGFR-2 being significantly higher in the stroma high group compared to the stroma low (p=0.030). Conclusions: These preliminary results reveal the potential presence of biochemical derangements in the TAS of tumors from patients with aggressive CC with increased activation of VEGFR-2. Considering the central role this protein plays in angiogenesis and cell migration, these results suggest that anti-VEGFR targeted therapy could be considered for a pre-stratified group of patients with aggressive tumors with high recurrence rates. Ongoing expanded pathway analysis with additional signalling proteins including downstream signalling components of VEGFR are being conducted in order to validate this pilot finding and identify new TAS related signalling derangements.
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Affiliation(s)
| | - Elisa Pin
- George Mason University, Manassas, VA
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13
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Vasen HFA, Wasser M, van Mil A, Tollenaar RA, Konstantinovski M, Gruis NA, Bergman W, Hes FJ, Hommes DW, Offerhaus GJA, Morreau H, Bonsing BA, de Vos tot Nederveen Cappel WH. Magnetic resonance imaging surveillance detects early-stage pancreatic cancer in carriers of a p16-Leiden mutation. Gastroenterology 2011; 140:850-6. [PMID: 21129377 DOI: 10.1053/j.gastro.2010.11.048] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 10/26/2010] [Accepted: 11/16/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Surveillance of high-risk groups for pancreatic cancer might increase early detection and treatment outcomes. Individuals with germline mutations in p16-Leiden have a lifetime risk of 15% to 20% of developing pancreatic cancer. We assessed the feasibility of detecting pancreatic cancer at an early stage and investigated the outcomes of patients with neoplastic lesions. METHODS Individuals with germline mutations in p16-Leiden (N = 79; 31 male; mean age, 56 years; range, 39-72 years) were offered annual surveillance by magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP). Those found to have neoplastic lesions were offered options for surgery or intensive follow-up. Individuals found to have possible neoplastic lesions were examined again by MRI/MRCP within 2 to 4 months. RESULTS After a median follow-up period of 4 years (range, 0-10 years), pancreatic cancer was diagnosed in 7 patients (9%). The mean age at diagnosis was 59 years (range, 49-72 years). Three of the tumors were present at the first examination, and 4 were detected after a negative result in the initial examination. All 7 patients had a resectable lesion; 5 underwent surgery, 3 had an R0 resection, and 2 had lymph node metastases. Possible precursor lesions (ie, duct ectasias, based on MRCP) were found in 9 individuals (11%). CONCLUSIONS MRI/MRCP detects small, solid pancreatic tumors and small duct ectasias. Although surveillance increases the rate of resectability, carriers of a p16-Leiden mutation develop aggressive tumors.
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Affiliation(s)
- Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
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14
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Doekhie FS, Mesker WE, Kuppen PJ, van Leeuwen GA, Morreau H, de Bock GH, Putter H, Tanke HJ, van de Velde CJ, Tollenaar RA. Detailed examination of lymph nodes improves prognostication in colorectal cancer. Int J Cancer 2010; 126:2644-52. [PMID: 19676050 DOI: 10.1002/ijc.24817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Up to 30% of stage II patients with curatively resected colorectal cancer (CRC) will develop disease recurrence. We evaluated whether examination of lymph nodes by multilevel sectioning and immunohistochemical staining can improve prognostication. Lymph nodes (n = 780) from 36 CRC patients who had developed disease recurrence (cases) and 72 patients who showed no recurrence of disease for at least 5 years (controls) were analyzed. Sections of 4 levels at 200-microm interval were immunohistochemically stained for cytokeratin expression. The first level was analyzed by conventional and automated microscopy, and the 3 following levels were analyzed by automated microscopy for the presence of tumor cells. Overall, cases showed more micrometastases (3 patients) than controls (1 patient). Analysis of a second level led to the additional detection of 1 patient with micrometastases (case) and 1 patient with macrometastasis (case). Examining more levels only led to additional isolated tumor cells, which were equally divided between cases and controls. Likewise, automated microscopy resulted only in detection of additional isolated tumor cells when compared with conventional microscopy. In multivariate analysis, micrometastases [odds ratio (OR) 26.3, 95% confidence interval (CI) 1.9-364.8, p = 0.015], T4 stage (OR 4.8, 95% CI 1.4-16.7, p = 0.013) and number of lymph nodes (OR 0.9, 95% CI 0.8-1.0, p = 0.028) were independent predictors for disease recurrence. Lymph node analysis of 2 levels and immunohistochemical staining add to the detection of macrometastases and micrometastases in CRC. Micrometastases were found to be an independent predictor of disease recurrence. Isolated tumor cells were of no prognostic significance.
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Affiliation(s)
- Fania S Doekhie
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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15
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Mesker WE, Johnstone EC, van Pelt GW, Midgley R, Liefers GJ, Smit VT, Kerr DJ, Tollenaar RA. Abstract 811: Stroma production within the primary tumor correlates with poor survival for stage I-II colon cancer patients. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-811] [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: 11/16/2022]
Abstract
Abstract
Background Recent models on metastatic invasion focus on the tumor-“host” interface, in particular the role of the stromal tissue. The stromal compartments are thought to play a major role in the process of wound healing, but there is also strong emphasis that CAF's (cancer-associated fibroblasts) are important promotors for tumor growth and progression. Assuming these models are correct we hypothesized that changes in the proportion of stroma in the primary tumor could reflect progression. We therefore investigated if the amount of intra-tumor stroma could be used as a candidate marker to identify which patients should be selected for adjuvant therapy and furthermore if treatment with a COX-2 inhibitor might improve patient outcome in those patients with high percentage of stroma (with or without chemotherapy)
Methods We have investigated the proportion of intra-tumor stroma on heamatoxylin-eosin (H&E) stained histological sections and distinguished between patients with a high amount of stroma (stroma-high) and patients with lower levels of stroma (stroma-low).
We have analyzed 135 stage I-II colon cancer patients for the proportion of tumor related stroma and for TGFβ-R2, SMAD4 and β-catenin, markers involved in pathways related to stromal production and epithelial-to-mesenchymal transition (EMT).
A series of 596 patients treated either with placebo or COX-2 inhibitor was also analyzed for proportion of stroma (VICTOR-trial).
Results
Of 135 analyzed patients 35 (25.7%) patients were stroma-high and 101 (74.3%) stroma-low. Significant differences in survival were observed between the two groups, with stroma-high patients showing poor survival (OS p<0.0001, HZ 2.59; DFS p=0.0002, HZ 2.31).
A high-risk group (n=14) was identified with stroma-high and SMAD4 loss (OS p=0.008, HZ 7.98, CI 4.12-15.44, DFS p=0.005, HZ 6.57, CI 3.43-12.56); 12 of 14 (85.7%) patients died within 3 years. In a logistic-regression analysis a high proportion of stroma and SMAD4 loss were strongly related (HZ 5.42, CI 2.13-13.82, p<0.001).
Results of the COX-2 inhibitor study are currently under evaluation but will be presented at the conference.
Conclusions: Conventional haematoxylin-eosin stained tumor slides contain more prognostic information than previously fathomed. This can be utilized by assessing the tumor-stroma ratio. The combination of analyzing the tumor-stroma ratio and staining for SMAD4 results in an independent parameter for confident prediction of clinical outcome. The inclusion of this parameter into standard pathological reports should be considered, in addition to the TNM classification.
Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 811.
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Affiliation(s)
| | - Elaine C. Johnstone
- 2Department of Clinical Pharmacology, Oxford University, Oxford, United Kingdom
| | | | - Rachel Midgley
- 2Department of Clinical Pharmacology, Oxford University, Oxford, United Kingdom
| | | | | | - David J. Kerr
- 2Department of Clinical Pharmacology, Oxford University, Oxford, United Kingdom
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16
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Speetjens FM, Liefers GJ, Korbee CJ, Mesker WE, van de Velde CJ, van Vlierberghe RL, Morreau H, Tollenaar RA, Kuppen PJ. Nuclear localization of CXCR4 determines prognosis for colorectal cancer patients. Cancer Microenviron 2009; 2:1-7. [PMID: 19308676 PMCID: PMC2787924 DOI: 10.1007/s12307-008-0016-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 11/10/2008] [Indexed: 12/17/2022]
Abstract
Chemokines and their receptors are implicated in formation of colorectal cancer metastases. Especially CXCR4 is an important factor, determining migration, invasiveness, metastasis and proliferation of colorectal cancer cells. Object of this study was to determine expression of CXCR4 in tumor tissue of colorectal cancer patients and associate CXCR4 expression levels to clinicopathological parameters. Levels of CXCR4 expression of a random cohort of patients, who underwent primary curative resection of a colorectal carcinoma, were retrospectively determined by quantitative real-time RT-PCR and semi-quantitative analyses of immunohistochemical stained paraffin sections. Expression levels were associated to clinicopathological parameters. Using RT-PCR we found that a high expression of CXCR4 in the primary tumor was an independent prognostic factor for a poor disease free survival (p = 0.03, HR: 2.0, CI = 1.1-3.7). Immunohistochemical staining showed that nuclear distribution of CXCR4 in the tumor cells was inversely associated with disease free and overall survival (p = 0.04, HR: 2.6, CI = 1.0-6.2), while expression in the cytoplasm was not associated with prognosis. In conclusion, our study showed that a high expression of nuclear localized CXCR4 in tumor cells is an independent predictor for poor survival for colorectal cancer patients.
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Affiliation(s)
- Frank M. Speetjens
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Gerrit Jan Liefers
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Cornelis J. Korbee
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Wilma E. Mesker
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Departments of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis J.H. van de Velde
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Ronald L. van Vlierberghe
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Hans Morreau
- Departments of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A. Tollenaar
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Peter J.K. Kuppen
- Departments of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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17
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Wouters MW, Wijnhoven BP, Karim-Kos HE, Blaauwgeers HG, Stassen LP, Steup WH, Tilanus HW, Tollenaar RA. High-volume versus low-volume for esophageal resections for cancer: the essential role of case-mix adjustments based on clinical data. Ann Surg Oncol 2007; 15:80-7. [PMID: 18004627 PMCID: PMC2190337 DOI: 10.1245/s10434-007-9673-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 09/13/2007] [Accepted: 09/17/2007] [Indexed: 02/06/2023]
Abstract
Background Most studies addressing the volume–outcome relationship in complex surgical procedures use hospital mortality as the sole outcome measure and are rarely based on detailed clinical data. The lack of reliable information about comorbidities and tumor stages makes the conclusions of these studies debatable. The purpose of this study was to compare outcomes for esophageal resections for cancer in low- versus high-volume hospitals, using an extensive set of variables concerning case-mix and outcome measures, including long-term survival. Methods Clinical data, from 903 esophageal resections performed between January 1990 and December 1999, were retrieved from the original patients’ files. Three hundred and forty-two patients were operated on in 11 low-volume hospitals (<7 resections/year) and 561 in a single high-volume center. Results Mortality and morbidity rates were significantly lower in the high-volume center, which had an in-hospital mortality of 5 vs 13% (P < .001). On multivariate analysis, hospital volume, but also the presence of comorbidity proved to be strong prognostic factors predicting in-hospital mortality (ORs 3.05 and 2.34). For stage I and II disease, there was a significantly better 5-year survival in the high-volume center. (P = .04). Conclusions Hospital volume and comorbidity patterns are important determinants of outcome in esophageal cancer surgery. Strong clinical endpoints such as in-hospital mortality and survival can be used as performance indicators, only if they are joined by reliable case-mix information.
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Affiliation(s)
- Michael W Wouters
- Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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18
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Steenvoorde P, Vogelaar FJ, Oskam J, Tollenaar RA. [Giant diverticulum of the sigmoid]. Ned Tijdschr Geneeskd 2004; 148:855; author reply 855. [PMID: 15141655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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19
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Schmidt MK, van Leeuwen FE, Klaren HM, Tollenaar RA, van 't Veer LJ. [Genetic research with stored human tissue: a coding procedure with optimal use of information and protection of privacy]. Ned Tijdschr Geneeskd 2004; 148:564-8. [PMID: 15074178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
To answer research questions concerning the course of disease and the optimal treatment of hereditary breast cancer, genetic typing together with the clinical and tumour characteristics of breast cancer patients are an important source of information. Part of the incidence of breast cancer can be explained by BRCA1 and BRCA2 germline mutations, which with current techniques can be retrospectively analysed in stored, paraffin-embedded tissue samples. In view of the implications of BRCA1- or BRCA2-carrier status for patients and other family members and the lack of clear legal regulations regarding the procedures to be followed when analysis is performed on historical material and no individual informed consent can be asked from the patients, an appropriate procedure for coding such data or rendering it anonymous is of great importance. By using the coding procedure described in this article, it becomes possible to follow and to work out in greater detail the guidelines of the code for 'Proper secondary use of human tissue' of the Federation of Biomedical Scientific Societies and to use these valuable databases again in the future.
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Affiliation(s)
- M K Schmidt
- Nederlands Kanker Instituut/Antoni van Leeuwenhoek Ziekenhuis, Plesmanlaan 121, 1066 CX Amsterdam
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20
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Kriege M, Brekelmans CT, Boetes C, Rutgers EJ, Oosterwijk JC, Tollenaar RA, Manoliu RA, Holland R, de Koning HJ, Klijn JG. MRI screening for breast cancer in women with familial or genetic predisposition: design of the Dutch National Study (MRISC). Fam Cancer 2004; 1:163-8. [PMID: 14574173 DOI: 10.1023/a:1021135809870] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mammography screening of women aged 50-70 years for breast cancer has proven to be effective in reducing breast cancer mortality. There is no consensus about the value of breast cancer screening in women aged 40-49 years. Five to ten per cent of all breast cancers are hereditary. One of the options to reduce the risk of breast cancer mortality for women with a familial or genetic predisposition is intensive surveillance. However, the effectiveness of mammography screening for breast cancer in these women, who are mainly younger than 50 years, is unproven. MRI might increase the effectiveness of screening in women with a familial or genetic predisposition. This paper describes the design of the Dutch national study for Magnetic Resonance Imaging (MRI) screening in women with a familial or genetic predisposition. The aims of this study are to investigate: the value of regular surveillance in women with a familial or genetic predisposition for breast cancer, the efficacy of MRI as compared to mammography, cost-effectiveness of regular screening and quality of life during surveillance. Included are women with a lifetime risk of familial breast cancer of 15% or more or BRCA1/2 mutation carriers, who visit one of the Dutch family cancer clinics. The aim is to include 2,500 women. The study started on 1 November 1999. On 1 January 2002, more than 1,700 women, including 210 proven carriers of a BRCA1 or BRCA2 mutation, were included in the study.
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Affiliation(s)
- M Kriege
- Rotterdam Family Cancer Clinic, Erasmus MC (University Medical Centre Rotterdam)/Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
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21
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de Bock GH, Tollenaar RA, Papelard H, Cornelisse CJ, Devilee P, van de Vijver MJ. Clinical and pathological features of BRCA1 associated carcinomas in a hospital-based sample of Dutch breast cancer patients. Br J Cancer 2001; 85:1347-50. [PMID: 11720473 PMCID: PMC2375234 DOI: 10.1054/bjoc.2001.2103] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Thus far, studies investigating the differences in tumour characteristics between breast cancer in BRCA1-carriers and other patients, have focused on highly selected groups of patients, potentially limiting the conclusions that can be drawn. Previously, we had identified 10 patients with BRCA1 germline mutations in a hospital-based series of 642 breast cancer patients not selected for age or family history. The aim of this analysis is to investigate the clinical and pathological features of these BRCA1 associated carcinomas as compared to other breast cancers in this representative sample. Tumours from patients with BRCA1 germline mutations (n = 10) were compared to an age-matched sample of other patients (n = 50) from the same cohort. The following characteristics were considered: axillary nodal status and tumour size, histologic parameters (tumour type, histologic grade, mitotic rate, tubule formation, nuclear grade, CIS and lymphangio invasion) and expression of several proteins (oestrogen and progesterone receptors, cyclin D1, p53, HER2/neu, E-cadherin). In BRCA1 associated tumours receptors for oestrogen and progesterone were expressed less frequently (respectively, P = 0.001 and P = 0.002) than in controls, which is in line with findings from other studies. Other differences were also in accordance with findings from other studies, although not statistically significant. We conclude that the features of BRCA1 associated tumours detected in a hospital-based series of breast cancer patients not selected for family history of age at diagnosis are similar to tumours in cases selected for family history or age at diagnosis.
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Affiliation(s)
- G H de Bock
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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22
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Kapiteijn E, Liefers GJ, Los LC, Kranenbarg EK, Hermans J, Tollenaar RA, Moriya Y, van de Velde CJ, van Krieken JH. Mechanisms of oncogenesis in colon versus rectal cancer. J Pathol 2001; 195:171-8. [PMID: 11592095 DOI: 10.1002/path.918] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Observations support the theory that development of left- and right-sided colorectal cancers may involve different mechanisms. This study investigated different genes involved in oncogenesis of colon and rectal cancers and analysed their prognostic value. The study group comprised 35 colon and 42 rectal cancers. Rectal cancer patients had been treated with standardized surgery performed by an experienced rectal cancer surgeon. Mutation analysis was performed for p53 in eight colon cancers and for APC and p53 in 22 rectal cancers. MLH1, MSH2, Bcl-2, p53, E-cadherin and beta-catenin were investigated by immunohistochemistry in all colorectal tumours. APC mutation analysis of the MCR showed truncating mutations in 18 of 22 rectal tumours (82%), but the presence of an APC mutation was not related to nuclear beta-catenin expression (p=0.75). Rectal cancers showed significantly more nuclear beta-catenin than colon cancers (65% versus 40%, p=0.04). p53 mutation analysis corresponded well with p53 immunohistochemistry (p<0.001). Rectal cancers showed significantly more immunohistochemical expression of p53 than colon cancers (64% versus 29%, p=0.003). In rectal cancers, a significant correlation was found between positive p53 expression and worse disease-free survival (p=0.008), but not in colon cancers. Cox regression showed that p53-expression (p=0.03) was an independent predictor for disease-free survival in rectal cancers. This study concluded that rectal cancer may involve more nuclear beta-catenin in the APC/beta-catenin pathway than colon cancer and/or nuclear beta-catenin may have another role in rectal cancer independently of APC. The p53-pathway seems to be more important in rectal cancer, in which it also has independent prognostic value. When prognostic markers are investigated in larger series, differences in biological behaviour between colon and rectal cancer should be considered.
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Affiliation(s)
- E Kapiteijn
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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23
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Liefers GJ, Tollenaar RA, Nakamura Y, van de Velde CJ. Genetic cancer syndromes and large-scale gene expression analysis: applications in surgical oncology. Eur J Surg Oncol 2001; 27:343-8. [PMID: 11417977 DOI: 10.1053/ejso.2001.1125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The last decade of the 20th century was characterized by an explosion in genetic discoveries. The Human Genome Project and technical advances have made it possible to unravel many genetic abnormalities underlying cancer. Many genes responsible for inherited cancer syndromes have been identified and diagnostic tests are readily available. The clinical implications of these tests are currently under debate. Large-scale gene expression analysis enables simultaneous monitoring of expression of thousands of genes, in vitro and in vivo. The identification of high risk patients and drug responsiveness, can be studied within the framework of complex molecular networks. This article will focus on the possibilities for surgical oncology.
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Affiliation(s)
- G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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24
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Gooszen AW, Tollenaar RA, Geelkerken RH, Smeets HJ, Bemelman WA, Van Schaardenburgh P, Gooszen HG. Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease. Br J Surg 2001; 88:693-7. [PMID: 11350443 DOI: 10.1046/j.1365-2168.2001.01748.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A primary anastomosis after resection of the sigmoid colon for suspected acute complicated diverticular disease has the advantage of saving the patient a secondary operation for restoring bowel continuity. Fear of anastomotic leakage often deters surgeons from making a primary anastomosis. METHODS A series of 45 patients who underwent primary anastomosis was studied prospectively to evaluate the feasibility of a primary anastomosis following acute sigmoid resection. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Mannheim Peritonitis Index (MPI) and Hughes' peritonitis classification were used to classify patients and to detect factors predictive of postoperative outcome. Death, anastomotic leakage and septic complications were main outcome measures. RESULTS Neither anastomotic leakage (four of 45 patients) nor death (three of 45) was related to a higher MPI, APACHE II or Hughes' score. More postoperative septic complications were seen in patients with a MPI over 16. Death, anastomotic leakage, reintervention and wound infection were observed more frequently in patients who presented with colonic obstruction than in those with abscess or perforation. CONCLUSION Primary anastomosis is safe and effective in non-obstructed cases of complicated diverticular disease. Colonic obstruction seems to be a risk factor for the development of postoperative complications.
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Affiliation(s)
- A W Gooszen
- Departments of Surgery, Utrecht University Hospital, Utrecht, The Netherlands
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25
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Jonges LE, Nagelkerke JF, Ensink NG, van der Velde EA, Tollenaar RA, Fleuren GJ, van de Velde CJ, Morreau H, Kuppen PJ. Caspase-3 activity as a prognostic factor in colorectal carcinoma. J Transl Med 2001; 81:681-8. [PMID: 11351040 DOI: 10.1038/labinvest.3780277] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Several techniques to determine apoptotic frequencies in tumors have been described. In this study, we report that biochemical detection of enzymatic caspase-3 activity is a simple and quantitative technique to measure apoptosis in colorectal tumor cells. The relevance of the level of apoptosis in colorectal cancer for the clinical course remains unclear. Therefore, we studied the correlation between caspase-3 activity and prognosis of the disease in relation to different factors known to be involved in apoptosis induction. High caspase-3 activity significantly correlated with a higher risk of recurrence and was preferentially found in tumors of the right side of the colon. No correlation was detected between high caspase-3 activity and altered protein expression of p53, beta-catenin, or proteins of mismatched repair genes. This indicates that high caspase-3 activity has no evident correlation with the genetic Wnt-signaling or the mismatch repair mutational pathways. The caspase-3 activity significantly correlated with CD57(+) tumor infiltrating cells. Therefore, high caspase-3 activity in right-sided tumors might be induced by a specific lymphocytic reaction.
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Affiliation(s)
- L E Jonges
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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26
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Hartgrink HH, Roelfsema F, Tollenaar RA, Hiddema PA, Pijl ME, van de Velde CJ. Primary pheochromocytoma extending into the right atrium: report of a case and review of the literature. Eur J Surg Oncol 2001; 27:115-9. [PMID: 11237502 DOI: 10.1053/ejso.2000.1020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pheochromocytoma rarely extends locally into the vena cava or the right atrium. We report a case of malignant pheochromocytoma with growth into the inferior vena cava, extending into the right atrium, address clinical aspects of this tumour and review the literature on this malignancy. Pre-operative work-up of this tumour should include measurements of urinary vanillyl mandelic acid and cathecholamine excretion, MRI and spiral CT of the abdomen and thorax. After the diagnosis is made the patient should be treated with catecholamine alpha-receptor blockade and if necessary with subsequent beta-receptor blockade. An aggressive surgical approach is always warranted, even in cases with very large localized tumours, because surgery has been shown to lead to relief of symptoms and to prolong survival in cases otherwise deemed irresectable. The optimal surgical exposure is obtained via a transsternal midline thoraco-laparotomy. If feasible, a combination of cardiopulmonary bypass, hypothermia, cardiac arrest and exsanguination procedures should be used. In case of local of tumour remnants after surgery or distant metastases treatment options are secondary surgery, tumour embolization, or treatment with radioactive labelled drugs, including(131)I-MIBG.
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Affiliation(s)
- H H Hartgrink
- Department of Surgical Oncology, Leiden University Medical Centre, The Netherlands
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27
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Gooszen AW, Gooszen HG, Veerman W, Van Dongen VM, Hermans J, Klien Kranenbarg E, Tollenaar RA. Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection. Eur J Surg 2001; 167:35-9. [PMID: 11213818 DOI: 10.1080/110241501750069792] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the comparative effects of two surgical regimens on the outcome of acute complicated diverticular disease. DESIGN Retrospective study. SETTING Teaching hospital, The Netherlands. SUBJECTS 60 patients who presented with acute complicated diverticular disease. INTERVENTIONS 28 patient were treated by sigmoid resection and a Hartmann operation, and 32 by resection with primary anastomosis and defunctioning stoma. MAIN OUTCOME MEASURES Morbidity and mortality. RESULTS The severity of peritonitis and the amount of faecal contamination were similar in the 2 groups. 12 patients died (7 in the Hartmann group and 5 in the primary anastomosis group). There were 3 radiological leaks with no clinical implications in the primary anastomosis group. 6 patients in the Hartmann group and 5 in the primary anastomosis group required reoperations for intra-abdominal abscess or infection. 7 and 3 patients, respectively, developed dysfunction of their stomas, and 9/21 and 3/27, respectively, required a permanent stoma (p = 0.02, 95% confidence interval of difference 0.07 to 0.56). 3 patients in the Hartmann group developed anastomotic leaks after closure of their stomas, 1 of whom required reoperation but died. No patient developed an anastomotic leak after closure of the stoma in the primary anastomosis group. CONCLUSION Both regimens are accepted treatments for patients with acute complicated diverticular disease, but because of the higher morbidity after the Hartmann procedure we prefer primary anastomosis with covering stoma.
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Affiliation(s)
- A W Gooszen
- Department of Surgery, University Medical Centre Utrecht, The Netherlands
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28
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van der Burg SH, de Cock K, Menon AG, Franken KL, Palmen M, Redeker A, Drijfhout J, Kuppen PJ, van de Velde C, Erdile L, Tollenaar RA, Melief CJ, Offringa R. Long lasting p53-specific T cell memory responses in the absence of anti-p53 antibodies in patients with resected primary colorectal cancer. Eur J Immunol 2001; 31:146-55. [PMID: 11169448 DOI: 10.1002/1521-4141(200101)31:1<146::aid-immu146>3.0.co;2-t] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Colorectal carcinoma is commonly associated with mutation and overexpression of p53, making this antigen a potential target for immune intervention. We analyzed humoral and proliferative immunity against p53 in the blood of patients with resected primary colorectal cancer. The majority of these patients displayed anti-p53 T helper (Th) immunity in the absence of measurable p53 specific antibody levels. The Th responses were long-lasting since they could be detected up to several years after resection of the primary tumor. In a number of cases the Th responses were highly sensitive, reflected by the recognition of naturally processed p53 protein. Our data argue that boosting of these responses in patients with minimal residual disease through p53-specific vaccination, may be employed for improving the chance of disease-free survival of these patients.
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Affiliation(s)
- S H van der Burg
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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Devilee P, Tollenaar RA, Cornelisse CJ. [From gene to disease; from BRCA1 or BRCA2 to breast cancer]. Ned Tijdschr Geneeskd 2000; 144:2549-51. [PMID: 11191790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Hereditary breast cancer is a heterogeneous syndrome, both phenotypically and genetically. It affects about 5% of all breast cancer patients. The presence of ovarian cancer or breast cancer in males defines important subtypes. BRCA1 and BRCA2 are involved in all hereditary breast cancer syndromes in varying degrees. Both genes confer strongly elevated breast and ovarian cancer risks in mutation carriers, but these risks may be subject to modifying effects by other factors (genetic and/or environmental) at the individual level. In the Netherlands, DNA testing is offered under the national health insurance programme and has led to the identification of over 500 families with either a BRCA1 or BRCA2 mutation. The results of the test are being used widely by Dutch women in the decision for or against prophylactic surgery.
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Affiliation(s)
- P Devilee
- Afd. Antropogenetica, Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden
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30
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Papelard H, de Bock GH, van Eijk R, Vliet Vlieland TP, Cornelisse CJ, Devilee P, Tollenaar RA. Prevalence of BRCA1 in a hospital-based population of Dutch breast cancer patients. Br J Cancer 2000; 83:719-24. [PMID: 10952774 PMCID: PMC2363536 DOI: 10.1054/bjoc.2000.1331] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The prevalence of disease-related BRCA1 mutations was investigated in 642 Dutch breast cancer patients not selected for family history or age at diagnosis. They were tested for germline mutations in the BRCA1 gene using an assay which detects small deletions and insertions (DSDI), as well as the two major genomic founder deletions present in the Dutch population. Data on family history and bilateral breast cancer were obtained retrospectively. Ten protein truncating mutations were detected and one in-frame deletion with an unknown relation to disease risk. Four patients carried the Dutch founder deletion of exon 22. Based on these results the estimated prevalence of breast cancer in the general population in the Netherlands attributable to BRCA1 mutations is 2.1%. Under 40 years-of-age and under 50 years-of-age this prevalence is 9.5% and 6. 4%, respectively. All mutation carriers were under 50 years-of-age at diagnosis of the first breast cancer, and five did not have any relative with breast cancer. The proportions of bilateral breast cancer in the mutation carriers and non-carriers did not differ from each other. These data indicate that in the general Dutch breast cancer population the great majority of BRCA1 mutations will be found in women diagnosed under 50 years-of-age.
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Affiliation(s)
- H Papelard
- Department of Medical Decision Making, Leiden University Medical Center, The Netherlands
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31
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Vahrmeijer AL, van Dierendonck JH, Keizer HJ, Beijnen JH, Tollenaar RA, Pijl ME, Marinelli A, Kuppen PJ, van Bockel JH, Mulder GJ, van de Velde CJ. Increased local cytostatic drug exposure by isolated hepatic perfusion: a phase I clinical and pharmacologic evaluation of treatment with high dose melphalan in patients with colorectal cancer confined to the liver. Br J Cancer 2000; 82:1539-46. [PMID: 10789721 PMCID: PMC2363396 DOI: 10.1054/bjoc.2000.1175] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A phase I dose-escalation study was performed to determine whether isolated hepatic perfusion (IHP) with melphalan (L-PAM) allows exposure of the liver to much higher drug concentrations than clinically achievable after systemic administration and leads to higher tumour concentrations of L-PAM. Twenty-four patients with colorectal cancer confined to the liver were treated with L-PAM dosages escalating from 0.5 to 4.0 mg kg(-1). During all IHP procedures, leakage of perfusate was monitored. Duration of IHP was aimed at 60 min, but was shortened in eight cases as a result of leakage from the isolated circuit. From these, three patients developed WHO grade 3-4 leukopenia and two patients died due to sepsis. A reversible elevation of liver enzymes and bilirubin was seen in the majority of patients. Only one patient was treated with 4.0 mg kg(-1) L-PAM, who died 8 days after IHP as a result of multiple-organ failure. A statistically significant correlation was found between the dose of L-PAM, peak L-PAM concentrations in perfusate (R = 0.86, P< or =0.001), perfusate area under the concentration-time curve (AUC; R = 0.82, P<0.001), tumour tissue concentrations of L-PAM (R = 0.83, P = 0.011) and patient survival (R = 0.52, P = 0.02). The peak L-PAM concentration and AUC of L-PAM in perfusate at dose level 3.0 mg kg(-1) (n = 5) were respectively 35- and 13-fold higher than in the systemic circulation, and respectively 30- and 5-fold higher than reported for high dose oral L-PAM (80-157 mg m(-2)) and autologous bone marrow transplantation. Median survival after IHP (n = 21) was 19 months and the overall response rate was 29% (17 assessable patients; one complete and four partial remissions). Thus, the maximally tolerated dose of L-PAM delivered via IHP is approximately 3.0 mg kg(-1), leading to high L-PAM concentrations at the target side. Because of the complexity of this treatment modality, IHP has at present no place in routine clinical practice.
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Affiliation(s)
- A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, The Netherlands
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32
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Daigo Y, Furukawa Y, Kawasoe T, Ishiguro H, Fujita M, Sugai S, Nakamori S, Liefers GJ, Tollenaar RA, van de Velde CJ, Nakamura Y. Absence of genetic alteration at codon 531 of the human c-src gene in 479 advanced colorectal cancers from Japanese and Caucasian patients. Cancer Res 1999; 59:4222-4. [PMID: 10485460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Activation of c-src, a cellular human gene homologous in sequence to the v-src gene of Rous sarcoma virus, had been thought to play an important role in the progression of several types of human cancers, without having undergone any genetic changes. However, recently truncating mutations at codon 531 of the c-src gene were reported in 12% of the advanced colon cancers, and it was also demonstrated that this change was activating, transforming, tumorigenic, and metastasis promoting. To investigate whether the codon 531-specific mutation could be involved in the carcinogenesis of colorectal cancer in the Japanese and Caucasian populations, we examined a total of 479 advanced colorectal cancers from 421 Japanese patients (46 of them with liver or lung metastases) and from 58 Caucasian patients (11 of them with liver metastases). Using the PCR-RFLP assay and additional single-strand conformation polymorphism analysis, we detected no genetic alteration in any of the advanced colorectal cancers. Our results suggest that the codon 531-specific mutational activation of c-src is unlikely to play a significant role in the malignant progression of colorectal cancers among most Japanese and Caucasian patients.
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Affiliation(s)
- Y Daigo
- Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, The University of Tokyo, Minato, Japan
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De Vries MR, Borel Rinkes IH, Swaak AJ, Hack CE, Van De Velde CJ, Wiggers T, Tollenaar RA, Kuppen PJ, Eggermont AM. Acute-phase response patterns in isolated hepatic perfusion with tumour necrosis factor alpha (TNF-alpha) and melphalan in patients with colorectal liver metastases. Eur J Clin Invest 1999; 29:553-60. [PMID: 10354218 DOI: 10.1046/j.1365-2362.1999.00480.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In this study, we have evaluated hepatotoxicity, secondary cytokine production and hepatic acute-phase response (APR) in patients who underwent isolated hepatic perfusion (IHP) with tumour necrosis factor (TNF) alpha and melphalan for irresectable colorectal liver metastases. DESIGN An extracorporeal veno-venous bypass was used to shunt blood from the lower body and intestines to the heart. Inflow catheters were placed in the hepatic artery and portal vein, and an outflow catheter in the inferior caval vein. The liver was perfused for 60 min with 0.4 mg of TNF-alpha plus 1 mg kg-1 melphalan (IHPTM group, n = 6) or 1 mg kg-1 melphalan (IHPM group, n = 3). The liver was washed with macrodex before restoring vascular continuity. RESULTS After the washout procedure, a TNF-alpha peak (169 +/- 38 pg mL-1) was demonstrated in the IHPTM group only. Both groups demonstrated peak levels of interleukin 6 (IL-6) in the perfusate as well as systemically. These were significantly higher in the IHPTM group. Acute-phase protein (APP) levels followed a similar pattern as has been demonstrated after major surgery, with no significant differences between both groups. The addition of TNF-alpha to the perfusate did not lead to a significant difference in APP levels and the time course between groups. CONCLUSIONS IHP with TNF and melphalan is followed by a transient systemic peak of TNF directly after liver washout. Secondary IL-6 induction was seen in the present study after IHP with and without TNF, which was highest when TNF was added. This phenomenon cannot be extrapolated to APP induction, which appeared unaffected by the addition of TNF, presumably because the surgical procedure itself already causes maximal stimulation of APP production.
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Affiliation(s)
- M R De Vries
- The Department of Surgical Oncology, Dr Daniël den Hoed Cancer Centre,University Hospital Rotterdam, The Netherlands
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Abstract
Recent developments in the field of molecular biology enable us to detect tumour cells at a submicroscopical level. In colorectal and breast cancer the most important prognostic factor is dissemination of malignant cells to locoregional lymph nodes. An important issue is whether molecular 'super'-staging augments the accuracy by which the prognosis of individual patients can be assessed. Over the past few years numerous studies have reported the use of different PCR-based techniques in various types of cancer. The reported incidence of micrometastases and specificity of different assays varies tremendously. This clearly indicates the need for uniformity in protocols. For colorectal cancer the use of molecular techniques may improve staging and guide clinical decisions. For breast cancer there is still need to prove the clinical implication of finding occult metastatic disease. Nevertheless, PCR-based techniques are a powerful tool in the staging of common solid tumours and are likely to find their way into the daily practice of diagnostic histopathologists in the near future.
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Affiliation(s)
- G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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35
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Abstract
BACKGROUND Standard treatment of colorectal cancer includes adjuvant chemotherapy for patients with stage III disease (defined by the presence of lymph-node metastases), but not for patients with stage II tumors (who have no lymph-node metastases). However, 20 percent of patients with stage II tumors die of recurrent disease. We investigated whether the detection of micrometastases can be used to identify patients with stage II disease who are at high risk for recurrence. METHODS We analyzed 192 lymph nodes from 26 consecutive patients with stage II colorectal cancer, using a carcinoembryonic antigen-specific nested reverse-transcriptase polymerase chain reaction. Five-year follow-up information was obtained on all patients. Observed and adjusted survival rates were assessed in the patients with and the patients without micrometastases. RESULTS Micrometastases were detected in one or more lymph nodes from 14 of 26 patients (54 percent). The adjusted five-year survival rate (for which only cancer-related deaths were considered) was 50 percent in this group, whereas in the 12 patients without micrometastases, the survival rate was 91 percent (P=0.02 by the log-rank test). The observed five-year survival rates were 36 percent and 75 percent, respectively (P=0.03). The groups were similar with respect to age, sex, tumor side (location in relation to the flexura lienalis), degree of tumor differentiation (grade), and diameter of the primary tumor. CONCLUSIONS Molecular detection of micrometastases is a prognostic tool in stage II colorectal cancer.
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Affiliation(s)
- G J Liefers
- Department of Surgery, Leiden University Medical Center, The Netherlands
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Tollenaar RA, van Krieken JH, van Slooten HJ, Bruinvels DJ, Nelemans KM, van den Broek LJ, Hermans J, van Dierendonck JH. Immunohistochemical detection of p53 and Bcl-2 in colorectal carcinoma: no evidence for prognostic significance. Br J Cancer 1998; 77:1842-7. [PMID: 9667656 PMCID: PMC2150312 DOI: 10.1038/bjc.1998.306] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To evaluate the prognostic significance of immunohistochemically detected p53 and Bcl-2 proteins in colorectal cancer, tissue sections from 238 paraffin-embedded colorectal carcinomas were immunostained for p53 (MAb DO-7 and CM-1 antiserum) and Bcl-2 (MAb Bcl-2:124). Staining patterns were assessed semiquantitatively and correlated with each other and with sex, age, tumour site, Dukes' classification, tumour differentiation, mucinous characteristics, lymphocyte and eosinophilic granulocyte infiltration, and patient survival. In our series, 35% of carcinomas showed no nuclear staining and 34% (DO-7) to 40% (CM-1) showed staining in over 30% of tumour cell nuclei. A majority of carcinomas that had been immunostained with CM-1 showed cytoplasmic staining, but this was not observed with DO-7. With respect to Bcl-2, 51% of tumours were completely negative, 32% displayed weak and 15% moderate staining; only 3% showed strong positive staining. No evidence was found for reciprocity between Bcl-2 expression and nuclear p53 accumulation. From 13 cases containing tumour-associated adenoma, four were Bcl-2 negative in premalignant and malignant cells, in another four cases these cells showed similar staining intensities and in the remaining cases only the malignant colorectal cells were Bcl-2 negative. Therefore, our data indicate that Bcl-2 is dispensable in the progression towards carcinoma. Except for an association between nuclear p53 accumulation and mucinous tumours (P = 0.01), no significant correlation was found between the clinicopathological parameters mentioned above and immunostaining pattern of (nuclear or cytoplasmic) p53 or Bcl-2.
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Affiliation(s)
- R A Tollenaar
- Department of Surgery, Leiden University Medical Center, The Netherlands
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37
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de Vries MR, Borel Rinkes IH, van de Velde CJ, Wiggers T, Tollenaar RA, Kuppen PJ, Vahrmeijer AL, Eggermont AM. Isolated hepatic perfusion with tumor necrosis factor alpha and melphalan: experimental studies in pigs and phase I data from humans. Recent Results Cancer Res 1998; 147:107-119. [PMID: 9670273 DOI: 10.1007/978-3-642-80460-1_11] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report our experience with isolated hepatic perfusion (IHP) with tumor necrosis factor (TNF) and melphalan in an experimental pig study and of a phase I study in humans. IHP was performed with inflow catheters in the hepatic artery and portal vein and an outflow catheter in eh caval vein. An extracorporeal venovenous bypass was used. IHP consisted of a 60-min perfusion with hyperthermia (> 41 degrees C). For the pig protocol rhTNF alpha 50 micrograms/kg alone (n = 5) or rhTNF alpha 50 micrograms/kg plus melphalan 1 mg/kg (n = 3) were added. In two control pigs no drugs were added. In the phase I study, patients received melphalan 1 mg/kg with 0.4 mg rhTNF alpha (n = 8) or 0.8 mg rhTNF alpha (n = 1). After the perfusion the liver was washed with Macrodex before vascular continuity was restored. All pigs but one survived the procedure. Systemic leakage was less than 0.02%. Transient, mild liver toxicity was seen in all pigs, including controls, as demonstrated by liver enzyme assays and histology. There was no significant hemodynamic, cardiopulmonary hematological, or renal toxicity. In the phase I clinical study there was leakage in one patient (cumulative leakage 20%). There were three perioperative deaths (one possibly drug-related). All patients demonstrated significant hepatotoxicity. Survival ranged from 6 to 26 months (median 10.3 months). All patients demonstrated a tumor response (partial response 5/6, 1/6 stable disease) with a median duration of 18 weeks. In contrast to our pig program, many problems were encountered in the phase I study. By using both the hepatic artery and portal vein for IHP we encountered more toxicity than expected based on data from the pig program, resulting in fatal coagulative disturbances in one patient who received the second rhTNF alpha dose. Furthermore, local control after one IHP with TNF alpha and melphalan is only temporary.
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Affiliation(s)
- M R de Vries
- Department of Surgical Oncology, Dr. Daniël den Hoed Cancer Center, University of Hospital Rotterdam, The Netherlands
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Kagie MJ, Kenter GG, Tollenaar RA, Hermans J, Trimbos JB, Fleuren GJ. p53 protein overexpression is common and independent of human papillomavirus infection in squamous cell carcinoma of the vulva. Cancer 1997; 80:1228-33. [PMID: 9317172 DOI: 10.1002/(sici)1097-0142(19971001)80:7<1228::aid-cncr5>3.0.co;2-g] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infection and p53 abnormalities might both play a role in the carcinogenesis of subtypes of squamous cell carcinoma of the vulva. In this study, the authors investigated the prevalence of and the relationship between p53 overexpression and HPV infection in patients with vulvar carcinoma. METHODS Immunohistochemical methods for the detection of p53 protein and consensus primer polymerase chain reaction (PCR) were used, followed by direct sequencing of the PCR product for the evaluation of HPV subtype infection. Sixty-six patients with squamous cell carcinoma of the vulva were available for this study. RESULTS DO7, an anti-p53 monoclonal antibody, showed p53 overexpression in 35 carcinomas (53%). Consensus primer PCR showed HPV infection in 12 carcinomas (18%). No significant association was observed between p53 overexpression or HPV infection and tumor subtype. Approximately 57% of the HPV negative carcinomas and 33% of the HPV positive carcinomas had p53 overexpression. With regard to the patients with DO7 positivity in > or =50% of the nuclei only, significantly more HPV negative carcinomas were DO7 positive compared with HPV positive carcinomas (41% vs. 0%, respectively; P = 0.018). No relation was found between either HPV infection or p53 overexpression and disease free survival. CONCLUSIONS p53 overexpression is common in both HPV positive and HPV negative carcinomas of the vulva. These findings indicate that these two both play a role in the pathogenesis of vulvar carcinoma, but do not influence disease free survival.
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Affiliation(s)
- M J Kagie
- Department of Gynecology, Leiden University Medical Centre, The Hague, The Netherlands
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Timmermans DR, Gooszen AW, Geelkerken RH, Tollenaar RA, Gooszen HG. Analysis of the variety in surgeons' decision strategies for the management of left colonic emergencies. Med Care 1997; 35:701-13. [PMID: 9219497 DOI: 10.1097/00005650-199707000-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study is to analyze surgeons' decision strategies about the optimal treatment for acute sigmoid resection for different patients. In particular, the authors wished to determine the predominant accepted treatment choice among surgeons, to determine the importance of patient characteristics for surgeons' evaluations of the appropriateness of treatments, and to identify the variety in decision strategies. METHODS A survey was carried out among all surgical members of the Netherlands Society of Gastro Intestinal Surgery, who evaluated 16 patient cases. Approximately 70% of the members completed the survey. RESULTS Overall, the predominant accepted strategy is resection, delayed anastomosis, and colostomy (Hartmann procedure). Consensus in terms of preferred treatment, however, was low. The most important factors influencing surgeons' evaluations of the appropriateness of treatments were the age of a patient, the degree of peritonitis, and the degree of fecal contamination. Further analysis showed that the variety in surgeons' decision strategies could not be explained by differences in experience, but was shown to be related to the evaluation of the appropriateness of treatment for 60-year-old patients and patients with a local peritonitis. Except for these factors, surgeons did not differ fundamentally in the evaluation of the factors that make a treatment more appropriate. Surgeons agreed about the optimal treatment for older patients in poor condition, although there is no epidemiologic literature to support this consensus position. CONCLUSIONS This study showed that lack of consensus in surgeons' choice of treatment could be explained partly by disagreement of the appropriateness of treatments for some, rather than all, patients.
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Affiliation(s)
- D R Timmermans
- Medical Decision Making Unit, Leiden University, The Netherlands
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40
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Kagie MJ, Kenter GG, Tollenaar RA, Hermans J, Trimbos JP, Fleuren GJ. p53 protein overexpression, a frequent observation in squamous cell carcinoma of the vulva and in various synchronous vulvar epithelia, has no value as a prognostic parameter. Int J Gynecol Pathol 1997; 16:124-30. [PMID: 9100065 DOI: 10.1097/00004347-199704000-00007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this study we have investigated the prevalence of p53 overexpression in various vulvar lesions and its significance as a prognostic parameter in patients with vulvar carcinoma. Overexpression of p53 was studied in 66 patients with squamous cell carcinoma of the vulva and in the following synchronous epithelial lesions: intraepithelial neoplasia grade I (VIN I) (n = 33), VIN II (n = 11), VIN III (n = 16), lichen sclerosus (n = 30), squamous cell hyperplasia (n = 37), normal vulvar skin of patients with vulvar carcinoma (n = 55), and in 18 samples of normal skin from healthy controls. Survival curves of the p53-positive and p53-negative patients were compared using the log-rank test. The use of DO7, and anti-p53 monoclonal antibody, showed p53 overexpression in 35 (53%) specimens of carcinoma, in eight (27%) of lichen sclerosus, in five (14%) of squamous cell hyperplasia, in six (18%) of VIN I, in two (18%) of VIN II, in two (13%) of VIN III, and in seven (13%) specimens of normal vulvar skin. Staining of normal skin from healthy controls showed no p53 positive specimens. No relationship between expression of p53 and disease-free survival in patients with vulvar carcinoma was present. In malignant, synchronous premalignant and non-neoplastic epithelial disorders of the vulva, p53 overexpression is a frequent observation, indicating that the latter two groups have characteristics of premalignant lesions. In addition, p53 overexpression was not a useful prognostic parameter for patients with vulvar carcinoma.
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Affiliation(s)
- M J Kagie
- Department of Gynecology, Leiden University Medical Centre, The Netherlands
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Tollenaar RA, Bonsing BA, Kuipers-Dijkshoorn NJ, Hermans J, van de Velde CJ, Cornelisse CJ, Fleuren GJ. Evidence of clonal divergence in colorectal carcinoma. Cancer 1997; 79:1304-14. [PMID: 9083151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the generation of DNA ploidy diversity in different stages of colorectal carcinoma development. METHODS DNA flow cytometry was performed on tissue samples from 20 colorectal adenomas, 38 colorectal carcinomas, 30 lymph node metastases, and 70 hematogenous metastases. RESULTS DNA aneuploidy was detected in 30% of the adenomas, 82% of the primary colorectal tumors, 57% of the lymph node metastases, 92% of the liver metastases, and 100% of the other distant hematogenous metastases. Multiple DNA tumor stemlines were found in 10%, 39%, 29%, 24%, and 40%, respectively. Sixty-two percent of the DNA tumor stemlines detected in the lymph node or liver metastases were also present in the primary tumors. In primary carcinomas and lymph node metastases, the DNA index distribution had a bimodal shape with a minimum at the 1.2-1.4 region. In the hematogenous metastases, a higher percentage of hypertetraploid stemlines was found. CONCLUSIONS The emergence of DNA aneuploidy as well as clonal divergence seems to take place during the transition from adenoma to carcinoma. The DNA aneuploid stemlines formed during this phase remain relatively stable over time, although ongoing clonal evolution at distant metastatic tumor sites cannot be completely ruled out.
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Affiliation(s)
- R A Tollenaar
- Department of Surgery, Leiden University Medical Centre, The Netherlands
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Kuppen PJ, Jonges LE, van de Velde CJ, Vahrmeijer AL, Tollenaar RA, Borel Rinkes IH, Eggermont AM. Liver and tumour tissue concentrations of TNF-alpha in cancer patients treated with TNF-alpha and melphalan by isolated liver perfusion. Br J Cancer 1997; 75:1497-500. [PMID: 9166943 PMCID: PMC2223491 DOI: 10.1038/bjc.1997.255] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In this study we determined the level of tumour necrosis factor alpha (TNF-alpha) in liver and tumour tissue samples obtained from patients with colorectal metastases confined to the liver, who were treated with isolated liver perfusion with TNF-alpha and melphalan. We adapted a standard enzyme-linked immunosorbent assay kit for the quantification of TNF-alpha in serum to measure the amount of this cytokine in solid tissue. For this purpose, we developed a buffer that lysed the tissues without affecting the TNF-alpha present. The minimum detection level was about 2 pg of TNF-alpha per mg tissue. Using this technique, we found a significant increase in the TNF-alpha level after perfusion in the liver tissue of all evaluable patients, which may explain the transient liver toxicity we observed in all patients. In tumour tissue, a significant TNF-alpha increase was observed in one out of five patients. The level of TNF-alpha in all liver tissue samples and some of the tumours after treatment by isolated liver perfusion was much higher than the peak serum concentrations obtained after systemic administration of the maximum tolerated dose of TNF-alpha. Furthermore, we demonstrated that the level of TNF-alpha in the liver tissue samples was about seven to eight times higher than in tumour tissue. We concluded that regional liver treatment resulted in a relatively high local level of TNF-alpha, but also that this cytokine did not preferentially accumulate in tumour tissue.
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Affiliation(s)
- P J Kuppen
- Department of Surgery, Leiden University Hospital, The Netherlands
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Houbiers JG, van der Burg SH, van de Watering LM, Tollenaar RA, Brand A, van de Velde CJ, Melief CJ. Antibodies against p53 are associated with poor prognosis of colorectal cancer. Br J Cancer 1995; 72:637-41. [PMID: 7669574 PMCID: PMC2033915 DOI: 10.1038/bjc.1995.386] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Mutation of the p53 gene is a common event in colorectal cancer. This alteration can result in cellular accumulation of p53 and may also induce p53 antibodies. Accumulation of p53 in tumour cells has been associated with poor prognosis of colorectal cancer. We tested preoperative sera from 255 patients with colorectal cancer by enzyme-linked immunosorbent assay (ELISA). A total of 70.2% had reactivity that was higher than the 'low' control serum. Employing a cut-off level of 10% of the 'high' control sample, 25.5% of the patients were positive for p53 antibodies. The presence of p53 antibodies correlated with the following prognostic factors: histological differentiation grade, shape of the tumour, and tumour invasion into blood vessels. Patients with p53 antibodies were shown to have decreased survival and decreased disease-free survival. Specifically for patients with cancer stage A and B1 the presence of p53 antibodies selected a subgroup with poor prognosis.
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Affiliation(s)
- J G Houbiers
- Department of Immunohaematology and Blood Bank, University Hospital Leiden, The Netherlands
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Gooszen AW, Geelkerken RH, Tollenaar RA, Timmermans DR, Kievit J, Gooszen HG. [Surgical strategy in acute or elective sigmoid resection in The Netherlands; survey based on a marketing model]. Ned Tijdschr Geneeskd 1994; 138:2005-10. [PMID: 7935958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To gain insight into the operative strategies used by Dutch surgeons for complicated diverticulitis and sigmoid carcinoma, and into the influence of patient risk factors and surgeon's experience on the preferred operative strategy. DESIGN Descriptive. METHOD A questionnaire was sent to all 148 members of the Dutch Society of Gastrointestinal Surgery, concerning 32 fictitious patients with sigmoid pathology. It was based on conjoint-analysis, a model used in marketing research. This model analyses qualities that make a product preferable to another product of the same product group. The operative choices were: resection with Hartmann's procedure, resection with primary anastomosis after on-table lavage, or with primary anastomosis only, or no primary resection but diverting stoma only, or some personal technique. The survey focused on experience of the surgeons with the operative procedures, and on treatment choices in four fictitious cases frequently encountered in general surgery. RESULTS There was little agreement concerning the preferred surgical option for treatment of complicated diverticular disease or sigmoid carcinoma. With the exception of one fictitious young, electively operated 'ideal' patient (resection with primary anastomosis) there is hardly any consensus among the surgeons with respect to preferred treatment. CONCLUSIONS Reasons to depart from the conceptually optimal treatment (resection and anastomosis) in complicated cases (from the point of view of the surgeon or the patient), and absence of agreement on responsible other treatment could be differences in appraisal of the importance of several risk factors, or differences in acquired decision making strategies. The literature offers no answer to the question which techniques should be preferred under various circumstances.
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Affiliation(s)
- A W Gooszen
- Academisch Ziekenhuis, afd. Heelkunde, Leiden
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Tollenaar RA, Liefers GJ, Repelaer van Driel OJ, van de Velde CJ. Scalp cooling has no place in the prevention of alopecia in adjuvant chemotherapy for breast cancer. Eur J Cancer 1994; 30A:1448-53. [PMID: 7833100 DOI: 10.1016/0959-8049(94)00280-i] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
35 patients were studied to determine the effectiveness of scalp hypothermia in the prevention of alopecia caused by adjuvant chemotherapy for breast cancer. Scalp hypothermia was induced by the newly developed Theracool cooling machine. The chemotherapeutic regimen consisted of one perioperative course of doxorubicin 50 mg/m2, cyclophosphamide 600 mg/m2 and 5-fluorouracil 600 mg/m2 (EORTC protocol 10854). Only 4 (11%) patients showed acceptable hair preservation (no or minor alopecia). 12 patients (34%) had moderate alopecia, all requiring a wig. 19 patients (54%) had complete alopecia. No scalp metastases were observed after scalp cooling. These results and a review of the literature suggest that scalp hypothermia to prevent alopecia may only be effective in a cytotoxic regimen containing an anthracycline as the sole alopecia-inducing agent. With current adjuvant chemotherapy for breast cancer, in which a combination of cyclophosphamide and an anthracycline is often used, there is no place for scalp hypothermia.
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Affiliation(s)
- R A Tollenaar
- Department of Surgery, University Hospital Leiden, The Netherlands
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Tollenaar RA, van de Velde CJ, Taat CW, Gonzalez Gonzalez D, Leer JW, Hermans J. External radiotherapy and extrahepatic bile duct cancer. Eur J Surg 1991; 157:587-9. [PMID: 1687249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The hospital records of patients with extrahepatic bile duct cancer who where treated surgically between 1968 and 1983 were reviewed. Of 55 patients, 16 (29%) received radiotherapy after surgery. The total dose given ranged from 40 to 60 Gy. Median follow-up time for analysis was 4.0 months and lasted until January 1988. The overall median survival was 4 months (range 0-36), that of the irradiated patients was 16 months (range 2-36), and that of the 39 patients who were not irradiated was 3 months (range 0-32). When the 13 post operative deaths were excluded the median survival was 4 months. Radiotherapy did not cause any severe complications. No firm conclusion about the role of radiotherapy can be drawn from these data because the patients were not randomly chosen to receive radiotherapy and selection was therefore biased. We conclude that most patients with extrahepatic bile duct cancer still die of locoregional disease. Effective adjuvant treatments are needed and should be evaluated in prospective randomized trials.
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Affiliation(s)
- R A Tollenaar
- Department of Surgery, University Hospital Leiden, The Netherlands
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