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Blank S, Otto M, Reißfelder C. [Efficacy and safety of the one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA)]. Chirurgie (Heidelb) 2024; 95:412-413. [PMID: 38634919 DOI: 10.1007/s00104-024-02091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Susanne Blank
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Mirko Otto
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Christoph Reißfelder
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Finze A, Vijgen GH, Betzler J, Orth V, Hetjens S, Reissfelder C, Otto M, Blank S. Malnutrition and vitamin deficiencies after surgery for esophageal and gastric cancer: A metanalysis. Clin Nutr ESPEN 2024; 60:348-355. [PMID: 38479934 DOI: 10.1016/j.clnesp.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Patients receiving oncological esophagectomy or gastrectomy are known to be at high risk for vitamin and micronutrient deficiency before, during and after surgery. However, there are no clear guidelines for these cancer patients regarding postoperative vitamin supplementation. METHODS We conducted a metanalysis consisting of 10 studies regarding vitamin and micronutrient deficiencies after oncological gastric or esophageal resection. 5 databases were searched. RESULTS Data was sufficient regarding Vitamins B12 and 25-OH D3 as well as calcium. We were able to show deficiencies in 25-OH Vitamin D3 levels (p < 0.001) and lower levels of Vitamin B12 and calcium (bit p < 0.001) when compared to the healthy population. CONCLUSIONS Patients from these groups are at risk for vitamin deficiencies. A guideline on postoperative supplementation is needed.
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Affiliation(s)
- Alida Finze
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Guy Hej Vijgen
- Department of Surgery, Laurentius Hospital, Monseigneur Driessenstraat 6, 6043 CV Roermond, the Netherlands
| | - Johanna Betzler
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Vanessa Orth
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Téoule P, Blank S, Boettcher M, Reißfelder C, Otto M. [Metabolic and bariatric surgery in comparison to intensive nonsurgical treatment in adolescents with severe obesity : A multicenter randomized controlled study in Sweden]. Chirurgie (Heidelb) 2023; 94:1039-1040. [PMID: 37903913 DOI: 10.1007/s00104-023-01985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Patrick Téoule
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Susanne Blank
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Michael Boettcher
- Klinik für Kinder- und Jugendchirurgie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Christoph Reißfelder
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Mirko Otto
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Boesing C, Schaefer L, Hammel M, Otto M, Blank S, Pelosi P, Rocco PRM, Luecke T, Krebs J. Individualized Positive End-expiratory Pressure Titration Strategies in Superobese Patients Undergoing Laparoscopic Surgery: Prospective and Nonrandomized Crossover Study. Anesthesiology 2023; 139:249-261. [PMID: 37224406 DOI: 10.1097/aln.0000000000004631] [Citation(s) in RCA: 2] [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: 05/26/2023]
Abstract
BACKGROUND Superobesity and laparoscopic surgery promote negative end-expiratory transpulmonary pressure that causes atelectasis formation and impaired respiratory mechanics. The authors hypothesized that end-expiratory transpulmonary pressure differs between fixed and individualized positive end-expiratory pressure (PEEP) strategies and mediates their effects on respiratory mechanics, end-expiratory lung volume, gas exchange, and hemodynamic parameters in superobese patients. METHODS In this prospective, nonrandomized crossover study including 40 superobese patients (body mass index 57.3 ± 6.4 kg/m2) undergoing laparoscopic bariatric surgery, PEEP was set according to (1) a fixed level of 8 cm H2O (PEEPEmpirical), (2) the highest respiratory system compliance (PEEPCompliance), or (3) an end-expiratory transpulmonary pressure targeting 0 cm H2O (PEEPTranspul) at different surgical positioning. The primary endpoint was end-expiratory transpulmonary pressure at different surgical positioning; secondary endpoints were respiratory mechanics, end-expiratory lung volume, gas exchange, and hemodynamic parameters. RESULTS Individualized PEEPCompliance compared to fixed PEEPEmpirical resulted in higher PEEP (supine, 17.2 ± 2.4 vs. 8.0 ± 0.0 cm H2O; supine with pneumoperitoneum, 21.5 ± 2.5 vs. 8.0 ± 0.0 cm H2O; and beach chair with pneumoperitoneum; 15.8 ± 2.5 vs. 8.0 ± 0.0 cm H2O; P < 0.001 each) and less negative end-expiratory transpulmonary pressure (supine, -2.9 ± 2.0 vs. -10.6 ± 2.6 cm H2O; supine with pneumoperitoneum, -2.9 ± 2.0 vs. -14.1 ± 3.7 cm H2O; and beach chair with pneumoperitoneum, -2.8 ± 2.2 vs. -9.2 ± 3.7 cm H2O; P < 0.001 each). Titrated PEEP, end-expiratory transpulmonary pressure, and lung volume were lower with PEEPCompliance compared to PEEPTranspul (P < 0.001 each). Respiratory system and transpulmonary driving pressure and mechanical power normalized to respiratory system compliance were reduced using PEEPCompliance compared to PEEPTranspul. CONCLUSIONS In superobese patients undergoing laparoscopic surgery, individualized PEEPCompliance may provide a feasible compromise regarding end-expiratory transpulmonary pressures compared to PEEPEmpirical and PEEPTranspul, because PEEPCompliance with slightly negative end-expiratory transpulmonary pressures improved respiratory mechanics, lung volumes, and oxygenation while preserving cardiac output. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Christoph Boesing
- Department of Anesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Laura Schaefer
- Department of Anesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Marvin Hammel
- Department of Anesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anesthesiology and Critical Care - San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Ilha do Fundao, Rio de Janeiro, Brazil
| | - Thomas Luecke
- Department of Anesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - Joerg Krebs
- Department of Anesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany; Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
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Blank S, Otto M, Belle S. [Cholecystolithiasis and intestinal bypass procedures]. Chirurgie (Heidelb) 2023; 94:512-517. [PMID: 36884048 DOI: 10.1007/s00104-023-01834-9] [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] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
With the increasing number of surgical interventions for obesity, the numbers of associated complications, such as gallstones after bariatric surgery are also increasing. The incidence of postbariatric symptomatic cholecystolithiasis is 5-10%; however, the numbers of severe complications due to gallstones and the probability of a necessary extraction of gallstones are low. For this reason, a simultaneous or preoperative cholecystectomy should only be carried out in symptomatic patients. Treatment with ursodeoxycholic acid reduced the risk of gallstone formation in randomized trials but not the risk of complications related to gallstones in cases of pre-existing gallstones. The most frequently used access route to bile ducts after intestinal bypass procedures is the laparoscopic approach via the stomach remnants. Other possible access routes are the enteroscopic approach as well as the endosonography-guided puncture of the stomach remnants.
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Affiliation(s)
- S Blank
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - M Otto
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - S Belle
- Medizinische Klinik II, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Finze A, Otto M, Reissfelder C, Blank S. [Therapeutic Options for Regaining Weight after Bariatric Surgery]. Zentralbl Chir 2022; 147:547-555. [PMID: 36479651 DOI: 10.1055/a-1957-5570] [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: 12/12/2022]
Abstract
PURPOSE The purpose of this article is to create an overview of diagnostic and therapeutic options for weight regain (WR) and insufficient weight loss (IWL) after bariatric surgery (BS). With increasing popularity of BS, WR is becoming more relevant. METHODS We combined recent literature on WR and IWL with personal experience to suggest possible proceedings if WR or IWL is diagnosed. RESULTS If an anatomical-pathological cause can be detected, surgical therapy is the most effective. If WR or IWL is idiopathic, a multimodal therapeutic concept is necessary for sufficient therapeutic success. Depending on the initial BS, a combination of lifestyle intervention, medication and surgical therapy seems most effective. CONCLUSIONS Extensive diagnostic testing is necessary prior to any surgical intervention. In idiopathic WR after Roux-en-Y Gastric Bypass (RYGB), we suggest lengthening the biliopancreatic limb and shortening the common channel. After Sleeve-Gastrectomy (SG), we currently see RYGB as most effective in patients with gastroesophageal reflux disease (GERD) and SADI-S as a feasible option if no GERD is present.
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Affiliation(s)
- Alida Finze
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Mirko Otto
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | | | - Susanne Blank
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
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Betzler J, Elfinger L, Büttner S, Weiß C, Rahbari N, Betzler A, Reißfelder C, Otto M, Blank S, Schölch S. Robot-assisted esophagectomy may improve perioperative outcome in patients with esophageal cancer – a single-center experience. Front Oncol 2022; 12:966321. [PMID: 36059666 PMCID: PMC9428717 DOI: 10.3389/fonc.2022.966321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Although the introduction of minimally invasive surgical techniques has improved surgical outcomes in recent decades, esophagectomy for esophageal cancer is still associated with severe complications and a high mortality rate. Robot-assisted surgery is already established in certain fields and robot-assisted esophagectomy may be a possible alternative to the standard minimally invasive esophagectomy. The goal of this study was to investigate whether robot assistance in esophagectomy can improve patient outcome while maintaining good oncological control. Material and methods Data of all patients who underwent minimally invasive esophagectomy between January 2018 and November 2021 at University Hospital Mannheim was collected retrospectively. Patients were divided into two cohorts according to operative technique (standard minimally invasive (MIE) vs. robot-assisted esophagectomy (RAMIE), and their outcomes compared. In a separate analysis, patients were propensity score matched according to age, gender and histological diagnosis, leading to 20 matching pairs. Results 95 patients were included in this study. Of those, 71 patients underwent robot-assisted esophagectomy and 24 patients underwent standard minimally invasive esophagectomy. Robot-assisted esophagectomy showed a lower incidence of general postoperative complications (52.1% vs. 79.2%, p=0.0198), surgical complications (42.3% vs. 75.0%, p=0.0055), a lower rate of anastomotic leakage (21.1% vs. 50.0%, p=0.0067), a lower Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0065) as well as a shorter duration of hospital stay (median of 15 vs. 26 days, p=0.0012) and stay in the intensive care unit (median of 4 vs. 7 days, p=0.028) than standard minimally invasive surgery. After additionally matching RAMIE and MIE patients according to age, gender and diagnosis, we found significant improvement in the RAMIE group compared to the MIE group regarding the Comprehensive Complication Index (median of 20.9 vs. 38.6, p=0.0276), anastomotic leakage (20% vs. 55%, p=0.0484) and severe toxicity during neoadjuvant treatment (0 patients vs. 9 patients, p=0.005). Conclusion Robot-assisted surgery can significantly improve outcomes for patients with esophageal cancer. It may lead to a shorter hospital stay as well as lower rates of complications, including anastomotic leakage.
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Affiliation(s)
- Johanna Betzler
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Surgical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
| | - Lea Elfinger
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sylvia Büttner
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiß
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nuh Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Betzler
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Surgical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- *Correspondence: Sebastian Schölch, ; Susanne Blank,
| | - Sebastian Schölch
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Surgical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Research Center (DKFZ) - Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- *Correspondence: Sebastian Schölch, ; Susanne Blank,
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Finze A, Betzler J, Hetjens S, Reissfelder C, Otto M, Blank S. Circular vs. linear stapling after minimally invasive and robotic-assisted esophagectomy: a pooled analysis. Langenbecks Arch Surg 2022; 407:1831-1838. [PMID: 35731445 PMCID: PMC9399041 DOI: 10.1007/s00423-022-02590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
Purpose Current data states that most likely there are differences in postoperative complications regarding linear and circular stapling in open esophagectomy. This, however, has not yet been summarized and overviewed for minimally invasive esophagectomy, which is being performed increasingly. Methods A pooled analysis was conducted, including 4 publications comparing linear and circular stapling techniques in minimally invasive esophagectomy (MIE) and robotic-assisted minimally invasive esophagectomy (RAMIE). Primary endpoints were anastomotic leakage, pulmonary complications, and mean hospital stay. Results Summarizing the 4 chosen publications, no difference in anastomotic insufficiency could be displayed (p = 0.34). Similar results were produced for postoperative pulmonary complications. Comparing circular stapling (CS) to linear stapling (LS) did not show a trend towards a favorable technique (p = 0.82). Some studies did not take learning curves into account. Postoperative anastomotic stricture was not specified to an extent that made a summary of the publications possible. Conclusions In conclusion, data is not sufficient to provide a differentiated recommendation towards mechanical stapling techniques for individual patients undergoing MIE and RAMIE. Therefore, further RCTs are necessary for the identification of potential differences between LS and CS. At this point in research, we therefore suggest evading towards choosing a single anastomotic technique for each center. Momentarily, enduring the learning curve of the surgeon has the greatest evidence in reducing postoperative complication rates.
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Affiliation(s)
- Alida Finze
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 60167, Mannheim, Germany.
| | - Johanna Betzler
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 60167, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 60167, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 60167, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 60167, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 60167, Mannheim, Germany
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Galata C, Ronellenfitsch U, Weiß C, Blank S, Reißfelder C, Hardt J. Correction to: Surgery for Gastric Remnant Cancer Results in Similar Overall Survival Rates Compared with Primary Gastric Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol 2021; 28:902. [PMID: 34664144 PMCID: PMC8626387 DOI: 10.1245/s10434-021-10917-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Christian Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Julia Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Gill C, Tomita S, Suhner J, D'Andrea M, Umphlett M, Blank S, Tsankova N, Shrivastava R, Fowkes M, Kolev V. Tumor infiltrating lymphocytes in brain metastases from gynecological malignancies. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.439] [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: 10/23/2022]
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Tomita S, Suhner J, Bucknor A, Orfanelli T, Carr C, Blank S, Loudon H. Perioperative bundle does not decrease the rate of surgical site infection in patients undergoing hysterectomy. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.483] [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: 10/23/2022]
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Galata C, Ronellenfitsch U, Weiß C, Blank S, Reißfelder C, Hardt J. Surgery for Gastric Remnant Cancer Results in Similar Overall Survival Rates Compared with Primary Gastric Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol 2020; 27:4196-4203. [PMID: 32488518 PMCID: PMC8502152 DOI: 10.1245/s10434-020-08669-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/27/2019] [Indexed: 01/03/2023]
Abstract
Background The purpose of this study was to investigate clinical features, prognostic factors, and overall survival (OS) in surgical patients with gastric remnant cancer (GRC). Methods A retrospective analysis of patients with gastrectomy for pT1–4 gastric cancer between October 1972 and February 2014 at our institution was performed. Clinical characteristics were compared between patients with GRC and those with primary gastric cancer (PGC). Multivariable Cox regression analysis was performed to determine the prognostic factors for OS in patients with GRC. A propensity score-matched cohort was used to investigate OS between the GRC and PGC groups. Results Of a baseline cohort of 1440 patients, 95 patients with GRC were identified. Patients with GRC underwent more multivisceral resections (p < 0.001) than patients with PGC despite lower tumor stages (p = 0.018); however, R0 resection rates were not significantly different (p = 0.211). The postoperative overall (p = 0.032) and major surgical (p = 0.021) complication rates and the 30-day (p = 0.003) and in-hospital (p = 0.008) mortality rates were higher in patients with GRC. In multivariable analysis, the only prognostic factors for worse OS in GRC were higher tumor stage (p < 0.001) and the occurrence of postoperative complications (p < 0.001). OS between propensity score-matched GRC and PGC groups was not significantly different (p = 0.772). Conclusions GRC required more invasive surgery than PGC; however, the feasibility of R0 resection was similar. The prognostic factors of GRC were similar to those of PGC, and OS was not significantly different between both groups. Patients with GRC benefit from extensive surgery when performed with low morbidity and mortality.
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Affiliation(s)
- Christian Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Julia Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Sisic L, Blank S, Nienhüser H, Haag GM, Jäger D, Bruckner T, Ott K, Schmidt T, Ulrich A. The postoperative part of perioperative chemotherapy fails to provide a survival benefit in completely resected esophagogastric adenocarcinoma. Surg Oncol 2020; 33:177-188. [DOI: 10.1016/j.suronc.2017.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/17/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023]
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Russkamp D, Aguilar‐Pimentel A, Alessandrini F, Gailus‐Durner V, Fuchs H, Ohnmacht C, Chaker A, Angelis MH, Ollert M, Schmidt‐Weber CB, Blank S. IL-4 receptor α blockade prevents sensitization and alters acute and long-lasting effects of allergen-specific immunotherapy of murine allergic asthma. Allergy 2019; 74:1549-1560. [PMID: 30829405 DOI: 10.1111/all.13759] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy (AIT) is the only causal treatment for allergy. However, success rates vary depending on the type of allergy and disease background of the patient. Hence, strategies targeting an increased therapeutic efficacy are urgently needed. Here, the effects of blockade of IL-4 and IL-13 signaling on different phases of AIT were addressed. METHODS The impact of the recombinantly produced IL-4 and IL-13 antagonist IL-4 mutein (IL-4M) on allergic sensitization and AIT outcome in experimental allergic asthma were analyzed in a murine model. The effects of IL-4M administration were assessed prior/during sensitization, immediately after AIT under allergen challenge, and two weeks post-treatment. RESULTS Intervention with IL-4M prior/during sensitization led to strong induction of IgG1, IgG2a, IgG2b, and IgG3, decrease of specific and total IgE, as well as of IL-5 in serum. Similar effects on the serum immunoglobulin levels were observed immediately after IL4M-supplemented AIT during allergen challenge. Additionally, IL4M markedly suppressed type-2 cytokine secretion of splenocytes beyond the effect of AIT alone. These effects were equaled to those of AIT alone two weeks post-treatment. Intriguingly, here, IL-4M induced a sustained decrease of Th2-biased Tregs (ST2+ FOXP3+ GATA3intermediate ). CONCLUSIONS IL-4 and IL-13 blockade during experimental AIT demonstrates beneficial effects on immunological key parameters such as immunoglobulin and cytokine secretion immediately after AIT. Although two weeks later these effects were dropped to those of AIT alone, the number of potentially disease-triggering Th2-biased Tregs was further significantly decreased by IL-4M treatment. Hence, IL-4/IL13-targeting therapies prime the immune memory in therapy success-favoring manner.
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Affiliation(s)
- D. Russkamp
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - A. Aguilar‐Pimentel
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
| | - F. Alessandrini
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - V. Gailus‐Durner
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
| | - H. Fuchs
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
| | - C. Ohnmacht
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - A. Chaker
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
- Department of Otolaryngology Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - M. H. Angelis
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
- Chair of Experimental Genetics School of Life Science Weihenstephan Technical University of Munich Freising Germany
- German Center for Diabetes Research (DZD) Neuherberg Germany
| | - M. Ollert
- Luxembourg Institute of Health (LIH) Esch‐sur‐Alzette Luxembourg
- Department of Dermatology and Allergy Center Odense Research Center for AnaphylaxisUniversity of Southern Denmark Odense Denmark
| | - C. B. Schmidt‐Weber
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - S. Blank
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
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Kohlruss M, Grosser B, Krenauer M, Slotta-Huspenina J, Jesinghaus M, Blank S, Novotny A, Reiche M, Schmidt T, Ismani L, Hapfelmeier A, Mathias D, Meyer P, Gaida MM, Bauer L, Ott K, Weichert W, Keller G. Prognostic implication of molecular subtypes and response to neoadjuvant chemotherapy in 760 gastric carcinomas: role of Epstein-Barr virus infection and high- and low-microsatellite instability. J Pathol Clin Res 2019; 5:227-239. [PMID: 31206244 PMCID: PMC6817827 DOI: 10.1002/cjp2.137] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 03/04/2019] [Revised: 05/06/2019] [Accepted: 06/11/2019] [Indexed: 12/15/2022]
Abstract
Epstein–Barr virus positivity (EBV(+)) and high‐microsatellite instability (MSI‐H) have been identified as molecular subgroups in gastric carcinoma. The aim of our study was to determine the prognostic and predictive relevance of these subgroups in the context of platinum/5‐fluorouracil (5‐FU) based preoperative chemotherapy (CTx). Additionally, we investigated the clinical relevance of the low‐MSI (MSI‐L) phenotype. We analysed 760 adenocarcinomas of the stomach or the gastro‐oesophageal junction encompassing 143 biopsies before CTx and 617 resected tumours (291 without and 326 after CTx). EBV was determined by PCR and in situ hybridisation for selected cases. MSI was analysed by PCR using five microsatellite markers and classified as MSI‐H and MSI‐L. Frequencies of EBV(+), MSI‐H and MSI‐L in the biopsies before CTx were 4.2, 10.5 and 4.9% respectively. EBV(+) or MSI‐H did not correlate with response, but MSI‐L was associated with better response (p = 0.011). In the resected tumours, frequencies of EBV(+), MSI‐H and MSI‐L were 3.9, 9.6 and 4.5% respectively. Overall survival (OS) was significantly different in the non‐CTx group (p = 0.014). Patients with EBV(+) tumours showed the best OS, followed by MSI‐H. MSI‐L was significantly associated with worse OS (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.21–4.04, p = 0.01). In the resected tumours after CTx, MSI‐H was also associated with increased OS (HR, 0.54; 95% CI, 0.26–1.09, p = 0.085). In multivariable analysis, molecular classification was an independent prognostic factor in the completely resected (R0) non‐CTx group (p = 0.035). In conclusion, MSI‐H and EBV(+) are not predictive of response to neoadjuvant platinum/5‐FU based CTx, but they are indicative of a good prognosis. In particular, MSI‐H indicates a favourable prognosis irrespective of treatment with CTx. MSI‐L predicts good response to CTx and its negative prognostic effect for patients treated with surgery alone suggests that MSI‐L might help to identify patients with potentially high‐benefit from preoperative CTx.
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Affiliation(s)
- Meike Kohlruss
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Bianca Grosser
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Marie Krenauer
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | | | - Moritz Jesinghaus
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Susanne Blank
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Alexander Novotny
- Department of Surgery, Technical University of Munich, Munich, Germany
| | - Magdalena Reiche
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Thomas Schmidt
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Liridona Ismani
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Daniel Mathias
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Petra Meyer
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Matthias M Gaida
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Lukas Bauer
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Katja Ott
- Department of Surgery, Klinikum Rosenheim, Rosenheim, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Institute of Pathology, Munich, Germany
| | - Gisela Keller
- Institute of Pathology, Technical University of Munich, Munich, Germany
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16
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Bauer L, Hapfelmeier A, Blank S, Reiche M, Slotta-Huspenina J, Jesinghaus M, Novotny A, Schmidt T, Grosser B, Kohlruss M, Weichert W, Ott K, Keller G. A novel pretherapeutic gene expression-based risk score for treatment guidance in gastric cancer. Ann Oncol 2019; 29:127-132. [PMID: 29069277 DOI: 10.1093/annonc/mdx685] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Perioperative chemotherapy is an established treatment of advanced gastric cancer patients. Treatment selection is based on clinical staging (cT). We aimed to establish and validate a prognostic score including clinical and molecular factors, to optimize treatment decisions for these patients. Patients and methods We analyzed 626 carcinomas of the stomach and of the gastro-esophageal junction from two academic centers including primarily resected and pre-/perioperatively treated patients. Patients were divided into a training (N = 269) and validation (N = 357) set. Expression of 11 target genes was measured by quantitative PCR in resected tumors. A risk score to predict overall survival (OS) was generated and validated. Intra-tumoral heterogeneity was assessed by analyzing 50 tumor areas from 10 patients. Results A risk score including the expression of CCL5, CTNNB1, EXOSC3 and LZTR1 and the clinical parameters cT, tumor localization and histopathologic type suggested two groups with a significant difference in OS [hazard ratio (HR) 0.30; 95% confidence interval (CI) 0.17-0.52]. The risk score was successfully validated in an independent cohort (HR 0.32; 95% CI 0.21-0.51; P < 0.001) as well as in subgroups of primarily resected (HR 0.30; 95% CI 0.17-0.54; P < 0.001) and pre-/perioperatively treated patients (HR 0.37; 95% CI 0.17-0.81; P = 0.009). A significant difference in OS of high- and low-risk patients was also found in primarily resected patients with intestinal (HR 0.45; 95% CI 0.23-0.90; P = 0.020) and nonintestinal-type carcinomas (HR 0.1; 95% CI 0.02-0.42; P < 0.001). Intra-tumor heterogeneity analysis indicated a classification reliability of 95% for a supposed analysis of three biopsies. Conclusion The identified risk score could substantially contribute to an improved management of gastric cancer patients in the context of perioperative chemotherapy.
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Affiliation(s)
- L Bauer
- Department of Pathology, Technical University of Munich, Munich, Germany
| | - A Hapfelmeier
- Department of Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - S Blank
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - M Reiche
- Department of Pathology, Technical University of Munich, Munich, Germany
| | - J Slotta-Huspenina
- Department of Pathology, Technical University of Munich, Munich, Germany
| | - M Jesinghaus
- Department of Pathology, Technical University of Munich, Munich, Germany
| | - A Novotny
- Department of Surgery, Technical University of Munich, Munich, Germany
| | - T Schmidt
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - B Grosser
- Department of Pathology, Technical University of Munich, Munich, Germany
| | - M Kohlruss
- Department of Pathology, Technical University of Munich, Munich, Germany
| | - W Weichert
- Department of Pathology, Technical University of Munich, Munich, Germany.,Department of Pathology, German Cancer Consortium (DKTK), Partner Site Munich, Technical University Munich, Munich, Germany
| | - K Ott
- Department of Surgery, Klinikum Rosenheim, Rosenheim, Germany
| | - G Keller
- Department of Pathology, Technical University of Munich, Munich, Germany
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Haag GM, Czink E, Ahadova A, Schmidt T, Sisic L, Blank S, Heger U, Apostolidis L, Berger AK, Springfeld C, Lasitschka F, Jäger D, Knebel Doeberitz M, Kloor M. Prognostic significance of microsatellite‐instability in gastric and gastroesophageal junction cancer patients undergoing neoadjuvant chemotherapy. Int J Cancer 2019; 144:1697-1703. [DOI: 10.1002/ijc.32030] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/19/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Georg Martin Haag
- Department of Medical Oncology, National Center for Tumor DiseasesUniversity Hospital Heidelberg Heidelberg Germany
| | - Elena Czink
- Department of Medical Oncology, National Center for Tumor DiseasesUniversity Hospital Heidelberg Heidelberg Germany
| | - Aysel Ahadova
- Department of Applied Tumor Biology, Institute of PathologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Thomas Schmidt
- Department of SurgeryUniversity Hospital Heidelberg Heidelberg Germany
| | - Leila Sisic
- Department of SurgeryUniversity Hospital Heidelberg Heidelberg Germany
| | - Susanne Blank
- Department of SurgeryUniversity Hospital Heidelberg Heidelberg Germany
| | - Ulrike Heger
- Department of SurgeryUniversity Hospital Heidelberg Heidelberg Germany
| | - Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor DiseasesUniversity Hospital Heidelberg Heidelberg Germany
| | - Anne Katrin Berger
- Department of Medical Oncology, National Center for Tumor DiseasesUniversity Hospital Heidelberg Heidelberg Germany
| | - Christoph Springfeld
- Department of Medical Oncology, National Center for Tumor DiseasesUniversity Hospital Heidelberg Heidelberg Germany
| | - Felix Lasitschka
- Institute of PathologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor DiseasesUniversity Hospital Heidelberg Heidelberg Germany
| | - Magnus Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of PathologyUniversity Hospital Heidelberg Heidelberg Germany
| | - Matthias Kloor
- Department of Applied Tumor Biology, Institute of PathologyUniversity Hospital Heidelberg Heidelberg Germany
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18
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Heger P, Blank S, Gooßen K, Nienhüser H, Diener MK, Ulrich A, Mihaljevic AL, Schmidt T. Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction-a systematic review and meta-analysis. Langenbecks Arch Surg 2019; 404:103-113. [PMID: 30607534 DOI: 10.1007/s00423-018-1745-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/10/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim of this systematic review and meta-analysis was to compare the oncological and perioperative outcomes of transhiatally extended gastrectomy (TEG) and thoracoabdominal esophagectomy (TAE) for therapy of adenocarcinomas of the esophagogastric junction (AEG) with focus on AEG type II, as the optimal approach for these tumors is still unclear. METHODS MEDLINE, EMBASE, and the Cochrane Library (CENTRAL) were searched until July 24, 2018. Studies comparing TAE and TEG for surgical treatment of AEG type tumors have been included. Patient's baseline and perioperative data have been extracted and meta-analyses have been conducted for the outcomes: number of dissected lymph nodes, R0-resection rate, anastomotic leak rate, postoperative morbidity, and 30-day mortality. RESULTS Of 6709 articles identified, 8 studies have been included for further analysis. One thousand thirty-four patients underwent TAE, and 1177 patients TEG. No differences were found between the approaches in regard to number of dissected lymph nodes (MD - 0.96; 95% CI - 3.07 to 1.15; p = 0.37), R0-resection rates (OR 0.97; 95% CI 0.57 to 1.63; p = 0.90), anastomotic leak rates (OR 1.13; 95% CI 0.69 to 1.86; p = 0.63), and 30-day mortality (OR 1.53; 95% CI 0.90 to 2.61; p = 0.11). However, a higher rate of postoperative morbidity was found after TAE (OR 1.55; 95% CI 1.12 to 2.14; p = 0.008). CONCLUSIONS The optimal approach to surgical therapy of AEG II still remains unclear. This study identified a significantly higher rate of postoperative morbidity after TAE at comparable surgical outcomes. Due to major limitations concerning the quality of included studies, current data strongly mandates a properly designed randomized controlled trial to identify the optimal surgical approach for AEG type II tumors.
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Affiliation(s)
- Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Käthe Gooßen
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Harris BR, Yu J, Wolff M, Rogers M, Blank S. Optimizing the impact of alcohol and drug screening and early intervention in a high-risk population receiving services in New York City sexual health clinics: A process and outcome evaluation of Project Renew. Prev Med 2018; 112:160-167. [PMID: 29673885 DOI: 10.1016/j.ypmed.2018.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 10/17/2022]
Abstract
Unhealthy substance use is associated with increased rates of STDs, including HIV. Within three high-risk New York City (NYC) sexual health clinics between 2008 and 2012 (n = 146,657), 17% of patients screened positive for a current SUD but only 5.3% ever received prior treatment. The goal of Project Renew was to expand the reach of substance use early intervention services within and across sexual health clinics citywide and decrease substance use, poor mental health, and risky sexual behavior. To accomplish this goal, Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based substance use early intervention model, was implemented in all eight NYC sexual health clinics February 2012-January 2015. Clinic patients were screened for substance misuse using the AUDIT/DAST-10, and those who screened positive were eligible for on-site brief intervention. Overall, 130,597 substance misuse screenings were conducted (66,989, or 51%, positive), and 17,474 on-site brief interventions and 1238 referrals were provided (not unique to individual patients). A 10% sample of 14,709 unique patients who screened positive were interviewed using a federal data collection tool at baseline and six months later to assess changes in substance use, sexual risk behaviors, mental health, and health status (n = 1328). At six-month follow-up, patients reported reduced substance use, less sexual activity, improved overall health, and fewer days of depression and anxiety compared to measures at baseline (p < 0.05). Based on positive results, Project Renew SBIRT services have been sustained, ensuring essential care which may help prevent acquisition of HIV/STDs among a large population of high-risk New Yorkers.
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Affiliation(s)
- B R Harris
- University at Albany School of Public Health, One University Place, Rensselaer, NY, USA.
| | - J Yu
- University at Albany School of Social Welfare, 135 Western Ave., Albany, NY, USA.
| | - M Wolff
- Mount Sinai Icahn School of Medicine, 1 Gustave L. Levy Place, New York, NY, USA
| | - M Rogers
- New York City Department of Health and Mental Hygiene Bureau of STD Control and Prevention, 42-09 28th St., Long Island City, NY, USA
| | - S Blank
- New York City Department of Health and Mental Hygiene Bureau of STD Control and Prevention, 42-09 28th St., Long Island City, NY, USA; Centers for Disease Control and Prevention, Division of STD Prevention, 1600 Clifton Road, Atlanta, GA, USA.
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20
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Heger U, Sisic L, Nienhüser H, Blank S, Hinz U, Haag GM, Ott K, Ulrich A, Büchler MW, Schmidt T. Neoadjuvant Therapy Improves Outcomes in Locally Advanced Signet-Ring-Cell Containing Esophagogastric Adenocarcinomas. Ann Surg Oncol 2018; 25:2418-2427. [PMID: 29855828 DOI: 10.1245/s10434-018-6541-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Only a few studies have analyzed multimodal treatment concepts in the subgroup of signet-ring-cell containing upper gastrointestinal (GI) cancer. Recent retrospective, multicentric data favor primary resection without neoadjuvant chemotherapy for gastric signet-ring-cell containing carcinomas (SRCs). We compared the outcomes of primarily resected carcinomas with neoadjuvantly treated, locally advanced esophagogastric SRCs. METHODS A total of 310 patients with esophagogastric SRC-staged cT3/4/Nany/Many from a prospective unicentric database were included in this study; 192 (61.9%) received neoadjuvant therapy (NEO group) and 118 (38.1%) were primarily resected (RES group). RESULTS Overall, 128 (41.3%) patients presented with adenocarcinoma of the esophagogastric junction (AEG) and 182 (58.7%) presented with gastric cancer. Neoadjuvant therapy was significantly associated with resection in curative intent (NEO: 91.1%; RES: 75.4%; P = 0.001), improved (y)pT category (P = 0.035), improved (y)pN category (P < 0.001), and R0 resections (curative intent cohort: 76.0% in NEO vs. 60.7% in RES; P = 0.010), among others, but not with postoperative complications. Overall survival was significantly improved by neoadjuvant treatment {median survival 28.5 months (95% confidence interval [CI] 14.4-39.6) vs. RES: 14.9 months (10.6-17.5); P < 0.001}, as well as in subgroups (AEG and gastric tumors, R0-resected patients, and patients with and without relevant comorbidities). Independent prognostic factors were neoadjuvant therapy (hazard ratio [HR] 0.66; P = 0.023), pT4 category (HR 1.71; P = 0.041), pN2 category (HR 1.86; P = 0.013), pN3 category (HR 2.40; P < 0.001), pM1 category (HR 1.95; P = 0.003), age > 70 years (HR 1.79; P = 0.006), gastric localization (HR 0.69; P = 0.032), American Society of Anesthesiologists classification 3/4 (HR 1.71; P = 0.004), and incomplete resection R1/2 (HR 1.6; P = 0.014). CONCLUSIONS Our results demonstrate a survival advantage for advanced-stage esophagogastric SRC patients by neoadjuvant treatment.
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Affiliation(s)
- Ulrike Heger
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Susanne Blank
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Georg Martin Haag
- National Center for Tumor Diseases (NCT), University Hospital, Heidelberg, Germany
| | - Katja Ott
- Department of Surgery, RoMed Klinikum, Rosenheim, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplant Surgery, University Hospital, Heidelberg, Germany.
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21
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Sisic L, Strowitzki MJ, Blank S, Nienhueser H, Dorr S, Haag GM, Jäger D, Ott K, Büchler MW, Ulrich A, Schmidt T. Postoperative follow-up programs improve survival in curatively resected gastric and junctional cancer patients: a propensity score matched analysis. Gastric Cancer 2018; 21:552-568. [PMID: 28741059 DOI: 10.1007/s10120-017-0751-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND To date there is no evidence that more intensive follow-up after surgery for esophagogastric adenocarcinoma translates into improved survival. This study aimed to evaluate the impact of standardized surveillance by a specialized center after resection on survival. METHODS Data of 587 patients were analyzed who underwent curative surgery for esophagogastric adenocarcinoma in our institution. Based on their postoperative surveillance, patients were assigned to either standardized follow-up (SFU) by the National Center for Tumor Diseases (SFU group) or individual follow-up by other physicians (non-SFU group). Propensity score matching (PSM) was performed to compensate for heterogeneity between groups. Groups were compared regarding clinicopathological findings, recurrence, and impact on survival before and after PSM. RESULTS Of 587 patients, 32.7% were in the SFU and 67.3% in the non-SFU group. Recurrence occurred in 39.4% of patients and 92.6% within the first 3 years; 73.6% were treated, and of those 17.1% underwent resection. In recurrent patients overall and post-recurrence survival (OS/PRS) was influenced by diagnostic tools (p < 0.05), treatment (p ≤ 0.001), and resection of recurrence (p ≤ 0.001). Standardized follow-up significantly improved OS (84.9 vs. 38.4 months, p = 0.040) in matched analysis and was an independent positive predictor of OS before and after PSM (p = 0.034/0.013, respectively). CONCLUSION After PSM, standardized follow-up by a specialized center significantly improved OS. Cross-sectional imaging and treatment of recurrence were associated with better outcome. Regular follow-up by cross-sectional imaging especially during the first 3 years should be recommended by national guidelines, since early detection might help select patients for treatment of recurrence and even resection in few designated cases.
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Affiliation(s)
- Leila Sisic
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Moritz J Strowitzki
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Susanne Blank
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Henrik Nienhueser
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Sara Dorr
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Georg Martin Haag
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Katja Ott
- Department of Surgery, RoMed Hospital Rosenheim, 83022, Rosenheim, Germany
| | - Markus W Büchler
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thomas Schmidt
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Blank S, Nienhüser H, Dreikhausen L, Sisic L, Heger U, Ott K, Schmidt T. Inflammatory cytokines are associated with response and prognosis in patients with esophageal cancer. Oncotarget 2018; 8:47518-47532. [PMID: 28537901 PMCID: PMC5564583 DOI: 10.18632/oncotarget.17671] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/17/2017] [Indexed: 12/31/2022] Open
Abstract
Background Esophageal cancer is often marked by aggressive tumor growth and poor prognosis. Patient groups who benefit from perioperative therapy are not yet defined. The tumor microenvironment and circulating factors as possible predictors of response and prognosis gain interest. This study aimed to investigate cytokines in patients’ serum and tumor tissue with regard to response and prognosis. Results Median survival between SCC and AC was not different (published previously). Lower levels of CCL11 (Eotaxin-1) and CXCL10 (IP-10) in the tumor tissue were associated with a better prognosis (p = 0.022; p = 0.002). In the AC subgroup higher concentrations of TGF-β3 in serum and corresponding tumor tissue were associated with adverse prognosis (p = 0.035; p = 0.006). An association with histopathological response was found for IL-12(p70) and CXCL10 in patients’ sera (p = 0.041; p = 0.032). The tissue levels of TGF-β1 and TGF-β2 were significantly lower in histopathological responders than in nonresponders (p = 0.033; p = 0.007). A similar trend was seen for TGF-β3, without statistical significance (p = 0.097). Materials and Methods Preoperative serum samples and corresponding tumor tissue (n = 54), only serum (n = 20) or only tissue (n = 4) were collected from patients undergoing surgery for cT3/4 esophageal squamous cell cancer (SCC) (n = 34) and adenocarcinoma (AC) (n = 44). All samples were taken after neoadjuvant treatment. All patients received perioperative chemo(radio)therapy. Cytokine levels of 17 different cytokines were measured by multiplex immunoassay and correlated with clinicopathological factors. Conclusions Two chemokines (CCL11 and CXCL10) in posttherapeutic tumor tissue were associated with prognosis in patients with esophageal cancer, lower levels indicating a better prognosis. Lower levels of TGF-β were associated with better response and prognosis in patients with AC.
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Affiliation(s)
- Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Lena Dreikhausen
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Katja Ott
- Romed Klinikum Rosenheim, 83022 Rosenheim, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
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Blank S, Bilò MB, Ollert M. Cover Image. Clin Exp Allergy 2018. [DOI: 10.1111/cea.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nienhüser H, Blank S, Sisic L, Kunzmann R, Heger U, Ott K, Büchler MW, Schmidt T, Ulrich A. [Gastric stump carcinoma: frequency, treatment, complications and prognosis]. Chirurg 2018; 88:317-327. [PMID: 27678402 DOI: 10.1007/s00104-016-0296-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric stump carcinoma develops in the gastric remnant after partial gastrectomy. While the frequency of gastric cancer is declining, the incidence of gastric stump carcinoma has remained stable due to the long latency period. As the surgical treatment of gastric ulcers by partial gastrectomy has become much less important, more and more gastric stump carcinomas develop after oncological resection. AIM This study compared the surgical therapy of gastric stump carcinoma with the therapy of primary gastric cancer. MATERIAL AND METHODS From 2001 to 2014 a total of 24 patients were surgically treated for gastric stump carcinoma in the University Hospital of Heidelberg. In the same time 428 patients underwent resection due to primary gastric cancer. Both groups were analyzed and compared with a focus on preoperative therapy, intraoperative differences, complications and overall survival. RESULTS Patients with gastric stump carcinoma were older at disease onset (68 years vs. 62 years, p = 0.003). Compared with primary gastric cancer, patients with gastric stump carcinoma were more often suspected of having lymph node (cN+) involvement (51.4 % vs. 41.7 %, p < 0.001) but neoadjuvant therapy was applied less often (48.7 % vs. 14.3 %, p < 0.01). For resection of gastric stump carcinoma, extended resections were more often necessary (54.5 % vs. 28.2 %, p < 0.001). There were no significant differences in mean overall survival between the two patient groups (64.4 months vs. 45.8 months, p = 0.34) CONCLUSION: Despite the differences described, the treatment of gastric stump carcinoma does not essentially differ from that of primary gastric cancer. Carcinomas of the gastric stump are more often locally advanced and in our opinion a neoadjuvant therapy should be applied analogue to gastric cancer even if evidence-based data on this point are limited.
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Affiliation(s)
- H Nienhüser
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
| | - S Blank
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
| | - L Sisic
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
| | - R Kunzmann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
| | - U Heger
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
| | - K Ott
- Abteilung für Allgemein-, Vaskulär und Thoraxchirurgie, RoMed Klinikum Rosenheim, 83022, Rosenheim, Deutschland
| | - M W Büchler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
| | - T Schmidt
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland
| | - A Ulrich
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
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Blank S, Schmidt T, Heger P, Strowitzki MJ, Sisic L, Heger U, Nienhueser H, Haag GM, Bruckner T, Mihaljevic AL, Ott K, Büchler MW, Ulrich A. Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach? Gastric Cancer 2018; 21:303-314. [PMID: 28685209 DOI: 10.1007/s10120-017-0746-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal surgical approach for adenocarcinoma directly at the esophagogastric junction (AEG II) is still under debate. This study aims to evaluate the differences between right thoracoabdominal esophagectomy (TAE) (Ivor-Lewis operation) and transhiatal extended gastrectomy (THG) for AEG II. METHODS From a prospective database, 242 patients with AEG II (TAE, n = 56; THG, n = 186) were included and analyzed according to characteristics and perioperative morbidity and mortality and overall survival (chi-square, Mann-Whitney U, log-rank, Cox regression). RESULTS Groups were comparable at baseline with exception of age. Patients older than 70 years were more frequently resected by THG (p = 0.003). No differences in perioperative morbidity (p = 0.197) and mortality (p = 0.711) were observed, including anastomotic leakages (p = 0.625) and pulmonary complications (p = 0.494). There was no significant difference in R0 resection (p = 0.719) and number of resected lymph nodes (p = 0.202). Overall median survival was 38.4 months. Survival after TAE was significantly longer than after THG (median OS not reached versus 33.6 months, p = 0.02). Multivariate analysis revealed pN-category (p < 0.001) and type of surgery (p = 0.017) as independent prognostic factors. The type of surgery was confirmed as prognostic factor in locally advanced AEG II (cT 3/4 or cN1), but not in cT1/2 and cN0 patients. CONCLUSIONS Our single-center experience suggests that patients with (locally advanced) AEG II tumors may benefit from TAE compared to THG. For further evaluation, a randomized trial would be necessary.
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Affiliation(s)
- Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Moritz J Strowitzki
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Henrik Nienhueser
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Georg Martin Haag
- Department of Medical Oncology, National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Katja Ott
- Romed Klinikum Rosenheim, Pettenkoferstr. 10, 83022, Rosenheim, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Blank S, Bilò MB, Ollert M. Component-resolved diagnostics to direct in venom immunotherapy: Important steps towards precision medicine. Clin Exp Allergy 2018; 48:354-364. [PMID: 29331065 DOI: 10.1111/cea.13090] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Stings of Hymenoptera can induce IgE-mediated systemic and even fatal allergic reactions. Venom-specific immunotherapy (VIT) is the only disease-modifying and curative treatment of venom allergy. However, choosing the correct venom for VIT represents a necessary prerequisite for efficient protection against further anaphylactic sting reactions after VIT. In the past, therapeutic decisions based on the measurement of specific IgE (sIgE) levels to whole venom extracts were not always straightforward, especially when the patient was not able to identify the culprit insect. In the last years, the increasing knowledge about the molecular structure and relevance of important venom allergens and their availability as recombinant allergens, devoid of cross-reactive carbohydrate determinants, resulted in the development of an advanced component-resolved diagnostics (CRD) approach in venom allergy. Already to date, CRD has increased the sensitivity of sIgE detection and enabled the discrimination between primary sensitization and cross-reactivity, particularly in patients with sensitization to both honeybee and vespid venom. Hence, CRD in many patients improves the selection of the appropriate immunotherapeutic intervention. Moreover, the detailed knowledge about sensitization profiles on a molecular level might open new options to identify patients who are at increased risk of side-effects or not to respond to immunotherapy. Therefore, increasing potential of CRD becomes evident, to direct therapeutic decisions in a personalized and patient-tailored manner. Reviewed here are the state of the art options, recent developments and future perspectives of CRD of Hymenoptera venom allergy.
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Affiliation(s)
- S Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy
| | - M Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Esch-sur-Alzette, Luxembourg.,Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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Liu A, Rowland M, Vesely S, Powell B, Freeman J, Blank S, Frey M, Gillen J, Moore K, Cass I. Impact of Intra-peritoneal Chemotherapy and Bevacizumab in Front Line Chemotherapy for Ovarian Cancer Among gBRCA and wtBRCA Patients: A Multi-Institutional, Frequency Matched, Case Control Study. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.060] [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: 11/26/2022]
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Heger P, Blank S, Diener MK, Ulrich A, Schmidt T, Büchler MW, Mihaljevic AL. Gastric Preconditioning in Advance of Esophageal Resection-Systematic Review and Meta-Analysis. J Gastrointest Surg 2017; 21:1523-1532. [PMID: 28439770 DOI: 10.1007/s11605-017-3416-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/27/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anastomotic leakage is one of the most severe complications following esophageal resection. Among other strategies, gastric ischemic preconditioning has been proposed to improve anastomotic integrity. The aim of this systematic review is to investigate whether gastric preconditioning has influence on peri- or postoperative outcomes after esophageal resection. METHODS A systematic literature search was performed to identify studies comparing gastric preconditioning with non-preconditioned patients for any indication of esophageal resection. Random-effects meta-analyses were conducted for main outcomes. RESULTS Gastric preconditioning did not reduce anastomotic leakages (OR 0.76; 95%-CI 0.51 to 1.13; p = 0.18), anastomotic strictures (OR 1.10; 95%-CI 0.58 to 2.10; p = 0.76;), major complications (OR 1.14; 95%-CI 0.60 to 2.14; p = 0.69), or in-hospital mortality (OR 0.62; 95%-CI 0.28 to 1.40; p = 0.25). However, preconditioning reduced the rate of severe leaks requiring reoperation (OR 0.20; 95%-CI 0.08 to 0.53; p = 0.001). Increasing the period between preconditioning and esophageal resection over 2 weeks did not reduce anastomotic leakage compared to shorter waiting times (OR 0.65; 95%-CI 0.38 to 1.13; p = 0.13). CONCLUSION With current evidence, gastric preconditioning does not seem to reduce overall rates of anastomotic leakage after esophageal resection but seems to reduce severity of leakages.
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Affiliation(s)
- Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Ott K, Blank S, Ruspi L, Bauer M, Sisic L, Schmidt T. Prognostic impact of nodal status and therapeutic implications. Transl Gastroenterol Hepatol 2017; 2:15. [PMID: 28447050 DOI: 10.21037/tgh.2017.01.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/11/2017] [Indexed: 12/11/2022] Open
Abstract
The prognostic impact of lymph node (LN) metastases in gastric cancer is generally accepted. In primarily resected patients the pN-category and LN ratio are independent prognostic factors. Number of involved LNs, number of resected LNs, lymphangiosis and micrometastases also influence the prognosis significantly. To guarantee a proper D2 lymphadenectomy (LAD) at least 25 LNs according to the German S3 guidelines for the treatment of gastric cancer should be removed. Also in neoadjuvantly treated patients the ypN-category and LN ratio play an important prognostic role, despite the fact that UICC staging system was development based only on primarily resected patients. The role of response of LNs in neoadjuvantly treated patients is still unclear and needs further investigation. It seems to be less important than the response of the primary tumor. Limited data exists, suggesting that preoperative treatment might reduce the number of LNs involved and improve ypN-category. Due to further development in gastric cancer like laparoscopic resection and effective perioperative treatment in locally advanced tumor the role and the prognostic impact of LAD is again in the focus of discussion.
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Affiliation(s)
- Katja Ott
- RoMed Klinikum Rosenheim, 83022 Rosenheim, Germany
| | - Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Laura Ruspi
- Department of General Surgery, University of Insubria, 21100 Varese, Italy
| | - Margit Bauer
- RoMed Klinikum Rosenheim, 83022 Rosenheim, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
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30
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Schiener M, Eberlein B, Moreno-Aguilar C, Pietsch G, Serrano P, McIntyre M, Schwarze L, Russkamp D, Biedermann T, Spillner E, Darsow U, Ollert M, Schmidt-Weber CB, Blank S. Application of recombinant antigen 5 allergens from seven allergy-relevant Hymenoptera species in diagnostics. Allergy 2017; 72:98-108. [PMID: 27496543 DOI: 10.1111/all.13000] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hymenoptera stings can cause severe anaphylaxis in untreated venom-allergic patients. A correct diagnosis regarding the relevant species for immunotherapy is often hampered by clinically irrelevant cross-reactivity. In vespid venom allergy, cross-reactivity between venoms of different species can be a diagnostic challenge. To address immunological IgE cross-reactivity on molecular level, seven recombinant antigens 5 of the most important Vespoidea groups were assessed by different diagnostic setups. METHODS The antigens 5 of yellow jackets, hornets, European and American paper wasps, fire ants, white-faced hornets, and Polybia wasps were recombinantly produced in insect cells, immunologically and structurally characterized, and their sIgE reactivity assessed by ImmunoCAP, ELISA, cross-inhibition, and basophil activation test (BAT) in patients with yellow jacket or Polistes venom allergy of two European geographical areas. RESULTS All recombinant allergens were correctly folded and structural models and patient reactivity profiles suggested the presence of conserved and unique B-cell epitopes. All antigens 5 showed extensive cross-reactivity in sIgE analyses, inhibition assays, and BAT. This cross-reactivity was more pronounced in ImmunoCAP measurements with venom extracts than in sIgE analyses with recombinant antigens 5. Dose-response curves with the allergens in BAT allowed a differentiated individual dissection of relevant sensitization. CONCLUSIONS Due to extensive cross-reactivity in various diagnostic settings, antigens 5 are inappropriate markers for differential sIgE diagnostics in vespid venom allergy. However, the newly available antigens 5 from further vespid species and the combination of recombinant allergen-based sIgE measurements with BAT represents a practicable way to diagnose clinically relevant sensitization in vespid venom allergy.
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Affiliation(s)
- M. Schiener
- Center of Allergy and Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; Munich Germany
| | - B. Eberlein
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | | | - G. Pietsch
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | - P. Serrano
- Hospital Universitario Reina Sofía; Córdoba Spain
| | - M. McIntyre
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | - L. Schwarze
- Institute of Biochemistry and Molecular Biology; University of Hamburg; Hamburg Germany
| | - D. Russkamp
- Center of Allergy and Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; Munich Germany
| | - T. Biedermann
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | - E. Spillner
- Immunological Engineering, Department of Engineering; Aarhus University; Aarhus Denmark
| | - U. Darsow
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | - M. Ollert
- Department of Infection and Immunity; Luxembourg Institute of Health (LIH); Esch-sur-Alzette Luxembourg
- Department of Dermatology and Allergy Center; Odense Research Center for Anaphylaxis; University of Southern Denmark; Odense Denmark
| | - C. B. Schmidt-Weber
- Center of Allergy and Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; Munich Germany
| | - S. Blank
- Center of Allergy and Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; Munich Germany
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Russkamp D, Aguilar-Pimentel A, Gailus-Durner V, Fuchs H, Schiener M, Ollert M, Hrabě de Angelis M, Schmidt-Weber C, Blank S. 417 Alum-free thermosensitive hydrogel as subcutaneous matrix for immunomodulators and allergens during specific immunotherapy. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.437] [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: 10/21/2022]
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Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, Aalberse RC, Agache I, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilò MB, Blank S, Bohle B, Bosshard PP, Breiteneder H, Brough HA, Caraballo L, Caubet JC, Crameri R, Davies JM, Douladiris N, Ebisawa M, EIgenmann PA, Fernandez-Rivas M, Ferreira F, Gadermaier G, Glatz M, Hamilton RG, Hawranek T, Hellings P, Hoffmann-Sommergruber K, Jakob T, Jappe U, Jutel M, Kamath SD, Knol EF, Korosec P, Kuehn A, Lack G, Lopata AL, Mäkelä M, Morisset M, Niederberger V, Nowak-Węgrzyn AH, Papadopoulos NG, Pastorello EA, Pauli G, Platts-Mills T, Posa D, Poulsen LK, Raulf M, Sastre J, Scala E, Schmid JM, Schmid-Grendelmeier P, van Hage M, van Ree R, Vieths S, Weber R, Wickman M, Muraro A, Ollert M. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol 2016; 27 Suppl 23:1-250. [PMID: 27288833 DOI: 10.1111/pai.12563] [Citation(s) in RCA: 500] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.
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Affiliation(s)
- P M Matricardi
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - J Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - H J Hoffmann
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Hilger
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Hofmaier
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - R C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - I Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Barber
- IMMA-School of Medicine, University CEU San Pablo, Madrid, Spain
| | - K Beyer
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - T Biedermann
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Blank
- Center of Allergy and Environment (ZAUM), Helmholtz Center Munich, Technical University of Munich, Munich, Germany
| | - B Bohle
- Division of Experimental Allergology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - P P Bosshard
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - H Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - H A Brough
- Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, UK
| | - L Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - J C Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - R Crameri
- Swiss Institute of Allergy and Asthma Research, University of Zürich, Davos, Switzerland
| | - J M Davies
- School of Biomedical Sciences, Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
| | - N Douladiris
- Allergy Unit, 2nd Paediatric Clinic, National & Kapodistrian University, Athens, Greece
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - P A EIgenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - M Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain
| | - F Ferreira
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - G Gadermaier
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - M Glatz
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - R G Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Hawranek
- Department of Dermatology, Paracelsus Private Medical University, Salzburg, Austria
| | - P Hellings
- Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - T Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Research Centre Borstel, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Division, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - M Jutel
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - S D Kamath
- Molecular Allergy Research Laboratory, Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville City, Qld, Australia
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - A Kuehn
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - G Lack
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A L Lopata
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - M Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - M Morisset
- National Service of Immuno-Allergology, Centre Hospitalier Luxembourg (CHL), Luxembourg, UK
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A H Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Pauli
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T Platts-Mills
- Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - D Posa
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - L K Poulsen
- Allergy Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J Sastre
- Allergy Division, Fundación Jimenez Díaz, Madrid, Spain
| | - E Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - J M Schmid
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - M van Hage
- Department of Medicine Solna, Clinical Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - R van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - R Weber
- School of Medicine, University of Colorado, Denver, CO, USA
- Department of Medicine, National Jewish Health Service, Denver, CO, USA
| | - M Wickman
- Sachs' Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - M Ollert
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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Michel J, Brockow K, Darsow U, Ring J, Schmidt-Weber CB, Grunwald T, Blank S, Ollert M. Added sensitivity of component-resolved diagnosis in hymenoptera venom-allergic patients with elevated serum tryptase and/or mastocytosis. Allergy 2016; 71:651-60. [PMID: 26836051 DOI: 10.1111/all.12850] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anaphylaxis caused by hymenoptera venom allergy is associated with elevation of baseline serum tryptase (sBT) and/or mastocytosis in about 5% of patients. Up to now, no information has become available on single venom allergen sIgE reactivity and the usefulness of component-resolved approaches to diagnose this high-risk patient group. To address the component-resolved sIgE sensitization pattern and diagnostic sensitivity in hymenoptera venom-allergic patients with elevated sBT levels and/or mastocytosis, a panel of yellow jacket and honeybee venom allergens was applied on a widely used IgE immunoassay platform. METHODS Fifty-three patients with mastocytosis and/or elevated sBT tryptase level and systemic reactions to hymenoptera venoms were analyzed for their IgE reactivity to recombinant yellow jacket and honeybee venom allergens by Immulite3 g. RESULTS sIgE reactivity to Ves v 1, Ves v 5, Api m 1 to Api m 4 and Api m 10 was found at a similar frequency in hymenoptera venom-allergic patients with and without elevated sBT levels and/or mastocytosis. However, the use of the recombinant allergens and a diagnostic cutoff of 0.1 kUA /L allowed the diagnosis of patients with otherwise undetectable IgE to venom extract. The diagnostic sensitivity of yellow jacket venom allergy using the combination of Ves v 1 and Ves v 5 was 100%. CONCLUSIONS In high-risk patients with elevated sBT levels and/or mastocytosis, the use of molecular components and decreasing the threshold sIgE level to 0.1 kUA /L may be needed to avoid otherwise undetectable IgE to hymenoptera venom extracts in about 8% of such patients.
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Affiliation(s)
- J. Michel
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
| | - K. Brockow
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
| | - U. Darsow
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
| | - J. Ring
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
| | - C. B. Schmidt-Weber
- Center of Allergy and Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; Munich Germany
- Member of the German Center of Lung Research (DZL); Hamburg Germany
| | | | - S. Blank
- Center of Allergy and Environment (ZAUM); Technical University of Munich and Helmholtz Center Munich; Munich Germany
| | - M. Ollert
- Department of Infection and Immunity; Luxembourg Institute of Health (LIH); Esch-sur-Alzette Luxembourg
- Department of Dermatology and Allergy Center; Odense Research Center for Anaphylaxis; University of Southern Denmark; Odense Denmark
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Blank S, Knebel P, Haag GM, Bruckner T, Klaiber U, Burian M, Schaible A, Sisic L, Schmidt T, Diener MK, Ott K. Immediate tumor resection in patients with locally advanced gastroesophageal adenocarcinoma with nonresponse to chemotherapy after 4 weeks of treatment versus resection after completion of chemotherapy (OPTITREAT trial, DRKS00004668): study protocol for a randomized controlled pilot trial. Pilot Feasibility Stud 2016; 2:18. [PMID: 27965838 PMCID: PMC5153833 DOI: 10.1186/s40814-016-0059-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 03/08/2016] [Indexed: 12/22/2022] Open
Abstract
Background Neoadjuvant chemotherapy is a standard of care for patients with adenocarcinoma of the esophagus and stomach in Europe, but still only 20–40 % respond to therapy and the critical issue; how to treat nonresponding patients is still unclear. So far, there is no randomized trial evaluating the impact of early termination of neoadjuvant chemotherapy and immediate tumor resection in nonresponding patients with locally advanced gastroesophageal cancer on postoperative outcome. With this exploratory pilot trial, we want to get first estimates about the effect of discontinuation of chemotherapy with the aim to plan and conduct a further definitive trial. Methods/design OPTITREAT is designed as a single-center, randomized controlled pilot trial with two parallel study groups. Four weeks after starting neoadjuvant chemotherapy in all patients, clinical response will be assessed by endoscopy and endosonographic ultrasound. Then, nonresponding patients (n = 84) will be randomized in a 1:1 ratio to intervention group with stopping chemotherapy and immediate tumor resection or control group with completion of chemotherapy before surgery. Outcome measures are overall survival, R0 resection rate, perioperative morbidity and mortality, histopathological response, and quality of life. Statistical analysis will be based on the intention-to-treat population. Due to the study design as an explorative pilot trial, no formal sample size calculation was performed. The planned total sample size of 120 patients is considered ethical and large enough to show the feasibility and safety of the concept. First data on differences between the study groups in the defined endpoints will also be generated. Discussion Individualized therapy is of utmost interest in the treatment of locally advanced gastroesophageal adenocarcinoma as less than half of the patients show objective response to current chemotherapy regimens. The findings of the OPTITREAT trial will help to get first data about clinical response evaluation followed by immediate tumor resection in nonresponding patients after 4 weeks of neoadjuvant chemotherapy. Based on the results of this pilot study, a future confirmatory trial will be planned to prove efficacy and evaluate significance. Trial registration German Clinical Trial Register number: DRKS00004668
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Affiliation(s)
- Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany.,Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Georg-Martin Haag
- Department of Medical Oncology, National Center of Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120 Germany
| | - Thomas Bruckner
- Institute of Medical Statistics and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg, 69120 Germany
| | - Ulla Klaiber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Maria Burian
- Department of General Visceral and Transplantation Surgery, Endoscopic Center, University of Gießen, Rudolf-Buchheimstr. 7, Gießen, 35392 Germany
| | - Anja Schaible
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany.,Interdisciplinary Endoscopic Center, University of Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120 Germany
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany.,Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120 Germany
| | - Katja Ott
- Department of Surgery, RoMed Klinikum, Pettenkoferstr. 10, Rosenheim, 83022 Germany
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Schmidt T, Alldinger I, Blank S, Klose J, Springfeld C, Dreikhausen L, Weichert W, Grenacher L, Bruckner T, Lordick F, Ulrich A, Büchler M, Ott K. Surgery in oesophago-gastric cancer with metastatic disease: Treatment, prognosis and preoperative patient selection. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Nienhueser H, Kunzmann R, Sisic L, Blank S, Strowitzk MJ, Bruckner T, Jäger D, Weichert W, Ulrich A, Büchler MW, Ott K, Schmidt T. Surgery of gastric cancer and esophageal cancer: Does age matter? J Surg Oncol 2015; 112:387-95. [PMID: 26303645 DOI: 10.1002/jso.24004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/26/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In the past, elderly patients with upper GI cancers were excluded from surgery or multimodal treatment only due to their advanced age. In an aging society this way of patient selection seems to be questionable. The aim of this retrospective exploratory study was to investigate how patients with upper GI cancer over the age of 70 years differ from younger patients in the postoperative course and which parameters influence overall survival in older patient populations. PATIENTS AND METHODS From 2002 to 2012 1,005 patients underwent resection of esophageal or gastric cancer at the University of Heidelberg. 272 patients were older than 70 years and analyzed in subgroups (70-74 years: n = 146; 75-79 years: n = 82; 80 years or older: n = 44). Patients older than 70 years were compared to patients under 70 years (n = 733) with focus on differences in patients characteristics and outcome. Statistical analyses were made retrospectively on a prospective database. RESULTS Fewer older patients were treated neoadjuvantly (< 70 years: 41.5%; > 70 years: 24.7%, P < 0.001) and extended resection (abdominothoracic approach) was applied less frequently compared to patients under 70 years (< 70 years: 38.9%; > 70 years: 19.9%, P < 0.001). The pNM-category (HR 1.41/2.56) and R-status (HR 1.78) remain the most important predictive factor for survival (all < 0.001). Female patients had a longer survival than men over the age of 70 (84.9 vs. 23.5 months, P < 0.01). Patients over 80 years had a significant shortened overall survival (> 80 years: 16.7 vs. < 70 years: 37.4 months) compared to the other subgroups (P < 0.001) and a significant increased in-hospital mortality (> 80 years: 20.5% vs. < 70 years: 6.0%, P = 0.002). CONCLUSIONS An exclusion from surgical therapy due to advanced age in general seems not to be justified. However, the decision for a surgical resection in patients over 80 years should be made with caution. pNM-categories and R0-resection remain the most important predictive factors for overall survival in all subgroups. No survival benefit for neoadjuvant treatment in patients over 70 years was found, while women survived longer than men. However, the decision concerning a (radio) chemotherapy should be made individually in each patient.
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Affiliation(s)
- Henrik Nienhueser
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Romy Kunzmann
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Leila Sisic
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Susanne Blank
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Moritz J Strowitzk
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Infomatics IMBI, University of Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center of Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Katja Ott
- Department of General, Vascular and Thoracic Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
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Sisic L, Vallböhmer D, Stoecklein NH, Blank S, Schmidt T, Driemel C, Möhlendick B, Knoefel WT, Odenthal M, Ott K. Serum microRNA profiles as prognostic or predictive markers in the multimodality treatment of patients with gastric cancer. Oncol Lett 2015; 10:869-874. [PMID: 26622585 DOI: 10.3892/ol.2015.3341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 02/27/2015] [Indexed: 12/22/2022] Open
Abstract
Despite the implementation of multimodality treatment strategies, the persistently poor prognosis of gastric cancer patients is predominantly caused by the lack of predictive markers for response assessment in the neoadjuvant setting, preventing individualized therapy. Therefore, the identification of novel predictive and prognostic markers for application in the multimodality treatment of gastric cancer patients is required. The aim of the present study was to characterize the serum microRNA (miRNA/miR) profile of gastric cancer patients undergoing multimodality therapy to identify possible prognostic and predictive markers. The study consisted of 32 patients with gastric cancer who had undergone either primary surgical resection (n=14) or neoadjuvant therapy followed by surgical resection (n=18). Histopathological regression was defined as a major histopathological response when the resected specimens contained <10% vital residual tumor cells. Intratumoral miRNA was isolated from pre-operative or post-neoadjuvant blood serum samples. Initially, microarray analyses were performed in six of the patients that received neoadjuvant treatment (three responders versus three non-responders), to assess the amplification profile of dysregulated miRNAs. Based on these findings, possible predictive or prognostic markers were validated in all study patients by performing single reverse transcription-polymerase chain reaction (RT-PCR) analysis. Depending on the extent of the histopathological regression, a differential miRNA expression profile was identified in the microarray analyses. Based on the amplification profile, miR-21, miR-29a and miR-221 were selected for additional validation. However, the single RT-PCR measurements of the three selected miRNAs did not exhibit any prognostic or predictive value in the patients treated with primary resection or neoadjuvant therapy and resection. Thus, the current pilot study failed to identify a prognostic or predictive value in selected miRNAs using single RT-PCR measurements, however, the microarray results revealed a differential microRNA expression profile depending on the histopathological regression. The findings of the present study may have been affected by the small sample size.
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Affiliation(s)
- Leila Sisic
- Department of General, Visceral, Pediatric and Vascular Surgery, University of Heidelberg, Heidelberg D-69115, Germany
| | - Daniel Vallböhmer
- Department of General, Visceral and Pediatric Surgery, University of Düsseldorf, Düsseldorf D-40225, Germany
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University of Düsseldorf, Düsseldorf D-40225, Germany
| | - Susanne Blank
- Department of General, Visceral, Pediatric and Vascular Surgery, University of Heidelberg, Heidelberg D-69115, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Pediatric and Vascular Surgery, University of Heidelberg, Heidelberg D-69115, Germany
| | - Christiane Driemel
- Department of General, Visceral and Pediatric Surgery, University of Düsseldorf, Düsseldorf D-40225, Germany
| | - Birte Möhlendick
- Department of General, Visceral and Pediatric Surgery, University of Düsseldorf, Düsseldorf D-40225, Germany
| | - Wolfram T Knoefel
- Department of General, Visceral and Pediatric Surgery, University of Düsseldorf, Düsseldorf D-40225, Germany
| | | | - Katja Ott
- Department of General, Visceral, Pediatric and Vascular Surgery, University of Heidelberg, Heidelberg D-69115, Germany
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Möbs C, Müller J, Rudzio A, Pickert J, Blank S, Jakob T, Spillner E, Pfützner W. Decline of Ves v 5-specific blocking capacity in wasp venom-allergic patients after stopping allergen immunotherapy. Allergy 2015; 70:715-9. [PMID: 25753563 DOI: 10.1111/all.12606] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/26/2022]
Abstract
While allergen-specific immunotherapy (AIT) is very efficient in hymenoptera venom (HV)-allergic patients, long-term outcome after finishing AIT is not well investigated, especially regarding mechanisms that are suggested to contribute to allergen-specific tolerance. Here, we analyse the Ves v 5-inhibitory activity of sera from wasp venom-allergic patients using the novel cell-free enzyme-linked immunosorbent facilitated antigen binding (ELIFAB) assay. Compared to pre-AIT, sera from patients undergoing AIT displayed an increased ability to inhibit Ves v 5 binding by IgE antibodies. In contrast, this inhibitory activity was reduced in patients having finished AIT 5-12 years ago. Allergen-blocking capacity correlated with serum concentrations of Ves v 5-specific IgG4 which rose during AIT but almost reached pretreatment levels in patients who had stopped AIT more than 5 years ago. These data raise questions about how long allergen tolerance is maintained in AIT-treated HV-allergic patients and suggest that the ELIFAB assay might be an easy-to-use tool assessing long-term tolerance in patients treated with HV-AIT.
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Affiliation(s)
- C. Möbs
- Clinical & Experimental Allergology; Department of Dermatology and Allergology; Philipps University Marburg; Marburg Germany
| | - J. Müller
- Clinical & Experimental Allergology; Department of Dermatology and Allergology; Philipps University Marburg; Marburg Germany
| | - A. Rudzio
- Clinical & Experimental Allergology; Department of Dermatology and Allergology; Philipps University Marburg; Marburg Germany
| | - J. Pickert
- Clinical & Experimental Allergology; Department of Dermatology and Allergology; Philipps University Marburg; Marburg Germany
| | - S. Blank
- Center of Allergy and Environment (ZAUM); Helmholtz Center Munich; Technical University Munich; Munich Germany
| | - T. Jakob
- Allergy Research Group; Department of Dermatology; Medical Center; University of Freiburg; Freiburg Germany
| | - E. Spillner
- Immunological Engineering; Department of Engineering; Aarhus University; Aarhus Denmark
| | - W. Pfützner
- Clinical & Experimental Allergology; Department of Dermatology and Allergology; Philipps University Marburg; Marburg Germany
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Springfeld C, Wiecha C, Kunzmann R, Heger U, Weichert W, Langer R, Stange A, Blank S, Sisic L, Schmidt T, Lordick F, Jäger D, Grenacher L, Bruckner T, Büchler MW, Ott K. Influence of Different Neoadjuvant Chemotherapy Regimens on Response, Prognosis, and Complication Rate in Patients with Esophagogastric Adenocarcinoma. Ann Surg Oncol 2015; 22 Suppl 3:S905-14. [DOI: 10.1245/s10434-015-4617-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Indexed: 12/17/2022]
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Blank S, Lordick F, Bader F, Burian M, Dobritz M, Grenacher L, Becker K, Weichert W, Langer R, Sisic L, Stange A, Jäger D, Büchler M, Bruckner T, Siewert J, Ott K. Post-therapeutic response evaluation by a combination of endoscopy and CT scan in esophagogastric adenocarcinoma after chemotherapy: better than its reputation. Gastric Cancer 2015; 18:314-25. [PMID: 24722800 DOI: 10.1007/s10120-014-0367-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 10/24/2013] [Accepted: 03/09/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy is an accepted standard of care for locally advanced esophagogastric cancer. As only a subgroup benefits, a response-based tailored treatment would be of interest. The aim of our study was the evaluation of the prognostic and predictive value of clinical response in esophagogastric adenocarcinomas. METHODS Clinical response based on a combination of endoscopy and computed tomography (CT) scan was evaluated retrospectively within a prospective database in center A and then transferred to center B. A total of 686/740 (A) and 184/210 (B) patients, staged cT3/4, cN0/1 underwent neoadjuvant chemotherapy and were then re-staged by endoscopy and CT before undergoing tumor resection. Of 184 patients, 118 (B) additionally had an interim response assessment 4-6 weeks after the start of chemotherapy. RESULTS In A, 479 patients (70%) were defined as clinical nonresponders, 207 (30%) as responders. Median survival was 38 months (nonresponders: 27 months, responders: 108 months, log-rank, p < 0.001). Clinical and histopathological response correlated significantly (p < 0.001). In multivariate analysis, clinical response was an independent prognostic factor (HR for death 1.4, 95% CI 1.0-1.8, p = 0.032). In B, 140 patients (76%) were nonresponders and 44 (24%) responded. Median survival was 33 months, (nonresponders: 27 months, responders: not reached, p = 0.003). Interim clinical response evaluation (118 patients) also had prognostic impact (p = 0.008). Interim, preoperative clinical response and histopathological response correlated strongly (p < 0.001). CONCLUSION Preoperative clinical response was an independent prognostic factor in center A, while in center B its prognostic value could only be confirmed in univariate analysis. The accordance with histopathological response was good in both centers, and interim clinical response evaluation showed comparable results to preoperative evaluation.
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Affiliation(s)
- Susanne Blank
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
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Dreikhausen L, Blank S, Sisic L, Heger U, Weichert W, Jäger D, Bruckner T, Giese N, Grenacher L, Falk C, Ott K, Schmidt T. Association of angiogenic factors with prognosis in esophageal cancer. BMC Cancer 2015; 15:121. [PMID: 25885021 PMCID: PMC4362831 DOI: 10.1186/s12885-015-1120-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 02/24/2015] [Indexed: 02/07/2023] Open
Abstract
Background Despite multimodal therapy esophageal cancer often presents with poor prognosis. To improve outcome, tumor angiogenesis and anti-angiogenic therapeutic agents have recently gained importance. However, patient subgroups who benefit from anti-angiogenic therapy are not yet defined. In this retrospective exploratory study we investigated 9 angiogenic factors in patients’ serum and tissue samples with regard to their association with clinicopathological parameters, prognosis and response in patients with locally advanced preoperatively treated esophageal cancer. Methods From 2007 to 2012 preoperative serum and corresponding tumor tissue (n = 54), only serum (n = 20) or only tumor tissue (n = 4) were collected from esophageal squamous cell carcinoma (SCC) (n = 34) and adenocarcinoma of the esophagogastric junction (AEG) (n = 44) staged cT3/4NanyM0/x after preoperative chemo(radio)therapy. Angiogenic cytokine levels in both tissue and serum were measured by multiplex immunoassay. Results Median survival in all patients was 28.49 months. No significant difference was found in survival between SCC and AEG (p = 0.90). 26 patients were histopathological responders. Histopathological response was associated with prognosis (p = 0.05). Angiogenic factors were associated with the following clinicopathological factors: tumor tissue expression of Angiopoietin-2 and Follistatin was higher in SCC compared to AEG (p = 0.022 and p = 0.001). High HGF and Follistatin expression in the tumor tissue was associated with poor prognosis in all patients (p = 0.037 and p = 0.036). No association with prognosis was found in the patients’ serum. Neither patients’ serum nor tumor tissue showed an association between angiogenic factors and response to neoadjuvant therapy. Conclusion Two angiogenic factors (HGF and Follistatin) in posttherapeutic tumor tissue are associated with prognosis in esophageal cancer patients. Biological differences of AEG and SCC with respect to angiogenesis were evident by the different expression of 2 angiogenic factors. Results are promising and should be pursued prospectively, optimally sequentially pre- and posttherapeutically. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1120-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lena Dreikhausen
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Susanne Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Leila Sisic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Wilko Weichert
- Department of Pathology, University of Heidelberg, 69120, Heidelberg, Germany.
| | - Dirk Jäger
- National Center of Tumor Diseases, University of Heidelberg, 69120, Heidelberg, Germany.
| | - Thomas Bruckner
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
| | - Natalia Giese
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Lars Grenacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Christine Falk
- Institute for Transplant Immunology, Hannover Medical School, Hannover, Germany.
| | - Katja Ott
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Heger U, Bader F, Lordick F, Burian M, Langer R, Dobritz M, Blank S, Bruckner T, Becker K, Herrmann K, Siewert JR, Ott K. Interim endoscopy results during neoadjuvant therapy for gastric cancer correlate with histopathological response and prognosis. Gastric Cancer 2015; 17:478-88. [PMID: 23996162 DOI: 10.1007/s10120-013-0296-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 04/18/2013] [Accepted: 08/14/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy for locally advanced gastric cancer leads to major histopathological response in less than 30 % of patients. Data on interim endoscopic response assessment do not exist. This exploratory prospective study evaluates early endoscopy after 50 % of the chemotherapy as predictor for later response and prognosis. METHODS Forty-seven consecutive patients were included (45 resected; 33 R0 resections). All patients received baseline endoscopy and CT scans, after 50 % of their chemotherapy (EGD-1, CT-1) and after completion of chemotherapy (EGD-2, CT-2). Interim endoscopic response (EGD-1) was assessed after having received 50 % (6 weeks) of the planned 12 weeks of neoadjuvant chemotherapy. Post-chemotherapy response was clinically assessed by a combination of CT scan (CT-2) and endoscopy (EGD-2). Histopathological response was determined by a standardized scoring system (Becker criteria). Endoscopic response was defined as a reduction of >75 % of the tumor mass. RESULTS Twelve patients were responders at EGD-1 and 13 at EGD-2. Nine patients (19.1 %) were clinical responders and 7 patients (15.6 %) were histopathological responders after chemotherapy. Specificity, accuracy, and negative predictive value of the interim EGD-1 for subsequent histopathological response were 31/38 (82 %), 36/47 (76 %), and 31/33 (93 %); and for recurrence or death, 28/30 (93.3 %), 38/47 (80.9 %), and 28/35 (80.0 %). Response at EGD-1 was significantly associated with histopathological response (p = 0.010), survival (p < 0.001), and recurrence-free survival (p = 0.009). CONCLUSIONS Interim endoscopy after 6 weeks predicts response and prognosis. Therefore, tailoring treatment according to interim endoscopic assessment could be feasible, but the findings of this study should be validated in a larger patient cohort.
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Affiliation(s)
- Ulrike Heger
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Brenner P, Abicht JM, Guethoff S, Buchholz S, Mayr T, Bauer A, Blank S, Kessler B, Wolf E, Becker C, Ayares D, McGregor C, Belka C, Hagl C, Reichart B. The Heterotopic Thoracic Cardiac Xenotransplantation Model (Pig-to-baboon) in Two Different Groups without and with an Additional Myelodepressive Regime. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544419] [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: 10/20/2022]
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Blank S, Deck C, Dreikhausen L, Weichert W, Giese N, Falk C, Schmidt T, Ott K. Angiogenic and growth factors in gastric cancer. J Surg Res 2014; 194:420-429. [PMID: 25577146 DOI: 10.1016/j.jss.2014.11.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/10/2014] [Accepted: 11/19/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antiangiogenic treatment is at the horizon in the palliative treatment of gastric cancer (GC), but data on proangiogenic biomarkers are still limited. The aim of this study was to analyze five proteins with a function in tumor angiogenesis: vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2), follistatin, leptin, and platelet endothelial cell adhesion molecule 1 (CD31) in peripheral blood and corresponding tumor tissue. MATERIAL AND METHODS From 2008-2010, tumor tissue (n = 76) and corresponding preoperative serum (n = 69) of patients with localized GC were collected; 45 had perioperative chemotherapy. Protein serum or tumor lysate levels of these factors were measured by an angiogenesis multiplex immunoassay and correlated with response and survival. RESULTS Serum Ang-2 had prognostic relevance in the whole study population (P = 0.027). In subgroup analysis, serum VEGF and Ang-2 had prognostic relevance in primarily resected patients (P = 0.028; P = 0.048) but no association was found in neoadjuvantly treated patients. Follistatin concentration in the tumor tissue was associated with prognosis in all patients (P = 0.019). Tumor VEGF concentrations were correlated with histopathologic response (P = 0.011), with patients showing >50% remaining tumor having higher VEGF concentrations. The tissue Ang-2/VEGF ratio was significantly correlated with both clinical and histopathologic response (P = 0.029, P = 0.009). Additionally, the level of leptin in the tissue was associated with clinical response: nonresponding patients had higher leptin levels than those of responding patients (P = 0.032). CONCLUSIONS Our results show the importance of angiogenetic factors in serum and tumor tissue in GC for prognosis and treatment response. Further trials in larger patient populations are warranted for a further evaluation of proangiogenetic factors as biomarkers in gastrointestinal cancer.
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Affiliation(s)
- Susanne Blank
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Catrin Deck
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Lena Dreikhausen
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Natalia Giese
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christine Falk
- Institute of Transplant Immunology, IFB-Tx, Hannover Medical School, Hannover, Germany
| | - Thomas Schmidt
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katja Ott
- Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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Schoch GG, Blank S, Tamminga M, Steimle T, Stargardt T. Forecasting Outpatient Pharmaceutical Expenditure for Cancer Treatment in Germany. Value Health 2014; 17:A621. [PMID: 27202186 DOI: 10.1016/j.jval.2014.08.2201] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- G G Schoch
- Techniker Krankenkasse, Hamburg, Germany
| | - S Blank
- Techniker Krankenkasse, Hamburg, Germany
| | - M Tamminga
- Techniker Krankenkasse, Hamburg, Germany
| | - T Steimle
- Techniker Krankenkasse, Hamburg, Germany
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Blank S, Stuetzer H, Hellmich M, Bunte A, Schauseil-Zipf U. [The use and benefit of the 'children with special health care needs screener' in the paediatric school entrance examinations 2004/2005 in Cologne]. Gesundheitswesen 2014; 77:93-101. [PMID: 24771099 DOI: 10.1055/s-0034-1370998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to provide an assessment of the usefulness of the questionnaire "Children with Special Health Care Needs Screener" (CSHCN Screener) as a screening instrument to identify children with special needs in the context of paediatric school entrance examinations (SEE).In a retrospective cross-sectional study of the years 2004 and 2005 in Cologne, Germany, the sum variables were derived from the results of the SEE in accordance to the 7 questions of the CSHCN Screener. The correlations of the SEE sum variables and the CSHCN Screener results were analysed and tested for correlations with sociodemographic factors.Of the 18 402 children of the cohorts 2004/2005, corresponding SEE findings and results of the CSHCN Screener were available for 13 076 children. The prevalence of children with special needs was only 6% according to the results of the CSHCN Screener. According to the SEE, however, 26% of the children showed diseases or developmental problems. Out of this group, only one in 8 children was identified by the CSHCN Screener (sensitivity 13%). The sensitivity of the screener was also 13% for children who had been diagnosed to be in need of special support by school physicians. In the case of girls and of children with migration family backgrounds, the sensitivity of the screener was even lower. The CSHCN Screener also could not detect the higher rate of special needs determined by school physicians in children from areas with high quotas of state family support payments.The results of the CSHCN Screener are not convincing, due to his low sensitivity. This is true with regard to its use as a diagnostic tool for the individual child at the beginning of school age as well for its use as an instrument to assess an increased need for support in cohorts of school entry students.
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Affiliation(s)
- S Blank
- Innere Abteilung, Malteser Krankenhaus St. Hildegardis, Köln
| | - H Stuetzer
- IMSIE - Institut für Medizinische Statistik, Informatik und Epidemiologie, University of Cologne, Köln
| | - M Hellmich
- IMSIE - Institut für Medizinische Statistik, Informatik und Epidemiologie, University of Cologne, Köln
| | - A Bunte
- KJGD - Kinder- und Jugendgesundheitsdienst, Gesundheitsamt Köln, Köln
| | - U Schauseil-Zipf
- Klinik und Poliklinik für Allgemeine Kinderheilkunde, University of Cologne, Köln
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Schmidt T, Sicic L, Blank S, Becker K, Weichert W, Bruckner T, Parakonthun T, Langer R, Büchler MW, Siewert JR, Lordick F, Ott K. Prognostic value of histopathological regression in 850 neoadjuvantly treated oesophagogastric adenocarcinomas. Br J Cancer 2014; 110:1712-20. [PMID: 24569472 PMCID: PMC3974097 DOI: 10.1038/bjc.2014.94] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [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: 10/13/2013] [Revised: 01/21/2014] [Accepted: 01/27/2014] [Indexed: 01/16/2023] Open
Abstract
Background: Recently, histopathological tumour regression, prevalence of signet ring cells, and localisation were reported as prognostic factors in neoadjuvantly treated oesophagogastric (junctional and gastric) cancer. This exploratory retrospective study analyses independent prognostic factors within a large patient cohort after preoperative chemotherapy including clinical and histopathological factors. Methods: In all, 850 patients presenting with oesophagogastric cancer staged cT3/4 Nany cM0/x were treated with neoadjuvant chemotherapy followed by resection in two academic centres. Patient data were documented in a prospective database and retrospectively analysed. Results: Of all factors prognostic on univariate analysis, only clinical response, complications, ypTNM stage, and R category were independently prognostic (P<0.01) on multivariate analysis. Tumour localisation and signet ring cells were independently prognostic only when investigator-dependent clinical response evaluation was excluded from the multivariate model. Histopathological tumour regression correlates with tumour grading, Laurén classification, clinical response, ypT, ypN, and R categories but was not identified as an independent prognostic factor. Within R0-resected patients only surgical complications and ypTNM stage were independent prognostic factors. Conclusions: Only established prognostic factors like ypTNM stage, R category, and complications were identified as independent prognostic factors in resected patients after neoadjuvant chemotherapy. In contrast, histopathological tumour regression was not found as an independent prognostic marker.
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Affiliation(s)
- T Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - L Sicic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - S Blank
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - K Becker
- Department of Pathology, Technische Universitaet Muenchen, 81675 Munich, Germany
| | - W Weichert
- Department of Pathology, University of Heidelberg, 69120 Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, 69120 Heidelberg, Germany
| | - T Parakonthun
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - R Langer
- Department of Pathology, University of Bern, 3010 Bern, Switzerland
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - J-R Siewert
- Directorate, University of Freiburg, 79095 Freiburg, Germany
| | - F Lordick
- University Cancer Center Leipzig (UCCL), University of Leipzig, 04103 Leipzig, Germany
| | - K Ott
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Ott K, Blank S, Jaeger D, Weichert W, Sisic L, Grenacher L, Büchler MW, Lordick F. Metastatic esophagogastric adenocarcinomas (EGA): Treatment, prognosis, and pretherapeutic selection options. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.142] [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
142 Background: Nowadays an increasing number of patients (pts.) with metastatic disease (MD) are discussed in interdisciplinary tumor boards. Preliminary results of the FLOT-3 study suggest a benefit for pts. with limited MD after resection compared to pts. with chemotherapy (CTx) only. Own published data suggest that a subgroup of pts. may benefit from surgery (ESJO, 2013). Primary objective of this retrospective explorative study was the outcome of pts. with resected metastatic EGA and the evaluation of our preoperative prognosis score (PPS) in a larger patients`series. Methods: From 2001-2012 123/800 EGA were classified as cM1 either confirmed intraoperatively as pM1 or confirmed by imaging during follow-up. Response evaluation was performed clinically by endoscopy and CT-scan, histopathologically by the Becker regression score. The PPS for pts. treated with CTx contains grading, clinical response and presumed R-category. Analysis was performed retrospectively from a prospective database. Results: M1 sites (70 AEG, 53 gastric cancer): 27 liver, 43 distant lymph nodes, 16 peritoneum, 10 lung, 6 others, 21 multiple. 11 (9%) were only explored, the rest resected. 49/112 (40%) had multivisceral resections. 63/112 (56%) were completely resected (R0). 72 had preoperative CTx, 51 primary resection. 26 (21%) were classified as clinical responder, 16 (13%) as histopathological responder, 30 (42%) as subgroup with improved prognosis by the PPS. The median survival was 20.0 months (m.). Survival was significantly increased by resection, a complete resection and a preoperative CTx (primary resection: 11m., after CTx: 30 m.)(all p=0.001), but not by multivisceral resection, number or type of metastases or localization of the primary tumor. In pts. who had preoperative CTx, clinical response and the PPS (21 m. versus 66 m., p=0.005) significantly influenced survival. In R0 pts. preoperative CTx (p=0.03), clinical response and the PPS remained prognostic (both p=0.001). Conclusions: A primary resection without preoperative CTx is not appropriate for metastatic EGA. Subgroups of pts. with limited metastatic spread may be selected for surgery using the PPS. Prospective randomized studies are required.
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Affiliation(s)
- Katja Ott
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Susanne Blank
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Dirk Jaeger
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany
| | - Leila Sisic
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Grenacher
- Diagnostic and Interventional Radiology University Heidelberg, Heidelberg, Germany
| | - Markus W. Büchler
- Clinic for General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Florian Lordick
- Universitätsklinikum Leipzig, Universitäres Krebszentrum (UCCL), Leipzig, Germany
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Ott K, Weichert W, Blank S, Jaeger D, Heger U, Sisic L, Büchler MW, Lordick F. Is primary surgery without preoperative chemotherapy the best treatment option for signet ring cell esophagogastric adenocarcinomas? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.106] [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
106 Background: Recent retrospective multicentric data favor a primary resection without neoadjuvant chemotherapy for signet ring cell (SRC) gastric cancer. Aim of this retrospective exploratory study is the comparison of primary resected with neoadjuvantly treated locally advanced SRC esophagogastric adenocarcinomas (EGA) in respect of outcome. Methods: From 2002-2012 200/646 resected EGA were classified as SRC by WHO classification (more than 50% signet ring cells) and staged cT3/4 Nany M0/x. Clinical response evaluation was based on endoscopy and CT-scan and histopathological regression was based on the Becker score (<10% residual tumor cells: responder). UICC 7th was used. Analysis was retrospectively from a prospective data base. Results: 103 were treated by preoperative chemotherapy (CTx), 97 were primary resected. 73 (37%) had AEG, 127 (63%) gastric cancer. Postoperative CTx was delivered in 62/103 (60%) of the patients with preoperative CTx and in 51/97 (53%) of the primary resected patients (p=0.28). In-hospital mortality was 4.5% (9/200). 20 (20%) were classified as clinical, 15 (8%) as histopathological responders. Preoperative CTx was significantly associated with worse pretherapeutic cT- (p=0.005) and cN- (p=0.008) categories, but subsequent lower (y)pN-category (p=0,001) and improved lymphnode ratio (p=0.001). Overall survival was significantly improved after preoperative CTx compared to primary resection (median survival 30.2 versus 17.6 months, p=0.001). Median survival of responding patients is not reached, median survival of nonresponder was 24.4 months (identical for clinical and histopathological responders) compared to 17.6 months in primary resected patients (p=0.002). The positive prognostic effect of preoperative CTx was significantly higher in AEG (p=0.004) compared to gastric cancer (p=0.067). In the 119 completely resected patients the survival was significantly improved by preoperative CTx (p=0.005), but it was no independent prognostic factor. Conclusions: A pre/periopative CTx seems also to be justified in SRC EGA. Relevant limitations are the retrospective and non-randomized design.
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Affiliation(s)
- Katja Ott
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany
| | - Susanne Blank
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Dirk Jaeger
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Heger
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Leila Sisic
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W. Büchler
- Clinic for General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Florian Lordick
- Universitätsklinikum Leipzig, Universitäres Krebszentrum (UCCL), Leipzig, Germany
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