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Ďásková N, Modos I, Krbcová M, Kuzma M, Pelantová H, Hradecký J, Heczková M, Bratová M, Videňská P, Šplíchalová P, Králová M, Heniková M, Potočková J, Ouřadová A, Landberg R, Kühn T, Cahová M, Gojda J. Multi-omics signatures in new-onset diabetes predict metabolic response to dietary inulin: findings from an observational study followed by an interventional trial. Nutr Diabetes 2023; 13:7. [PMID: 37085526 PMCID: PMC10121613 DOI: 10.1038/s41387-023-00235-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
AIM The metabolic performance of the gut microbiota contributes to the onset of type 2 diabetes. However, targeted dietary interventions are limited by the highly variable inter-individual response. We hypothesized (1) that the composition of the complex gut microbiome and metabolome (MIME) differ across metabolic spectra (lean-obese-diabetes); (2) that specific MIME patterns could explain the differential responses to dietary inulin; and (3) that the response can be predicted based on baseline MIME signature and clinical characteristics. METHOD Forty-nine patients with newly diagnosed pre/diabetes (DM), 66 metabolically healthy overweight/obese (OB), and 32 healthy lean (LH) volunteers were compared in a cross-sectional case-control study integrating clinical variables, dietary intake, gut microbiome, and fecal/serum metabolomes (16 S rRNA sequencing, metabolomics profiling). Subsequently, 27 DM were recruited for a predictive study: 3 months of dietary inulin (10 g/day) intervention. RESULTS MIME composition was different between groups. While the DM and LH groups represented opposite poles of the abundance spectrum, OB was closer to DM. Inulin supplementation was associated with an overall improvement in glycemic indices, though the response was very variable, with a shift in microbiome composition toward a more favorable profile and increased serum butyric and propionic acid concentrations. The improved glycemic outcomes of inulin treatment were dependent on better baseline glycemic status and variables related to the gut microbiota, including the abundance of certain bacterial taxa (i.e., Blautia, Eubacterium halii group, Lachnoclostridium, Ruminiclostridium, Dialister, or Phascolarctobacterium), serum concentrations of branched-chain amino acid derivatives and asparagine, and fecal concentrations of indole and several other volatile organic compounds. CONCLUSION We demonstrated that obesity is a stronger determinant of different MIME patterns than impaired glucose metabolism. The large inter-individual variability in the metabolic effects of dietary inulin was explained by differences in baseline glycemic status and MIME signatures. These could be further validated to personalize nutritional interventions in patients with newly diagnosed diabetes.
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Affiliation(s)
- N Ďásková
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - I Modos
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - M Krbcová
- Department of Internal Medicine, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Kuzma
- Institute of Microbiology of the CAS, Prague, Czech Republic
| | - H Pelantová
- Institute of Microbiology of the CAS, Prague, Czech Republic
| | - J Hradecký
- Faculty of Forestry and Wood Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - M Heczková
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - M Bratová
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - P Videňská
- Mendel University, Department of Chemistry and Biochemistry, Brno, Czech Republic
| | - P Šplíchalová
- RECETOX, Faculty of Science Masaryk University, Brno, Czech Republic
| | - M Králová
- Ambis University, Department of Economics and Management, Prague, Czech Republic
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - M Heniková
- Department of Internal Medicine, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Potočková
- Department of Internal Medicine, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Ouřadová
- Department of Internal Medicine, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - R Landberg
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Goteborg, Sweden
| | - T Kühn
- Institute of Global Food Security, Queen's University Belfast, Belfast, UK
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - M Cahová
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | - J Gojda
- Department of Internal Medicine, Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Ditsch N, Pochert N, Schneider M, Köpke M, Mattmer A, Hunstiger S, Sagasser J, Kahl H, Metz A, Reiger M, Neumann A, Banys-Paluchowski M, Untch M, Dannecker C, Jeschke U, Traidl-Hoffmann C, Kühn T. Cytokine identification in seroma fluid after mastectomy in breast cancer patients – first results of SerMa pilot study subgroup. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01583-0] [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: 11/21/2022]
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3
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Holopainen E, Kokkola H, Faiola C, Laakso A, Kühn T. Insect Herbivory Caused Plant Stress Emissions Increases the Negative Radiative Forcing of Aerosols. J Geophys Res Atmos 2022; 127:e2022JD036733. [PMID: 36249538 PMCID: PMC9540253 DOI: 10.1029/2022jd036733] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 06/16/2023]
Abstract
Plant stress in a changing climate is predicted to increase plant volatile organic compound (VOC) emissions and thus can affect the formed secondary organic aerosol (SOA) concentrations, which in turn affect the radiative properties of clouds and aerosol. However, global aerosol-climate models do not usually consider plant stress induced VOCs in their emission schemes. In this study, we modified the monoterpene emission factors in biogenic emission model to simulate biotic stress caused by insect herbivory on needleleaf evergreen boreal and broadleaf deciduous boreal trees and studied the consequent effects on SOA formation, aerosol-cloud interactions as well as direct radiative effects of formed SOA. Simulations were done altering the fraction of stressed and healthy trees in the latest version of ECHAM-HAMMOZ (ECHAM6.3-HAM2.3-MOZ1.0) global aerosol-climate model. Our simulations showed that increasing the extent of stress to the aforementioned tree types, substantially increased the SOA burden especially over the areas where these trees are located. This indicates that increased VOC emissions due to increasing stress enhance the SOA formation via oxidation of VOCs to low VOCs. In addition, cloud droplet number concentration at the cloud top increased with increasing extent of biotic stress. This indicates that as SOA formation increases, it further enhances the number of particles acting as cloud condensation nuclei. The increase in SOA formation also decreased both all-sky and clear-sky radiative forcing. This was due to a shift in particle size distributions that enhanced aerosol reflecting and scattering of incoming solar radiation.
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Affiliation(s)
- E. Holopainen
- Atmospheric Research Centre of Eastern FinlandFinnish Meteorological InstituteKuopioFinland
- Aerosol Physics Research GroupUniversity of Eastern FinlandKuopioFinland
| | - H. Kokkola
- Atmospheric Research Centre of Eastern FinlandFinnish Meteorological InstituteKuopioFinland
| | - C. Faiola
- Department of Ecology and Evolutionary BiologyUniversity of California IrvineIrvineCAUSA
- Department of ChemistryUniversity of California IrvineIrvineCAUSA
| | - A. Laakso
- Atmospheric Research Centre of Eastern FinlandFinnish Meteorological InstituteKuopioFinland
| | - T. Kühn
- Atmospheric Research Centre of Eastern FinlandFinnish Meteorological InstituteKuopioFinland
- Aerosol Physics Research GroupUniversity of Eastern FinlandKuopioFinland
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Rief A, Kühn T, Peintinger F, Hartmann S, Stickeler E, de Boniface J, Gentilini O, Ruf F, Fröhlich S, Thill M, Hauptmann M, Berger T, Wihlfahrt K, Karadeniz GC, Rubio IT, Gasparri ML, Kontos M, Bonci EA, Niinikoski L, Murawa D, Appelgren M, Hahn M, Pristauz-Telsnigg G, Czihak J, Banys-Paluchowski M. AXSANA – AXillary Surgery After NeoAdjuvant Treatment: Eine prospektive, multizentrische Kohortenstudie der EUBREAST-Studiengruppe zur Bewertung verschiedener chirurgischer Verfahren des axillären Stagings bei initial nodal-positiven PatientInnen nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- A Rief
- Medizinische Universität Graz, Univ. Klinik für Frauenheilkunde und Geburtshilfe, Graz, Österreich
| | - T Kühn
- Klinikum Esslingen, Klinik für Frauenheilkunde und Geburtshilfe, Esslingen, Deutschland
| | - F Peintinger
- Medizinische Universität Graz, Univ. Klinik für Frauenheilkunde und Geburtshilfe, Graz, Österreich
| | - S Hartmann
- Universitätsklinikum Rostock, Klinik für Frauenheilkunde und Geburtshilfe, Rostock, Deutschland
| | - E Stickeler
- Universitätsklinikum Aachen, Klinik für Frauenheilkunde und Geburtshilfe, Aachen, Deutschland
| | - J de Boniface
- Karolinska Institutet, Dept. of Molecular Medicine and Surgery, Stockholm, Sweden
- Capio St. Göran’s Hospital, Dept. of Surgery, Stockholm, Sweden
| | | | - F Ruf
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe, Campus Lübeck, Lübeck, Deutschland
| | - S Fröhlich
- Universitätsklinikum Rostock, Klinik für Frauenheilkunde und Geburtshilfe, Rostock, Deutschland
| | - M Thill
- AGAPLESION Markus Krankenhaus, Klinik für Gynäkologie und gynäkologische Onkologie, Frankfurt am Main, Deutschland
| | - M Hauptmann
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - T Berger
- Müritz-Klinikum Waren, Klinik für Frauenheilkunde und Geburtshilfe, Waren, Deutschland
| | - K Wihlfahrt
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe, Campus Kiel, Kiel, Deutschland
| | - G Cakmak Karadeniz
- Zonguldak BEUN The School of Medicine, General Surgery Department, Breast and Endocrine Unit, Kozlu/Zonguldak, Turkey
| | - I T Rubio
- Clínica Universidad de Navarra, Breast Surgical Unit, Madrid, Spain
| | - M L Gasparri
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
- University of the Italian Switzerland (USI), Faculty of Biomedicine, Lugano, Switzerland
| | - M Kontos
- 1st Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E-A Bonci
- Department of Surgical Oncology,” Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca, Romania
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - L Niinikoski
- Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - D Murawa
- Department of General Surgery and Surgical Oncology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - M Appelgren
- Karolinska Institutet, Dept. of Molecular Medicine and Surgery, Stockholm, Sweden
| | - M Hahn
- Department für Frauengesundkeit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - G Pristauz-Telsnigg
- Medizinische Universität Graz, Univ. Klinik für Frauenheilkunde und Geburtshilfe, Graz, Österreich
| | - J Czihak
- LKH Villach, Abteilung für Gynäkologie und Geburtshilfe, Villach, Österreich
| | - M Banys-Paluchowski
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe, Campus Lübeck, Lübeck, Deutschland
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Herbert LS, Wöckel A, Kreienberg R, Kühn T, Flock F, Felberbaum R, Janni W, Curtaz CJ, Kiesel M, Schlaiß T, Diessner J, Salmen J, Schwentner L, Fink V, Bekes I, Leinert E, Lato K, Polasik A, Schochter F, Singer S. Inwieweit fühlen sich die Brustkrebs-Überlebenden 5 Jahre nach der Diagnose gut über die Krankheit und die Behandlung informiert? Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1749034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- L S Herbert
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - A Wöckel
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - R Kreienberg
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen
| | | | - R Felberbaum
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kempten, Klinikverbund Allgäu gGmbH, Kempten
| | - W Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - CJ Curtaz
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - M Kiesel
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - T Schlaiß
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - J Diessner
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - J Salmen
- Frauenklinik und Poliklinik, Universitätsklinikum, Würzburg
| | - L Schwentner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - V Fink
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - I Bekes
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - E Leinert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - K Lato
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - A Polasik
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - F Schochter
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Ulm
| | - S Singer
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (UMBEI); Mainz
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Ditsch N, Schneider M, Pochert N, Ansorge N, Strieder A, Sagasser J, Kühn T, Neumann A, Reiger M, Traidl-Hoffmann C, Jeschke U, Dannecker C. 48P T-helper cell-driven immune response as an effect for seroma formation (SF) after mastectomy (ME) in breast cancer (BC) (SerMa pilot EUBREAST 5). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.063] [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: 11/24/2022] Open
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Paepke S, Thill M, Peisker U, Ohlinger R, Gruber I, Malter W, Kümmel S, Hahn M, Kühn T, Reinisch M, Stachs A, Reimer T. One size fits all? Novel pulse biopsy platform offers improved needle control, high tissue yield and multiple needle options – pre-clinical results. Breast 2021. [DOI: 10.1016/s0960-9776(21)00172-7] [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] Open
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8
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Hartmann S, Kühn T, de Boniface J, Stachs A, Winckelmann A, Frisell J, Wiklander-Bråkenhielm I, Stubert J, Gerber B, Reimer T. Carbon tattooing for targeted lymph node biopsy after primary systemic therapy in breast cancer: prospective multicentre TATTOO trial. Br J Surg 2021; 108:302-307. [DOI: 10.1093/bjs/znaa083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/15/2020] [Indexed: 01/31/2023]
Abstract
Abstract
Background
Several techniques for targeted lymph node biopsy in patients with node-positive breast cancer receiving primary systemic therapy are in use, each with their inherent advantages and disadvantages. The aim of the TATTOO trial was to evaluate the feasibility and accuracy of carbon tattooing of positive lymph nodes as a method for targeted lymph node biopsy avoiding radiation exposure, high costs, and preoperative localization procedures.
Methods
Patients with initially cT1–4c cN1–3 cM0 invasive breast cancer were included in this prospective multicentre trial. Before initiation of primary systemic therapy, a carbon suspension was injected into the most suspicious axillary lymph node. Targeted lymph node biopsy was performed in all patients after completion of primary systemic therapy. Additional sentinel lymph node biopsy was done in those with axillary downstaging, and completion axillary lymph node dissection in patients still presenting with suspicious lymph nodes.
Results
A total of 118 patients were included and 110 were eligible for data analysis. The detection rate for the targeted lymph node was 93.6 per cent (103 of 110), and the sentinel lymph node was identical to the targeted lymph node in 60 per cent. The false-negative rate for the combination of targeted and sentinel node lymph node biopsy (targeted axillary dissection) was 9 per cent.
Conclusion
Targeted axillary dissection after carbon tattooing is associated with a high detection rate, an acceptable false-negative rate, and appears feasible for clinical use even in healthcare settings with limited resources.
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Affiliation(s)
- S Hartmann
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - T Kühn
- Department of Obstetrics and Gynaecology, Klinikum Esslingen, Esslingen, Germany
| | - J de Boniface
- Department of Surgery, Capio St Göran’s Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Stachs
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - A Winckelmann
- Department of Obstetrics and Gynaecology, Klinikum Esslingen, Esslingen, Germany
| | - J Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - J Stubert
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - B Gerber
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
| | - T Reimer
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock, Germany
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Herbert SL, Wöckel A, Kreienberg R, Kühn T, Flock F, Felberbaum R, Janni W, Curtaz C, Kiesel M, Stüber T, Diessner J, Salmen J, Schwentner L, Fink V, Bekes I, Leinert E, Lato K, Polasik A, Schochter F, Singer S. To which extent do breast cancer survivors feel well informed about disease and treatment 5 years after diagnosis? Breast Cancer Res Treat 2020; 185:677-684. [PMID: 33104958 PMCID: PMC7921033 DOI: 10.1007/s10549-020-05974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/08/2020] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment. METHODS In a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models. RESULTS There were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (β 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (β - 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (β -0.34, p 0.03) and by immigrants (β -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (β 0.19/0.19/0.20/0.25; each p < 0.01). CONCLUSION Health care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs.
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Affiliation(s)
- S L Herbert
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany.
| | - A Wöckel
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - R Kreienberg
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - T Kühn
- Department of Gynaecology and Obstetrics, Hospital Esslingen, Esslingen, Germany
| | - F Flock
- Department of Gynaecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
| | - R Felberbaum
- Department of Gynaecology and Obstetrics, Hospital Kempten, Kempten, Germany
| | - W Janni
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - C Curtaz
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - M Kiesel
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - T Stüber
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Diessner
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Salmen
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Würzburg, Germany
| | - L Schwentner
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - V Fink
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - I Bekes
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - E Leinert
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - K Lato
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - A Polasik
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - F Schochter
- Department of Gynaecology and Obstetrics, University of Ulm, Ulm, Germany
| | - S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
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Banys-Paluchowski M, Stickeler E, de Boniface J, Gentilini O, Thill M, Hartmann S, Fasching PA, Huebner H, Krawczyk N, Blohmer JU, Solbach C, Untch M, Kühn T. AXSANA (AXillary Surgery After NeoAdjuvant Treatment): A European prospective multicenter cohort study to evaluate different surgical methods of axillary staging (sentinel lymph node biopsy, targeted axillary dissection, axillary dissection) in clinically node-positive breast cancer patients treated with neoadjuvant chemotherapy. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - E Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen
| | - J de Boniface
- Dept. of Molecular Medicine and Surgery, Karolinska Institutet
- Dept. of Surgery, Capio St. Göran’s Hospital
| | | | - M Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus
| | - S Hartmann
- Universitäts-Frauenklinik, Klinikum Südstadt Rostock
| | - PA Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN
| | - H Huebner
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN
| | - N Krawczyk
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf
| | - JU Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, CCM
| | - C Solbach
- Brustzentrum, Universitätsklinikum Frankfurt
| | - M Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen
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Paepke S, Kiechle M, Karsten M, Blohmer J, Schmidt G, Stassek J, Kühn T, Thill M. SPIO-guided Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer – first monoinstitutional data and perspectives. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30590-6] [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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Hartmann S, Stachs A, Kühn T, Winckelmann A, de Boniface J, Gerber B, Reimer T. Target Lymph Node Biopsy (TLNB) nach Kohlenstoffmarkierung bei Mammakarzinom-Patientinnen im Rahmen der primären Systemtherapie – Ergebnisse der TATTOO-Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Hartmann
- Universitätsfrauenklinik am Klinikum Südstadt
| | - A Stachs
- Universitätsfrauenklinik am Klinikum Südstadt
| | | | | | | | - B Gerber
- Universitätsfrauenklinik am Klinikum Südstadt
| | - T Reimer
- Universitätsfrauenklinik am Klinikum Südstadt
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13
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Cordova R, Knaze V, Viallon V, Rust P, Schalkwijk CG, Weiderpass E, Wagner KH, Mayen-Chacon AL, Aglago EK, Dahm CC, Overvad K, Tjønneland A, Halkjær J, Mancini FR, Boutron-Ruault MC, Fagherazzi G, Katzke V, Kühn T, Schulze MB, Boeing H, Trichopoulou A, Karakatsani A, Thriskos P, Masala G, Krogh V, Panico S, Tumino R, Ricceri F, Spijkerman A, Boer J, Skeie G, Rylander C, Borch KB, Quirós JR, Agudo A, Redondo-Sánchez D, Amiano P, Gómez-Gómez JH, Barricarte A, Ramne S, Sonestedt E, Johansson I, Esberg A, Tong T, Aune D, Tsilidis KK, Gunter MJ, Jenab M, Freisling H. Dietary intake of advanced glycation end products (AGEs) and changes in body weight in European adults. Eur J Nutr 2020; 59:2893-2904. [PMID: 31701336 DOI: 10.1007/s00394-019-02129-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Advanced glycation end products (AGEs) can be formed in foods by the reaction of reducing sugars with proteins, and have been shown to induce insulin resistance and obesity in experimental studies. We examined the association between dietary AGEs intake and changes in body weight in adults over an average of 5 years of follow-up. METHODS A total of 255,170 participants aged 25-70 years were recruited in ten European countries (1992-2000) in the PANACEA study (Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home in relation to Anthropometry), a sub-cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition). Body weight was measured at recruitment and self-reported between 2 and 11 years later depending on the study center. A reference database for AGEs was used containing UPLC-MS/MS-measured Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) in 200 common European foods. This reference database was matched to foods and decomposed recipes obtained from country-specific validated dietary questionnaires in EPIC and intake levels of CEL, CML, and MG-H1 were estimated. Associations between dietary AGEs intake and body weight change were estimated separately for each of the three AGEs using multilevel mixed linear regression models with center as random effect and dietary AGEs intake and relevant confounders as fixed effects. RESULTS A one-SD increment in CEL intake was associated with 0.111 kg (95% CI 0.087-0.135) additional weight gain over 5 years. The corresponding additional weight gain for CML and MG-H1 was 0.065 kg (0.041-0.089) and 0.034 kg (0.012, 0.057), respectively. The top six food groups contributing to AGEs intake, with varying proportions across the AGEs, were cereals/cereal products, meat/processed meat, cakes/biscuits, dairy, sugar and confectionary, and fish/shellfish. CONCLUSION In this study of European adults, higher intakes of AGEs were associated with marginally greater weight gain over an average of 5 years of follow-up.
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Affiliation(s)
- R Cordova
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - V Knaze
- Section of Early Detection and Prevention, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - V Viallon
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - P Rust
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - C G Schalkwijk
- Department of Internal Medicine, Laboratory of Metabolism and Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Weiderpass
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - K-H Wagner
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - A-L Mayen-Chacon
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - E K Aglago
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - C C Dahm
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - K Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center Copenhagen, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Halkjær
- Danish Cancer Society Research Center Copenhagen, Copenhagen, Denmark
| | - F R Mancini
- CESP, Fac. de médecine, Univ. Paris-Sud, Fac. de médecine-UVSQ-INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - M-C Boutron-Ruault
- CESP, Fac. de médecine, Univ. Paris-Sud, Fac. de médecine-UVSQ-INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - G Fagherazzi
- CESP, Fac. de médecine, Univ. Paris-Sud, Fac. de médecine-UVSQ-INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - V Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutrition Science, University of Potsdam, Nuthetal, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | | | - A Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, ATTIKON University Hospital, Haidari, Greece
| | - P Thriskos
- Hellenic Health Foundation, Athens, Greece
| | - G Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Panico
- Dipartimento di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, Azienda Sanitaria Provinciale (ASP) Ragusa, Ragusa, Italy
| | - F Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Turin, TO, Italy
| | - A Spijkerman
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - J Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - C Rylander
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - K B Borch
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - A Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Redondo-Sánchez
- Andalusian School of Public Health. Biomedical Research Institute ibs.GRANADA, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - P Amiano
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - J-H Gómez-Gómez
- Department of Epidemiology and Murcia Regional Health Council, Universidad de Murcia, Murcia, Spain
| | - A Barricarte
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Ramne
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - E Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - I Johansson
- Department of Odontology, Umeå University, Umeå, Sweden
| | - A Esberg
- Department of Odontology, Umeå University, Umeå, Sweden
| | - T Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - K K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine University Campus Ioannina, Ioannina, Greece
| | - M J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), 150 cours Albert Thomas, CEDEX 08, 69372, Lyon, France.
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Matuschek C, Budach W, Bojar H, Fehm T, Nestle-Krämling C, Corradini S, Fastner G, Seidel C, Krug D, Tamaskovics B, Bölke E, Kühn T, Haussmann J. Präoperative Strahlentherapie (PRT) und Systemtherapie beim Mammakarzinom – welche Faktoren beeinflussen das Gesamtüberleben (OS)? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- C Matuschek
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - W Budach
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | | | - T Fehm
- Universitätsfrauenklinik Düsseldorf, Frauenklinik
| | | | - S Corradini
- Ludwig-Maximilians-Universität München, Klinik für Strahlentherapie und Radioonkologie
| | - G Fastner
- Universitätsklinik Salzburg, Klinik für Strahlentherapie und Radioonkologie
| | - C Seidel
- Universitätsklinik Leipzig, Klinik für Strahlentherapie und Radioonkologie
| | - D Krug
- Universiätsklinik Schleswig-Holstein, Campus Kiel, Klinik für Strahlentherapie und Radioonkologie
| | - B Tamaskovics
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - E Bölke
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
| | - T Kühn
- Klinikum Esslingen, Frauenklinik
| | - J Haussmann
- Universitätsklinikum Düsseldorf, Klinik für Strahlentherapie und Radioonkologie
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Srour B, Hüsing A, Gonzales Maldonado S, Kühn T, Kaaks R. Theoretical prediction of life expectancy using lifestyle factors in the EPIC-Heidelberg cohort. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.054] [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: 11/12/2022] Open
Abstract
Abstract
Background
The past few decades have witnessed a substantial increase in life expectancy in Western countries, leading to an increase in the prevalence of age-related chronic diseases. Several lifestyle risk factors (i.e. smoking, adiposity, unhealthy diet, heavy alcohol drinking and lack of physical activity) have been responsible for a large proportion of premature deaths, as they can affect the incidence of age-related chronic diseases. Our objective was to predict the loss of residual life expectancy (RLE) associated with these lifestyle factors, using data from the EPIC-Heidelberg cohort, linked to an up-to-date mortality registry.
Methods
A total of 23,324 German adults, aged 40 years and above were included (1994-1998) and followed until June 2019. A multi-adjusted parametric proportional hazard model (Gompertz hazard distribution), used to predict survival probabilities, followed by a life table approach was used.
Results
At age 40, being a heavy smoker (> 10 cigarettes/day) was associated with 10.5 y loss of RLE in men and 8.3 in women. Low body mass index (< 22.5 kg/m2) was associated with a RLE loss of 3.7 y in men and 1.4 y in women, while obesity was associated with 4.4 y in men and 3.8 y in women. Heavy alcohol drinking (> 4 drinks/day) was associated with a loss of 4.5 y in men, and high red/processed meat consumption (≥ 120 g/day) was associated with a loss of 1.1y in men and 2.1 y in women. Compared with an overall healthy lifestyle, combined unhealthy behaviors were associated with a loss of RLE of 21.4 y in men and 15.5 y in women.
Conclusions
Prevention strategies encouraging the adoption of an overall healthy lifestyle, particularly by avoiding smoking, heavy alcohol drinking, excess body fatness and reducing red/processed meat consumption, help reducing premature deaths. An extension of this project using blood biomarkers measures is ongoing.
Key messages
Adopting a healthy lifestyle by avoiding or reducing the exposure to risk factors might contribute to a longer life expectancy. Tobacco use, adiposity, and alcohol are probably the main modifiable lifestyle factors affecting life expectancy.
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Affiliation(s)
- B Srour
- Division of Cancer Epidemiology, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - A Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - S Gonzales Maldonado
- Division of Cancer Epidemiology, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center DKFZ, Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center DKFZ, Heidelberg, Germany
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Gerber B, Schneeweiss A, Möbus V, Golatta M, Tesch H, Krug D, Denkert C, Lübbe K, Heil J, Ataseven B, Klare P, Untch M, Kast K, Jackisch C, Seither F, Nekljudova V, Loibl S, Kühn T. Management of the axilla for high-risk early breast cancer (EBC) before and after neoadjuvant chemotherapy (NACT): an analysis of the multicentre GeparOcto trial. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
- B Gerber
- Department of Obstetrics and Gynaecology, University of Rostock
| | | | | | | | - H Tesch
- Bethanien Krankenhaus Frankfurt
| | - D Krug
- Universitätsklinikum Schleswig-Holstein Kiel, Klinik für Strahlentherapie
| | - C Denkert
- Universitätsklinikum Marburg, Institut für Pathologie UKGM
| | - K Lübbe
- Diakovere Henriettenstiftung Hannover
| | - J Heil
- Universitätsklinikum Heidelberg
| | | | - P Klare
- Praxisklinik Krebsheilkunde für Frauen
| | | | - K Kast
- Universitätsklinikum Carl Gustav Carus Dresden
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Kolberg HC, Kühn T, Krajewska M, Bauerfeind I, Fehm TN, Fleige B, Helms G, Lebeau A, Stäbler A, Loibl S, Untch M, Kolberg-Liedtke C. Factors associated with axillary conversion after neoadjuvant chemotherapy (NAT) in initially node positive breast cancer patients – a transSENTINA analysis. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
| | | | | | | | - TN Fehm
- Universitätsklinikum Düsseldorf
| | | | - G Helms
- Universitätsklinikum Tübingen
| | - A Lebeau
- Universitätsklinikum Hamburg - Eppendorf
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Banys-Paluchowski M, Stickeler E, de Boniface J, Gentilini O, Thill M, Hartmann S, Fasching PA, Huebner H, Krawczyk N, Blohmer JU, Solbach C, Untch M, Kühn T. AXSANA (AXillary Surgery After NeoAdjuvant Treatment): A European prospective multicenter cohort study to evaluate different surgical methods of axillary staging (sentinel lymph node biopsy, targeted axillary dissection, axillary dissection) in clinically node-positive breast cancer patients treated with neoadjuvant chemotherapy. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
| | - E Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen
| | - J de Boniface
- Dept. of Molecular Medicine and Surgery, Karolinska Institutet
- Dept. of Surgery, Capio St. Göran’s Hospital
| | | | - M Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus
| | - S Hartmann
- Universitäts-Frauenklinik, Klinikum Südstadt Rostock
| | - PA Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN
| | - H Huebner
- Frauenklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen-EMN
| | - N Krawczyk
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf
| | - J-U Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, CCM
| | - C Solbach
- Brustzentrum, Universitätsklinikum Frankfurt
| | - M Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen
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Hartmann S, Stachs A, Kühn T, Winckelmann A, de Boniface J, Gerber B, Reimer T. TLNB (Target-Lymph-Node-Biopsy) nach Kohlenstoffmarkierung bei Mammakarzinom-Patientinnen nach primärer Systemtherapie Ergebnisse der TATTOO-Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Bucher F, Mussinghoff P, Kühn T, Stahl A, Böhringer D. [Technical aspects of quality assurance for intravitreal injections (IVI)]. Ophthalmologe 2020; 117:307-312. [PMID: 31912270 DOI: 10.1007/s00347-019-01029-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Successful quality assurance in intravitreal injection (IVI) of medications requires a complex information technology infrastructure. The main challenges are data availability independent of location, standardization of clinical data, integration of extensive and currently non-standardized image documentation from coherence tomography and compliance with data protection regulations. OBJECTIVE In this article the technical implementation and data protection principles are reviewed. MATERIAL AND METHODS Essential aspects in the implementation of quality assurance in the field of IVI are discussed in a systematic approach. RESULTS In the field of network architectures web-based applications supplemented by local virtual private networks (VPN) and/or other software instances have recently replaced the previously commonly used physical data medium exchange. The standardization of the data, e.g. by converting the visual acuity into logMAR, plays an important role in the collection of treatment data. Multiple non-standardized data formats in optical coherence tomography complicate the general quality assurance structure and comparability of data. CONCLUSION International standards will probably facilitate this in the near future. Until then individual solutions have to be found on site.
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Affiliation(s)
- F Bucher
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - P Mussinghoff
- Augenzentrum am St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Kühn
- ContraCare GmbH, Fürth, Nürnberg, Deutschland
| | - A Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - D Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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de Gregorio A, Nagel G, Rothenbacher D, Möller P, Rempen A, Schlicht E, Fritz S, Flock F, Felberbaum R, Friedl TWP, Thiel F, Kühn T, Kuhn P, Tzschaschel M, Janni W, Wiesmüller L, Huober J. Das BRandO Biology and Outcome (BiO)-Projekt – eine Registerstudie zum biologischen Erkrankungsprofil und klinischen Verlauf bei Mamma- und Ovarialkarzinomen (BReast and Ovarian Cancer). Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- A de Gregorio
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm
| | - G Nagel
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm
| | - D Rothenbacher
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm
| | - P Möller
- Institut für Pathologie, Universitätsklinik Ulm
| | - A Rempen
- Klinik für Frauenheilkunde und Geburtshilfe, Diakonieklinikum, Schwäbisch-Hall
| | - E Schlicht
- Klinik für Frauenheilkunde und Geburtshilfe, Kliniken Ostalb, Mutlangen
| | - S Fritz
- Klinik für Frauenheilkunde und Geburtshilfe, Sanaklinikum Biberach
| | - F Flock
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Memmingen
| | - R Felberbaum
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kempten
| | - TWP Friedl
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm
| | - F Thiel
- Klinik für Frauenheilkunde und Geburtshilfe, Alb-Fils Klinik Göppingen
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen
| | - P Kuhn
- Comprehensive Cancer Center Ulm, Universitätsklinik Ulm
| | - M Tzschaschel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm
| | - W Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm
| | - L Wiesmüller
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm
| | - J Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm
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Nabieva N, Kellner S, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of patient and tumor characteristics on early therapy persistence with letrozole in postmenopausal women with early breast cancer: results of the prospective Evaluate-TM study with 3941 patients. Ann Oncol 2019; 29:186-192. [PMID: 29045642 DOI: 10.1093/annonc/mdx630] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Patients' compliance and persistence with endocrine treatment has a significant effect on the prognosis in early breast cancer (EBC). The purpose of this analysis was to identify possible reasons for non-persistence, defined as premature cessation of therapy, on the basis of patient and tumor characteristics in individuals receiving adjuvant treatment with letrozole. Patients and methods The EvAluate-TM study is a prospective, multicenter, noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive EBC in the early therapy phase. Treatment persistence was evaluated at two pre-specified study visits after 6 and 12 months. As a measure of early therapy persistence the time from the start to the end of treatment (TTEOT) was analyzed. Cox regression analyses were carried out to identify patient characteristics and tumor characteristics predicting TTEOT. Results Out of the total population of 3941 patients with EBC, 540 (13.7%) events involving treatment cessation unrelated to disease progression were observed. This was due to drug-related toxicity in the majority of cases (73.5%). Persistence rates were 92.2%, 86.9%, and 86.3% after 6, 12, and 15 months, respectively. The main factors influencing premature treatment discontinuation were older age [hazard ratio (HR) 1.02/year], comorbidities (HR 1.06 per comorbidity), low body mass index, and lower tumor grade (HR 0.85 per grade unit). Conclusion These results support the view that older, multimorbid patients with low tumor grade and low body mass index are at the greatest risk for treatment discontinuation and might benefit from compliance and support programs.
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Affiliation(s)
- N Nabieva
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Kellner
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.,Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Clinics of Cologne gGmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany.,Breast Center, Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - N Fersis
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Protestant County Hospital of Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- HELIOS Kliniken Schwerin GmbH, Schwerin, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Lippe-Detmold, Lippe-Detmold, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital of Rendsburg, Rendsburg, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C Rauh
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - C M Bayer
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - A Jacob
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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23
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Perrier F, Viallon V, Ambatipudi S, Ghantous A, Cuenin C, Hernandez-Vargas H, Chajès V, Baglietto L, Matejcic M, Moreno-Macias H, Kühn T, Boeing H, Karakatsani A, Kotanidou A, Trichopoulou A, Sieri S, Panico S, Fasanelli F, Dolle M, Onland-Moret C, Sluijs I, Weiderpass E, Quirós JR, Agudo A, Huerta JM, Ardanaz E, Dorronsoro M, Tong TYN, Tsilidis K, Riboli E, Gunter MJ, Herceg Z, Ferrari P, Romieu I. Association of leukocyte DNA methylation changes with dietary folate and alcohol intake in the EPIC study. Clin Epigenetics 2019; 11:57. [PMID: 30940212 PMCID: PMC6444439 DOI: 10.1186/s13148-019-0637-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background There is increasing evidence that folate, an important component of one-carbon metabolism, modulates the epigenome. Alcohol, which can disrupt folate absorption, is also known to affect the epigenome. We investigated the association of dietary folate and alcohol intake on leukocyte DNA methylation levels in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Leukocyte genome-wide DNA methylation profiles on approximately 450,000 CpG sites were acquired with Illumina HumanMethylation 450K BeadChip measured among 450 women control participants of a case-control study on breast cancer nested within the EPIC cohort. After data preprocessing using surrogate variable analysis to reduce systematic variation, associations of DNA methylation with dietary folate and alcohol intake, assessed with dietary questionnaires, were investigated using CpG site-specific linear models. Specific regions of the methylome were explored using differentially methylated region (DMR) analysis and fused lasso (FL) regressions. The DMR analysis combined results from the feature-specific analysis for a specific chromosome and using distances between features as weights whereas FL regression combined two penalties to encourage sparsity of single features and the difference between two consecutive features. Results After correction for multiple testing, intake of dietary folate was not associated with methylation level at any DNA methylation site, while weak associations were observed between alcohol intake and methylation level at CpG sites cg03199996 and cg07382687, with qval = 0.029 and qval = 0.048, respectively. Interestingly, the DMR analysis revealed a total of 24 and 90 regions associated with dietary folate and alcohol, respectively. For alcohol intake, 6 of the 15 most significant DMRs were identified through FL. Conclusions Alcohol intake was associated with methylation levels at two CpG sites. Evidence from DMR and FL analyses indicated that dietary folate and alcohol intake may be associated with genomic regions with tumor suppressor activity such as the GSDMD and HOXA5 genes. These results were in line with the hypothesis that epigenetic mechanisms play a role in the association between folate and alcohol, although further studies are warranted to clarify the importance of these mechanisms in cancer. Electronic supplementary material The online version of this article (10.1186/s13148-019-0637-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Perrier
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150, cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - V Viallon
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150, cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - S Ambatipudi
- Epigenetics Group, IARC, Lyon, France.,MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - C Cuenin
- Epigenetics Group, IARC, Lyon, France
| | | | - V Chajès
- Nutritional Epidemiology Group, IARC, Lyon, France
| | - L Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Matejcic
- Nutritional Epidemiology Group, IARC, Lyon, France.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - A Karakatsani
- Hellenic Health Foundation, Athens, Greece.,2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | - A Kotanidou
- Hellenic Health Foundation, Athens, Greece.,1st Department of Critical Care Medicine and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | | | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - F Fasanelli
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, Turin, Italy
| | - M Dolle
- National Institute of Public Health and the Environment (RIVM), Centre for Health Protection (pb12), Bilthoven, The Netherlands
| | - C Onland-Moret
- Department of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, Utrecht, The Netherlands
| | - I Sluijs
- Department of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, Utrecht, The Netherlands
| | - E Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - A Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - E Ardanaz
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.,Navarra Public Health Institute, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - M Dorronsoro
- Public Health Direction and Biodonostia Research Institute and CIBERESP, Basque Regional Health Department, San Sebastian, Spain
| | - T Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - M J Gunter
- Nutritional Epidemiology Group, IARC, Lyon, France
| | - Z Herceg
- Epigenetics Group, IARC, Lyon, France
| | - P Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150, cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| | - I Romieu
- Nutritional Epidemiology Group, IARC, Lyon, France
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24
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Kolberg HC, Liedtke C, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Stäbler A, Loibl S, Untch M, Kühn T. Abstract PD8-02: Residual axillary involvement in early breast cancer in patients with positive sentinel nodes after neoadjuvant chemotherapy (NACT). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The association between pathological complete remission (pCR) in the breast and clinical/pathological parameters is well established, whereas the role of these parameters in the prediction of residual axillary involvement after NACT is unclear. The goal is to identify a subset of patients who do not need axillary treatment. We used data from Arm B of the SENTINA trial to analyze this association.
Methods:Patients from arm B of the SENTINA trial with clinically and sonographically unsuspicious axillary nodes but with histologically proven involvement of SLNs prior to NACT were analyzed. All patients had SLNB and axillary dissection after NACT. Univariate analyses were performed to evaluate the association between clinical/pathological parameters and axillary involvement after NACT.
Results:Arm B of the SENTINA study contained 360 patients, 318 of which were evaluable with respect to the above parameters. After NACT 71/318 (22.3%) patients had involved SLNs or non-SLNs; 71/318 (22.3%) had a pCR in the breast. We observed a significant association between pCR in the breast and negative ER status, negative PR status, positive HER2 status, triple negative (TN) status, tumor size before and after NACT, multifocality, lobular morphology and axillary involvement after NACT. Regarding residual axillary burden only the associations with lobular morphology, extracapsular invasion, multifocality, positive HER2 status and pCR in the breast were statistically significant.
Conclusion:Our analysis demonstrates that patients enrolled in the SENTINA trial with clinically and sonographically unsuspicious axillary nodes but proven histological involvement of SLNs prior to NACT have positive axillary nodes in 22.3 % after NACT. This rate is confirming similar results from other groups. Although we found statistically significant associations between pCR in the breast and clinical/pathological parameters, only the association between lobular type, extracapsular invasion, positive HER2 status and pCR in the breast and residual axillary involvement after NACT were statistically significant. We cannot clearly identify a subset of patients for whom axillary treatment after NACT could be safely omitted if SLNs were positive. Our data are well in line with recently presented data demonstrating that the association between pCR in the breast and free axillary nodes after NACT is particularly strong in patients with TN and HER2 positive tumors. This question will be addressed in future trials currently under development.
Citation Format: Kolberg H-C, Liedtke C, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Stäbler A, Loibl S, Untch M, Kühn T. Residual axillary involvement in early breast cancer in patients with positive sentinel nodes after neoadjuvant chemotherapy (NACT) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-02.
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Affiliation(s)
- H-C Kolberg
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - C Liedtke
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - I Bauerfeind
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Fehm
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - B Fleige
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Hauschild
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - G Helms
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Lebeau
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Schmatloch
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - P Schrenk
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - L Schwentner
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Stäbler
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Loibl
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Untch
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Kühn
- Marienhospital Bottrop, Bottrop, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum Berlin-Buch, Berlin, Germany; Spital Rheinfelden, Rheinfelden, Switzerland; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Elisabeth-Krankenhaus Kassel, Kassel, Germany; Kepler Universitätsklinikum, Linz, Austria; Gynova, Reith, Austria; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
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Fasching PA, Eggemann H, Krocker J, Häberle L, Volz B, Kleine-Tebbe A, Blohmer JU, Kittel K, Hufnagel M, Janni W, Emons G, Simon E, Köhler U, Thomssen C, Kohls A, Beckmann MW, Hielscher C, Krabisch P, Zeiser T, Brodkorb T, Baier F, Nabieva N, Kellner S, Untch M, Stadie S, Budner M, Breitbach GP, Keller M, Stickeler E, Kühn T, Tolkmitt M, Belau AK, Schmidt M, Ulm K, Kümmel S. Abstract P1-13-01: Final results of the ASG1-3 study, a randomized phase III study comparing a standard dose chemotherapy with epirubicin/cyclophosphamide and paclitaxel with a dose dense regimen with epirubicin and paclitaxel. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-13-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Dose dense chemotherapy (DDT) has shown improvements of disease-free survival (DFS) and overall survival for primary breast cancer patients with a high risk of relapse. There are much less data about the effect of DDT in patients with intermediate risk of recurrence (1-3 positive axillary lymph nodes). Aim of this prospectively randomized trial was to investigate the superiority of a DDT schedule over a standard chemotherapy (ST) in primary breast cancer patients with 1-3 positive axillary lymph nodes.
Methods
The ASG1-3 study is a prospectively randomized, open label phase III study of the Adjuvant Study Group of the NOGGO association. Patients were eligible for the trial, if they had a primary invasive breast cancer (pT1-3) with 1-3 positive axillary lymph nodes and no evidence of distant metastases. Patients were randomized to an adjuvant therapy with either 4 cycles epirubicin (90mg/m2 body surface area, BSA) and cyclophosphamide (600mg/m2 BSA) q3w, followed by 4 cycles of paclitaxel (175mg/m2 BSA) referred to as ST or to a therapy with 4 cycles of epicubicin (120 mg/m2 BSA) q2w and primary G-CSF support followed by 4 cycles of paclitaxel (175mg/m2 BSA) q2w and primary G-CSF support referred to as DDT. Trastuzumab was not given in this study. The study was designed to show an increase of 70% DFS (ST) to 80% DFS (DDT) 5 years after randomization. Comparisons were conducted using Kaplan Meier estimates, log rank tests and Cox regression analyses. In an exploratory way, subgroup analyses were performed for HER2, hormone receptor status and grading using Cox regression models with interaction terms.
Results
A total of 936 patients were eligible for survival analysis, of which 465 were randomized to ST and 471 to DDT from 2001 to 2004. Patient characteristics were mainly well balanced, with patients being 52.5/52.1 years old, 71.9/78.1% being hormone receptor positive, 24.4/24.6% being HER2 positive and 38.6/38.8% having a tumor grade of 3 in the ST arm and DDT arm respectively. 53 events occurred after ST and 46 after DDT. Adjusted hazard ratio (HR) was 0.87 (95%CI: 0.57-1.35; p=0.54). 5 year DFS rates were 85% (ST) vs. 87% (DDT). Hematological toxicities were the most common grade 3 or 4 adverse events. Grade 3/4 neutropenia occurred in 57.2 vs. 28.0%, grade 3/4 anemia in 15.3% vs. 17.1% and grade 3 /4 pain symptoms were seen in 13.2 vs. 12.4% of the patients in the ST arm vs. DDT arm respectively. Other grade 3/4 toxicities were less frequent than 10%. Subgroup analysis showed a significant interaction (p<0.001) between HER2 status and randomization arm with regard to DFS. In HER2 negative patients the HR was 1.53 (95%CI: 0.91-2.59), whereas in HER2 positive patients the HR was 0.22 (95%CI: 0.09-0.55). Patients with HER2 positive disease and DDT had a similar prognosis like HER2 negative patients.
Conclusion
In the overall population a statistically significant improvement of DFS could not be shown for the DDT arm. In patients with HER2 positive breast cancer DDT chemotherapy improved the disease-free survival to a prognosis which was similar to patients with HER2 negative disease.
Citation Format: Fasching PA, Eggemann H, Krocker J, Häberle L, Volz B, Kleine-Tebbe A, Blohmer J-U, Kittel K, Hufnagel M, Janni W, Emons G, Simon E, Köhler U, Thomssen C, Kohls A, Beckmann MW, Hielscher C, Krabisch P, Zeiser T, Brodkorb T, Baier F, Nabieva N, Kellner S, Untch M, Stadie S, Budner M, Breitbach G-P, Keller M, Stickeler E, Kühn T, Tolkmitt M, Belau AK, Schmidt M, Ulm K, Kümmel S. Final results of the ASG1-3 study, a randomized phase III study comparing a standard dose chemotherapy with epirubicin/cyclophosphamide and paclitaxel with a dose dense regimen with epirubicin and paclitaxel [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-01.
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Affiliation(s)
- PA Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - H Eggemann
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - J Krocker
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - L Häberle
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - B Volz
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - A Kleine-Tebbe
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - J-U Blohmer
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - K Kittel
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - M Hufnagel
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - W Janni
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - G Emons
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - E Simon
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - U Köhler
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - C Thomssen
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - A Kohls
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - MW Beckmann
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - C Hielscher
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - P Krabisch
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - T Zeiser
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - T Brodkorb
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - F Baier
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - N Nabieva
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - S Kellner
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - M Untch
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - S Stadie
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - M Budner
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - G-P Breitbach
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - M Keller
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - E Stickeler
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - T Kühn
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - M Tolkmitt
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - AK Belau
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - M Schmidt
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - K Ulm
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
| | - S Kümmel
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; University Hospital Magedeburg, Magdeburg, Germany; Breast Cancer Center, Sana Klinkum Lichtenberg, Berlin, Germany; Biostatistics and Data Management Unit; University Hospital Erlangen, Erlangen, Germany; DRK-Kliniken Berlin Köpenick, Berlin, Germany; Charité University Hospital Campus Charité-Mitte, Berlin, Germany; Praxisklinik Krebsheilkunde für Frauen – Brustzentrum, Berlin, Germany; Ulm University Hospital, Ulm, Germany; University Hospital Göttingen, Göttingen, Germany; Torgau Hospital "Johann Kentmann" gGmbH, Torgau, Germany; Hospital St. Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle, Germany; Evang. Hospital Ludwigsfelde -Teltow gGmbH, Ludwigsfelde-Teltow, Germany; gSUND Gynäkologie Kompetenzzentrum Stralsund, Stralsund, Germany; Klinikum Chemnitz gGmbH, Chemnitz, Germany; Paracelsus Hospital, Henstedt-Ulzburg, Germany; Helios Clinics Berlin Buch, Berlin, Germany; Medical Centre, Pa
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Liedtke C, Kolberg HC, Krajewska M, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Staebler A, Loibl S, Untch M, Kühn T. Abstract PD8-03: Conversion rates from positive to negative axillary involvement in breast cancer patients presenting with biopsy-proven axillary metastases prior to primary systemic therapy (PST) – A transSENTINA subproject. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Modern chemotherapy carries a high potential of converting patients with clinically suspicious axillary nodes (cN+) prior to PST to clinically (ycN0) or pathologically (ypN0) negative nodes after PST. Clinical and sonographical axillary assessment, however, may be inadequate and therefore pathological assessment of suspicious axillary nodes is recommended. We analyzed the association between clinical / pathological parameters and positive to negative conversion in patients with biopsy-proven axillary metastases in Arm C of the SENTINA trial (i.e. patients with “true conversion”).
Methods:
Arm C of the SENTINA trial included patients converting from cN+ to ycN0 through PST from a prospective study. We limited our analysis to patients who had biopsy-proven axillary involvement. Univariate regression analysis was carried out to assess the association between patients with vs. without axillary disease after PST in i) patients with biopsy-proven involvement and ii) patients without biopsy proof of metastases.
Results:
Among 596 patients in arm C of the SENTINA trial with clinically and or sonographically suspicious ipsilateral axillary nodes, 439 (73,7%) 157 (26,3%) patients had a biopsy. In 152 patients (96,8%), lymph node metastases were confirmed and in 5 patients (3,2%), no malignant cells were identified. In both groups, we found a significant association (p<0,05) between increased rate of axillary conversion and small tumor diameter after PST, absence of multifocality, absence of lymphovascular invasion (LVI), ER and/or PR negativity, HER2 negativity, triple negative disease, and complete pathological response (pCR). No multiple testing corrections were performed due to an exploratory setting. However, only among patients with biopsy-proven involvement prior to PST, we found grade-3-tumors to be significantly associated with reduced probability of residual axillary involvement (76.1 vs. 33.8%, compared to G1 and G2, p=0.0323).
Conclusion:
Our analysis demonstrates that in patients with biopsy-proven axillary involvement before NST, parameters associated with axillary conversion are similar to those among patients classified as having nodal disease based on clinical and or sonographical assessment (cN+). Our analyses demonstrate that in biopsy-proven axillary metastases before NST, modern chemotherapy regimens result in significant rates of axillary conversion. This underscores the need to deescalate axillary staging / treatment with the goal to further avoid unnecessary axillary surgery.
Citation Format: Liedtke C, Kolberg H-C, Krajewska M, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Staebler A, Loibl S, Untch M, Kühn T. Conversion rates from positive to negative axillary involvement in breast cancer patients presenting with biopsy-proven axillary metastases prior to primary systemic therapy (PST) – A transSENTINA subproject [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-03.
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Affiliation(s)
- C Liedtke
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - H-C Kolberg
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Krajewska
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - I Bauerfeind
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Fehm
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - B Fleige
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - G Helms
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Lebeau
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - A Staebler
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - S Loibl
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - M Untch
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
| | - T Kühn
- Charite Hospital Berlin, Berlin, Germany; Marienhospital Bottrop, Bottrop, Germany; Klinikum Landshut, Landshut, Germany; Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Helios-Klinikum, Berlin-Buch, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Klinikum Esslingen, Esslingen, Germany
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Liedtke C, Kolberg HC, Kerschke L, Görlich D, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Stäbler A, Schmatloch S, Hausschild M, Schwentner L, von Minckwitz G, Loibl S, Untch M, Kühn T. Systematic analysis of parameters predicting pathological axillary status (ypN0 vs. ypN+) in patients with breast cancer converting from cN+ to ycN0 through primary systemic therapy (PST). Clin Exp Metastasis 2018; 35:777-783. [PMID: 30324492 DOI: 10.1007/s10585-018-9938-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
Abstract
Optimization of axillary staging among patients converting from clinically node-positive disease to clinically node-negative disease through primary systemic therapy is needed. We aimed at developing a nomogram predicting the probability of positive axillary status after chemotherapy based on clinical/pathological parameters. Patients from study arm C of the SENTINA trial were included. Univariable/multivariable analyses were performed for 13 clinical/pathological parameters to predict a positive pathological axillary status after chemotherapy using logistic regression models. Odds ratios and 95%-confidence-intervals were reported. Model performance was assessed by leave-one-out cross-validation. Calculations were performed using the SAS Software (Version 9.4, SAS Institute Inc., Cary, NC, USA). 369 of 553 patients in Arm C were included in multivariable analysis. Stepwise backward variable selection based on a multivariable analysis resulted in a model including estrogen receptor (ER) status (odds ratio (OR) 3.916, 95% confidence interval (CI) 2.318-6.615, p < 0.001), multifocality (OR 2.106, 95% CI 1.203-3.689, p = 0.0092), lymphovascular invasion (OR 9.196, 95% CI 4.734-17.864, p < 0.001), and sonographic tumor diameter after PST (OR 1.034, 95% CI 1.010-1.059, p = 0.0051). When validated, our model demonstrated an accuracy of 70.2% using 0.5 as cut-point. An area under the curve of 0.81 was calculated. The use of individual parameters as predictors of lymph node status after chemotherapy resulted in an inferior accuracy. Our model was able to predict the probability of a positive axillary nodal status with a high accuracy. The use of individual parameters showed reduced predictive performance. Overall, tumor biology was the strongest parameter in our models.
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Affiliation(s)
- C Liedtke
- Department of Gynecology, Charité University Hospital Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - L Kerschke
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - D Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - I Bauerfeind
- Department of Gynecology and Obstetrics, Klinikum Landshut, Landshut, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Dusseldorf, Germany
| | - B Fleige
- Department of Pathology, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - G Helms
- Department of Gynecology and Obstetrics, University Medical Centre Tübingen, Tübingen, Germany
| | - A Lebeau
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stäbler
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | | | - M Hausschild
- Klinikum Rheinfelden, Schweiz, Rheinfelden, Switzerland
| | - L Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - S Loibl
- German Breast Group, Neu Isenburg, Germany
| | - M Untch
- Department of Gynecology and Obstetrics, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - T Kühn
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Centre, Klinikum Esslingen, Esslingen, Germany
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de Gregorio A, Rempen A, Schlicht E, Fritz S, Flock F, Kühn T, Thiel F, Felberbaum R, Kuhn P, Rothenbacher D, Albrecht S, Ernst K, Schochter F, Tzschaschel M, Friedl TWP, Möller P, Janni W, Huober J, Nagel G. Erste epidemiologische Daten zum Patientenkollektiv des BRandO Biology and Outcome (BiO)-Projekts (BReast and Ovarian Cancer). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - A Rempen
- Klinik für Frauenheilkunde und Geburtshilfe, Diakonieklinikum, Schwäbisch-Hall, Schwäbisch-Hall, Deutschland
| | - E Schlicht
- Klinik für Frauenheilkunde und Geburtshilfe, Kliniken Ostalb, Mutlangen, Deutschland
| | - S Fritz
- Klinik für Frauenheilkunde und Geburtshilfe, Sanaklinikum, Biberach, Deutschland
| | - F Flock
- Klinik für Frauenheilkunde und Geburtshilfe Memmingen, Memmingen, Deutschland
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Deutschland
| | - F Thiel
- Klinik am Eichert, Frauenklinik, Göppingen, Göppingen, Deutschland
| | - R Felberbaum
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kempten, Kempten, Deutschland
| | - P Kuhn
- Comprehensive Cancer Center Ulm, Universitätsklinik Ulm, Ulm, Deutschland
| | - D Rothenbacher
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland
| | - S Albrecht
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - K Ernst
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - F Schochter
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | | | - TWP Friedl
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinik Ulm, Ulm, Deutschland
| | - W Janni
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - J Huober
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - G Nagel
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland
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Nabieva N, Fehm T, Häberle L, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Popovic M, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauss T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Hack CC, Schmidt K, Belleville E, Brucker SY, Kümmel S, Beckmann MW, Wallwiener D, Hadji P, Fasching PA. Influence of side-effects on early therapy persistence with letrozole in post-menopausal patients with early breast cancer: Results of the prospective EvAluate-TM study. Eur J Cancer 2018; 96:82-90. [PMID: 29679775 DOI: 10.1016/j.ejca.2018.03.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endocrine treatment (ET) with an aromatase inhibitor (AI) is the treatment of choice in post-menopausal patients with hormone receptor-positive early breast cancer (EBC). However, adverse events (AEs) often lead to treatment discontinuation. This analysis aimed to identify side-effects that lead to patients failing to persist with letrozole treatment. PATIENTS AND METHODS Post-menopausal hormone receptor-positive EBC patients starting ET with letrozole were enroled in EvAluate-TM, a non-interventional study. Information regarding treatment compliance and persistence was gathered in months 6 and 12. Persistence was defined as the time from 30 d after the start to the end of treatment. The influence on persistence of musculoskeletal syndrome, menopausal disorder, sleep disorder and other AEs within the first 30 d was analysed using Cox regression analyses. RESULTS Among 3887 patients analysed, the persistence rate after 12 months was >85%. In all, 568 patients (14.6%) discontinued the treatment, 358 of whom (63.0%) did so only because of side-effects. The main AEs influencing persistence were musculoskeletal symptoms (hazard ratio [HR] 2.55; 95% confidence interval [CI], 1.90-3.42), sleep disorders (HR 1.95; 95% CI, 1.41-2.70) and other AEs (HR 2.03; 95% CI, 1.51-2.73). Menopausal disorder was not associated with non-persistence (HR 1.17; 95% CI, 0.74-1.84). CONCLUSIONS These results suggest that side-effects of AIs such as musculoskeletal syndrome and sleep disorder lead to ET discontinuation within the first treatment year in significant numbers of EBC patients. Compliance programmes adapted for subgroups that are at risk for early non-persistence might help to ensure the recommended therapy duration. CLINICAL TRIALS NUMBER CFEM345DDE19.
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Affiliation(s)
- N Nabieva
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Fehm
- Department of Gynecology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany; Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - L Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - J de Waal
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - M Rezai
- Luisen-Hospital Düsseldorf, Düsseldorf, Germany
| | - B Baier
- Department of Gynecology, Dachau Clinic, Dachau, Germany
| | - G Baake
- Oncological Medical Practice Pinneberg, Pinneberg, Germany
| | | | | | - M Warm
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; Breast Center, Clinics of Cologne GmbH, Holweide, Cologne, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - R Wuerstlein
- Breast Center, Department of Gynecology, Cologne University Hospital, Cologne, Germany; University Hospital Munich (LMU), Dept. of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich, Germany
| | - J-U Deuker
- Vinzenz-Hospital Hannover GmbH, Hannover, Germany
| | - P Dall
- Department of Gynecology, Lüneburg Clinic, Lüneburg, Germany
| | - B Richter
- Elbland Clinics, Meissen-Radebeul, Germany
| | - G Wachsmann
- County Hospital of Böblingen, Böblingen, Germany
| | - C Brucker
- Department of Gynecology, University Hospital, Paracelsus Private Medical University of Nuremberg, Nuremberg, Germany
| | - J W Siebers
- Department of Gynecology, St. Josef's Hospital, Offenburg, Germany
| | - M Popovic
- Department of Gynecology, Bayreuth Clinic GmbH, CCC ER-EMN, Bayreuth, Germany
| | - T Kuhn
- Karl-Olga-Hospital Stuttgart, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - C Wolf
- Medical Center Ulm, Ulm, Germany
| | - H-W Vollert
- Friedrichshafen Clinic, Friedrichshafen, Germany
| | - G-P Breitbach
- Department of Gynecology, Neunkirchen Clinic, Neunkirchen, Germany
| | - W Janni
- Department of Gynecology, Ulm University Hospital, Ulm, Germany
| | - R Landthaler
- Gynecological Medical Practice of the County Hospital of Krumbach, Krumbach, Germany
| | - A Kohls
- Evangelic County Hospital Ludwigsfelde-Teltow, Ludwigsfelde-Teltow, Germany
| | - D Rezek
- Marien-Hospital Wesel, Wesel, Germany
| | - T Noesselt
- Department of Gynecology of the County Hospital of Hameln, Hameln, Germany
| | - G Fischer
- Mittweida Hospital gGmbH, Mittweida, Germany
| | - S Henschen
- Johanniter Hospital Genthin Stendal gGmbH, Hansestadt Stendal, Germany
| | - T Praetz
- Caritas-Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - V Heyl
- Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - T Kühn
- Department of Gynecology, Esslingen Clinics a.N., Esslingen, Germany
| | - T Krauss
- Department of Gynecology Passau, Passau, Germany
| | - C Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - A Hohn
- County Hospital Kiel GmbH, Kiel, Germany
| | - H Tesch
- Oncology Bethanien Frankfurt, Frankfurt, Germany
| | - C Mundhenke
- Department of Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Hein
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C C Hack
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - K Schmidt
- Novartis Pharma GmbH Nuremberg, Nuremberg, Germany
| | | | - S Y Brucker
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - S Kümmel
- Breast Unit, Essen Mitte Clinics, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Wallwiener
- Department of Gynecology, University of Tübingen, Tübingen, Germany
| | - P Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - P A Fasching
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area Nuremberg, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
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30
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Bembenek A, Büchels H, Decker T, Dunst J, Müllerleile U, Munz DL, Ostertag H, Sautter-Bihl ML, Schirrmeister H, Tulusan AH, Untch M, Winzer KJ, Wittekind C, Kühn T. Sentinel node biopsy in breast cancer. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1623907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe international consensus conference from St. Gallen concerning the treatment of early breast cancer concluded in 2003, that sentinel node biopsy was now accepted as method allowing axillary staging in breast cancer. This procedure may avoid complete lymph node dissection in appropriate cases. Since numerous questions associated with the technique are still not defined and the procedure itself is not yet standardized, the German Society of Senology defined the conditions for the routine clinical use of sentinel node biopsy in an interdisciplinary consensus meeting.
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31
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Botteri E, Ferrari P, Roswall N, Tjønneland A, Hjartåker A, Huerta JM, Fortner RT, Trichopoulou A, Karakatsani A, La Vecchia C, Pala V, Perez-Cornago A, Sonestedt E, Liedberg F, Overvad K, Sánchez MJ, Gram IT, Stepien M, Trijsburg L, Börje L, Johansson M, Kühn T, Panico S, Tumino R, Bueno-de-Mesquita HBA, Weiderpass E. Alcohol consumption and risk of urothelial cell bladder cancer in the European prospective investigation into cancer and nutrition cohort. Int J Cancer 2017; 141:1963-1970. [PMID: 28722206 DOI: 10.1002/ijc.30894] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 11/11/2022]
Abstract
Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition cohort. We included 476,160 individuals mostly aged 35-70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically nonsignificant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00-1.06 for each additional 12 g/day). HR in smokers was 1.04 (95% CI 1.01-1.07). Men reporting high baseline intakes of alcohol (>96 g/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03-2.40) compared to those reporting moderate intakes (<6 g/day), but no dose-response relationship emerged. In men, an increased risk of aggressive forms of UCC was observed even at lower doses (>6 to 24 g/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 g/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01-1.91) and smokers (1.39; 95% CI 1.01-1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly because of residual confounding by tobacco smoking.
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Affiliation(s)
- E Botteri
- Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
- National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway
| | - P Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - N Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Athens, Greece
| | - A Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | - C La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - V Pala
- Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - E Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Liedberg
- Department of Translational Medicine, Division of Clinical and Experimental Urothelial Carcinoma Research, Lund University, Malmö, Sweden
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - M J Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - M Stepien
- International Agency for Research on Cancer, Lyon, France
| | - L Trijsburg
- International Agency for Research on Cancer, Lyon, France
| | - L Börje
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - M Johansson
- International Agency for Research on Cancer, Lyon, France
- Department for biobank research, Umeå University, Umeå, Sweden
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - S Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit "Civic - M.P. Arezzo" Hospital ASP, Ragusa, Italy
| | - H B As Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
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32
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Chajès V, Assi N, Biessy C, Ferrari P, Rinaldi S, Slimani N, Lenoir GM, Baglietto L, His M, Boutron-Ruault MC, Trichopoulou A, Lagiou P, Katsoulis M, Kaaks R, Kühn T, Panico S, Pala V, Masala G, Bueno-de-Mesquita HB, Peeters PH, van Gils C, Hjartåker A, Standahl Olsen K, Borgund Barnung R, Barricarte A, Redondo-Sanchez D, Menéndez V, Amiano P, Wennberg M, Key T, Khaw KT, Merritt MA, Riboli E, Gunter MJ, Romieu I. A prospective evaluation of plasma phospholipid fatty acids and breast cancer risk in the EPIC study. Ann Oncol 2017; 28:2836-2842. [PMID: 28950350 DOI: 10.1093/annonc/mdx482] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Intakes of specific fatty acids have been postulated to impact breast cancer risk but epidemiological data based on dietary questionnaires remain conflicting. MATERIALS AND METHODS We assessed the association between plasma phospholipid fatty acids and breast cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition study. Sixty fatty acids were measured by gas chromatography in pre-diagnostic plasma phospholipids from 2982 incident breast cancer cases matched to 2982 controls. Conditional logistic regression models were used to estimate relative risk of breast cancer by fatty acid level. The false discovery rate (q values) was computed to control for multiple comparisons. Subgroup analyses were carried out by estrogen receptor (ER) and progesterone receptor expression in the tumours. RESULTS A high level of palmitoleic acid [odds ratio (OR) for the highest quartile compared with the lowest OR (Q4-Q1) 1.37; 95% confidence interval (CI), 1.14-1.64; P for trend = 0.0001, q value = 0.004] as well as a high desaturation index (DI16) (16:1n-7/16:0) [OR (Q4-Q1), 1.28; 95% C, 1.07-1.54; P for trend = 0.002, q value = 0.037], as biomarkers of de novo lipogenesis, were significantly associated with increased risk of breast cancer. Levels of industrial trans-fatty acids were positively associated with ER-negative tumours [OR for the highest tertile compared with the lowest (T3-T1)=2.01; 95% CI, 1.03-3.90; P for trend = 0.047], whereas no association was found for ER-positive tumours (P-heterogeneity =0.01). No significant association was found between n-3 polyunsaturated fatty acids and breast cancer risk, overall or by hormonal receptor. CONCLUSION These findings suggest that increased de novo lipogenesis, acting through increased synthesis of palmitoleic acid, could be a relevant metabolic pathway for breast tumourigenesis. Dietary trans-fatty acids derived from industrial processes may specifically increase ER-negative breast cancer risk.
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Affiliation(s)
- V Chajès
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon.
| | - N Assi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - C Biessy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - P Ferrari
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - S Rinaldi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - N Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | | | - L Baglietto
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M His
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M C Boutron-Ruault
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - A Trichopoulou
- Hellenic Health Foundation, Athens; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - P Lagiou
- Hellenic Health Foundation, Athens; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, USA
| | | | - R Kaaks
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples
| | - V Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - P H Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo
| | - K Standahl Olsen
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - R Borgund Barnung
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - A Barricarte
- Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona; CIBER Epidemiology and Public Health CIBERESP, Madrid
| | - D Redondo-Sanchez
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.Granada, Hospitales Universitarios de Granada, Granada; Universidad de Granada, Granada
| | | | - P Amiano
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Public Health Division of Gipuzkoa, Health Department, Basque Region, San Sebastian, Spain
| | - M Wennberg
- Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - T Key
- The Cancer Epidemiology Unit, University of Oxford, Oxford
| | - K T Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - M J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - I Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
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Petzke F, Brückle W, Eidmann U, Heldmann P, Köllner V, Kühn T, Kühn-Becker H, Strunk-Richter M, Schiltenwolf M, Settan M, von Wachter M, Weigl M, Häuser W. Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom. Schmerz 2017; 31:246-254. [DOI: 10.1007/s00482-017-0201-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Jay R, Brennan P, Brenner, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi, Katzke V, Kühn T, Boeing H, Bergmann MM, Steffen A, Naska A, Trichopoulou A, Trichopoulos D, Saieva C, Grioni S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Weiderpass E, Arriola L, Molina-Montes E, Duell EJ, Santiuste C, Alonso de la Torre R, Barricarte Gurrea A, Stocks T, Johansson M, Ljungberg B, Wareham N, Khaw KT, Travis RC, Cross AJ, Murphy N, Riboli E, Scelo G. Alcohol consumption and the risk of renal cancers in the European Prospective Investigation into Cancer and Nutrition (EPIC). Wozniak MB, Brennan P, Brenner DR, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Katzke V, Kühn T, Boeing H, Bergmann MM, Steffen A, Naska A, Trichopoulou A, Trichopoulos D, Saieva C, Grioni S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Weiderpass E, Arriola L, Molina-Montes E, Duell EJ, Santiuste C, Alonso de la Torre R, Barricarte Gurrea A, Stocks T, Johansson M, Ljungberg B, Wareham N, Khaw KT, Travis RC, Cross AJ, Murphy N, Riboli E, Scelo G.Int J Cancer. 2015 Oct 15;137(8):1953-66. [Epub 2015 Apr 28]. doi: 10.1002/ijc.29559. Urol Oncol 2017; 35:117. [PMID: 28159493 DOI: 10.1016/j.urolonc.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cancer. However, there is no information available on the associations in renal cancer subsites. From 1992 to 2010, 477,325 men and women in the European Prospective Investigation into Cancer and Nutrition cohort were followed for incident renal cancers (n = 931). Baseline and lifetime alcohol consumption was assessed by country-specific, validated dietary questionnaires. Information on past alcohol consumption was collected by lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. In multivariate analysis, total alcohol consumption at baseline was inversely associated with renal cancer; the HR and 95% CI for the increasing categories of total alcohol consumption at recruitment vs. the light drinkers category were 0.78 (0.62-0.99), 0.82 (0.64-1.04), 0.70 (0.55-0.90), and 0.91 (0.63-1.30), respectively, (ptrend = 0.001). A similar relationship was observed for average lifetime alcohol consumption and for all renal cancer subsites combined or for renal parenchyma subsite. The trend was not observed in hypertensive individuals and not significant in smokers. In conclusion, moderate alcohol consumption was associated with a decreased risk of renal cancer.
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Paepke S, Gruber I, Kühn T, Blohmer JU, Ohlinger R, Thill M, Hahn M. Nadelbiopsien in der Axilla – Ergebnisse einer Fragebogenuntersuchung der Arbeitsgemeinschaft Minimal-invasive Mammainterventionen (AG MIMI). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592821] [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] Open
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Hack CC, Fasching PA, Fehm T, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Wuerstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesselt T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauß T, Thomssen C, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Hadji P, Brucker SY, Wallwiener D, Paepke D, Kümmel S, Beckmann MW. Interest in integrative medicine among postmenopausal hormone receptor-positive breast cancer patients receiving letrozole treatment in the EvAluate-TM study. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593261] [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] Open
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Huseinovic E, Winkvist A, Slimani N, Park MK, Freisling H, Boeing H, Buckland G, Schwingshackl L, Weiderpass E, Rostgaard-Hansen AL, Tjønneland A, Affret A, Boutron-Ruault MC, Fagherazzi G, Katzke V, Kühn T, Naska A, Orfanos P, Trichopoulou A, Pala V, Palli D, Ricceri F, Santucci de Magistris M, Tumino R, Engeset D, Enget T, Skeie G, Barricarte A, Bonet CB, Chirlaque MD, Amiano P, Quirós JR, Sánchez MJ, Dias JA, Drake I, Wennberg M, Boer JMA, Ocké MC, Verschuren WMM, Lassale C, Perez-Cornago A, Riboli E, Ward H, Forslund HB. Meal patterns across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. Public Health Nutr 2016; 19:2769-80. [PMID: 27194183 PMCID: PMC10271196 DOI: 10.1017/s1368980016001142] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/23/2016] [Accepted: 04/14/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. DESIGN Cross-sectional study utilizing dietary data collected through a standardized 24 h diet recall during 1995-2000. Eleven predefined intake occasions across a 24 h period were assessed during the interview. In the present descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion. SETTING Twenty-seven centres across ten European countries. SUBJECTS Women (64 %) and men (36 %) aged 35-74 years (n 36 020). RESULTS Pronounced differences in meal patterns emerged both across centres within the same country and across different countries, with a trend for fewer intake occasions per day in Mediterranean countries compared with central and northern Europe. Differences were also found for daily energy intake provided by lunch, with 38-43 % for women and 41-45 % for men within Mediterranean countries compared with 16-27 % for women and 20-26 % for men in central and northern European countries. Likewise, a south-north gradient was found for daily energy intake from snacks, with 13-20 % (women) and 10-17 % (men) in Mediterranean countries compared with 24-34 % (women) and 23-35 % (men) in central/northern Europe. CONCLUSIONS We found distinct differences in meal patterns with marked diversity for intake frequency and lunch and snack consumption between Mediterranean and central/northern European countries. Monitoring of meal patterns across various cultures and populations could provide critical context to the research efforts to characterize relationships between dietary intake and health.
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Affiliation(s)
- E Huseinovic
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
| | - A Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - N Slimani
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - MK Park
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - H Freisling
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
| | - G Buckland
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - L Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway – Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | | | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Affret
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - MC Boutron-Ruault
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - G Fagherazzi
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - V Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - T Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - A Naska
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - P Orfanos
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - V Pala
- Epidemiology and Prevention Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic – M.P. Arezzo’ Hospital, ASP Ragusa, Ragusa, Italy
| | - D Engeset
- Norwegian Food Safety Authority, Head Office, Oslo, Norway
| | - T Enget
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - A Barricarte
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - CB Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - MD Chirlaque
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - P Amiano
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - JR Quirós
- Public Health Directorate, Asturias, Spain
| | - MJ Sánchez
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - JA Dias
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - I Drake
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - M Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - JMA Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - MC Ocké
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - WMM Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Lassale
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - A Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - H Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - H Bertéus Forslund
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
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Witzel I, Loibl S, Laakmann E, Augustin D, Flock F, Dohmen HH, Durmus G, Frank M, Hesse T, Ignatov A, Kühn T, Neunhöffer T, Park-Simon TW, Schmidt M, Stefek A, Weide R, Würschmidt F, Fehm T, Moebus V, von Minckwitz G, Burchardi N, Mueller V. Abstract P6-17-08: Brain metastases in breast cancer network Germany (BMBC, GBG 79): First analysis of 548 patients from the multicenter registry. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-17-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The incidence of brain metastases (BM) in breast cancer patients is rising and has become a major clinical challenge. So far, limited therapeutic options and insights into the biology of BM exist since only a few studies analyzed exclusively data of breast cancer patients. In order to improve this situation, our multicenter registry was initiated in 2014: Brain Metastases in Breast Cancer Network Germany (BMBC, GBG79).
Materials and Methods: Patients with BM diagnosed since 2000, a history of breast cancer and no history of other malignant or neurologic disease can be included. Registration is allowed retrospectively as well as prospectively into a web–based database ("MedCodes"). Characteristics of the primary tumor, metastatic disease and BM as well as treatment details are documented. For this first analysis, 548 patients from 39 German centers were included.
Results: Median age at first diagnosis of BM was 55 years (25 – 90 years). 43% of patients (233/548) were HER2 positive, 19% (n=105) were triple–negative and 25% (n= 138) had luminal primary tumors indicating a selection of patients with specific tumor biology who develop BM. 54 % of the patients (n=267) had up to three BM whereas 45% (n=223) had more than three BM. 19% of patients (n=106) had BM without evidence of extracranial disease. 27% of the patients (n=146) underwent surgery of the BM. Of these patients, 61% (n= 89) were treated with whole brain radiotherapy and 16% (n=23) with stereotactic radiotherapy. In patients without surgery (n=397), 73% (n=289) received whole brain radiotherapy and 7% (n=28) stereotactic radiotherapy.
Median time from diagnosis of primary breast cancer to BM was 38.5 month for the entire cohort (CI95% 35.4 – 43.3). The time from first diagnosis to BM was shorter for triple–negative patients (20.9 month, CI95% 15.5 – 25.9) compared with patients with HER2–positive (37.0 month, CI95% 30.5 – 42.0) or luminal tumors (48.3 month, CI95% 38.2 – 54.0) (p<0.001). Median time from first diagnosis of BM to death in the entire cohort was 6.1 months (CI95%: 5.2 – 7.3). One year survival rate from diagnosis of BM was 32.2 % (CI95%: 2.2 – 67.8). Regarding tumor subtypes, HER2–positive patients had the longest median survival with 9.4 months (CI95%: 7.1 – 13.4) compared with 6 months (CI95%: 4.0 – 7.3) for luminal primary tumors and 3.2 months (CI95%: 2.1 – 4.6) for triple–negative patients (p<0.001). HER2 positive patients receiving HER2–directed therapy after the diagnosis of BM lived longer than those without (median 9.6 vs. 5.5 months, p=0.029). Regarding the number of BM, no difference in survival was observed between one, two or three BM (median survival of 7.8 months). However, survival was shorter in those patients with more than three BM (5.2 months; p=0.007).
Conclusion: This is so far the largest analysis of breast cancer patients with BM treated in Germany. In this cohort, triple–negative subtype or more than three BM were associated with shorter survival from the diagnosis of BM. HER2 positive patients with no HER2 directed therapy after the diagnosis of BM showed a shorter survival. The recruitment of the registry is ongoing and we aim to include more than 1000 patients by the end of 2015.
Citation Format: Witzel I, Loibl S, Laakmann E, Augustin D, Flock F, Dohmen H-H, Durmus G, Frank M, Hesse T, Ignatov A, Kühn T, Neunhöffer T, Park-Simon T-W, Schmidt M, Stefek A, Weide R, Würschmidt F, Fehm T, Moebus V, von Minckwitz G, Burchardi N, Mueller V. Brain metastases in breast cancer network Germany (BMBC, GBG 79): First analysis of 548 patients from the multicenter registry. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-17-08.
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Affiliation(s)
- I Witzel
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - S Loibl
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - E Laakmann
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - D Augustin
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - F Flock
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - H-H Dohmen
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - G Durmus
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - M Frank
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - T Hesse
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - A Ignatov
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - T Kühn
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - T Neunhöffer
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - T-W Park-Simon
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - M Schmidt
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - A Stefek
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - R Weide
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - F Würschmidt
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - T Fehm
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - V Moebus
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - G von Minckwitz
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - N Burchardi
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
| | - V Mueller
- University Medical Center Hamburg- Eppendorf, Hamburg, Germany; German Breast Group, Neu-Isenburg, Germany; Donauisar Clinic Deggendorf, Deggendorf, Germany; Clinic Memmingen, Memmingen, Germany; Clinic St. Elisabeth Straubing GmbH, Straubing, Germany; Rems-Murr-Clinic-Winnenden, Winnenden, Germany; Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany; Diakonieclinic Rotenburg (Wümme) gGmbH, Rotenburg, Germany; Clinic of The Otto-V.-Guericke-University, Magdeburg, Germany; Clinic Esslingen, Esslingen, Germany; Dr.-Horst-Schmidt-Clinic, Wiesbaden, Germany; Hannover Medical School, Hannover, Germany; University Clinic Mainz, Mainz, Germany; Johanniter-Clinic Genthin-Stendal, Stendal, Germany; Clinic for Hematological and Oncological Diseases, Koblenz, Germany; Radiology Alliance Hamburg, Hamburg, Germany; AGO Trafo (Translational Research Board), Germany; AGO-B (Breast Study Group), Germany
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Haftenberger M, Mensink GBM, Herzog B, Kluttig A, Greiser KH, Merz B, Nöthlings U, Schlesinger S, Vogt S, Thorand B, Peters A, Ittermann T, Völzke H, Schipf S, Neamat-Allah J, Kühn T, Kaaks R, Boeing H, Bachlechner U, Scheidt-Nave C, Schienkiewitz A. Changes in body weight and obesity status in German adults: results of seven population-based prospective studies. Eur J Clin Nutr 2015; 70:300-5. [PMID: 26508458 DOI: 10.1038/ejcn.2015.179] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/17/2015] [Accepted: 09/28/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to quantify body weight changes in German adult populations during the past decades. SUBJECTS/METHODS Longitudinal analysis of seven cohort studies covering different age ranges between 18 and 83 years. Baseline examinations were between 1994 and 2007 and follow-up durations between 4.0 and 11.9 years. For each study, mean change in body weight per year and 10-year change in body mass index (BMI) classification were analyzed. For the middle age group of 45-64 years, meta-analysis was conducted to obtain an overall estimate for Germany. RESULTS Among men weight gain was highest in the youngest participants and decreased with advancing age. Among women weight gain was on a stable high level among those younger than 45 years and decreased at older age. Within 10 years, 30-40% of middle-aged participants with normal baseline weight became pre-obese or obese and 20-25% of those with pre-obesity at baseline became obese, whereas >80% of persons who were obese at baseline remained obese over time. The estimated average weight change in adults aged 45-64 years was 0.25 (95% confidence interval (CI): 0.18-0.33) kg/year among men and 0.24 (0.17-0.30) kg/year among women. CONCLUSIONS We could observe a moderate weight gain over the past years in German middle-aged populations of 0.25 kg/year. Obesity prevention needs to be targeted to specific subgroups in the population, especially to younger adults, who seem to be most vulnerable for gaining weight. Obesity intervention needs to be improved, as the majority of obese adults remained obese over time.
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Affiliation(s)
- M Haftenberger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - G B M Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - B Herzog
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - K H Greiser
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - B Merz
- Institute for Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - U Nöthlings
- Institute for Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - S Schlesinger
- Institute of Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - S Vogt
- Institute of Epidemiology II, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - B Thorand
- Institute of Epidemiology II, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - A Peters
- Institute of Epidemiology II, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany.,German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - T Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre of Cardiovascular Research, Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - S Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - J Neamat-Allah
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
| | - U Bachlechner
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
| | - C Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - A Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Heil J, Kümmel S, Schaefgen B, Paepke S, Thomssen C, Rauch G, Ataseven B, Große R, Dreesmann V, Kühn T, Loibl S, Blohmer J, Minckwitz G. 1830 Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30781-x] [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: 10/22/2022]
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Meissner J, Tichy D, Katzke V, Kühn T, Dietrich S, Schmitt T, Ziepert M, Kuhnt E, Rixecker T, Zorn M, Witzens-Harig M, Pfreundschuh M, Ho A. Long-term ovarian function in women treated with CHOP or CHOP plus etoposide for aggressive lymphoma. Ann Oncol 2015; 26:1771-6. [DOI: 10.1093/annonc/mdv227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/04/2015] [Indexed: 01/01/2023] Open
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42
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Stenczer B, Lindauer E, Kühn T. Endometriose in der Postmenopause. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558369] [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] Open
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Scharl A, Kühn T, Papathemelis T, Salterberg A. The Right Treatment for the Right Patient - Personalised Treatment of Breast Cancer. Geburtshilfe Frauenheilkd 2015; 75:683-691. [PMID: 26257405 PMCID: PMC4520989 DOI: 10.1055/s-0035-1546270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/04/2015] [Accepted: 06/19/2015] [Indexed: 01/13/2023] Open
Abstract
The probability of healing breast cancer has been greatly improved in recent decades through the introduction and optimisation of multi-modal therapies and interdisciplinary treatments. Today, in addition to surgery or radiation, most patients receive a systemic treatment. To prevent excessive treatment, patients whose prognosis is so good that certain adjuvant therapies can be foregone or reduced must be identified. A lack of compliance with therapy, especially in the endocrine therapies stretching over years, is a further problem. As only treatments that are also carried out can improve chances of survival, efforts to improve compliance must be intensified. Studies show that lifestyle changes influence the efficiency of medication on the one hand, and on the other hand can also by themselves achieve a relevant improvement of the prognosis. Therefore, it is time not only to treat the tumour, but to also focus on the patient as a whole in therapeutic interventions.
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Affiliation(s)
- A. Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg
| | - T. Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen
| | | | - A. Salterberg
- Department of Gynaecology and Obstetrics, Sana Clinics, Cham
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44
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Bamia C, Lagiou P, Jenab M, Aleksandrova K, Fedirko V, Trichopoulos D, Overvad K, Tjønneland A, Olsen A, Clavel-Chapelon F, Boutron-Ruault MC, Kvaskoff M, Katzke VA, Kühn T, Boeing H, Nöthlings U, Palli D, Sieri S, Panico S, Tumino R, Naccarati A, Bueno-de-Mesquita HB, Peeters PHM, Weiderpass E, Skeie G, Quirós JR, Agudo A, Chirlaque MD, Sanchez MJ, Ardanaz E, Dorronsoro M, Ericson U, Nilsson LM, Wennberg M, Khaw KT, Wareham N, Key TJ, Travis RC, Ferrari P, Stepien M, Duarte-Salles T, Norat T, Murphy N, Riboli E, Trichopoulou A. Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study. Br J Cancer 2015; 112:1273-82. [PMID: 25742480 PMCID: PMC4385950 DOI: 10.1038/bjc.2014.654] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations. METHODS In 486,799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d(-1) increments of vegetable/fruit intakes. RESULTS Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d(-1) increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d(-1) increment): 1.01; 95% CI: 0.92-1.11. CONCLUSIONS Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.
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Affiliation(s)
- C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens 115 27, Greece
| | - P Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens 115 27, Greece
- Department of Epidemiology, Harvard School of Public Health, 02115 Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens 106 79, Greece
| | - M Jenab
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - K Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal 14558, Germany
| | - V Fedirko
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta 30322, GA, USA
| | - D Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, 02115 Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens 106 79, Greece
- Hellenic Health Foundation, Athens 115 27, Greece
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, DK-8000 Aarhus C, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
| | - A Olsen
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
| | - F Clavel-Chapelon
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, F-94805 Paris, France
- Paris South University, UMRS 1018, Villejuif, F-94805 Paris, France
- IGR, Villejuif, F-94805 Paris, France
| | - M-C Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, F-94805 Paris, France
- Paris South University, UMRS 1018, Villejuif, F-94805 Paris, France
- IGR, Villejuif, F-94805 Paris, France
| | - M Kvaskoff
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, F-94805 Paris, France
- Paris South University, UMRS 1018, Villejuif, F-94805 Paris, France
- IGR, Villejuif, F-94805 Paris, France
| | - V A Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal 14558, Germany
| | - U Nöthlings
- Department of Nutrition and Food Sciences, University of Bonn, 53111 Bonn, Germany
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute–ISPO, 50139 Florence, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia Federico II University, 80131 Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic–M.P. Arezzo' Hospital, ASP 97100 Ragusa, Italy
| | - A Naccarati
- HuGeF–Human Genetics Foundation–Torino Molecular and Genetic Epidemiology Unit, 10126 Torino, Italy
| | - HB(as) Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - P H M Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
- Cancer Registry of Norway, NO-0304 Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 Stockholm, Sweden
- Department of Genetic Epidemiology, Folkhälsan Research Center, 00250 Helsinki, Finland
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
| | - J R Quirós
- Public Health Directorate, CP 33006 Oviedo, Asturias, Spain
| | - A Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain
| | - M-D Chirlaque
- Epidemiology Department, Murcia Regional Health Council, E-30008 Murcia, Spain
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain
| | - M-J Sanchez
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, 18080 Granada, Spain
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain
- Navarre Public Health Institute, 31003 Pamplona, Spain
| | - M Dorronsoro
- Basque Regional Health Department, Public Health Direction, 4-20013 Donostia, San Sebastian, Spain
- Biodonostia Research Institute CIBER Epidemiology and Public Health CIBERESP, s/n 20014 San Sebastian, Spain
| | - U Ericson
- Diabetes and Cardiovascular disease, Genetic Epidemiology Department of Clinical Sciences in Malmö Lund University, SE-205 92 Malmo, Sweden
| | - L M Nilsson
- Department of Nutritional Research, Public Health and Clinical Medicine, Umeå University, SE-901 85 Umeå, Sweden
- Arcum, Arctic Research Centre at Umeå University, SE-901 85 Umeå, Sweden
| | - M Wennberg
- Department of Nutritional Research, Public Health and Clinical Medicine, Umeå University, SE-901 85 Umeå, Sweden
| | - K-T Khaw
- University of Cambridge, CB2 0SR Cambridge, UK
| | - N Wareham
- University of Cambridge, CB2 0SR Cambridge, UK
- MRC Epidemiology Unit, CB2 0QQ Cambridge, UK
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF Oxford, UK
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF Oxford, UK
| | - P Ferrari
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - M Stepien
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - T Duarte-Salles
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - T Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - N Murphy
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens 115 27, Greece
- Hellenic Health Foundation, Athens 115 27, Greece
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Paepke S, Pfob C, Ohlinger R, Thill M, Kühn T, Blohmer J, Hahn M, Gruber I, Scheidhauer K, Kiechle M. P317 From radical to minimal-invasive – first clinical results of a non-surgical SLNB. Breast 2015. [DOI: 10.1016/s0960-9776(15)70347-4] [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] Open
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Maalick Z, Korhonen H, Kokkola H, Kühn T, Romakkaniemi S. Modelling artificial sea salt emission in large eddy simulations. Philos Trans A Math Phys Eng Sci 2014; 372:rsta.2014.0051. [PMID: 25404679 PMCID: PMC4240950 DOI: 10.1098/rsta.2014.0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We study the dispersion of sea salt particles from artificially injected sea spray at a cloud-resolving scale. Understanding of how different aerosol processes affect particle dispersion is crucial when designing emission sources for marine cloud brightening. Compared with previous studies, we include for the first time an explicit treatment of aerosol water, which takes into account condensation, evaporation and their effect on ambient temperature. This enables us to capture the negative buoyancy caused by water evaporation from aerosols. Additionally, we use a higher model resolution to capture aerosol loss through coagulation near the source point. We find that, with a seawater flux of 15 kg s(-1), the cooling due to evaporation can be as much as 1.4 K, causing a delay in particle dispersion of 10-20 min. This delay enhances particle scavenging by a factor of 1.14 compared with simulations without aerosol water. We further show that both cooling and particle dispersion depend on the model resolution, with a maximum particle scavenging efficiency of 20% within 5 h after emission at maximum resolution of 50 m. Based on these results, we suggest further regional high-resolution studies which model several injection periods over several weeks.
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Affiliation(s)
- Z Maalick
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland
| | - H Korhonen
- Finnish Meteorological Institute, Climate Research, PO Box 503, Helsinki 00101, Finland
| | - H Kokkola
- Finnish Meteorological Institute, PO Box 1627, Kuopio 70211, Finland
| | - T Kühn
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland
| | - S Romakkaniemi
- Finnish Meteorological Institute, PO Box 1627, Kuopio 70211, Finland
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Fasching PA, Fehm T, Kellner S, de Waal J, Rezai M, Baier B, Baake G, Kolberg HC, Guggenberger M, Warm M, Harbeck N, Würstlein R, Deuker JU, Dall P, Richter B, Wachsmann G, Brucker C, Siebers JW, Fersis N, Kuhn T, Wolf C, Vollert HW, Breitbach GP, Janni W, Landthaler R, Kohls A, Rezek D, Noesslet T, Fischer G, Henschen S, Praetz T, Heyl V, Kühn T, Krauß T, Thomssen C, Kümmel S, Hohn A, Tesch H, Mundhenke C, Hein A, Rauh C, Bayer CM, Jacob A, Schmidt K, Belleville E, Hadji P, Wallwiener D, Grischke EM, Beckmann MW, Brucker SY. Evaluation of Therapy Management and Patient Compliance in Postmenopausal Patients with Hormone Receptor-positive Breast Cancer Receiving Letrozole Treatment: The EvaluateTM Study. Geburtshilfe Frauenheilkd 2014; 74:1137-1143. [PMID: 25568468 DOI: 10.1055/s-0034-1383401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction: The EvaluateTM study (Evaluation of therapy management and patient compliance in postmenopausal hormone receptor-positive breast cancer patients receiving letrozole treatment) is a prospective, non-interventional study for the assessment of therapy management and compliance in the routine care of postmenopausal women with invasive hormone receptor-positive breast cancer receiving letrozole. The parameters for inclusion in the study are presented and discussed here. Material and Methods: Between January 2008 and December 2009 a total of 5045 patients in 310 study centers were recruited to the EvaluateTM study. Inclusion criteria were hormone receptor-positive breast cancer and adjuvant treatment or metastasis. 373 patients were excluded from the analysis for various reasons. Results: A total of 4420 patients receiving adjuvant treatment and 252 patients with metastasis receiving palliative treatment were included in the study. For 4181 patients receiving adjuvant treatment, treatment with the aromatase inhibitor letrozole commenced immediately after surgery (upfront). Two hundred patients had initially received tamoxifen and started aromatase inhibitor treatment with letrozole at 1-5 years after diagnosis (switch), und 39 patients only commenced letrozole treatment 5-10 years after diagnosis (extended endocrine therapy). Patient and tumor characteristics were within expected ranges, as were comorbidities and concurrent medication. Conclusion: The data from the EvaluateTM study will offer a good overview of therapy management in the routine care of postmenopausal women with hormone receptor-positive breast cancer. Planned analyses will look at therapy compliance and patient satisfaction with how information is conveyed and the contents of the conveyed information.
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Affiliation(s)
- P A Fasching
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - T Fehm
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf ; Universitätsfrauenklinik Tübingen, Tübingen
| | - S Kellner
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - J de Waal
- Frauenklinik im Klinikum Dachau, Dachau
| | - M Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - B Baier
- Frauenklinik im Klinikum Dachau, Dachau
| | - G Baake
- Klinikum Pinneberg, Pinneberg
| | | | | | - M Warm
- Brustzentrum, Universitäts-Frauenklinik Köln, Köln ; Brustzentrum, Klinken der Stadt Köln gGmbH Holweide, Köln
| | - N Harbeck
- Brustzentrum, Universitäts-Frauenklinik Köln, Köln ; Brustzentrum der Universität München, Frauenkliniken Großhadern und Maistrasse-Innenstadt, München
| | - R Würstlein
- Brustzentrum, Universitäts-Frauenklinik Köln, Köln ; Brustzentrum der Universität München, Frauenkliniken Großhadern und Maistrasse-Innenstadt, München
| | - J-U Deuker
- Vinzenzkrankenhaus Hannover gGmbH, Hannover
| | - P Dall
- Frauenklinik, Klinikum Lüneburg, Lüneburg
| | - B Richter
- Elblandkliniken Meißen-Radebeul Standort Radebeul, Radebeul
| | | | - C Brucker
- Universitätsklinik für Frauenheilkunde, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - J W Siebers
- Frauenklinik des St. Josefsklinik Offenburg, Offenburg
| | - N Fersis
- Frauenklinik, Klinikum Bayreuth GmbH, Comprehensive Cancer Center Erlangen-EMN, Bayreuth
| | - T Kuhn
- Karl-Olga-Krankenhaus, Stuttgart
| | - C Wolf
- Medizinisches Zentrum Ulm, Ulm
| | | | - G-P Breitbach
- Städtisches Klinikum Neunkirchen Gynäkologie und Geburtshilfe, Neunkirchen
| | - W Janni
- Frauenklinik des Universitätsklinikums Ulm, Ulm
| | - R Landthaler
- Gynäkologische Praxis in der Kreisklinik, Krumbach
| | - A Kohls
- Evangelisches Krankenhaus Ludwigsfelde-Teltow, Ludwigsfelde
| | - D Rezek
- Marien-Hospital Wesel, Wesel
| | - T Noesslet
- Frauenklinik am Kreiskrankenhaus Hameln, Hameln
| | - G Fischer
- Landkreis Mittweida Krankenhaus gGmbH, Mittweida
| | - S Henschen
- Johanniter Krankenhaus Genthin Stendal gGmbH, Stendal
| | - T Praetz
- Praxis Dr. Praetz, Bad Mergentheim
| | - V Heyl
- Asklepios Paulinen Klinik Wiesbaden, Wiesbaden
| | - T Kühn
- Frauenklinik, Städtische Kliniken Esslingen a. N., Esslingen
| | | | - C Thomssen
- Frauenklinik, Universitätsklinik Halle Wittenberg, Halle
| | - S Kümmel
- Brustzentrum, Kliniken Essen Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen
| | - A Hohn
- Kreiskrankenhaus Rendsburg, Rendsburg
| | - H Tesch
- Onkologie Bethanien, Frankfurt
| | - C Mundhenke
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel
| | - A Hein
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - C Rauh
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - C M Bayer
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
| | - A Jacob
- Novartis Pharma GmbH, Nürnberg
| | | | | | - P Hadji
- Krankenhaus Nordwest, Klinik für Gynäkologie und Gebursthilfe, Frankfurt
| | | | | | - M W Beckmann
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen
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von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Gerber B, Gnauert K, Heinrich B, Prätz T, Groh U, Tanzer H, Villena C, Tulusan A, Liedtke B, Blohmer JU, Kittel K, Mau C, Potenberg J, Schilling J, Just M, Weiss E, Bückner U, Wolfgarten M, Lorenz R, Doering G, Feidicker S, Krabisch P, Deichert U, Augustin D, Kunz G, Kast K, von Minckwitz G, Nestle-Krämling C, Rezai M, Höß C, Terhaag J, Fasching P, Staib P, Aktas B, Kühn T, Khandan F, Möbus V, Solbach C, Tesch H, Stickeler E, Heinrich G, Wagner H, Abdallah A, Dewitz T, Emons G, Belau A, Rethwisch V, Lantzsch T, Thomssen C, Mattner U, Nugent A, Müller V, Noesselt T, Holms F, Müller T, Deuker JU, Schrader I, Strumberg D, Uleer C, Solomayer E, Runnebaum I, Link H, Tomé O, Ulmer HU, Conrad B, Feisel-Schwickardi G, Eidtmann H, Schumacher C, Steinmetz T, Bauerfeind I, Kremers S, Langanke D, Kullmer U, Ober A, Fischer D, Kohls A, Weikel W, Bischoff J, Freese K, Schmidt M, Wiest W, Sütterlin M, Dietrich M, Grießhammer M, Burgmann DM, Hanusch C, Rack B, Salat C, Sattler D, Tio J, von Abel E, Christensen B, Burkamp U, Köhne CH, Meinerz W, Graßhoff ST, Decker T, Overkamp F, Thalmann I, Sallmann A, Beck T, Reimer T, Bartzke G, Deryal M, Weigel M, Huober J, Weder P, Steffens CC, Lemster S, Stefek A, Ruhland F, Hofmann M, Schuster J, Simon W, Kronawitter U, Clemens M, Fehm T, Janni W, Latos K, Bauer W, Roßmann A, Bauer L, Lampe D, Heyl V, Hoffmann G, Lorenz-Salehi F, Hackmann J, Schlag R. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†. Ann Oncol 2014; 25:2363-2372. [PMID: 25223482 DOI: 10.1093/annonc/mdu455] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER NCT 00567554, www.clinicaltrials.gov.
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Affiliation(s)
- G von Minckwitz
- Headquarter, German Breast Group, Neu-Isenburg; Department of Gynaecology and Obstetrics, University Hospital, Frankfurt.
| | - S Loibl
- Headquarter, German Breast Group, Neu-Isenburg
| | - M Untch
- Department of Gynaecology and Obstetrics, Klinikum Berlin-Buch, Berlin
| | - H Eidtmann
- Department of Gynaecology and Obstetrics, University Hospital, Kiel
| | - M Rezai
- Breast Center, Luisenkrankenhaus, Düsseldorf
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University Hospital, Erlangen
| | - H Tesch
- Department of Medical Oncology, Chop GmbH, Frankfurt
| | - H Eggemann
- Department of Gynaecology and Obstetrics, University Hospital, Magdeburg
| | - I Schrader
- Department of Gynaecology and Obstetrics, Henriettenstiftung, Hannover
| | - K Kittel
- Department of Gynaecology and Obstetrics, Praxisklinik, Berlin
| | - C Hanusch
- Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, München
| | - J Huober
- Department of Gynaecology and Obstetrics, University Hospital, Ulm
| | - C Solbach
- Department of Gynaecology and Obstetrics, University Hospital, Frankfurt
| | - C Jackisch
- Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach
| | - G Kunz
- Department of Gynaecology and Obstetrics, St Johannes Hospital, Dortmund
| | - J U Blohmer
- Department of Gynaecology and Obstetrics, St Gertrauden-Hospital, Berlin
| | - M Hauschild
- Department of Gynaecology and Obstetrics, Hospital, Rheinfelden
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital, Tübingen
| | | | - B Gerber
- Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany
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Liedtke C, Goerlich D, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Staebler A, Minckwitz GV, Untch M, Kühn T. Validierung eines Nomogramms zur Prädiktion von Non-Sentinellymphknoten-Metastasen bei Patientinnen mit primär-systemischer Therapie (PST) – eine transSENTINA Substudie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388447] [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: 10/24/2022] Open
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di Giuseppe R, Kühn T, Hirche F, Buijsse B, Dierkes J, Fritsche A, Kaaks R, Boeing H, Stangl G, Weikert C. Circulating plasma fibroblast growth factor-23 is associated with hemorrhagic but not with ischemic stroke: Results from a german population study. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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