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Gampenrieder SP, Dezentjé V, Lambertini M, de Nonneville A, Marhold M, Le Du F, Cortés Salgado A, Alpuim Costa D, Vaz Batista M, Chic Ruché N, Tinchon C, Petzer A, Blondeaux E, Del Mastro L, Targato G, Bertucci F, Gonçalves A, Viret F, Bartsch R, Mannsbart C, Deleuze A, Robert L, Saavedra Serrano C, Gion Cortés M, Sampaio-Alves M, Vitorino M, Pecen L, Singer C, Harbeck N, Rinnerthaler G, Greil R. Influence of HER2 expression on prognosis in metastatic triple-negative breast cancer-results from an international, multicenter analysis coordinated by the AGMT Study Group. ESMO Open 2023; 8:100747. [PMID: 36563519 PMCID: PMC10024122 DOI: 10.1016/j.esmoop.2022.100747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is associated with poor prognosis, and new treatment options are urgently needed. About 34%-39% of primary TNBCs show a low expression of human epidermal growth factor receptor 2 (HER2-low), which is a target for new anti-HER2 drugs. However, little is known about the frequency and the prognostic value of HER2-low in metastatic TNBC. PATIENTS AND METHODS We retrospectively included patients with TNBC from five European countries for this international, multicenter analysis. Triple-negativity had to be shown in a metastatic site or in the primary breast tumor diagnosed simultaneously or within 3 years before metastatic disease. HER2-low was defined as immunohistochemically (IHC) 1+ or 2+ without ERBB2 gene amplification. Survival probabilities were calculated by the Kaplan-Meier method, and multivariable hazard ratios (HRs) were estimated by Cox regression models. RESULTS In total, 691 patients, diagnosed between January 2006 and February 2021, were assessable. The incidence of HER2-low was 32.0% [95% confidence interval (CI) 28.5% to 35.5%], with similar proportions in metastases (n = 265; 29.8%) and primary tumors (n = 425; 33.4%; P = 0.324). The median overall survival (OS) in HER2-low and HER2-0 TNBC was 18.6 and 16.1 months, respectively (HR 1.00; 95% CI 0.83-1.19; P = 0.969). Similarly, in multivariable analysis, HER2-low had no significant impact on OS (HR 0.95; 95% CI 0.79-1.13; P = 0.545). No difference in prognosis was observed between HER2 IHC 0/1+ and IHC 2+ tumors (HR 0.89; 95% CI 0.69-1.17; P = 0.414). CONCLUSIONS In this large international dataset of metastatic TNBC, the frequency of HER2-low was 32.0%. Neither in univariable nor in multivariable analysis HER2-low showed any influence on OS.
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Affiliation(s)
- S P Gampenrieder
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - V Dezentjé
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Lambertini
- Medical Oncology Department, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università di Genova, Genova, Italy
| | - A de Nonneville
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - M Marhold
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - F Le Du
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - A Cortés Salgado
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Alpuim Costa
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal; NOVA Medical School, (NMS), Faculdade de Ciências Médicas (FCM), Lisbon, Portugal; Centro de Medicina Subaquática e Hiperbárica (CMSH), Marinha Portuguesa, Lisbon, Portugal
| | - M Vaz Batista
- Oncology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - N Chic Ruché
- Department of Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | - C Tinchon
- Department for Haemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - A Petzer
- Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern-Elisabethinen, Linz, Austria
| | - E Blondeaux
- U.O. Epidemiology Unit, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy
| | - L Del Mastro
- Medical Oncology Department, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università di Genova, Genova, Italy
| | - G Targato
- Dipartimento di Oncologia, Ospedale Santa Maria della Misericordia di Udine, Udine, Italy
| | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - F Viret
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - R Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - C Mannsbart
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - A Deleuze
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - L Robert
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - C Saavedra Serrano
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Gion Cortés
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Sampaio-Alves
- Faculdade de Medicina, Universidade do Porto (FMUP), Oporto, Portugal
| | - M Vitorino
- Oncology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - L Pecen
- Institute of Computer Science, Czech Academy of Sciences, Praha, Czech Republic; Faculty of Medicine in Pilsen - Charles University, Pilsen, Czech Republic
| | - C Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - N Harbeck
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany
| | - G Rinnerthaler
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Greil
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Ameri P, Schnabel RB, Pecen L, Diemberger I, Gwechenberger M, Siller-Matula J, Kirchhof P, De Caterina R. Two-year outcomes of patients with atrial fibrillation and heart failure: the ETNA-AF-Europe registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.619] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is an established risk factor for stroke and systemic embolic events (SEE) in subjects with atrial fibrillation (AF), but it is debated whether this risk varies according to left ventricular ejection fraction (LVEF).
Methods
We investigated the impact of HF in the ETNA-AF-Europe registry, a prospective, multi-centre, post-authorisation, observational study enrolling patients treated with edoxaban for AF in 825 sites from 10 European countries. This 2-year follow-up analysis is based on a data snapshot from 26 October 2020. HF was defined as a) history of HF or b) ischaemic cardiomyopathy or c) EF <40% or d) dyspnoea not due to chronic obstructive pulmonary disease together with ≥1 of the following: ischaemic heart disease, valvular heart disease, or hypertension treated with ≥3 drugs. Patients' characteristics are summarised descriptively and clinical outcomes are reported as annualised event rates. The hazard ratio (HR) with 95% confidence intervals (CI) for the association of HF with the outcomes was assessed in Cox regression models with stepwise variable selection.
Results
Of the 13,133 patients, 1,854 (14.1%) had HF; LVEF was available for 1,489 (80.3%), and was <40% in 671 (43.9%) and ≥40% in 857 (56.1%). Patients with HF were more often men and slightly older than those without (Table 1). As expected, they also had more cardiovascular (CV) comorbidities and higher CHA2DS2-VASC and, to a lesser extent, HAS-BLED scores (Table 1). At the end of the 2-year follow-up, the rates of ischaemic stroke/transient ischaemic attack (TIA)/SEE, major bleeding, intracranial haemorrhage (ICH), CV death, and all-cause death were higher in patients with than without HF (Figure 1).
When patients with HF were categorized according to LVEF, ischaemic stroke/TIA/SEE was more frequent in those with LVEF ≥40% vs those with LVEF <40%. By contrast, more patients with LVEF <40% died due to any as well as CV causes. The rates of major bleeding and ICH were comparable between the two subgroups (Figure 1).
Univariable Cox regression analysis confirmed the association of HF with major bleeding (HR 2.01, 95% CI [1.49–2.71]) and all-cause death (2.62 [2.28–3.02]), but not with ischaemic stroke/TIA/SEE (1.06 [0.72–1.55]). The results were consistent when LVEF was taken into account: the HRs for LVEF <40% or LVEF ≥40%, respectively, were 1.60 (0.99–2.60) and 1.55 (1.02–2.38) for major bleeding, 2.11 (1.69–2.63) and 1.59 (1.28–1.97) for all-cause death, and 0.66 (0.31–1.41) and 1.19 (0.71–1.98) for ischaemic stroke/TIA/SEE.
Conclusions
In this real-world, large cohort of patients with AF on edoxaban, those with HF at baseline faced more ischaemic, bleeding, and death events, and having HF increased the risk of major bleeding and death, with no differences according to LVEF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This research was funded by Daiichi Sankyo Europe.
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Affiliation(s)
- P Ameri
- University of Genova, Department of Internal Medicine , Genova , Italy
| | - R B Schnabel
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - L Pecen
- The Czech Academy of Sciences, Institute of Computer Science , Prague , Czechia
| | - I Diemberger
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES , Bologna , Italy
| | - M Gwechenberger
- Medical University of Vienna, Division of Cardiology, Department of Internal Medicine II , Vienna , Austria
| | - J Siller-Matula
- Medical University of Vienna, Division of Cardiology, Department of Internal Medicine II , Vienna , Austria
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - R De Caterina
- University of Pisa, Chair of Cardiology , Pisa , Italy
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De Caterina R, Unverdorben M, Lee BC, Yamashita T, Lin WS, Wang CC, Pecen L, Borrow A, Chen C, Kirchhof P. Real-world effectiveness and safety of edoxaban in patients with and without a history of ischaemic stroke: results from the ETNA-AF programme. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2702] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) patients with a history of ischaemic stroke (IS) have a higher risk for recurrent IS events and were largely excluded from the pivotal, randomised, controlled phase 3 trials on oral anticoagulants. Thus, the effectiveness and safety of edoxaban in these patients need to be studied in a real-world setting.
Purpose
To compare edoxaban real-world effectiveness and safety in AF patients with or without an IS history.
Methods
The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients receiving edoxaban for stroke prevention. This snapshot analysis summarises baseline characteristics with medical history and 2-year annualised rates of all-cause death, cardiovascular (CV) death, stroke (haemorrhagic, ischaemic, any), and bleeding (including major bleeding [MB], major gastrointestinal [GI] bleeding, intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding [CRNMB], and any bleeding) in patients with or without IS history.
Results
Data from 27,333 patients (3215 with prior IS and 24,118 without) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with IS history were significantly older, more likely ≥75 years of age, and had a lower mean body weight and creatinine clearance (P<0.0001 for all; Table). Patients with IS history also had significantly higher baseline stroke (CHA2DS2-VASc) and bleeding (HAS-BLED) risk scores (P<0.0001 for both; Table). A significantly higher percentage of patients with IS history had previous transient ischaemic attacks (TIA), MB, and ICH (P<0.0001 for all; Table). Patients with IS history more likely received edoxaban 30 mg vs 60 mg at baseline (P<0.0001). Effectiveness and safety outcomes hazard ratios are shown in the Figure. Patients with IS history had significantly higher rates of all-cause death (4.5% vs 3.0%; P<0.0001), CV death (1.9% vs 1.4%; P=0.004), IS (2.5% vs 0.5%; P<0.0001), any stroke (3.1% vs 0.7%; P<0.0001), and TIA (0.5% vs 0.2%; P=0.0002). Patients with IS history had significantly higher annualised rates of MB (1.6% vs 1.0%; P<0.0001), major GI bleeding (0.8% vs 0.5%; P=0.003), ICH (0.6% vs 0.3%; P<0.0001), haemorrhagic stroke (0.5% vs 0.2%; P<0.0001), CRNMB (2.3% vs 1.3%; P<0.0001), and any bleeding (6.1% vs 4.1%; P<0.0001).
Conclusions
Patients with AF who have a history of IS are more likely elderly; have histories of MB, ICH, and TIA; and have high baseline stroke and bleeding risk scores. Patients with IS history receiving edoxaban have a considerably higher likelihood of experiencing IS or TIA, whereas the risk of experiencing any bleeding event (with the exception of ICH) is only modestly higher than in those without IS history.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo
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Affiliation(s)
- R De Caterina
- University of Pisa and Pisa University Hospital , Pisa , Italy
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - B C Lee
- Hallym University Sacred Heart Hospital , Anyang , Korea (Republic of)
| | | | - W S Lin
- Tri-Service General Hospital and National Defense Medical Center , Taipei , Taiwan
| | - C C Wang
- Linkou Chang Gung Memorial Hospital and Chang Gung University , Taoyuan , Taiwan
| | - L Pecen
- Institute of Computer Science ASCR , Prague , Czechia
| | - A Borrow
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - P Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham , Birmingham , United Kingdom
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De Vries TAC, Pecen L, Komen JJ, De Groot JR, Kirchhof P, De Caterina R. The association between dyslipidaemia treatment and the risk of clinical events in edoxaban-treated patients with atrial fibrillation: insights from the 2-year follow-up of ETNA-AF-Europe. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.618] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Dyslipidaemia is a major risk factor for cardiovascular (CV) events. This increased risk can be attenuated with lipid-lowering therapies (LLT), such as statins, which are associated with a relative risk reduction of CV events of 22% for each 1 mmol/L reduction in low-density lipoprotein cholesterol.
Purpose
To explore the association between use of LLT and clinical outcomes in routine practice patients with atrial fibrillation (AF) receiving edoxaban.
Methods
ETNA-AF-Europe is a prospective, multi-centre, post-authorisation, observational cohort study conducted in 825 centres, enrolling routine practice patients with AF treated with edoxaban in 10 European countries. This registry is still ongoing and patients are to be followed-up annually for 4 years after enrollment. In the current sub-study, on the now available first 2 years of follow-up, patients were categorised by use of LLT at baseline. We used Cox proportional hazards models to determine the associations between LLT use and adverse clinical events, including the composite of any stroke and systemic embolic events (SEE), major bleeding, and death, after adjusting for confounding factors at baseline.
Results
Of 13,133 patients with AF, 36.3% (n=4761) used LLT at baseline. Among those receiving LLT, 90.7% received statins only and 3.6% received combination therapy with a statin. Most patients in both treatment groups were 65 years or older and had one or more CV-risk factors aside from a history of AF. Patients receiving LLT were older and had a higher prevalence of CV co-morbidities (including diabetes, hypertension, peripheral artery disease and coronary heart disease) than those who did not receive LLT (Table 1).
After correction for confounders, treatment with LLT was associated with a significantly lower rate of any stroke or SEE (HR: 0.61; 95% CI: 0.42–0.88), ischaemic stroke (HR: 0.54; 95% CI: 0.35–0.83), all-cause death (HR: 0.73; 95% CI: 0.63–0.85) and CV-death (HR: 0.73; 95% CI: 0.60–0.90), but not with bleeding events or myocardial infarction (Figure 1).
Conclusion
These findings suggest a protective effect of LLT on the risk of stroke in anticoagulated patients with AF, although an overall better CV risk management in these patients probably contributed to this reduced risk. Notably, both mono- and combination-LLT were seemingly underused in our cohort, highlighting the potential for further reductions of CV risks in the AF patients seen in our clinics.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This research was funded by Daiichi Sankyo Europe.
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Affiliation(s)
- T A C De Vries
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - L Pecen
- The Czech Academy of Sciences, Institute of Computer Science , Prague , Czechia
| | - J J Komen
- Daiichi Sankyo Netherlands , Amsterdam , The Netherlands
| | - J R De Groot
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - R De Caterina
- University of Pisa, Chair of Cardiology , Pisa , Italy
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Siller-Matula J, Unverdorben M, Wang CC, Koretsune Y, Pecen L, Borrow A, Chen C, Kirchhof P, De Caterina R. The real-world effectiveness and safety of edoxaban treatment in 27,333 Global ETNA-AF programme patients with and without a history of heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2700] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure (HF) occurs in approximately 26% of patients with atrial fibrillation (AF). Real-world data of oral anticoagulation with edoxaban in AF patients with HF history are limited.
Purpose
To compare edoxaban effectiveness and safety in AF patients with or without HF history.
Methods
The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients receiving edoxaban for stroke prevention. This snapshot analysis summarises baseline characteristics and 2-year annualised rates of all-cause death, cardiovascular (CV) death, stroke (haemorrhagic, ischaemic, any), and bleeding (major bleeding [MB], major gastrointestinal [GI] bleeding, intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding [CRNMB], and any bleeding) in patients with or without HF history. Univariate Cox regression models assessed clinical outcomes.
Results
Data from 27,333 patients (5258 with HF history) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with HF history were significantly older and had lower mean body weight and creatinine clearance (P<0.0001 all; Table). Patients with HF history had significantly higher baseline stroke (CHA2DS2-VASc) and bleeding (HAS-BLED) risk scores (P<0.0001 both; Table). Significantly more patients with HF history reported previous experiences with MB (P=0.001) and major GI bleeding (P=0.007); these patients were also more likely to receive 30 mg edoxaban vs 60 mg edoxaban (P<0.0001; Table). Patients with HF history had significantly (P<0.0001 both) higher rates of all-cause (6.1% vs 2.5%; hazard ratio [HR] (95% confidence interval [CI]), 2.41 [2.17–2.68]) and CV death (2.8% vs 1.2%; HR [95% CI], 2.39 [2.05–2.80]), and fatal bleeding (0.3% vs 0.2%; HR [95% CI], 1.86 [1.20–2.89]; Figure). The proportion of all-cause deaths that were fatal bleeding events was 6% and 7% for patients with and without HF, respectively. Additionally, patients with HF history had significantly (P<0.0001 both) higher rates of MB (1.7% vs 0.9%; HR [95% CI], 1.87 [1.53–2.28]) and major GI bleeding (1.1% vs 0.4%; HR [95% CI], 2.69 [2.07–3.49]), with a greater proportion of MB events classified as major GI bleeding (64.5% vs 44.8%; P<0.0001). Patients with HF history also had significantly (P<0.0001 both) higher rates of CRNMB (HR [95% CI], 1.87 [1.58–2.21]) and any bleeding (HR [95% CI], 1.49 [1.34–1.65]). Rates of ICH and haemorrhagic stroke were similar in both groups.
Conclusions
In AF patients receiving edoxaban, the rates of MB, major GI bleeding, and CV or all-cause death were higher when comparing those with versus without HF history. The higher incidence of MB and major GI bleeding in patients with HF history did not lead to proportionally higher fatal bleeding rates among all-cause deaths.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo
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Affiliation(s)
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - C C Wang
- Linkou Chang Gung Memorial Hospital and Chang Gung University , Taoyuan , Taiwan
| | | | - L Pecen
- Institute of Computer Science ASCR , Prague , Czechia
| | - A Borrow
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - P Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham , Birmingham , United Kingdom
| | - R De Caterina
- University of Pisa and Pisa University Hospital , Pisa , Italy
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De Vries TAC, Pecen L, Komen JJ, Diemberger I, Fumagalli S, De Groot JR, Kirchhof P, De Caterina R. Perceived frailty and clinical outcomes in men and women with atrial fibrillation treated with edoxaban: insights from the 2-year follow-up of ETNA-AF-Europe. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2544] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Many clinicians estimate the frailty of patients solely using their clinical expertise instead of validated scores. Previous reports show that women are more often perceived as frail than men. It is uncertain whether the same trend is observed in patients with atrial fibrillation (AF) and if the association between perceived frailty and adverse clinical outcomes is affected by sex.
Purpose
To assess whether sex affects the association between frailty status and adverse clinical outcomes in patients with AF.
Methods
ETNA-AF-Europe is an ongoing, post-authorisation, prospective cohort study conducted in 825 centres enrolling patients with AF treated with edoxaban in 10 European countries. In this substudy on the first 2-years of follow-up, patients were categorised in four subgroups based on sex and clinician-perceived frailty at baseline. We calculated incidence rates (per 100 patient-years) of the composite endpoint of any stroke or systemic embolic event (SEE), of major bleeding, and of all-cause death for the four subgroups; and determined the unadjusted association between perceived frailty (frail vs non-frail) and each outcome, stratified by sex, using Cox proportional hazards models. To assess for consistency in our findings, we tested the same associations by sex category but using objective risk factors: age (>74 vs <65 years) and CHA2DS2-VASc score (≥4 vs <4).
Results
Information about frailty-status was recorded for 12,254 (93.3%) patients, of whom 8.5% of men and 15.4% of women were perceived as frail by their clinician (p<0.0001) (Table 1). For both sex categories calculated separately, the risk of any stroke or SEE, major bleeding, or all-cause death was higher in the frail than in the non-frail patients (Figure 1A). However, the difference in risks of stroke or SEE between frail and non-frail patients was greater for men (HR 3.77, 95% confidence interval [CI] 2.25–6.31) than for women (HR 2.18, 95% CI 1.34–3.55) and a similar trend toward a greater risk-difference for men was seen for the risk of all-cause death (HR 4.58, 95% CI 3.76–5.59 vs HR 3.63, 95% CI 2.94–4.49). There was no marked difference between sex categories in the association between frailty-status and major bleeding (HR 2.86, 95% CI 1.81–4.50 vs HR 2.56, 95% CI 1.68–3.90) (Figure 1A). The association of age or CHA2DS2-VASc subgroups with clinical outcomes were either similar between sexes or suggested a possible lower risk-difference for men (Figure 1B and 1C).
Conclusion
In our cohort, differences in the risks of clinical outcomes between those who were perceived as frail and those who were not is more pronounced for men than women. Because we did not observe similar trends in the associations between age or CHA2DS2-VASc score subgroups and clinical outcomes, our results indicate that clinicians perceive the extent of frailty differently in men than in women.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This research was funded by Daiichi Sankyo Europe.
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Affiliation(s)
- T A C De Vries
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - L Pecen
- The Czech Academy of Sciences, Institute of Computer Science , Prague , Czechia
| | - J J Komen
- Daiichi Sankyo Netherlands , Amsterdam , The Netherlands
| | - I Diemberger
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine – DIMES , Bologna , Italy
| | - S Fumagalli
- University of Florence, Department of Experimental and Clinical Medicine , Florence , Italy
| | - J R De Groot
- Amsterdam University Medical Center, Department of Cardiology , Amsterdam , The Netherlands
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - R De Caterina
- University of Pisa, Chair of Cardiology , Pisa , Italy
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7
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Patti G, Pecen L, Casalnuovo G, Kirchhof P, De Caterina R. Clinical outcomes in patients with atrial fibrillation with or without concomitant diabetes after two years of edoxaban treatment: ETNA-AF-Europe registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2405] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Concomitant diabetes mellitus (DM) in patients with atrial fibrillation (AF) has been associated with a higher risk of stroke/systemic embolic events (SEE), and higher mortality.
Purpose
To evaluate effectiveness and safety outcomes in AF patients with different types of concomitant DM vs those without concomitant DM after 2 years of edoxaban treatment in a sub-analysis of the prospective ETNA-AF-Europe registry.
Methods
Patients with AF who received edoxaban once daily were enrolled across 825 centres in 10 European countries. This sub-analysis is based on a data snapshot from 26th October 2020. Patients were grouped by DM status (with or without DM; insulin-treated or non-insulin-treated DM). Baseline characteristics are summarised descriptively. Kaplan-Meier (KM) survival curves of outcomes were constructed; annualised event rates (AERs; %/year) and comparisons between patients with or without DM by univariate analysis are presented. Comparisons of patients with insulin- vs non-insulin-treated DM were made by multivariate analysis adjusted for HbA1c.
Results
Patients' demographics and baseline characteristics are shown in Table 1. Of 13,133 patients with AF, 2885 (22.0%) had DM. Among patients with DM, 2756 (95.6%) received treatment: 605 (22.0%) with insulin and 2151 (78.0%) with non-insulin treatments. KM curves for effectiveness and safety outcomes are shown in Figure 1. AERs (%/year) of ischaemic stroke/transient ischaemic attack (TIA)/SEE were 0.86% in patients with AF and no DM, 0.87% with non-insulin-treated DM (p=0.9216 vs no DM) and 1.81% with insulin-treated DM (p=0.0022 vs no DM; p=0.0014 vs non-insulin-treated DM). AERs of myocardial infarction (MI) were 0.40%, 0.43% (p=0.7454 vs no DM), and 1.04% (p=0.0033 vs no DM) respectively; of major bleeding were 0.90%, 1.10% (p=0.2427 vs no DM), and 1.71% (p=0.0106 vs no DM), respectively; and of all-cause death were 3.36%, 5.02% (p<0.0001 vs no DM), and 8.91% (p<0.0001 vs no DM) respectively. In a multivariate analysis of DM patients adjusted for HbA1c (patients with AF and DM with HbA1c measured, n=1869), patients with AF and insulin-treated DM had a higher risk of stroke/TIA/SEE (HbA1c adjusted HR [95% CI]: 2.13 [1.12–4.05], p=0.0205) and all-cause death (1.83 [1.35–2.49], p=0.0001) vs those with non-insulin-treated DM; no significant difference in the risk of MI (2.10 [0.78–5.66], p=0.1448) or major bleeding (1.81 [0.95–3.44], p=0.0706) was detected between the groups.
Conclusion
In patients with AF and DM, risk of stroke/TIA/SEE, MI and major bleeding was confined to insulin-treated DM patients only. These patients also had poorer survival rates vs those without DM and those with non-insulin-treated DM, reinforcing previously published data showing a strong association between insulin treatment and poorer outcomes, and a mild/absent association between non-insulin treatments and poorer outcomes in patients with AF and DM.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This research was funded by Daiichi Sankyo Europe.
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Affiliation(s)
- G Patti
- Maggiore della Carità Hospital, Department of Thoracic and Cardiovascular Diseases , Novara , Italy
| | - L Pecen
- The Czech Academy of Science, Institute of Computer Science , Prague , Czechia
| | | | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - R De Caterina
- University of Pisa, Chair of Cardiology , Pisa , Italy
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Russo V, Wang CC, Unverdorben M, Yamashita T, Pecen L, Borrow A, Chen C, Kirchhof P, De Caterina R. Two-year effectiveness and safety outcomes in 27,333 edoxaban-treated patients with and without a history of major bleeding from the Global ETNA-AF programme. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2701] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation patients with a history of major bleeding (MB) are at high risk of future bleeding events; this history was an exclusion criterion in pivotal phase 3 trials of anticoagulation for stroke prevention. Real-world edoxaban effectiveness and safety in patients with a history of MB were analysed from the global ETNA programme.
Purpose
To compare edoxaban effectiveness and safety in AF patients with or without an MB history.
Methods
The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients treated with edoxaban for stroke prevention. This snapshot analysis summarises global baseline characteristics and 2-year annualised rates of all-cause death, cardiovascular death, stroke (haemorrhagic, ischaemic, any), and bleeding (including MB, major gastrointestinal bleeding [MGIB], intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding, and any bleeding) in patients with or without MB history.
Results
Data from 27,333 patients (479 with MB history and 26,854 without) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with MB history were significantly older (P<0.0001) and more likely to be ≥75 years of age (P=0.0003), to be male (P=0.024), and to have a lower body weight and creatinine clearance (P<0.0001 for both) (Table). Globally, antiplatelet use was significantly higher in patients with MB history compared with patients without (P=0.005). Patients with MB history were more likely to have previously diagnosed heart failure (HF, P=0.001) and to receive 30 mg vs 60 mg edoxaban at baseline (P<0.0001). Hazard ratios for effectiveness and safety outcomes are shown in the Figure. Patients with MB history had significantly higher annualised rates of all-cause death (5.7% vs 3.1%; P<0.0001), ischaemic stroke (1.8% vs 0.7%; P=0.002), and any stroke (3.1% vs 0.9%; P<0.0001) than patients without MB history. Patients with MB history also had significantly higher annualised rates of MB (3.6% vs 1.0%; P<0.0001), MGIB (1.5% vs 0.5%; P=0.001), ICH (1.5% vs 0.3%; P<0.0001), fatal bleeding (0.9% vs 0.2%; P<0.0001), and fatal ICH (0.5% vs 0.1%; P=0.0002). Among patients with MB history, the annualised rate of ICH did not differ between patients with ICH history (1.42%/yr) vs without (1.65%/yr); whereas the annualised rate of MGIB was significantly higher in patients with MGIB history vs without (4.14%/yr vs 1.08%/yr; P=0.0337).
Conclusions
Patients with AF receiving edoxaban and who have a history of MB are more likely elderly, male, and have comorbidities, including HF. These patients are also more susceptible to any adverse cardiovascular event. ICH event rates were not higher in patients with prior ICH than those with non-ICH major bleedings, whereas history of MGIB was associated with a high risk of MGIB recurrence.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo
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Affiliation(s)
- V Russo
- University of Campania Luigi Vanvitell , Naples , Italy
| | - C C Wang
- Linkou Chang Gung Memorial Hospital and Chang Gung University , Taoyuan , Taiwan
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | | | - L Pecen
- Institute of Computer Science ASCR , Prague , Czechia
| | - A Borrow
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge , NJ , United States of America
| | - P Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham , Birmingham , United Kingdom
| | - R De Caterina
- University of Pisa and Pisa University Hospital , Pisa , Italy
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9
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Moser J, Unverdorben M, Wang CC, Bruggenjurgen B, Lee BC, Chen C, Pecen L, Yamashita T, De Caterina R, Kirchhof P. Effectiveness and safety of edoxaban in 27,333 patients from ETNA-AF with and without a history of intracranial haemorrhage after 2 years of treatment. Europace 2022. [DOI: 10.1093/europace/euac053.288] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo, Inc. Medical writing and editorial support were provided by Atreju Lackey, PhD of AlphaBioCom, LLC, and funded by Daiichi Sankyo, Inc.
Background/Introduction
Once-daily edoxaban significantly reduced the risk of intracranial haemorrhage (ICH) compared with well-managed warfarin in atrial fibrillation (AF) patients in the ENGAGE AF-TIMI 48 trial. The effectiveness and safety of edoxaban in patients with prior ICH is unknown.
Purpose
To compare the effectiveness and safety of edoxaban in AF patients with or without a history of ICH.
Methods
The Global ETNA-AF programme is composed of and, thus, integrates data from multiple prospective, observational, and noninterventional regional studies collecting data of AF patients treated with edoxaban for stroke prevention. This snapshot analysis presents global and regional baseline characteristics with medical history and 2-year annualised rates of all-cause mortality, stroke (haemorrhagic, ischaemic, any), and bleeding (major bleeding [MB] including ICH, clinically relevant nonmajor bleeding [CRNMB], any bleeding), in patients with or without ICH history.
Results
Overall, 27,333 patients from Europe, Japan, South Korea, and Taiwan were analysed, including 367 with prior ICH and 26,966 without prior ICH. There were proportionally fewer patients with a history of ICH in the European population. Patients with a history of ICH were older (P=0.006), had a lower body mass index (P<0.0001), had a lower creatinine clearance (P=0.0001), and had more comorbidities, with a higher percentage of patients with a history of stroke, transient ischaemic attack (TIA), or MB (Table 1); the higher level of comorbidities noted in patients with a history of ICH was also reflected by higher baseline CHA2DS2-VASc and HAS-BLED scores (Table 1). Patients with a history of ICH were more likely receiving 30 mg edoxaban at baseline, whereas patients without ICH history were more often on 60 mg edoxaban (each P<0.0001). In patients with vs without ICH history, all-cause mortality (5.10% vs 3.14%; P=0.01), ischaemic stroke (1.79% vs 0.73%; P=0.006), and any stroke rates (3.25% vs 0.95%; P<0.0001) were higher (Table 2). Patients with vs without ICH history had higher annualised rates of MB (2.50% vs 1.00%; P=0.001), ICH (1.42% vs 0.27%; P<0.0001), haemorrhagic stroke (1.42% vs 0.20%; P<0.0001), CRNMB (2.49% vs 1.40%; P=0.04), and any bleeding (7.57% vs 4.27%; P=0.001), but these rates were low compared to other high-risk populations. ICH was not selected as a predictor of cardiovascular outcomes on multivariate prediction modelling. ICH had non-significant effects in predicting all-cause death (HR 1.22), ischemic stroke (HR 1.14), and major bleeding (HF 1.37) and repeat ICH (HR 1.94).
Conclusions
Patients with a history of ICH are a small, elderly, multimorbid subgroup of patients with AF. Treatment with the non-vitamin K antagonist oral anticoagulant edoxaban resulted in relatively low rates of major events.
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Affiliation(s)
- J Moser
- University Heart Centre Hamburg, Department of Cardiology, Hamburg, Germany
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | - CC Wang
- Linkou Chang Gung Memorial Hospital and Chang Gung University, Division of Cardiology, Department of Internal Medicine, Taoyuan, Taiwan
| | - B Bruggenjurgen
- Steinbeis-University, Institute for Health Economics, Berlin, Germany
| | - BC Lee
- Hallym University Sacred Heart Hospital, Department of Neurology, Anyang, Korea (Republic of)
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | - L Pecen
- Institute of Computer Science ASCR, Prague, Czechia
| | - T Yamashita
- Cardiovascular Institute, Department of Cardiovascular Medicine, Tokyo, Japan
| | - R De Caterina
- University of Pisa, Department of Surgery, Medical, Molecular and Critical Area Pathology, Pisa, Italy
| | - P Kirchhof
- University Heart Centre Hamburg, Department of Cardiology, Hamburg, Germany
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Gampenrieder S, Dezentjé V, Lambertini M, de Nonneville A, Marhold M, Le Du F, Saavedra Serrano C, Alpuim Costa D, Blondeaux E, Del Mastro L, Bertucci F, Gonçalves A, Bartsch R, Deleuze A, Cortés Salgado A, Vitorino M, Tinchon C, Pecen L, Rinnerthaler G, Greil R. 177P Low HER2 expression does not influence prognosis in metastatic triple-negative breast cancer: Results from an international, multicenter analysis coordinated by the Austrian Group Medical Tumor Therapy (AGMT). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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11
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Morrone D, Chen C, Dinshaw L, Jiang W, Kim YH, Kirchhof P, Koretsune Y, Pecen L, Reimitz PE, Wang CC, Yamashita T, Unverdorben M, De Caterina R. Edoxaban treatment in real-world practice is highly concordant with ESC atrial fibrillation guidelines: results from the non-interventional global ETNA-AF program. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2980] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The ESC atrial fibrillation management guidelines recommend a risk-based approach to oral anticoagulant (OAC) therapy. How clinical practice aligns with these recommendations is of interest.
Purpose
To analyse real world data from Global ETNA-AF program in patient groups stratified by stroke and bleeding risk scores according to ESC guidelines.
Methods
Global ETNA-AF is a multicentre, prospective, noninterventional program evaluating the safety and effectiveness of edoxaban in patients from European and Asian countries. Baseline characteristics and clinical event data at 2-year follow-up were analysed in 4 subgroups defined by CHA2DS2-VASc score (≥3 for female / ≥2 for male [OAC recommended] vs 2 for female / 1 for male [OAC should be considered]) and HAS-BLED score (≥3 [Bleeding risk high] vs <3 [Bleeding risk low]) (Table 1).
Results
Of 27,616 patients included in this analysis, 23,152 (83.8%) were in the “OAC recommended” category and 3,539 (12.8%) were in the “OAC should be considered” category. Only 3.3% of patients did not meet ESC guideline criteria for OAC initiation. Among patients with high bleeding risk, 98% were in the “OAC recommended” category. A similar distribution was observed across regions (Table 2). The recommended edoxaban dose was used in the vast majority (>80%) of patients across all risk stratification subgroups. In the “OAC recommended” category, patients with high bleeding risk had higher rates of thromboembolic, bleeding, and death events than those with low bleeding risk.
Conclusion
Data from routine clinical practice in Global ETNA-AF demonstrate high concordance of edoxaban treatment with ESC guidelines. Edoxaban dose is consistent with label recommendation in the vast majority (>80%) of patients. Clinical event rates were generally low across all risk groups, including acceptable bleeding rates in anticoagulated patients with high bleeding risk.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Table 1. Subgroups as per ESC guidelinesTable 2. Patient characteristics & events
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Affiliation(s)
- D Morrone
- University Hospital of Pisa, Pisa, Italy
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge, NJ, United States of America
| | - L Dinshaw
- University Heart Center Hamburg, Hamburg, Germany
| | - W Jiang
- Daiichi Sankyo, Inc., Basking Ridge, NJ, United States of America
| | - Y.-H Kim
- Korea University, Seoul, Korea (Republic of)
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Y Koretsune
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - L Pecen
- Institute of Computer Science of the Czech Academy of Science, Prague, Czechia
| | - P.-E Reimitz
- Daiichi Sankyo Europe GmbH, Clinical Operations and Biostatistics and Data Operations, Munich, Germany
| | - C.-C Wang
- Korea University, Seoul, Korea (Republic of)
| | - T Yamashita
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge, NJ, United States of America
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12
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De Caterina R, Wang R, Shi L, Pecen L, Ye X, Reimitz PE, Chen C, Unverdorben M, Giugliano R. Effectiveness and safety of edoxaban in atrial fibrillation patients from the ETNA-AF global registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0556] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
ETNA-AF (ETNA) is a multinational, prospective, observational study evaluating the experience with edoxaban in the clinical practice of patients with atrial fibrillation (AF). ENGAGE AF-TIMI 48 was a randomized double-blind trial that tested the clinical benefits of edoxaban versus warfarin. The recommended dose is 60 mg, dose-reduced to 30 mg daily in patients with at least 1 of 3 label-indicated criteria (renal impairment [creatinine clearance: 15–≤50 mL/min], weight ≤60 kg, or concomitant use of potent P-glycoprotein inhibitors).
Purpose
We assessed whether the effectiveness and safety of edoxaban in clinical practice were consistent with findings from the pivotal randomized clinical trial.
Methods
We obtained patient-level data from ETNA and ENGAGE AF-TIMI 48. We initially extracted patients from similar geographic regions, and then used propensity-score matching (PSM) to adjust key baseline characteristic differences between studies. The primary effectiveness endpoint was all stroke or systemic embolism (SSE) and mortality; the safety endpoint was major bleeding (MB). We used Cox proportional hazards models to compare event rates for the clinical outcomes between ETNA and ENGAGE AF-TIMI 48.
Results
8,615 AF patients with CHADS2 score ≥2 received the 60 mg edoxaban recommended dose (5,462 ETNA; 3,153 ENGAGE AF-TIMI 48). After PSM, key baseline characteristics were well-balanced between the studies: mean age 71.0 years (SD: 9.07); for both ETNA and ENGAGE AF-TIMI 48 median CHA2DS2-VASc score and median HAS-BLED score were 4 and 2. The annualized incidence rate of SSE was 1.65% in ETNA vs 1.53% in ENGAGE AF-TIMI 48 (HR 0.98; 95% CI 0.49, 1.93; p=0.94). ETNA had similar annualized mortality, 2.81%, compared with ENGAGE AF-TIMI 48, 2.34%, (HR 1.49; 95% CI 0.84, 2.63; p=0.17). MB was less frequent in ETNA vs ENGAGE AF-TIMI 48 (1.10% vs 3.56%; HR 0.25; 95% CI 0.14, 0.44; p<0.05). Findings were similar for the recommended 30 mg edoxaban reduced dose.
Conclusions
The effectiveness of edoxaban in clinical practice from a large registry was consistent with efficacy findings from the randomized controlled trial. We observed a lower rate of bleeding events in the ETNA observational study compared with the ENGAGE AF-TIMI 48 trial.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo Inc.
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Affiliation(s)
- R De Caterina
- University of Pisa and Pisa University Hospital, Pisa, Italy
| | - R Wang
- Daiichi Sankyo, Basking Ridge, United States of America
| | - L Shi
- Evidera, Waltham, United States of America
| | - L Pecen
- Academy of Sciences of the Czech Republic, Institute of Informatics, Prague, Czechia
| | - X Ye
- Daiichi Sankyo, Basking Ridge, United States of America
| | | | - C Chen
- Daiichi Sankyo, Basking Ridge, United States of America
| | - M Unverdorben
- Daiichi Sankyo, Basking Ridge, United States of America
| | - R.P Giugliano
- Brigham and Women's Hospital and Harvard Medical School, Boston, United States of America
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Dinshaw L, Chen C, De Caterina R, Jiang W, Kim YH, Koretsune Y, Morrone D, Pecen L, Reimitz PE, Wang CC, Yamashita T, Unverdorben M, Kirchhof P. Temporal trend of clinical events in patients with atrial fibrillation on edoxaban therapy: results from the non-interventional global ETNA-AF program. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2979] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with atrial fibrillation (AF) who initiated vitamin K antagonist (VKA) were at highest risk of stroke and bleeding in the first few months of therapy. Understanding of the temporal trend of clinical events in AF patients on non-VKA oral anticoagulant (NOAC) therapy should aid therapeutic decisions.
Purpose
To evaluate the temporal trend of clinical events in AF patients receiving edoxaban in routine clinical practice in the Global ETNA-AF program.
Methods
Global ETNA-AF is a multicentre, prospective, noninterventional program evaluating the safety and effectiveness of edoxaban in patients from European and Asian countries. Thromboembolic, bleeding and death events were analysed separately for the 1st and 2nd year of the follow-up period, using a time-to-first-event estimation of cumulative incidence and annual rate via Kaplan-Meier method.
Results
A total of 27,617 patients were included in this analysis, 48.6% from Europe and 51.4% from Japan, Korea, and Taiwan. Baseline characteristics were consistent with typical AF population in real world studies (Table 1). Approximately 83% of patients received the recommended edoxaban dose. Annualized rates of ischaemic stroke and major bleeding (ISTH) were lower in the 2nd year than in the 1st year: ischaemic stroke 0.59% (95% CI, 0.50–0.70) vs 0.86% (95% CI, 0.75–0.98), p=0.015; major bleeding 0.87% (95% CI, 0.75–1.00) vs 1.15% (95% CI, 1.02–1.29), p=0.036. The trend toward lower rates of ischaemic stroke and major bleeding in the 2nd year was consistent across regions. All-cause mortality increased slightly from the 1st year to the 2nd year, which was not statistically significant and was not driven by cardiovascular (CV) mortality (Table 2).
Conclusion
In routine clinical practice in the Global ETNA-AF program, major bleeding and ischaemic stroke rates in >27,000 patients on edoxaban therapy declined from 1st year to 2nd year. Further analyses will investigate whether such trend is influenced by selection for healthier patients over time. Longer follow-up is needed to better understand long-term trends.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Table 1. Baseline characteristicsTable 2. Annualised clinical event rates
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Affiliation(s)
- L Dinshaw
- University Heart Center Hamburg, Hamburg, Germany
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge, NJ, United States of America
| | | | - W Jiang
- Daiichi Sankyo, Inc., Basking Ridge, NJ, United States of America
| | - Y.-H Kim
- Korea University, Seoul, Korea (Republic of)
| | - Y Koretsune
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - D Morrone
- University Hospital of Pisa, Pisa, Italy
| | - L Pecen
- Institute of Computer Science of the Czech Academy of Science, Prague, Czechia
| | - P.-E Reimitz
- Daiichi Sankyo Europe GmbH, Clinical Operations and Biostatistics and Data Operations, Munich, Germany
| | - C.-C Wang
- Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - T Yamashita
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge, NJ, United States of America
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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14
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De Caterina R, De Groot J, Weiss T, Kelly P, Monteiro P, Deharo J, De Asmundis C, Lopez-De-Sa E, Waltenberger J, Steffel J, Levy P, Bakhai A, Pecen L, Kirchhof P. Age-adjusted risk factors are independently associated with an increased risk of ischaemic stroke, transient ischaemic stroke and systemic embolism in the ETNA-AF-Europe registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0474] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Oral anticoagulation is highly effective in preventing ischaemic stroke in patients with atrial fibrillation, but 1–2% of the patients suffer an ischaemic stroke upon anticoagulation. Outcomes are further influenced by various factors, and recent research has focussed on identifying risk factors that could be helpful in predicting stroke outcomes in anticoagulated patients. This could further assist clinicians in timely identification and management of high-risk patients.
Purpose
The present analysis aims to assess the age-adjusted risk predictors of ischaemic stroke and systemic embolic events (SEE) (including transient ischaemic attack [TIA]) during two-year follow-up of unselected European patients with AF in the ETNA-AF-Europe registry.
Methods
ETNA-AF-Europe is a prospective, multi-centre, post-authorisation, observational study conducted in 825 centres enrolling patients treated with edoxaban once daily in 10 European countries. Wald Chi square tested the association between risk predictors and stroke and SEE after adjusting for age, given that age is a well-known, strong predictor of stroke.
Results
A total of 13,417 patients with AF (edoxaban 60 mg: n=10,248; edoxaban 30 mg: n=3169) completed the two-year follow-up. The mean age was 73.6±9.5 years, with ∼84% of the patients aged over 65 years. The mean weight was 81.0±17.3 kg, estimated glomerular filtration rate was 74.4±30.5 ml/min/1.73m2 and males were 56.6%. The mean CHA2DS2-VASc and HAS-BLED scores were 3.2 and 2.5, respectively.
Univariate analysis demonstrated that history of TIA at baseline was the strongest age-adjusted predictor of stroke and SEE (Wald Chi-square: 77.69; p<0.0001) (Figure 1), followed by CHA2DS2-VASc score (41.09; p<0.0001) (Figure 2), history of ischaemic stroke (29.47; p<0.0001), history of any stroke (all strokes combined including stroke of unknown/unspecified type) (29.18; p<0.0001), subjective frailty as assessed by physician (20.60; p<0.0001), and HAS-BLED score (17.22; p<0.0001).
Conclusion
History of TIA, CHA2DS2-VASc score, history of stroke, frailty and HAS-BLED score are independently associated with an increased age-adjusted risk of ischaemic stroke, TIA and SEE in anticoagulated patients with AF. These findings highlight the importance of optimising anticoagulation therapy in secondary prevention of TIA and in patients with high CHA2DS2-VASc scores, ensuring the correct use of NOACs - adherence and correct dosing - in this high-risk population. These findings also suggest that additional therapies could be needed to prevent stroke in this population.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH Figure 1. History of TIA as a predictorFigure 2. CHA2DS2-VASc score as a predictor
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Affiliation(s)
- R De Caterina
- University of Pisa, Chair of Cardiology, Pisa, Italy
| | - J.R De Groot
- Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The)
| | - T.W Weiss
- Karl Landsteiner Institute, Institute for Cardiometabolic Diseases, St. Polten, Austria
| | - P Kelly
- University College Dublin, Department of Neurology, HRB Stroke Clinical Trials Network Ireland, Dublin, Ireland
| | - P Monteiro
- Centro Hospitalar e Universitario de Coimbra, Department of Cardiology, Coimbra, Portugal
| | - J.C Deharo
- AP-HM, Aix Marseille University, Hospital Timone, Cardiologie, Rythmologie, Marseille, France
| | - C De Asmundis
- Universitair Ziekenhuis Brussels, Department of Cardiology, Brussels, Belgium
| | - E Lopez-De-Sa
- Hospital Universitario La Paz, IDIPAZ, CIBERCV, Cardiological Intensive Care Unit, Cardiology Service, Madrid, Spain
| | - J Waltenberger
- University of Munster, Department of Cardiovascular Medicine, Munster, Germany
| | - J Steffel
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - P Levy
- Universite Paris-Dauphine, PSL Research University, LEDa-LEGOS, Department of Economics, Paris, France
| | - A Bakhai
- Royal Free London NHS Foundation Trust, Department of Cardiology, London, United Kingdom
| | - L Pecen
- Institute of Computer Science of the Czech Academy of Science, the Czech Academy of Science, Prague, Czechia
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
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Kirchhof P, De Groot J, Weiss T, Kelly P, Monteiro P, Deharo J, De Asmundis C, Lopez-De-Sa E, Waltenberger J, Steffel J, Levy P, Bakhai A, Pecen L, De Caterina R. Age-adjusted risk factors are independently associated with an increased risk of major bleeding during the two-year follow-up of the ETNA-AF-Europe registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0577] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non-vitamin K antagonist oral anticoagulants (NOACs) are a preferred treatment option over warfarin for anticoagulation in patients with atrial fibrillation (AF). Management decisions for thromboprophylaxis in AF need to balance the risk of stroke against the risk of bleeding. Various patient characteristics have been identified as independent risk factors for bleeding. A substantial number of bleeding events might be prevented if independent predictors of bleeding were identified.
Purpose
The present analysis aims at assessing age-adjusted risk predictors of major bleeding during two-year follow-up of unselected European patients with AF in the ETNA-AF-Europe registry.
Methods
ETNA-AF-Europe is a prospective, multi-centre, post-authorisation, observational study conducted in 825 centres enrolling patients treated with edoxaban once daily in 10 European countries. Wald Chi square tested the association between risk predictors and major bleeding after adjusting for age, given that age is a well-known, strong predictor of anticoagulation-related bleeding in patients with AF.
Results
Overall, 13,417 patients with AF (edoxaban 60 mg: n=10,248; edoxaban 30 mg: n=3169) completed the two-year follow-up. The mean age was 73.6±9.5 years, with ∼84% of the patients aged over 65 years. Mean CHA2DS2-VASc and HAS-BLED scores were 3.2 and 2.5, respectively. 438 (3.3%) patients had a history of bleeding events at baseline, of which 138 (1.0%) had a history of major bleeding event.
Univariate analysis demonstrated that recalculated glomerular filtration rate (Cockcroft-Gault Equation) (GFR-CG) at baseline was the strongest age-adjusted predictor of major bleeding (Wald Chi-Square: 31.84; p<0.0001) (Figures 1 and 2), followed by history of major or clinically relevant non-major (CRNM) bleeding (24.08; p<0.0001), HAS-BLED score (21.10; p<0.0001), history of heart failure (derived) (16.59; p<0.0001), subjective frailty as assessed by physician (17.35; p=0.0002), history of major bleeding (14.14; p=0.0002), chronic obstructive pulmonary disease (COPD) (12.84; p=0.0003), CHA2DS2-VASc (12.14; p=0.0005), history of myocardial infarction (MI) (7.79; p=0.005), and left ventricular ejection fraction (LVEF) categorised by 40% (5.45; p=0.02).
Conclusion
Bleeding events on therapy with edoxaban can be predicted by quantifying kidney disease and capturing information on heart failure, frailty, prior bleeding, chronic obstructive lung disease and history of myocardial infarction. These data highlight the need for optimal management of anticoagulation therapy and close follow-up of patients with such risk profiles.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH Figure 1. GFR-CG as a predictor of major bleedingFigure 2. Predictors of major bleeding
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Affiliation(s)
- P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - J.R De Groot
- Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The)
| | - T.W Weiss
- Karl Landsteiner Institute, Institute for Cardiometabolic Diseases, St. Polten, Austria
| | - P Kelly
- University College Dublin, Department of Neurology, HRB Stroke Clinical Trials Network Ireland, Dublin, Ireland
| | - P Monteiro
- Centro Hospitalar e Universitario de Coimbra, Department of Cardiology, Coimbra, Portugal
| | - J.C Deharo
- AP-HM, Aix Marseille University, Hospital Timone, Cardiologie, Rythmologie, Marseille, France
| | - C De Asmundis
- Universitair Ziekenhuis, Department of Cardiology, Brussels, Belgium
| | - E Lopez-De-Sa
- Hospital Universitario La Paz, IDIPAZ, CIBERCV, Cardiological Intensive Care Unit, Cardiology Service, Madrid, Spain
| | - J Waltenberger
- University of Munster, Department of Cardiovascular Medicine, Munster, Germany
| | - J Steffel
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - P Levy
- Universite Paris-Dauphine, PSL Research University, LEDa-LEGOS, Department of Economics, Paris, France
| | - A Bakhai
- Royal Free London NHS Foundation Trust, Department of Cardiology, London, United Kingdom
| | - L Pecen
- Institute of Computer Science of the Czech Academy of Science, the Czech Academy of Science, Prague, Czechia
| | - R De Caterina
- University of Pisa, Chair of Cardiology, Pisa, Italy
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Morrone D, Unverdorben M, Chen C, Dinshaw L, Jiang W, Kim YH, Kirchhof P, Koretsune Y, Pecen L, Reimitz PE, Wang CC, Yamashita T, De Caterina R. Low bleeding and stroke rates with minor age-dependent increase confirm the safety and effectiveness of edoxaban in patients with atrial fibrillation across age groups: Two-year results from ETNA-AF. Europace 2021. [DOI: 10.1093/europace/euab116.272] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo
Background
Age is a risk factor for ischemic stroke and bleeding in patients with atrial fibrillation (AF). The large dataset from the global prospective, noninterventional ETNA-AF program allows for analysis of the impact of age on clinical events in AF patients treated with edoxaban.
Purpose
Evaluate the safety and effectiveness of edoxaban by age subgroups and the impact of age on clinical events.
Methods
Baseline patient characteristics, thromboembolic and bleeding events, and mortality data were collected from patients with 2-year follow-up in ETNA-AF program and analyzed in defined age subgroups. Cox regression analysis was conducted using age as a continuous variable and clinical events as outcome variables.
Results
A total of 27,617 patients were categorized into four age subgroups: <65, 65-74, 75-84 and ≥85 years. Patient demographics and baseline characteristics are shown in the Table. Percentage of male, mean body weight, and mean creatinine clearance decreased with age, whereas percentages of patients with heart failure, patients on reduced dose edoxaban 30 mg, mean stroke and bleeding risk scores increased with age. The annualized rates of ischemic stroke and major bleeding increased with age, yet remained low. Importantly, the rate of intracranial hemorrhage was low across age groups, including the ≥85 years group. The hazard ratio (HR) for ischemic stroke was 1.041 (95%CI 1.028-1.053), ie. with a 1-year increase in age, the risk of ischemic stroke increased by 4.1%. The HRs for other clinical events were: major bleeding 1.044 (95%CI 1.033-1.055), intracranial hemorrhage 1.027 (95%CI 1.007-1.046), major gastrointestinal bleeding 1.065 (95%CI 1.048-1.081), all-cause mortality 1.086 (95%CI 1.079-1.093).
Conclusion
Two-year follow-up data from the global ETNA-AF program support the use of edoxaban as a safe and effective treatment for AF patients across all age groups, including the very elderly, in routine clinical care. The impact of age on the risk of ICH was smaller than that of ischemic stroke and major bleeding. <65 yr(N = 4,278) ≥65-74 yr(N = 9,396) ≥75-84 yr(N = 10,728) ≥85 yr(N = 3,214) Age [years], mean (SD)Male, %Weight [kg], mean (SD) 57.3 (6.6)72.580.6 (20.3) 69.9 (2.9)61.973.0 (17.7) 79.1 (2.8)53.968.0 (16.0) 87.9 (2.8)42.260.1 (14.9) CrCL [mL/min], mean (SD)CHA2DS2-VASc, mean (SD)Mod. HAS-BLED≠, mean (SD) 101.8 (33.7)1.6 (1.1)1.4 (1.0) 75.3 (22.3)2.8 (1.2)2.5 (1.1) 57.9 (18.1)4.1 (1.2)2.7 (1.0) 42.5 (14.3)4.4 (1.3)2.7 (1.0) 2-year clinical events Major Bleeding (ISTH)%/yr [95% CI] Intracranial Hemorrhage%/yr [95% CI] Major GI Bleeding%/yr [95% CI] 0.49 [0.35; 0.68] 0.18 [0.09; 0.30] 0.22 [0.13; 0.36] 0.84 [0.70; 0.99] 0.26 [0.18; 0.34] 0.34 [0.26; 0.44] 1.16 [1.00; 1.32] 0.31 [0.23; 0.40]0.60 [0.49; 0.72] 1.88 [1.51; 2.30] 0.46 [0.29; 0.69]1.19 [0.90; 1.53] Any Stroke%/yr [95% CI]Ischemic Stroke%/yr [95% CI]Hemorrhagic Stroke%/yr [95% CI] 0.54 [0.38; 0.73]0.38[0.26; 0.56]0.12[0.06; 0.23] 0.79 [0.66; 0.94]0.59[0.47; 0.71]0.19[0.13; 0.27] 1.15 [1.00; 1.32]0.89[0.76; 1.04]0.23[0.16; 0.31] 1.53 [1.21; 1.92]1.21[0.92; 1.56]0.320.18; 0.52] All-cause Death%/yr [95% CI]CV Death (sensitivity)%/yr [95% CI] 1.05 [0.83; 1.32]0.51[0.36; 0.70] 1.82 [1.62; 2.04]0.83[0.69; 0.98 3.51 [3.25; 3.80]1.65[1.47; 1.84] 9.08 [8.27; 9.96]4.16[3.62; 4.77] ≠Excluding labile INR.
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Affiliation(s)
- D Morrone
- University Hospital of Pisa, Pisa, Italy
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | - L Dinshaw
- University Heart Center Hamburg, Hamburg, Germany
| | - W Jiang
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | - Y-H Kim
- Korea University, Seoul, Korea (Republic of)
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Y Koretsune
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - L Pecen
- Institute of Computer Science of the Czech Academy of Science, Prague, Czechia
| | - P-E Reimitz
- Daiichi Sankyo Europe, GmbH, Munich, Germany
| | - C-C Wang
- Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - T Yamashita
- National Hospital Organization Osaka National Hospital, Osaka, Japan
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Dinshaw L, Unverdorben M, Chen C, De Caterina R, Jiang W, Kim YH, Koretsune Y, Morrone D, Pecen L, Reimitz PE, Wang CC, Yamashita T, Kirchhof P. Annualized clinical event rates during two-year follow-up are low in 27,617 atrial fibrillation patients on edoxaban: results from the global noninterventional ETNA-AF program. Europace 2021. [DOI: 10.1093/europace/euab116.273] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo
Background and Purpose
The large global Edoxaban Treatment in routiNe clinical prActice (ETNA)-AF program was designed to assess the safety and effectiveness of edoxaban, complementing randomized clinical trials.
Methods
ETNA collects data on patient characteristics and clinical events in unselected AF patients treated with edoxaban for stroke prevention, integrating data from prospective, noninterventional studies conducted in Europe, Japan, South Korea, and Taiwan.
Results
The 2-year follow-up analysis included 27,617 patients, the majority of whom (82.6%) received the recommended dose according to the local label. At baseline, the mean age was 73.6 ± 9.8 years and 58.1% were male. Half of the patients (50.5%) were 75 years or older. The CHA2DS2-VASc score was 3.3 ± 1.5, and the modified HAS-BLED score was 2.4 ± 1.1. The rate of ischemic stroke was 0.74%/yr, major bleeding 1.02%/yr, intracranial hemorrhage 0.29%/yr, and major gastrointestinal (GI) bleeding 0.51%/yr. All-cause mortality was 3.13%/yr, and cardiovascular (CV) mortality 1.45%/yr (see Table).
Conclusion
The rates of ischemic stroke and major bleeding events remained low globally and across regions during the two-year follow-up period in AF patients treated with edoxaban. Global(N = 27,617) Japan(N = 11,330) Korea/Taiwan(N = 2,870) Europe(N = 13,417) Age, mean (SD) 73.6 (9.8) 74.2 (10.1) 71.6 (9.5) 73.6 (9.5) Gender, male, % 58.1 59.4 60.2 56.6 Weight [kg], median (IQR) 69 (58, 81) 59 (51, 68) 65 (57, 73) 80 (70, 90) CrCL [mL/min], mean (SD) 68.7 (28.4) 63.9 (25.8) 63.4 (23.7) 74.4 (30.5) CHA2DS2-VASc, mean (SD) 3.3 (1.5) 3.5 (1.7) 3.1 (1.4) 3.2 (1.4) Mod. HAS-BLED≠, mean (SD) 2.4 (1.1) 2.4 (1.1) 2.3 (1.1) 2.5 (1.1) Edoxaban 60mg/30mg, % 53.5 / 46.5 27.6 / 72.4 48.8 / 51.2 76.4 / 23.6 2-year clinical events, N (%/year), [95% CI] Major Bleeding (ISTH) 477 (1.02) [0.93; 1.11] 188 (1.09) [0.94; 1.25] 51 (1.00) [0.74; 1.31] 238 (0.97) [0.85; 1.11] Intracranial Hemorrhage 135 (0.29) [0.24; 0.34] 68 (0.39) [0.30; 0.50] 17 (0.33) [0.19; 0.53] 50 (0.20) [0.15; 0.27] Major GI Bleeding 241 (0.51) [0.45; 0.58] 122 (0.70) [0.58; 0.84] 18 (0.35) [0.21; 0.55] 101 (0.41) [0.33; 0.50] Any Stroke 455 (0.97) [0.88; 1.06] 244 (1.41) [1.24; 1.60] 54 (1.06) [0.80; 1.38] 157 (0.64) [0.54; 0.75] Ischemic Stroke 347 (0.74) [0.66; 0.82] 179 (1.03) [0.89; 1.20] 43 (0.84) [0.61; 1.13] 125 (0.51) [0.42; 0.61] Hemorrhagic Stroke 99 (0.21) [0.17; 0.26] 67 (0.39) [0.30; 0.49] 9 (0.17) [0.08; 0.33] 23 (0.09) [0.06; 0.14] All-cause Death 1479 (3.13) [2.98; 3.30] 470 (2.70) [2.46; 2.96] 72 (1.40) [1.09; 1.76] 937 (3.80) [3.56; 4.05] CV Death 684 (1.45) [1.34; 1.56] 140 (0.80) [0.68; 0.95] 26 (0.50) [0.33; 0.74] 518 (2.10) [1.92; 2.29] ≠Excluding labile INR.
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Affiliation(s)
- L Dinshaw
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Unverdorben
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | - C Chen
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | | | - W Jiang
- Daiichi Sankyo, Inc., Basking Ridge, United States of America
| | - Y-H Kim
- Korea University, Seoul, Korea (Republic of)
| | - Y Koretsune
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - D Morrone
- University Hospital of Pisa, Pisa, Italy
| | - L Pecen
- Institute of Computer Science of the Czech Academy of Science, Prague, Czechia
| | - P-E Reimitz
- Daiichi Sankyo Europe, GmbH, Munich, Germany
| | - C-C Wang
- Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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Gkekas I, Novotny J, Fabian P, Nemecek R, Palmqvist R, Strigård K, John S, Pecen L, Reginacova K, Gunnarsson U. Mismatch repair status predicts survival after adjuvant treatment in stage II colon cancer patients. J Surg Oncol 2020; 121:392-401. [PMID: 31828810 DOI: 10.1002/jso.25798] [Citation(s) in RCA: 4] [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: 10/15/2019] [Accepted: 11/25/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Stage II colon cancer is primarily a surgical disease. Only a still not well-defined subset of patients may benefit from postoperative adjuvant chemotherapy. The relationship between adjuvant chemotherapy and survival after relapse is furthermore still not definitely explored in this group of patients. A number of reports suggest some association between defective mismatch repair (dMMR) and colorectal cancer stage II prognosis, but due to contradictory results from existing studies, the exact predictive role is still not fully understood. METHODS Retrospective multicenter study including 451 stage II colon cancer patients. The proficiency or deficiency of mismatch repair was tested using immunohistochemistry and analyzed in relationship to two survival outcomes: overall survival (OS) and postrelapse survival. RESULTS Patients with dMMR (20.4%) derived no OS benefit from adjuvant chemotherapy (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.47-2.38; P = .897). Patients with proficient mismatch repair (pMMR) tumors receiving adjuvant chemotherapy had the significantly better OS in comparison to those not receiving chemotherapy (HR, 0.54; 95% CI, 0.35-0.82; P = .004). This relationship remained significant in multivariable analysis (HR, 0.42; 95% CI, 0.22-0.78; P = .007). Patients with pMMR relapsing after adjuvant treatment lived significantly longer than those relapsing without previous adjuvant treatment (HR, 0.55; 95% CI, 0.32-0.96; P = .033) and this result remained significant in the multivariable model (HR, 0.49; 95% CI, 0.26-0.93; P = .030). CONCLUSION In stage II CC patients, adjuvant chemotherapy improves therapeutic outcomes only in patients with pMMR tumors. Survival after relapse in patients having received adjuvant chemotherapy is significantly longer for patients with pMMR. No survival benefit from adjuvant chemotherapy was seen among patients with dMMR tumors.
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Affiliation(s)
- I Gkekas
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - J Novotny
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - P Fabian
- Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Nemecek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Palmqvist
- Department of Medical Biosciences/Pathology, Umea University, Umea, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - S John
- Department of Medical Biology and Genetics, Faculty of Medicine Hradec Kralove, Charles University, Prague, Czech Republic
| | - L Pecen
- Faculty Hospital Pilsen, Charles University, Prague, Czech Republic
| | - K Reginacova
- Department of Radiotherapy and Oncology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - U Gunnarsson
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
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Gelbenegger G, Postula M, Pecen L, Halvorsen S, Lesiak M, Schoergenhofer C, Jilma B, Hengstenberg C, Siller-Matula JM. P668Aspirin for primary prevention of cardiovascular disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0274] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Platelet inhibition by aspirin reduces ischemic events but increases the risk of bleeding events. Yet, the role of aspirin in primary prevention of cardiovascular disease remains unclear.
Purpose
To produce a clinically relevant benefit-risk assessment of aspirin for primary prevention of cardiovascular disease.
Methods
We performed a meta-analysis of aspirin effects in primary prevention of cardiovascular disease comprising 13 randomized-controlled trials in 164.225 patients comparing aspirin versus placebo/control during a mean follow-up period of 6.4 years. Using a random effect model, relative risks and 95% confidence intervals were calculated for each outcome.
Results
Aspirin reduced the relative risk of ischemic stroke by 10% (RR: 0.90; 95% CI: 0.82–0.99), myocardial infarction by 14% (RR: 0.86; 95% CI: 0.77–0.95) and the major adverse cardiovascular events by 9% (RR: 0.91; 95% CI: 0.86–0.95) but was associated with a 46% relative risk increase of major bleeding events (RR: 1.46; 95% CI: 1.30–1.64). Aspirin did not reduce the risk of cardiovascular mortality (RR: 0.99; 95% CI: 0.90–1.08), all-cause mortality (RR: 0.98; 95% CI: 0.93–1.02) or cancer (RR 1.05; 95% CI, 0.87–1.26). Aspirin use did not translate into a net clinical benefit adjusted for event-associated mortality risk (mean 0.034%; 95% CI: −0.18 to 0.25%).
Forest plot of major outcomes.
Conclusions
Aspirin use in primary prevention is associated with a reduced risk of stroke and myocardial infarction, but at a cost of an increased risk of major bleeding.
Acknowledgement/Funding
None
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Affiliation(s)
- G Gelbenegger
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - M Postula
- Medical University of Warsaw, Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Warsaw, Poland
| | - L Pecen
- Institute of Computer Science ASCR, Prague, Czechia
| | - S Halvorsen
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - M Lesiak
- Poznan University of Medical Sciences, 1st Department of Cardiology, Poznan, Poland
| | - C Schoergenhofer
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - B Jilma
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J M Siller-Matula
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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Cavallari I, Patti G, Pecen L, Lucerna M, Huber K, Rohla M, Renda G, Siller-Matula J, Ricci F, Kirkhhof P, De Caterina R. P3837Net clinical benefit of NOACs vs. VKAs in elderly patients with atrial fibrillation: a pooled analysis from the real-world PREFER in AF and PREFER in AF PROLONGATION registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I Cavallari
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G Patti
- University Campus Bio-Medico of Rome, Rome, Italy
| | - L Pecen
- Charles University of Pilsen, Pilsen, Czech Republic
| | - M Lucerna
- Daiichi Sankyo Europe, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Rohla
- Wilhelminen Hospital, Vienna, Austria
| | - G Renda
- G. d'Annunzio University, Chieti, Italy
| | | | - F Ricci
- G. d'Annunzio University, Chieti, Italy
| | - P Kirkhhof
- University of Birmingham, Birmingham, United Kingdom
| | - R De Caterina
- University of Birmingham, Birmingham, United Kingdom
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Cavallari I, Patti G, Lucerna M, Pecen L, Siller-Matula J, Kirchhof P, De Caterina R. P5153Net clinical benefit of oral anticoagulation in very elderly patients with atrial fibrillation: a sub-analysis from the PREFER in AF registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5153] [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: 11/13/2022] Open
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Rohla M, Weiss T, Pecen L, Rincon Diaz L, Zamorano J, Schilling R, Kotecha D, Lucerna M, Huber K, De Caterina R, Kirchhof P. P4604Residual stroke risk of anticoagulated patients with atrial fibrillation: PREFER in AF European registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4604] [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: 11/12/2022] Open
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Zigmond J, Pecen L, Tichopad A, Roberts CS, Jomaa I. Modeled Outcomes and Overall Costs of the 13-Valent Pneumococcal Conjugate Vaccine in the Tunisian National Vaccination Program. Value Health 2014; 17:A607-A608. [PMID: 27202107 DOI: 10.1016/j.jval.2014.08.2122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Zigmond
- CEEOR s. r. o., Prague, Czech Republic
| | - L Pecen
- CEEOR s. r. o., Prague, Czech Republic
| | | | | | - I Jomaa
- Pfizer Pharmaceuticals Tunisia, Tunis, Tunisia
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Tichopad A, Koblizek V, Kolek V, Pecen L. Doctors' Failure in Observance of the COPD Management Guidelines: Case of the CZECH Republic. Value Health 2014; 17:A603. [PMID: 27202088 DOI: 10.1016/j.jval.2014.08.2092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - V Koblizek
- Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic
| | - V Kolek
- Olomouc University Hospital, Olomouc, Czech Republic
| | - L Pecen
- CEEOR s. r. o., Prague, Czech Republic
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25
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Tichopad A, Pecen L, Roberts CS, Uglesic L, Tesovic G, Rogier K. Cost-Effectiveness of 13-Valent Versus 10-Valent Pneumococcal Conjugate Vaccine Use in Croatia National Vaccination Program. Value Health 2014; 17:A608-A609. [PMID: 27202116 DOI: 10.1016/j.jval.2014.08.2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - L Pecen
- CEEOR s. r. o., Prague, Czech Republic
| | | | - L Uglesic
- Pfizer Croatia d. o. o., Zagreb, Croatia
| | - G Tesovic
- University of Zagreb Medical School, Zagreb, Croatia
| | - K Rogier
- Pfizer bv, Capelle a/d IJssel, The Netherlands
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Hajek P, Pecen L, Bulejova L, Cook M, Dolezal T, Dolezel J, Duba J, Dukova I, Fuksa L, Heislerova M, Jaskova K, Karasek P, Klimes J, Kminek A, Kucera Z, Vesela Š, Vothova P, Svihovec J. Multicriteria Decision Analysis (MCDA) In HTA - Pilot Study in the Czech Republic. Value Health 2014; 17:A439. [PMID: 27201174 DOI: 10.1016/j.jval.2014.08.1143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P Hajek
- Pfizer s r. o., Prague, Czech Republic
| | - L Pecen
- CEEOR s. r. o., Prague, Czech Republic
| | | | - M Cook
- BAYER s. r. o., Prague, Czech Republic
| | - T Dolezal
- VALUE OUTCOMES, Prague, Czech Republic
| | - J Dolezel
- GlaxoSmithKline, s. r. o., Prague, Czech Republic
| | - J Duba
- OAKS Consulting s. r. o., Prague 9, Czech Republic
| | | | - L Fuksa
- General Health Insurance Company of the Czech Republic, Praha, Czech Republic
| | - M Heislerova
- University Hospital in Motol, Prague, Czech Republic
| | | | - P Karasek
- Novartis s. r. o., Prague, Czech Republic
| | | | - A Kminek
- AstraZeneca, Prague, Czech Republic
| | - Z Kucera
- Sanofi-Aventis, Prague, Czech Republic
| | | | - P Vothova
- Pfizer s r. o., Prague, Czech Republic
| | - J Svihovec
- University Hospital in Motol, Prague, Czech Republic
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27
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Finek J, Holubec L, Topolcan O, Elgrova L, Skalova A, Pecen L. The importance of prognostic factors in premenopausal women with breast cancer. Anticancer Res 2007; 27:1893-6. [PMID: 17649790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Basic conventional prognostic factors for breast cancer include the age of the patient, tumor grade, regional lymph nodes status, and estrogen (ER) and progesterone (PR) receptor status. Positivity of the HER2 receptor (c-erbB-2) seems to be a new prognostic and predictive factor. Prognostic factors seem to be more important in the high-risk group of the premenopausal females. We evaluated individual prognostic factors (age, histology, TNM classification, ER, PR, CA 15-3, CEA, HER2) and their impact on disease-free survival (DFS) and overall survival (OS) during the 5-year follow-up period. PATIENTS AND METHODS Forty-two patients were monitored after standard oncology treatment for a period of at least 5 years. The statistical significance of the individual prognostic parameters was evaluated in relationship to the time to progression (DFS and OS). RESULTS The following were evaluated as statistically significant prognostic parameters for DFS: PR positivity (p = 0.0036), proliferative marker MIB1 (p = 0.0108), pre-operative level of CA 15-3 (p = 0.0425), ER negativity (p = 0.0507). The following were evaluated as statistically significant prognostic parameters for OS: PR positivity (p = 0.0003), MIB1 (p = 0.0005), ER (p = 0.0440), pre-operative level of CEA (p = 0.0495). Positivity of immunohistochemically performed test of c-erbB-2 was not statistically significant for DFS os OS (p = 0.6361 and 0.9323, respectively). CONCLUSION The statistically significant prognostic importance of the levels of tumor markers CA 15-3 and CEA for prognosis in breast cancer of premenopausal females was proven. So far, these factors have been underestimated. The prognostic parameters of ER, PR and MIB1 were statistically significant. While no prognostic importance was confirmed for c-erbB-2 positivity; this factor cannot be evaluated in premenopausal females separately from the other prognostic factors due to the predictive value in relation to the adjuvant therapy (patients with HER+, ER+, PR-).
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Affiliation(s)
- J Finek
- Department of Oncology, University Hospital and Medical Faculty, Pilsen, Czech Republic.
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28
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Prázný M, Ježková J, Horová E, Lazárová V, Hána V, Kvasnicka J, Pecen L, Marek J, Skrha J, Krsek M. Impaired microvascular reactivity and endothelial function in patients with Cushing's syndrome: influence of arterial hypertension. Physiol Res 2007; 57:13-22. [PMID: 17223725 DOI: 10.33549/physiolres.931126] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to evaluate skin microvascular reactivity (MVR) and possible influencing factors (fibrinolysis, oxidative stress, and endothelial function) in patients with Cushing's syndrome. Twenty-nine patients with active Cushing's syndrome (ten of them also examined after a successful operation) and 16 control subjects were studied. Skin MVR was measured by laser Doppler flowmetry during post-occlusive (PORH) and thermal hyperemia (TH). Malondialdehyde and Cu,Zn-superoxide dismutase were used as markers of oxidative stress. Fibrinolysis was estimated by tissue plasminogen activator (tPA) and its inhibitor (PAI-1). N-acetyl-beta-glucosaminidase, E-selectin, P-selectin, and ICAM-1 were used as markers of endothelial function. Oxidative stress and endothelial dysfunction was present in patients with hypercortisolism, however, increased concentration of ICAM-1 was also found in patients after the operation as compared to controls (290.8+/-74.2 vs. 210.9+/-56.3 ng.ml(-1), p<0.05). Maximal perfusion was significantly lower in patients with arterial hypertension during PORH and TH (36.3+/-13.0 vs. 63.3+/-32.4 PU, p<0.01, and 90.4+/-36.6 vs. 159.2+/-95.3 PU, p<0.05, respectively) and similarly the velocity of perfusion increase during PORH and TH was lower (3.2+/-1.5 vs. 5.2+/-3.4 PU.s(-1), p<0.05, and 0.95+/-0.6 vs. 1.8+/-1.1 PU.s(-1), p<0.05, respectively). The most pronounced impairment of microvascular reactivity was present in patients with combination of arterial hypertension and diabetes mellitus.
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Affiliation(s)
- M Prázný
- Third Department of Internal Medicine, First Faculty of Medicine, Prague, Czech Republic.
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29
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Babjuk M, Soukup V, Mares J, Dusková J, Pecen L, Pesl M, Pavlík I, DvorRcek J. Association of PAX5 expression with clinical outcome in patients with TaT1 transitional cell carcinoma of the bladder. Urology 2006; 67:756-61. [PMID: 16566978 DOI: 10.1016/j.urology.2005.10.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 10/03/2005] [Accepted: 10/28/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the frequency and intensity of PAX5 gene messenger ribonucleic acid (mRNA) expression in TaT1 bladder cancer tissue, as well as its correlation with clinicopathologic variables and patient outcome. METHODS The RNA expression of PAX5 was evaluated with reverse transcriptase polymerase chain reaction in the tumor tissue of 75 patients with stage TaT1 bladder cancer treated with transurethral resection. Patients were observed with cystoscopy and urinary cytologic evaluation. The association between PAX5 expression and clinicopathologic variables and patient outcome was evaluated. Benign urothelium from 8 patients with benign prostatic hyperplasia was obtained. These patients were used as a control group. RESULTS PAX5 expression was found in 62 patients with bladder cancer (82.7%) but in no patient from the control group. High PAX5 expression (greater than 0.2) was confirmed in 19 patients (25.3%). No significant relationship was observed between quantity of PAX5 expression and clinicopathologic variables. The 3-year recurrence-free and progression-free survival rates in highly positive patients were 13.2% and 71.6%, compared with 40.6% and 92.8%, respectively, in patients with weak or negative expression (log-rank test, P = 0.0075, P = 0.022). Multivariate Cox proportional hazard model analysis identified PAX5 expression as an independent predictor of tumor recurrence. CONCLUSIONS PAX5 gene expression is a frequent finding in superficial transitional cell carcinoma of the bladder. High levels of PAX5 are associated with poorer recurrence-free and progression-free survival rates. Moreover, PAX5 expression was found to be an independent prognostic factor for recurrence-free survival by a multivariate analysis.
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Affiliation(s)
- M Babjuk
- Department of Urology, General Faculty Hospital, 1st Medical Faculty, Charles University, Postgraduate Institute, Praha, Czech Republic.
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30
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Pikner R, Ludvíkova M, Ryska A, Kholova I, Holubec L, Topolcan O, Pecen L, Fínek J. TPS, thymidine kinase, VEGF and endostatin in cytosol of thyroid tissue samples. Anticancer Res 2005; 25:1517-21. [PMID: 16033053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The aim of the study was to determine whether VEGF, TPS, TK or Endostatin determination in tissue cytosol may have some additional value in distinguishing among different types of thyroid lesions. These markers were chosen as representatives of the 2 main pathways (angiogenesis and proliferation) involved in thyroid diseases. VEGF is the most potent angiogenic promoter and Endostatin plays an opposing role. Thymidine kinase (TK) is a marker of DNA synthesis and TPS, cytokeratin 18 fragments, is a marker of the rate of proliferation. We determined qualitatively all four markers in tissue extracts: cytosol from 157 tissue specimens (93 goitre, 12 Hashimoto's thyroiditis, 39 adenomas and 13 carcinomas). In 6 cases we were able to compare both normal and pathological tissue samples from a single patient. Statistically significant differences were found in the measured markers, but outliers were present in all groups. This fact does not permit their use in differential diagnosis. The highest levels of all markers were reached in adenomas, being higher than in carcinomas, probably explained by the higher overall metabolic rate in adenomas.
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Affiliation(s)
- R Pikner
- Second Department of Internal Medicine, Charles University Prague, Faculty of Medicine, Hradec Králové, Czech Republic.
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31
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Babjuk M, Soukup V, Petrík R, Pavlík I, Jirsa M, Dvorácek J, Pecen L. [Fluorescence cystoscopy in the diagnostics and treatment of superficial urinary bladder tumors]. Cas Lek Cesk 2005; 144 Suppl 2:15-8. [PMID: 16277179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND 5-aminolevulinic acid induced fluorescence cystoscopy can detect more tumour lesions comparing to standard cystoscopy. The goal of our study was to assess the influence of fluorescence cystoscopy used during transurethral resection on the recurrence rate and the length of tumor-free interval in stage Ta, Tl transitional cell carcinoma of the urinary bladder. METHODS AND RESULTS In prospective randomized study 109 patients with primary or recurrent stage Ta Tl bladder transitional cell carcinoma treated with transurethral resection were enrolled. 17 patients with high grade tumors were evaluated separately. In group A the transurethral resection was performed with standard white light endoscopy, in group B with fluorescence cystoscopy. The patients were followed using standard cystoscopy and urinary cytology. Recurrence free interval was evaluated in whole groups and also for single and multiple and for primary and recurrent tumors separately. The median time to recurrence was 8.05 months in group A and was significantly shorter than 13.54 months in group B (p = 0.04, log-rank test). In separate analyses the median time to recurrence was significantly shorter using fluorescence cystoscopy in multiple (p = 0.004) and in recurrent (p = 0.02) tumors, but not in solitary and primary tumors. CONCLUSIONS 5-aminolevulinic acid induced fluorescence cystoscopy used during transurethral resection reduces the early recurrence rate in stage Ta Tl bladder transitional cell carcinoma.
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Affiliation(s)
- M Babjuk
- Urologická klinika 1. LF UK a VFN, Praha a Katedra urologie IPVZ, Praha.
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Zimovjanova M, Sykora V, Novotny J, Gatek J, Petruzelka L, Holubec L, Pecen L. Comparative analysis of thymidylate synthase, thymidine phosphorylase and dihydropyrimidine dehydrogenase expression in colorectal cancer and surrounding normal tissue. Neoplasma 2005; 52:208-10. [PMID: 15875081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Thymidylate synthase [TS], thymidine phosphorylase [TP] and dihydropyrimidine dehydrogenase [DPD] play the essential role in the activation and catabolism of the fluoropyrimidines used in cancer therapy. Its expression may influence the antitumor activity or toxicity of these drugs. We studied the expression levels of selected enzymes in colorectal tumors and adjacent normal mucosa. The analysis of TS, TP and DPD gene expression was performed using quantitative Real time PCR technique (Roche) in 15 (TS), 64 (TP) and 12 (DPD) of 64 colorectal cancer patients. The mean gene expression of TS, TP and DPD was found to be 3.29; 3.79 and 8.24 in tumors and 1.88; 3.80 and 19.69 in normal mucosa. The corresponding median gene expression was 1.87; 2.32 and 4.50 for tumors and 2.14; 2.63 and 11.64 for normal tissue. We did not find any significant differences in TS, TP and DPD gene expression between colorectal tumor and surrounding mucosa.
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Affiliation(s)
- M Zimovjanova
- Department of Oncology, General Teaching Hospital, 12880 Prague, Czech Republic.
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Abstract
We examined circadian blood pressure (BP) variation (expressed as a relative night-time BP decline) in subjects with primary aldosteronism (78 patients), pheochromocytoma (n=45) and Cushing's syndrome (n=18). Subjects with aldosterone-producing adenoma (n=21) and pheochromocytoma (n=27) were also investigated after the tumour removal. In all, 65 patients with essential hypertension served as a control group. The night-time BP decline was significantly attenuated in all three forms of endocrine hypertension compared to the control group (primary aldosteronism P<0.0001, pheochromocytoma P<0.0001 for systolic and diastolic BP and Cushing's syndrome P<0.0001/<0.001 vs essential hypertension). In the case of pheochromocytoma, the absence of the night-time BP decrease was more prominent compared to the primary aldosteronism group (P=0.003/0.001) and for the diastolic BP also in comparison with the Cushing's syndrome group (P=0.03). Tumour removal led in both groups to the restoration of the previously altered circadian rhythm (aldosterone-producing adenoma: P=0.0005/0.0009; pheochromocytoma: P=0.001/0.0007). Our study demonstrates a blunted circadian BP variation in all forms of adrenal hypertension in comparison with essential hypertension. This reduction of the night-time BP decrease was more prominent in pheochromocytoma than in primary aldosteronism or Cushing's syndrome.
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Affiliation(s)
- T Zelinka
- 3rd Department of Medicine, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic.
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Kholová I, Ludvíková M, Ryska A, Hanzelková Z, Cap J, Pecen L, Topolcan O. Immunohistochemical detection of dipeptidyl peptidase IV (CD 26) in thyroid neoplasia using biotinylated tyramine amplification. Neoplasma 2003; 50:159-64. [PMID: 12937847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Differential diagnosis between malignant and benign thyroid tumors derived from follicular cells can pose certain difficulties in routine surgical pathology. The aim of the study was to evaluate dipeptidyl peptidase IV (DPP IV/CD 26) in differential diagnostics of thyroid lesions. DPP IV/CD 26 was evaluated in thyroid glands of 309 patients (261 females and 48 males, age range of patients 15-80 years). DPP IV/CD 26 was assessed in paraffin-embedded thyroid specimens immunohistochemically using commercially available antibody (Serotec) and biotinylated tyramine amplification kit (DAKO). Well-differentiated carcinoma revealed DPP IV/CD 26 positivity in 33 out of 42 cases (79%). Neither medullary nor insular carcinoma was DPPIV/CD 26 positive (only one case of each tested). DPPIV/CD 26 expression in isolated cells was seen in 18/261 (7%) benign disorders. The sensitivity of the method was 68%, the specificity was 94%, and the diagnostic accuracy was 91%, respectively, using 5% threshold of positive follicular cells. DPP IV/CD 26 can be assessed immunohistochemically using biotinylated tyramine amplification kit. DPP IV/CD 26 could be an adjunct in the thyroid gland differential diagnosis. However, DPP IV/CD 26 positivity is limited to the group of well-differentiated carcinomas, particularly papillary carcinoma. Furthermore, it is of limited value for follicular and oncocytic tumors.
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Affiliation(s)
- I Kholová
- Department of Pathology, Charles University Faculty Hospital, Hradec Králové, Czech Republic
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Jezková J, Marek J, Prázný M, Krsek M, Malícková K, Rosická M, Jarkovská Z, Pecen L. [Effect of hypercortisolism on development of atherosclerotic changes in blood vessels]. Vnitr Lek 2003; 49:656-67. [PMID: 14518092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
UNLABELLED Hypercortisolism is associated with a high risk of sickness rate and death rate particularly in view of facilitated arteriosclerotic processes. It is most frequently induced by drug therapy, but endogenous hypercortisolism (Cushing's syndrome) may serve as a suitable model of the effect of hypercortisolism on vascular wall. Our cohort included the following groups of patients and control individuals: 1. a group of patients with florid so far untreated Cushing's syndrome--14 patients, 2. a control group to these patients--16 individuals, 3. a group recently operated on and healed-up patients with Cushing's syndrome--8 patients, 4. a group of previous of previous cured-up patients with Cushing's syndrome--27 subjects, 5. a control group to those patients of group 4--17 persons. The following differences were found between the respective groups: 1. the ultrasonographic examination of carotid arteries demonstrated sclerotic plates or carotid stenosis in 21.3% of patients with florid Cushing's syndrome and 41.4% in patients with corticolism having been cured-up against 11.7% in the relevant control group; 2. the examination of skin microcirculation by the laser-doppler method revealed a lower velocity of perfusion increase during examination of postocclusion hyperemia in patients with florid Cushing's syndrome and hypercortisolism having been cured-up against a control group (CUSH., P < 0.04; previous cured-up, P < 0.02) as well as thermally-induced hyperemia (CUSH., P < 0.03; formerly cured-up, P < 0.04); 3. the laboratory examination of patients with florid Cushing's syndrome revealed higher values of LDL-cholesterol (P < 0.05) and total cholesterol (P < 0.001), malonyldialdehyde as an indicator of increased formation of oxygen radicals (P < 0.05) and oromucoid, the protein of acute phase, signaling a chronic inflammation (P < 0.05); 4. in patients who previously suffered from hypercortisolism increased levels of fibrinogen (P < 0.03) and the cytoadhesive molecule ICAM-1 (P < 0.05) were accompanied by decreased levels of the growth factor of vascular endothelia (VEGF) (P < 0.05) against patients with florid Cushing's syndrome. CONCLUSION The findings of the examinations performed indicate that increased incidence of arteriosclerotic processes is present in patients with the florid Cushing's syndrome as well as in those who have suffered from Cushing's syndrome before.
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Affiliation(s)
- J Jezková
- III. interní klinika 1. lékarské fakulty UK a VFN, Praha
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Treska V, Cechura M, Molácek J, Certík B, Pecen L. [Rupture of abdominal aortic aneurysm (RAAA)--predictors of the early postoperative mortality]. Zentralbl Chir 2003; 128:557-60. [PMID: 12884141 DOI: 10.1055/s-2003-40812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the main factors of the 30 days mortality rate of patients operated on for abdominal aortic aneurysm rupture (RAAA. PATIENTS AND METHOD Univariate and multivariate analysis of various factors associated with RAAA was performed in a group of 73 patients operated on for RAAA between 1996-2001. RESULTS The 30 days mortality rate was 35.6 %. The main factors of mortality were: misdiagnosis, cardio- pulmonary-cerebral resuscitation (CPCR) on admission, configuration of RAAA, number of blood transfusions, hypotension on admission (p < 0.0001) and duration of operation, type of reconstruction and hypertension in anamnesis (p < 0.01). Important factors (p < 0.05) of postoperative mortality were also low haemoglobin level on admission, abdominal aortic aneurysm (AAA) diameter and ischaemic heart disease in anamnesis. The probability of patient's death is the highest (p < 0.003), if factors like CPCR, number of blood transfusions and aneurysm diameter are combined (multivariate analysis, stepwise method). CONCLUSION The early detection and surgical or endovascular elective treatment of AAA, the regular dispensation of patients with small AAA especially in hypertonics, the correct diagnosis of RAAA without time delay are the best tools for patients survival. The patient's chance for survival increases with highly trained prehospital resuscitation system and experienced team of vascular surgeons and anesthesiologists.
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Affiliation(s)
- V Treska
- Department of Surgery, University Hospital, Plzen, Czech Republic.
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Malícková K, Jezková J, Janatková I, Fucíková T, Marek J, Pecen L. [Endothelial, phospholipid and oxidized LDL antibodies in patients with endogenous hypercortisolism]. Epidemiol Mikrobiol Imunol 2003; 52:59-65. [PMID: 12822535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Antiphospholipid (APLA), antiendothelial (AECA) and anti-oxidized LDL (anti-oxLDL) autoantibodies are found in vascular disorders. Pathogenetic contingency of atherosclerosis and these autoantibodies is still discussed, the mechanisms of their action in atherogenesis are not quite clear so far. Patients in various stages of endogenous hypercorticism as a model of accelerated atherosclerosis were investigated. We have sought possible correlations between autoantibodies and parameters of atherosclerosis with regard to the influence of endogenous hypercorticism on the inflammation. Low titres of autoantibodies in patients with active forms of disease result from the immunosuppressive effect of steroids. None of investigated group had high titres of APLA. No differences were found in AECA occurrence. No correlation of APLA, anti-oxLDL nor AECA with urinary free cortisol and plasma cortisol was found. There were no significant differences in autoantibody titres between patients with or without carotid stenosis. These results suggest, that autoantibodies may not always influence the development and progression of atherosclerotic lesions.
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Affiliation(s)
- K Malícková
- Ustav imunologie a mikrobiologie VFN a 1. LF UK, Praha.
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Holubec L, Topolcan O, Pikner R, Pecen L, Holubec Sen L, Finek J, Ludvikova M, Cerna M. Criteria for the selection of referential groups in tumor marker statistical evaluation on the basis of a retrospective study. Anticancer Res 2003; 23:865-70. [PMID: 12820315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The authors of this study are concerned with the analysis of optimal criteria for the selection of referential groups in the statistical evaluation of tumor markers for early detection of recurrent disease. Although criteria for the selection of optimal referential groups have already been published on a number of occasions (EGTM recommendation), these criteria are not followed in daily routine, which leads to a false interpretation of results and the impossibility of comparing individual studies. The commonest problem is an incorrect determination of cut-off, caused by not following the recommended specificities at 95%, which results in an incorrect assessment of tumor marker sensitivities. Other faulty interpretations happen in consequence of inaccurate and not clearly defined referential groups, which differ from each other by, for example, stage of the disease, length of the follow-up and so on. Comparing tumor marker results still remains a problem, since they are assessed with diagnostic kits from different manufacturers which may misrepresent the final value of the results, and thus imitate remission or progression of the tumor disease. Similarly, mutual comparison of results from prospective and retrospective studies without standardization of clinical conditions leads to an unreliable interpretation. The authors show, through concrete examples, the possibility of a completely different interpretation of the results in identical referential groups in consequence of their inaccurate characteristics.
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Affiliation(s)
- L Holubec
- 2nd Dept. of Internal Medicine, Department of Clinical Oncology and Radiotherapy, Charles University Hospital, Pilsen, Czech Republic
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Kholová I, Ryska A, Ludvíková M, Pecen L, Cáp J. [Dipeptidyl peptidase IV (DPP IV, CD 26): a tumor marker in cytologic and histopathologic diagnosis of lesions of the thyroid gland]. Cas Lek Cesk 2003; 142:167-71. [PMID: 12756846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Morphological diagnostics of thyroid gland tumours faces certain differential diagnostic problems. Extensive histological examination of the entire tumour is required for the final diagnosis of follicular and oncocytic tumours. Thus, assessment of reliable definitive cytological and/or intraoperative histological diagnosis is not possible. No marker of malignancy has been so far generally accepted in the thyroid tumour diagnosis. The aim of the study was to evaluate membrane protease dipeptidyl peptidase IV (DPP IV) in the differential diagnosis of thyroid tumours. METHODS AND RESULTS DPP IV was assessed cytochemically in 254 smears, histochemically in 314 cryostat sections, and immunohistochemically in 309 paraffin-embedded sections obtained from the group of 336 patients. There were 283 females and 53 males with the mean age of 48 years (range 15-80 years) in this series. Sensitivity of cytochemical detection was 71%, specificity was 96%, and diagnostic accuracy was 93% using the 50% threshold. Histochemically, sensitivity was 71%, specificity was 93%, and diagnostic accuracy was 90% using the 5% threshold. Using the immunohistochemical assessment, sensitivity was 68%, specificity was 94%, and diagnostic accuracy was 91% using the 5% threshold. CONCLUSIONS According to our results, DPP IV can be used as a marker of malignancy in well-differentiated carcinomas of follicular cell origin, namely in papillary carcinoma. However, it is less reliable in follicular and oncocytic carcinomas.
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Affiliation(s)
- I Kholová
- Fingerlandův ústav patologie LF UK a FN, Hradec Králové.
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Kholová I, Ludvíkova M, Ryska A, Topolcan O, Pikner R, Pecen L, Cáp J, Holubec L. Diagnostic role of markers dipeptidyl peptidase IV and thyroid peroxidase in thyroid tumors. Anticancer Res 2003; 23:871-5. [PMID: 12820316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND In seeking to improve the differential diagnosis between malignant and benign thyroid tumors of follicular cell origin, we assessed the expression of dipeptidyl peptidase IV (DPP IV) and thyroid peroxidase (TPO). DPP IV is a membrane peptidase expressed in many human tissues, excluding the normal thyroid gland. However, aberrant expression has been described in thyroid carcinomas. TPO is an essential enzyme in the biosynthesis of thyroid hormones with various types of expression in pathological thyroid lesions. MATERIALS AND METHODS A total of 151 thyroid glands were examined: 24 malignant tumors, 29 benign tumors, 98 benign lesions and 5 normal glands. DPP IV expression was analyzed by a histochemical technique in both frozen sections and imprint/aspirate smears. TPO was assessed immunohistochemically in paraffin-embedded specimens. RESULTS DPP IV sensitivity in frozen section was 56% and its specificity was 99%, in both cases with a 50% threshold. In cytology, the sensitivity was 68% and the specificity was 98% using the 50% threshold. TPO sensitivity and specificity was 64% and 99%, respectively. The sensitivity and specificity of both markers was 92% and 94%, respectively. CONCLUSION We recommend adding DPP IV and TPO to the list of diagnostic tumor markers for malignant thyroid tumors of follicular cell origin.
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Affiliation(s)
- I Kholová
- Fingerland Department of Pathology, Charles University Medical Faculty Hospital, Hradec Králové, Czech Republic
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41
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Abstract
Fine needle aspiration cytology (FNAC) of the thyroid gland is a well-established method. However, it has inherent limitations, especially in the diagnosis of follicular and oncocytic tumours and in distinguishing between nuclear atypia in colloid goitre with regressive changes and cystic papillary carcinoma. The aim of our study was to evaluate dipeptidyl peptidase IV (DPP IV) as a marker of malignancy in FNAC. We tested 254 thyroid specimens (intraoperative imprint smears) for DPP IV. The sensitivity was 71%, the specificity was 96%, and the diagnostic accuracy was 93%, respectively, with a threshold of 50% of positive cells. To the best of our knowledge it is the largest histologically confirmed study reported in the literature. We suggest the assessment of DPP IV as an adjunct diagnostic marker of malignancy in thyroid specimens suspicious of papillary carcinoma. However, the value of the marker in follicular lesions is very limited.
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Affiliation(s)
- I Kholová
- The Fingerland Department of Pathology, Charles University Faculty Hospital, Hradec Králové, Czech Republic
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Hauerová D, Pikner R, Topolcan O, Mrázová D, Holubec L, Pecen L. [Thyroid disease in pregnant women and its development after childbirth]. Vnitr Lek 2002; 48:1060-4. [PMID: 12577458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To assess the incidence of post-partum thyropathies in women with positive antibodies against thyroid peroxidase in the second trimester of pregnancy. MATERIAL AND METHODS Based on a cross-sectional study of the prevalence of abnormal laboratory parameters of thyroid function in a group of 650 pregnant women in the second trimester of pregnancy the authors invited for subsequent clinical examination and repeated controls women with elevated antibodies against thyroid peroxidase (antiTPO) above 60 mU/l (1). The group comprised 75 pregnant women, incl. 44 (58.7%) who attended the examination. After delivery the authors examined the serum levels of TSH, fT4, antiTPO, if necessary fT3 and TRAK. RESULTS 18, i.e. 58.1% women developed post-partum thyroiditis, incl. 10, i.e. 55.6% who developed hypothyroidism and 8, i.e. 44.4% who developed hyperthyroidism. CONCLUSION Based on the presented study the authors recommend in pregnant women in the first trimester of pregnancy to introduce assessment of thyrotropin (TSH) and free thyroxin (fT$) and antibodies against thyroid peroxidase (antiTPO)[to detect neuropsychic sequelae on the infant after delivery. The investigation of serum levels of antiTPO antibodies will make it possible to select a group of women in risk of by the development of post-partum thyropathies which must be followed up.
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Affiliation(s)
- D Hauerová
- II. interní klinika Lékarské fakulty UK a FN, Plzen
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Hauerová D, Pikner R, Topolcan O, Mrázová D, Holubec L, Pecen L. [Prevalence of thyroid gland disorders in pregnant women in the West Bohemia Region during their 2nd trimester of pregnancy in the year 2000--pilot study]. Vnitr Lek 2002; 48:629-31. [PMID: 12197405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The diagnostics and the treatment of the disorders of the thyroid gland in pregnancy belong to the most important topics for most endocrinologists in the whole world. Untreated or mistreated thyroid gland disorders may influence the course of pregnancy and development of the foetus and child. Autoimmune thyroiditis, hyperthyroidism and hypothyroidism represent the most common thyreopaties in pregnancy and that is why the aim of the study was to establish their prevalence in population of pregnant women of the West Bohemia region. In our study we assessed serum levels of thyrotropin (TSH), free tyroxin (fT4) and antithyroid peroxidase antibodies (antiTPO) in 650 pregnant women. Sera were acquired during routine blood sampling for Down syndrome screening in the 2nd trimester of pregnancy. In our group we found the prevalence of 1.5% of hypothyroidism and 9.4% of autoimmune thyroiditis and we revealed no case of thyrotoxicosis, only subnormal TSH in 2.3%.
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Affiliation(s)
- D Hauerová
- II. interní klinika Lékarské fakulty UK a Fakultní nemocnice, Plzen
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Suchá R, Ulcová-Gallová Z, Pavelková-Seifertová P, Krizanovská K, Bouse V, Svábek L, Rokyta P, Balvín M, Pecen L, Rokyta Z. [Fructose and glucose in follicular fluid and serum of women undergoing stimulation in an in vitro fertilization program]. Ceska Gynekol 2002; 67:144-8. [PMID: 12078549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To find out if there is some amount of fructose in the follicular fluid of IVF stimulated patients. If so then to compare fructose and glucose levels with IVF outcome, type of stimulation and infertility factors. DESIGN Retrospective study. SETTING Department of Gynaecology and Obstetrics, Charles University, the Czech Republic. METHODS 202 women undergoing IVF treatment since 11/1999 till 02/2001 were evaluated. We measured a level of fructose and glucose in a sample of serum and follicular fluid (FF) obtained at ovum pick-up. Then the results were compared with the IVF outcome, the length of stimulation and infertility factors. The control group consists of 23 women with a pure andrologic factor of infertility. RESULTS At the day of pick-up the serum concentration of glucose and fructose taken on an empty stomach is on average 5.43 +/- 1.35 mmol/l and 25.05 +/- 9.26 micrograms/ml compared to 5.26 +/- 1.00 mmol/l and 23.69 +/- micrograms/ml in control group. The concentration of both glucose and fructose in FF correlates with their serum level. The FF concentration of glucose is on average 3.75 +/- 1.32 mmol/l (70% of serum concentration) and fructose 11.34 +/- 5.29 micrograms/ml (48% of serum concentration) by comparison with 3.78 +/- 0.91 mmol/l (73%) and 12.37 +/- 7.06 micrograms/ml (53%) in control group. CONCLUSION There is a possible influence of follicular fluid saccharides like glucose and fructose in process of fertilization. We derived this hypothesis from studies evaluating the role of saccharides in endometrial secretion, cervical mucous and seminal plasma. We assumed that patients with a successful IVF cycle have a lower fructose concentration in FF. The clinical pregnancy is really mildly lower but this difference is not statistically significant. We confirmed FF fructose is in close correlation with its serum concentration. But we did not confirm the FF glucose and FF fructose concentration is related to the IVF outcome.
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Affiliation(s)
- R Suchá
- Gynekologicko-porodnická klinika UK LF a FN v Plzni
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Simícková M, Nekulová M, Pecen L, Cernoch M, Vagundová M, Pacovský Z. Quantitative determination of telomerase activity in breast cancer and benign breast diseases. Neoplasma 2002; 48:267-73. [PMID: 11712677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Telomerase plays an important role in maintaining the stability of chromosomes. This ribonucleoprotein prevents chromosome ends (telomeres) from gradual loss with each cell division. It enables tumor cells to maintain telomere length, allowing indefinite replicative capacity. Telomerase activity has been detected in the majority of tumor and germ cells and in immortalized cell lines. Quantitative telomerase PCR-ELISA (TeloTAGGG Telomerase PCR ELISA(PLUS)) was evaluated for distinguishing benign and malignant breast tissue. Activity of telomerase was determined in 27 samples of fibrocystic and dysplastic tissues, 28 fibroadenomas and phylloid tumors, and 154 breast cancer tissues; 59 specimens were analyzed retrospectively. Analytical precision and linearity of the assay was tested using breast carcinoma cell line ZR-75-1 and breast tumor tissue extracts. About 4% of tumor samples were excluded from analysis due to interferences in the PCR reaction. Relative telomerase activity differed significantly in the groups of dysplastic tissues, fibroadenomas and carcinomas. The highest activity was found in breast cancer tissue. This method can identify breast cancer tissue with 73% clinical sensitivity and 93% specificity as compared to benign breast tumors. We did not find a correlation between telomerase activity and the tissue levels of estrogen and progesterone receptors, HER-2/neu oncoprotein concentration, tumor size, and lymph node positivity. Probability of disease-free survival was significantly lower for patients with telomerase activity higher than median value. As the assay for telomerase activity has very high analytical sensitivity and high specificity for cancer cells, this routinely used method may prove useful for distinguishing malignant phenotype of breast tissues.
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Affiliation(s)
- M Simícková
- Masaryk Memorial Cancer Institute, Brno, Czech Republic.
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Babjuk M, Kostírová M, Mudra K, Pecher S, Smolová H, Pecen L, Ibrahim Z, Dvorácek J, Jarolím L, Novák J, Zima T. Qualitative and quantitative detection of urinary human complement factor H-related protein (BTA stat and BTA TRAK) and fragments of cytokeratins 8, 18 (UBC rapid and UBC IRMA) as markers for transitional cell carcinoma of the bladder. Eur Urol 2002; 41:34-9. [PMID: 11999463 DOI: 10.1016/s0302-2838(01)00015-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the role of BTA stat, BTA TRAK, UBC Rapid, UBC IRMA and voided urinary cytology in the detection of bladder transitional cell carcinoma (TCC). METHODS The study included 78 patients with TCC of the bladder (group A), 62 patients with a history of bladder TCC without tumor recurrence at the time of examination (B, control group), 20 patients with other malignancy of the urinary tract (C), 38 patients with non-malignant urinary tract diseases (D), 10 patients with urinary tract infection (E) and 10 healthy volunteers (F). Except in group F, voided urine was collected before cystoscopy or cystectomy. RESULTS The specificity and sensitivity in bladder cancer detection were 87.1 and 74.4%, respectively with BTA stat, 79.3 and 48.7%, respectively with UBC Rapid, 100 and 33.3%, respectively with cytology, 72.6 and 75.6%, respectively with BTA TRAK, 64.5 and 70.5%, respectively with UBC IRMA. CONCLUSIONS The BTA stat and BTATRAK tests are superior to UBC Rapid, UBC IRMA and urinary cytology in detection of bladder TCC. In daily practice however cytology remains the best adjunct to cystoscopy because of its high sensitivity in Tis and 100% specificity. Cystoscopy cannot be replaced by any of evaluated methods.
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Affiliation(s)
- M Babjuk
- Department of Urology, General Teaching Hospital, 1st Medical Faculty, Charles University, Postgraduate Institute, Prague, Czech Republic.
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Babjuk M, Soukup V, Mareš J, Dušková J, Sedláček Z, Trková M, Pecen L, Dvořáček J, Hanuš T, Kočvara R, Novák J, Povýšil C. Int Urol Nephrol 2002; 34:495-501. [DOI: 10.1023/a:1025652203472] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Valík D, Nekulová M, Pecen L, Votavová I. [How external quality evaluation programs affect the quality of laboratory results in routine practice in the Czech Republic]. Cas Lek Cesk 2001; 140:538-44. [PMID: 11702480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Goals of our study were: 1. to assess quality of our analytical work and application of concepts of good laboratory practice using different EQA surveys, 2. to evaluate performance and efficiency of systems for internal quality control using EQA program that is independent on local subjective and objective influences and 3. to observe how single EQA programs differ and how they contribute the ability of laboratories to manage their overall quality. Using one-way ANOVA, we compared our 1999 results in the local EQA survey AKS (SEKK s r.o., Czech Republic) to our results in CN3 Comprehensive Chemistry Survey (College of American Pathologists, USA) for analyses provided in CN3 with the definitive method correlated target values, the design of which assures accuracy of the field methods on patient specimens. In 4 out of 9 methods, the material AKS predicted target values that were significantly different from that of CN3; calcium sodium, uric acid and cholesterol. The CN3 survey provided link of our results of internal quality control and national EQA to the largest proficiency testing available worldwide in clinical chemistry. Out data suggest that a possibility exists to improve the design of target values for materials used for small national EQA surveys as well as the program administration so that local characteristics of field method on patient specimens could be better monitored.
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Affiliation(s)
- D Valík
- Oddĕlení biochemie-Masarykův onkologický ústav, Brno.
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Gaja A, Churý Z, Pecen L, Fra ková H, Jandáková E, Hejlová N. Bone marrow and peripheral blood leptin levels in lymphoproliferative diseases--relation to the bone marrow fat and infiltration. Neoplasma 2001; 47:307-12. [PMID: 11130249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Leptin is a nonglycosylated protein produced mostly by adipocytes. The role ofleptin in body weight regulation through its anorectic effect in hypothalamus is very well known. Less known are other leptin effects such as the stimulation of hematopoesis and some parts of immunity system. The role of leptin in the pathogenesis of some malignant tumors is discussed. Only a little is known about bone marrow adipocyte leptin production. We examined leptin concentrations in the sera from peripheral blood and bone marrow, the percentage of bone marrow fat, the degree of bone marrow infiltration, the body mass index (BMI) in 42 patients with lymphoproliferative diseases. We found that bone marrow has significantly lower leptin levels (6,6+/-10,9 ng/ml) than peripheral blood (9,1+/-11,5 ng/ml) (p < 0.0001). Bone marrow and peripheral blood leptin levels have also a significant thin correlation (r = +0.91, p < 0.0001). Bone marrow (r = +0.55, p < 0.0005) and peripheral blood (r = +0.52, p < 0.0005) leptin concentrations are significantly correlated to BMI. Blood serum leptin (r = +0.46, p < 0.003) and bone marrow leptin (r = +0.40, p < 0.01) are related to the bone marrow fat percentage. In addition we found a negative correlation of blood serum leptin (r = -0.59, p < 0.0001) and bone marrow leptin (r = -0.42, p < 0.005) to bone marrow malignant infiltration. When we divided the patients into groups with bone marrow infiltration more than 10% and without or less than 10% infiltration, the first group had significantly lower peripheral blood (p < 0.001) and bone marrow (p < 0.02) leptin. We also confirmed a relation of bone marrow fat and infiltration (r = +0.49, p < 0.001). Our results suggest a relationship among leptin levels in blood or bone marrow and bone marrow infiltration in lymphoproliferative diseases. This fact needs further investigation and an evaluation of its application in clinical practice.
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Affiliation(s)
- A Gaja
- Masaryk Memorial Cancer Institute, Brno, Czech Republic.
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Abstract
UNLABELLED The pathogenesis of abdominal aortic aneurysms (AAA) is a complex process in which atherosclerosis and inflammation play a leading role. Cytokines are important mediators of both processes. The aim of our study was to determine whether plasma levels of cytokines which are most involved in AAA pathogenesis can be used as endogenous markers of AAA development, and thus to facilitate the decision on surgical intervention in cases when this is clinically unclear (e.g. small AAA). In the prospective study a total of 90 patients with AAA were examined. These patients were divided into the following groups according to symptoms and AAA diameter: symptomatic AAAs, including ruptures (n=16); asymptomatic AAAs (n=74); AAAs with a diameter of up to 5 cm (n=30), AAAs of 5-8 cm (n=38), and AAAs with a diameter over 8 cm (n=22). The average age of the patients was 70.7 (56-82) years. The male to female ratio was 4:1 (71:19). A control group consisted of 30 healthy individuals of similar age and sex presentation with no manifestation of atherosclerosis. Plasma levels of cytokines were assessed in venous blood by means of radio- or enzymo-immunoassay. Statistical processing of the results was conducted with ANOVA and Wilcoxon tests with Spearman correlation, where p<0.05 was considered to be statistically significant. Plasma concentrations of cytokines were significantly higher in AAA patients than in healthy individuals. In AAA patients the tumour necrosis factor-alpha (TNF-alpha) and interleukin (IL-8) levels were low in large and in symptomatic AAAs. IL-6 levels were increased with increasing AAA diameter and symptoms. IL-8 levels (p<0.05) showed a statistically significant correlation with the diameter, and TNF-alpha (p<0.05) with the symptoms of AAA. IL-1beta, IL-2 and IL-6 did not show any significant changes with different AAA diameter or symptomatology. IN CONCLUSION IL-8 and TNF-alpha can be used as endogenous markers of the process of AAA development, in deciding for either surgical or endovascular treatment of patients when the clinical indication is not entirely clear.
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Affiliation(s)
- V Treska
- Surgical Clinic, Faculty Hospital, Charles University, Plzen, Czech Republic
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