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Hoek VT, Buettner S, Sparreboom CL, Detering R, Menon AG, Kleinrensink GJ, Wouters MWJM, Lange JF, Wiggers JK. A preoperative prediction model for anastomotic leakage after rectal cancer resection based on 13.175 patients. Eur J Surg Oncol 2022; 48:2495-2501. [PMID: 35768313 DOI: 10.1016/j.ejso.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION This study aims to develop a robust preoperative prediction model for anastomotic leakage (AL) after surgical resection for rectal cancer, based on established risk factors and with the power of a large prospective nation-wide population-based study cohort. MATERIALS AND METHODS A development cohort was formed by using the DCRA (Dutch ColoRectal Audit), a mandatory population-based repository of all patients who undergo colorectal cancer resection in the Netherlands. Patients aged 18 years or older were included who underwent surgical resection for rectal cancer with primary anastomosis (with or without deviating ileostomy) between 2011 and 2019. Anastomotic leakage was defined as clinically relevant leakage requiring reintervention. Multivariable logistic regression was used to build a prediction model and cross-validation was used to validate the model. RESULTS A total of 13.175 patients were included for analysis. AL was diagnosed in 1319 patients (10%). A deviating stoma was constructed in 6853 patients (52%). The following variables were identified as significant risk factors and included in the prediction model: gender, age, BMI, ASA classification, neo-adjuvant (chemo)radiotherapy, cT stage, distance of the tumor from anal verge, and deviating ileostomy. The model had a concordance-index of 0.664, which remained 0.658 after cross-validation. In addition, a nomogram was developed. CONCLUSION The present study generated a discriminative prediction model based on preoperatively available variables. The proposed score can be used for patient counselling and risk-stratification before undergoing rectal resection for cancer.
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Affiliation(s)
- V T Hoek
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - S Buettner
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - C L Sparreboom
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - R Detering
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - A G Menon
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - G J Kleinrensink
- Department of Neuroscience-Anatomy, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J K Wiggers
- Department of Colorectal Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Centre Amsterdam, the Netherlands
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Boerner T, Drill E, Pak LM, Nguyen B, Sigel CS, Doussot A, Shin P, Goldman DA, Gonen M, Allen PJ, Balachandran VP, Cercek A, Harding J, Solit DB, Schultz N, Kundra R, Walch H, D’Angelica MI, DeMatteo RP, Drebin J, Kemeny NE, Kingham TP, Simpson AL, Hechtman JF, Vakiani E, Lowery MA, Ijzermans J, Buettner S, Groot Koerkamp B, Doukas M, Chandwani R, Jarnagin WR. Genetic Determinants of Outcome in Intrahepatic Cholangiocarcinoma. Hepatology 2021; 74:1429-1444. [PMID: 33765338 PMCID: PMC8713028 DOI: 10.1002/hep.31829] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Genetic alterations in intrahepatic cholangiocarcinoma (iCCA) are increasingly well characterized, but their impact on outcome and prognosis remains unknown. APPROACH AND RESULTS This bi-institutional study of patients with confirmed iCCA (n = 412) used targeted next-generation sequencing of primary tumors to define associations among genetic alterations, clinicopathological variables, and outcome. The most common oncogenic alterations were isocitrate dehydrogenase 1 (IDH1; 20%), AT-rich interactive domain-containing protein 1A (20%), tumor protein P53 (TP53; 17%), cyclin-dependent kinase inhibitor 2A (CDKN2A; 15%), breast cancer 1-associated protein 1 (15%), FGFR2 (15%), polybromo 1 (12%), and KRAS (10%). IDH1/2 mutations (mut) were mutually exclusive with FGFR2 fusions, but neither was associated with outcome. For all patients, TP53 (P < 0.0001), KRAS (P = 0.0001), and CDKN2A (P < 0.0001) alterations predicted worse overall survival (OS). These high-risk alterations were enriched in advanced disease but adversely impacted survival across all stages, even when controlling for known correlates of outcome (multifocal disease, lymph node involvement, bile duct type, periductal infiltration). In resected patients (n = 209), TP53mut (HR, 1.82; 95% CI, 1.08-3.06; P = 0.03) and CDKN2A deletions (del; HR, 3.40; 95% CI, 1.95-5.94; P < 0.001) independently predicted shorter OS, as did high-risk clinical variables (multifocal liver disease [P < 0.001]; regional lymph node metastases [P < 0.001]), whereas KRASmut (HR, 1.69; 95% CI, 0.97-2.93; P = 0.06) trended toward statistical significance. The presence of both or neither high-risk clinical or genetic factors represented outcome extremes (median OS, 18.3 vs. 74.2 months; P < 0.001), with high-risk genetic alterations alone (median OS, 38.6 months; 95% CI, 28.8-73.5) or high-risk clinical variables alone (median OS, 37.0 months; 95% CI, 27.6-not available) associated with intermediate outcome. TP53mut, KRASmut, and CDKN2Adel similarly predicted worse outcome in patients with unresectable iCCA. CDKN2Adel tumors with high-risk clinical features were notable for limited survival and no benefit of resection over chemotherapy. CONCLUSIONS TP53, KRAS, and CDKN2A alterations were independent prognostic factors in iCCA when controlling for clinical and pathologic variables, disease stage, and treatment. Because genetic profiling can be integrated into pretreatment therapeutic decision-making, combining clinical variables with targeted tumor sequencing may identify patient subgroups with poor outcome irrespective of treatment strategy.
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Affiliation(s)
- Thomas Boerner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Esther Drill
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Linda M. Pak
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bastien Nguyen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carlie S. Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexandre Doussot
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Shin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra A. Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David B. Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY;,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nikolaus Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ritika Kundra
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Henry Walch
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Jeffrey Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy E. Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amber L. Simpson
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Jaclyn F. Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - J.N.M. Ijzermans
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - S. Buettner
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - B. Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M. Doukas
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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van den Berg I, Buettner S, van den Braak RRJC, Ultee KHJ, Lingsma HF, van Vugt JLA, Ijzermans JNM. Low Socioeconomic Status Is Associated with Worse Outcomes After Curative Surgery for Colorectal Cancer: Results from a Large, Multicenter Study. J Gastrointest Surg 2020; 24:2628-2636. [PMID: 31745899 PMCID: PMC7595960 DOI: 10.1007/s11605-019-04435-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Socioeconomic status (SES) has been associated with early mortality in cancer patients. However, the association between SES and outcome in colorectal cancer patients is largely unknown. The aim of this study was to investigate whether SES is associated with short- and long-term outcome in patients undergoing curative surgery for colorectal cancer. METHODS Patients who underwent curative surgery in the region of Rotterdam for stage I-III colorectal cancer between January 2007 and July 2014 were included. Gross household income and survival status were obtained from a national registry provided by Statistics Netherlands Centraal Bureau voor de Statistiek. Patients were assigned percentiles according to the national income distribution. Logistic regression and Cox proportional hazard regression were performed to assess the association of SES with 30-day postoperative complications, overall survival and cancer-specific survival, adjusted for known prognosticators. RESULTS For 965 of the 975 eligible patients (99%), gross household income could be retrieved. Patients with a lower SES more often had diabetes, more often underwent an open surgical procedure, and had more comorbidities. In addition, patients with a lower SES were less likely to receive (neo) adjuvant treatment. Lower SES was independently associated with an increased risk of postoperative complications (Odds ratio per percent increase 0.99, 95%CI 0.99-0.998, p = 0.004) and lower cancer-specific mortality (Hazard ratio per percent increase 0.99, 95%CI 0.98-0.99, p = 0.009). CONCLUSION This study shows that lower SES is associated with increased risk of postoperative complications, and poor cancer-specific survival in patients undergoing surgery for stage I-III colorectal cancer after correcting for known prognosticators.
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Affiliation(s)
- I. van den Berg
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - S. Buettner
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | | | - K. H. J. Ultee
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - H. F. Lingsma
- Department of Public Health, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - J. L. A. van Vugt
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - J. N. M. Ijzermans
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
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Lambrichts DPV, de Smet GHJ, Buettner S, Lange JF. Reply to Wee. Colorectal Dis 2018; 20:1151-1152. [PMID: 30295417 DOI: 10.1111/codi.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 02/08/2023]
Affiliation(s)
| | - G H J de Smet
- Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Buettner
- Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J F Lange
- Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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5
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Erath JW, Buettner S, Weiler H, Vamos M, Von Jeinsen B, Heyl S, Schalk R, Mutlak H, Zeiher AM, Fichtlscherer S, Honold J. P2733Prognostic implications of preclinical airway management with laryngeal tube (LTS-D) or endotracheal tube in out-of-hospital cardiac arrest patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J W Erath
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - S Buettner
- JW Goethe University, Nephrology, Frankfurt am Main, Germany
| | - H Weiler
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - M Vamos
- JW Goethe University, Cardiology/Electrophysiology, Frankfurt am Main, Germany
| | - B Von Jeinsen
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Heyl
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - R Schalk
- JW Goethe University, Anaesthesiology, Frankfurt am Main, Germany
| | - H Mutlak
- JW Goethe University, Anaesthesiology, Frankfurt am Main, Germany
| | - A M Zeiher
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - S Fichtlscherer
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - J Honold
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
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6
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Margonis GA, Sasaki K, Gholami S, Kim Y, Andreatos N, Rezaee N, Deshwar A, Buettner S, Allen PJ, Kingham TP, Pawlik TM, He J, Cameron JL, Jarnagin WR, Wolfgang CL, D'Angelica MI, Weiss MJ. Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases. Br J Surg 2018; 105:1210-1220. [PMID: 29691844 DOI: 10.1002/bjs.10838] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/05/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study sought to develop a clinical risk score for resectable colorectal liver metastasis (CRLM) by combining clinicopathological and clinically available biological indicators, including KRAS. METHODS A cohort of patients who underwent resection for CRLM at the Johns Hopkins Hospital (JHH) was analysed to identify independent predictors of overall survival (OS) that can be assessed before operation; these factors were combined into the Genetic And Morphological Evaluation (GAME) score. The score was compared with the current standard (Fong score) and validated in an external cohort of patients from the Memorial Sloan Kettering Cancer Center (MSKCC). RESULTS Six preoperative predictors of worse OS were identified on multivariable Cox regression analysis in the JHH cohort (502 patients). The GAME score was calculated by allocating points to each patient according to the presence of these predictive factors: KRAS-mutated tumours (1 point); carcinoembryonic antigen level 20 ng/ml or more (1 point), primary tumour lymph node metastasis (1 point); Tumour Burden Score between 3 and 8 (1 point) or 9 and over (2 points); and extrahepatic disease (2 points). The high-risk group in the JHH cohort (GAME score at least 4 points) had a 5-year OS rate of 11 per cent, compared with 73·4 per cent for those in the low-risk group (score 0-1 point). Importantly, in cohorts from both the JHH and MSKCC (747 patients), the discriminatory capacity of the GAME score was superior to that of the Fong score, as demonstrated by the C-index and the Akaike information criterion. CONCLUSION The GAME score is a preoperative prognostic tool that can be used to inform treatment selection.
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Affiliation(s)
- G A Margonis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - K Sasaki
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Gholami
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Y Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Andreatos
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Rezaee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Deshwar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Buettner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - P J Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - T M Pawlik
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J L Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - W R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - C L Wolfgang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M J Weiss
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Van Vugt J, Buettner S, Alferink L, Bossche N, de Bruin R, Darwish Murad S, Polak W, Metselaar H, Ijzermans J. SUN-P072: Low Skeletal Muscle Mass is Associated with Increased Hospital Costs in Patients with Cirrhosis Listed for Liver Transplantation. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30555-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Hausmann D, Aksöz N, von Hardenberg J, Martini T, Westhoff N, Buettner S, Schoenberg SO, Riffel P. Prostate cancer detection among readers with different degree of experience using ultra-high b-value diffusion-weighted Imaging: Is a non-contrast protocol sufficient to detect significant cancer? Eur Radiol 2017; 28:869-876. [PMID: 28799090 DOI: 10.1007/s00330-017-5004-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the accuracy of a T2-weighted (T2w) - and a parallel transmit zoomed b = 2000 s/mm2 (b2000) - diffusion-weighted imaging sequence among three readers with different degrees of experience for prostate cancer (Pca) detection. METHODS Ninety-three patients with suspected Pca were enrolled. For b2000 a two-dimensional spatially-selective RF pulse using an echo-planar transmit trajectory was applied, and the field of view (FOV) was reduced to one-third. All three readers (Reader A: 7, B 4 and C <1 years of experience in prostate MRI) independently evaluated b2000 with regard to the presence of suspicious lesions that displayed increased signal. The results were compared to histopathology obtained by real-time MR/ultrasound fusion and systematic biopsy. RESULTS In 62 patients Pca was confirmed. One significant Pca (Gleason score (GS) 7b) was missed by Reader C. Overall, sensitivity/specificity/positive predictive value/negative predictive value were 90/71/86/79% for Reader A, 87/84/92/76% for Reader B and 85/74/87/72% for Reader C, respectively. Detection rates for significant Pca (GS >7a) were 100/100/94% for Readers A/B/C, respectively. Inter-reader agreement was generally good (Kappa A/B: 0.8; A/C: 0.82; B/C: 0.74). CONCLUSION B2000 in combination with a T2w could be useful to detect clinically significant Pca. KEY POINTS • Significant prostate cancer using zoomed ultra-high b-value DWI was detected. • Diagnostic performance among readers with different degrees of experience was good. • mp- MRI of the prostate using a comprehensive non-contrast protocol is clinically feasible.
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Affiliation(s)
- D Hausmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
| | - N Aksöz
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - J von Hardenberg
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - T Martini
- Department of Urology, University of Ulm, Ulm, Germany
| | - N Westhoff
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Buettner
- Department of Statistics and Biomathematics, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - P Riffel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
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Margonis GA, Amini N, Buettner S, Besharati S, Kim Y, Sobhani F, Kamel IR, Pawlik TM. Impact of early postoperative platelet count on volumetric liver gain and perioperative outcomes after major liver resection. Br J Surg 2016; 103:899-907. [DOI: 10.1002/bjs.10120] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/13/2015] [Accepted: 01/05/2016] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Although perioperative platelet count has been associated with postoperative morbidity and mortality, its impact on liver regeneration has not been examined directly. This study sought to determine the impact of platelet count on liver regeneration after major liver resection using cross-sectional imaging volumetric assessment.
Methods
Patients who underwent major liver resection between 2004 and 2015 and had available data on immediate postoperative platelet count, as well as preoperative and postoperative CT images, were identified retrospectively. Resected liver volume was subtracted from total liver volume (TLV) to define postoperative remnant liver volume (RLVp). The liver regeneration index was defined as the relative increase in liver volume within 2 months ((RLV2m – RLVp)/RLVp, where RLV2m is the remnant liver volume around 2 months after surgery). The association between platelet count, liver regeneration and outcomes was assessed.
Results
A total of 99 patients met the inclusion criteria. Overall, 25 patients (25 per cent) had a low platelet count (less than 150 × 109/l), whereas 74 had a normal–high platelet count (at least 150 × 109/l). Despite having comparable clinicopathological characteristics and RLVp/TLV at surgery (P = 0·903), the relative increase in liver volume within 2 months was considerably lower in the low-platelet group (3·9 versus 16·5 per cent; P = 0·043). Patients with a low platelet count had an increased risk of postoperative complications (72 versus 38 per cent; P = 0·003), longer hospital stay (8 versus 6 days; P = 0·004) and worse median overall survival (24·5 versus 67·3 months; P = 0·005) than those with a normal or high platelet count.
Conclusion
After major liver resection, a low postoperative platelet count was associated with inhibited liver regeneration, as well as worse short- and long-term outcomes. Immediate postoperative platelet count may be an early indicator to identify patients at increased risk of worse outcomes.
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Affiliation(s)
- G A Margonis
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Amini
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Buettner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Besharati
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Y Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - F Sobhani
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - I R Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - T M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Meyer K, Buettner S, Ghezzi D, Zeviani M, Bano D, Nicotera P. Loss of apoptosis-inducing factor critically affects MIA40 function. Cell Death Dis 2015; 6:e1814. [PMID: 26158520 PMCID: PMC4650723 DOI: 10.1038/cddis.2015.170] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/22/2015] [Indexed: 01/28/2023]
Abstract
Mitochondrial apoptosis-inducing factor (AIF) influences the oxidative phosphorylation (OXPHOS) system and can be recruited as a mediator of cell death. Pathogenic mutations in the AIFM1 gene cause severe human diseases. Clinical manifestations include inherited peripheral neuropathies, prenatal cerebral abnormalities and progressive mitochondrial encephalomyopathies. In humans, rodents and invertebrates, AIF deficiency results in loss of respiratory complexes and, therefore, impaired OXPHOS. The molecular mechanisms underlying AIF-induced mitochondrial dysfunction remain elusive. Here we show that AIF physically interacts with the oxidoreductase CHCHD4/MIA40. In patient-derived fibroblasts as well as in tissues and glia cells from Harlequin (Hq) mutant mice, AIF deficiency correlates with decreased MIA40 protein levels, without affecting mRNA transcription. Importantly, MIA40 overexpression counteracts loss of respiratory subunits in Hq cells. Together, our findings suggest that MIA40 reduction contributes to the effects of AIF deficiency on OXPHOS, as it may impact on the correct assembly and maintenance of the respiratory subunits. This may be relevant for the development of new therapeutic approaches for AIF-related mitochondrial disorders.
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Affiliation(s)
- K Meyer
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - S Buettner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - D Ghezzi
- IRCCS Foundation Institute of Neurology ‘C. Besta', Milan, Italy
| | - M Zeviani
- MRC Mitochondrial Biology Unit, Cambridge, UK
| | - D Bano
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - P Nicotera
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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Walker R, Ruderman I, Masterson R, Cohney S, Salvadori M, Conti P, Bertoni E, Durrbach A, Citterio F, Mulloy L, David-Neto E, Russ G, Vitko S, Zhang R, Xing J, Harler MB, Grinyo J, Rugiu C, Trubian A, Bernich P, Lupo A, Asbe-Vollkopf A, Pannu A, Hoefeld H, Gauer S, Gossmann J, Kachel HG, Froese S, Korom S, Geiger H, Hauser IA, Liefeldt L, Kluener C, Glander P, Giessing M, Gralla O, Neumayer HH, Budde K, Kroencke T, Liborio AB, Barros RM, Esmeraldo RM, Oliveira MLMB, Nogueira Paes FJV, Mendoza TR, Silva Junior GB, Daher EF, Siekierka-Harreis M, Bantis C, Kouri NM, Schwandt C, Rump LC, Ivens K, Slatinska J, Honsova E, Burgelova M, Slimackova E, Viklicky O, Tabernero G, Rivero K, Fernandez G, Canueto J, Garcia P, Fraile P, Lucas C, Tabernero JM, Bargnoux AS, Simon N, Garrigue V, Dupuy AM, Mourad G, Cristol JP, Yapici U, Kers J, Bemelman F, Roelofs J, Groothoff J, van der Loos C, van Donselaar-van der Pant K, Idu M, Claessen N, ten Berge I, Florquin S, Knap B, Dragonja Z, Dobnik S, Buturovic Ponikvar J, Ponikvar R, Kandus A, Bren A, Hauser IA, Kleemann J, Gauer S, Engel J, Winter S, Hoefeld H, Asbe-Vollkopf A, Brzoska M, Obermueller N, Geiger H, Schaeffeler E, Oldak M, Pazik J, Lewandowski Z, Sitarek E, Dabrowski M, Ploski R, Malejczyk J, Durlik M, Slubowska K, Urbanowicz A, Sadowska A, Lichodziejewska B, Kurnicka K, Galazka Z, Chmura A, Durlik M, Masin-Spasovska J, Spasovski G, Petrusevska G, Popov Z, Ivanovski N, Di Napoli A, Salvatori MF, Franco F, Di Lallo D, Guasticchi G, Sancho A, Gavela E, Beltran S, Kanter J, Alemany B, Crespo JF, Pallardo LM, Lionet A, Beuscart JB, Buob D, BenHenda A, Provot F, Hazzan M, Noel C, Galan-Sanchez F, Marin-Casanova P, Mazuecos A, Garcia-Alvarez T, Aznar E, Rodriguez-Iglesias M, Ossareh S, Salami M, Mohammad E, Hosseini M, Pawlik A, Chudek J, Kolonko A, Wilk J, Jalowiecki P, Wiecek A, Zyablitskaya E, Galkina E, Yushina E, Botelho C, Aires P, Santos L, Romaozinho C, Macario F, Alves R, Veiga P, Mota A, Yashi M, Yagisawa T, Kimura T, Nukui A, Fujiwara T, Sakuma Y, Ishikawa N, Iwabuchi T, Muraishi O, Glander P, Hambach P, Liefeldt L, Neumayer HH, Budde K, Esmen S, Keven K, Sengul S, Ozcan M, Ensari A, Tuzuner A, Calayoglu R, Nergizoglu G, Gullu Koca T, Koca N, Ersoy A, Faria B, Bustorff M, Barros F, Tavares I, Santos J, Ferreira I, Sampaio S, Pestana M, Keven K, Suvak B, Sengul S, Kurultak I, Calayoglu R, Tutkak H, Choi HM, Yang HN, Jo SK, Cho WY, Kim HK, Aybal Kutlugun A, Altun B, Akman U, Aki T, Turkmen E, Yildirim T, Altindal M, Yilmaz R, Yasavul U, Gullu Koca T, Koca N, Ersoy A, Thiem U, Heinze G, Gossler U, Perkmann T, Kainberger F, Muhlbacher F, Horl W, Borchhardt K, Sanchez-Escuredo A, Holgado S, Biosca C, Granada ML, Barluenga E, Lauzurica R, Romero R, Espinal A, Torregrossa V, Bayes B, Tomida K, Hamano T, Fujii N, Ichimaru N, Matsui I, Isaka Y, Rakugi H, Takahara S, Gavela E, Sancho A, Kanter J, Beltran S, Avila A, Crespo JF, Pallardo LM, Dor F, Massey E, Frunza M, Johnson R, Lennerling A, Loven C, Mamode N, Pascalev A, Sterckx S, Van Assche K, Zuidema W, Weimar W, Botelho C, Aires P, Santos L, Romaozinho C, Macario F, Alves R, Veiga P, Mota A, Allwin R, Gauer S, Roessel, Hoefeld H, Brzoska M, Buettner S, Gossmann J, Belwe V, Geiger H, Hauser IA, Apaza J, Gonzalez E, Polanco N, Bengoa I, Cadenillas C, Andres A, Morales JM, Rocha S, Fonseca I, Martins LS, Vidinha J, Dias L, Almeida M, Pedroso S, Henriques A, Cabrita A, Neretljak I, Mihovilovic K, Vidas Z, Jurenec F, Knotek M, Justa S, Minz R, Minz M, Anand S, Sharma A, Lacquaniti A, Donato V, Chirico V, Pettinato G, Buemi M, Galle J, Addison J, Perry P, Claes K, Farouk M, Guerin A, Kiss I, Winearls C, Di Giulio S, Basic-Jukic N, Slavicek J, Bubic-Filipi L, Kes P, Scholbach T, Wang HK, Yang AH, Loong CC, Wu TH, Abboud I, Antoine C, Serrato T, Lefaucheur C, Pillebout E, Gaudez F, Fieux F, Flamant M, Verine J, Viglietti D, Peraldi MN, Glotz D. Transplantation: clinical studies (2). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Galluzzi L, Vanden Berghe T, Vanlangenakker N, Buettner S, Eisenberg T, Vandenabeele P, Madeo F, Kroemer G. Programmed necrosis from molecules to health and disease. Int Rev Cell Mol Biol 2011; 289:1-35. [PMID: 21749897 DOI: 10.1016/b978-0-12-386039-2.00001-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
During the past decade, cell death researchers have witnessed a gradual but deep conceptual revolution: it has been unequivocally shown that necrosis, which for long had been considered as a purely accidental cell death mode, can also be induced by finely regulated signal transduction pathways. In particular, when caspases are inhibited by pharmacological or genetic means, the ligation of death receptors such as the tumor necrosis factor receptor 1 (TNFR1) can lead to the assembly of a supramolecular complex containing the receptor-interacting protein kinases 1 and 3 (RIP1 and RIP3) that delivers a pronecrotic signal. Such complex has recently been dubbed necrosome and mediates the execution of a specific instance of regulated necrosis, necroptosis. Soon, it turned out that programmed necrosis occurs in nonmammalian model organisms and that it is implicated in human diseases including ischemia and viral infection. In this review, we first describe the historical evolution of the concept of programmed necrosis and the molecular mechanisms that underlie necroptosis initiation and execution. We then provide evidence suggesting that necroptosis represents an ancient and evolutionarily conserved cell death modality that may be targeted for drug development.
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Rockenfeller P, Ring J, Muschett V, Beranek A, Buettner S, Carmona-Gutierrez D, Eisenberg T, Khoury C, Rechberger G, Kohlwein SD, Kroemer G, Madeo F. Fatty acids trigger mitochondrion-dependent necrosis. Cell Cycle 2010; 9:2836-42. [PMID: 20647757 DOI: 10.4161/cc.9.14.12267] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Obesity is characterised by lipid accumulation in non-adipose tissues, leading to organ degeneration and a wide range of diseases, including diabetes, heart attack and liver cirrhosis. Free fatty acids (FFA) are believed to be the principal toxic triggers mediating the adverse cellular effects of lipids. Here, we show that various cooking oils used in human nutrition cause cell death in yeast in the presence of a triacylglycerol lipase, mimicking the physiological microenvironment of the small intestine. Combining genetic and cell death assays, we demonstrate that elevated FFA concentrations lead to necrotic cell death, as evidenced by loss of membrane integrity and release of nuclear HMGB1. FFA-mediated necrosis depends on functional mitochondria and leads to the accumulation of reactive oxygen species. We conclude that lipotoxicity is executed via a mitochondrial necrotic pathway, challenging the dogma that the adverse effects of lipid stress are exclusively apoptotic.
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Fickenscher K, Buettner S. Lessons from the trenches in physician integration. Physician Exec 1996; 22:14-8. [PMID: 10161349] [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: 02/11/2023]
Abstract
Beyond the theoretical basis for integration, three core considerations stand out as the primary reasons for pursuing integration from a physician's perspective. In the authors' experience, the ability to make a case for physician integration stands or falls based on the ability of the integrated delivery system to address these considerations: Gain greater access to capital; develop human resources with talents in managed care and the full spectrum of care services; and sustain an information infrastructure. This article explores the lessons learned in pursuing physician integration.
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Reimer P, Weissleder R, Lee AS, Buettner S, Wittenberg J, Brady TJ. Asialoglycoprotein receptor function in benign liver disease: evaluation with MR imaging. Radiology 1991; 178:769-74. [PMID: 1994416 DOI: 10.1148/radiology.178.3.1994416] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An arabinogalactan-coated ultrasmall superparamagnetic iron oxide (AG-USPIO) preparation specific for asialoglycoprotein (ASG) receptors on hepatocytes was used as a magnetic resonance (MR) imaging contrast agent in the evaluation of a spectrum of benign liver diseases in animal models. The activity of hepatocyte ASG receptors, which directly reflects liver function, was directly assessed by measuring liver relaxation times in vitro and MR signal intensity in vivo. The following measurements allowed three-dimensional assessment of liver function: (a) liver relaxation time, (b) native MR signal intensities of liver, (c) response of liver to the AG-USPIO probe (percentage decrease of liver signal intensity after intravenous administration of 10 mumol/kg of AG-USPIO: normal liver 55%, fatty liver 57%, acute hepatitis 36%, chronic hepatitis 29%, and cirrhosis 46%), and (d) redistribution of hepatocyte-specific AG-USPIO to the spleen (present in hepatitis and cirrhosis but not in normal liver and fatty liver). The results of this study indicate that cellular hepatic abnormalities can be detected and quantitated with MR receptor imaging.
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Affiliation(s)
- P Reimer
- Department of Radiology, Massachusetts General Hospital, Charlestown
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