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Weigel S, Heindel W, Decker T, Weyer-Elberich V, Kerschke L, Gerß J, Hense HW. Digital Breast Tomosynthesis versus Digital Mammography for Detection of Early-Stage Cancers Stratified by Grade: A TOSYMA Subanalysis. Radiology 2023; 309:e231533. [PMID: 38051184 DOI: 10.1148/radiol.231533] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Background Breast cancer screening with digital breast tomosynthesis (DBT) plus synthesized mammography (SM) increases invasive tumor detection compared with digital mammography (DM). However, it is not known how the prognostic characteristics of the cancers detected with the two screening approaches differ. Purpose To compare invasive breast cancers detected with DBT plus SM (test arm) versus DM (control arm) screening with regard to tumor stage, histologic grade, patient age, and breast density. Materials and Methods This exploratory subanalysis of the Tomosynthesis plus Synthesized Mammography (TOSYMA) study, which is a multicenter randomized controlled trial embedded in the German mammography screening program, recruited women aged 50-70 years from July 2018 to December 2020. It compared invasive cancer detection rates (iCDRs), rate differences, and odds ratios (ORs) between the arms stratified by Union for International Cancer Control (UICC) stage (I vs II-IV), histologic grade (1 vs 2 or 3), age group (50-59 vs 60-70 years), and Breast Imaging Reporting and Data System categories of breast density (A or B vs C or D). Results In total, 49 462 (median age, 57 years [IQR, 53-62 years]) and 49 669 (median age, 57 years [IQR, 53-62 years]) participants were allocated to DBT plus SM and DM screening, respectively. The iCDR of stage I tumors with DBT plus SM was 51.6 per 10 000 women (255 of 49 462) and with DM it was 30.0 per 10 000 women (149 of 49 669). DBT plus SM depicted more stage I tumors with grade 2 or 3 (166 of 49 462, 33.7 per 10 000 women) than DM (106 of 49 669, 21.3 per 10 000 women; rate difference, +12.3 per 10 000 women [95% CI: 0.3, 24.9]; OR, 1.6 [95% CI: 0.9, 2.7]). DBT plus SM achieved the highest iCDR of stage I tumors with grade 2 or 3 among women aged 60-70 years with dense breasts (41 of 7364, 55.4 per 10 000 women; rate difference, +21.6 per 10 000 women [95% CI: -21.1, 64.3]; OR, 1.6 [95% CI: 0.6, 4.5]). Conclusion DBT plus SM screening appears to lead to higher detection of early-stage invasive breast cancers of grade 2 or 3 than DM screening, with the highest rate among women aged 60-70 years with dense breasts. Clinical trial registration no. NCT03377036 © RSNA, 2023 See also the editorial by Ha and Chang in this issue.
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Affiliation(s)
- Stefanie Weigel
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Walter Heindel
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Thomas Decker
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Veronika Weyer-Elberich
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Laura Kerschke
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Joachim Gerß
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Hans-Werner Hense
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
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Weigel S, Heindel W, Hense HW, Decker T, Gerß J, Kerschke L. Breast Density and Breast Cancer Screening with Digital Breast Tomosynthesis: A TOSYMA Trial Subanalysis. Radiology 2023; 306:e221006. [PMID: 36194110 DOI: 10.1148/radiol.221006] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Digital breast tomosynthesis (DBT) plus synthesized mammography (SM) reduces the diagnostic pitfalls of tissue superimposition, which is a limitation of digital mammography (DM). Purpose To compare the invasive breast cancer detection rate (iCDR) of DBT plus SM versus DM screening for different breast density categories. Materials and Methods An exploratory subanalysis of the TOmosynthesis plus SYnthesized MAmmography (TOSYMA) study, a randomized, controlled, multicenter, parallel-group trial recruited within the German mammography screening program from July 2018 to December 2020. Women aged 50-69 years were randomly assigned (1:1) to DBT plus SM or DM screening examination. Breast density categories A-D were visually assessed according to the Breast Imaging Reporting and Data System Atlas. Exploratory analyses were performed of the iCDR in both study arms and stratified by breast density, and odds ratios and 95% CIs were determined. Results A total of 49 762 women allocated to DBT plus SM and 49 796 allocated to DM (median age, 57 years [IQR, 53-62 years]) were included. In the DM arm, the iCDR was 3.6 per 1000 screening examinations in category A (almost entirely fatty) (16 of 4475 screenings), 4.3 in category B (102 of 23 534 screenings), 6.1 in category C (116 of 19 051 screenings), and 2.3 in category D (extremely dense breasts) (six of 2629 screenings). The iCDR in the DBT plus SM arm was 2.7 per 1000 screening examinations in category A (12 of 4439 screenings), 6.9 in category B (154 of 22 328 screenings), 8.3 in category C (156 of 18 772 screenings), and 8.1 in category D (32 of 3940 screenings). The odds ratio for DM versus DBT plus SM in category D was 3.8 (95% CI: 1.5, 11.1). The invasive cancers detected with DBT plus SM were most often grade 2 tumors; in category C, it was 58% (91 of 156 invasive cancers), and in category D, it was 47% (15 of 32 invasive cancers). Conclusion The TOmosynthesis plus SYnthesized MAmmography trial revealed higher invasive cancer detection rates with digital breast tomosynthesis plus synthesized mammography than digital mammography in dense breasts, relatively and absolutely most marked among women with extremely dense breasts. ClinicalTrials.gov registration no.: NCT03377036 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Moy in this issue.
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Affiliation(s)
- Stefanie Weigel
- From the Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany (S.W., W.H., T.D.); Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (H.W.H.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (J.G., L.K.)
| | - Walter Heindel
- From the Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany (S.W., W.H., T.D.); Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (H.W.H.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (J.G., L.K.)
| | - Hans-Werner Hense
- From the Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany (S.W., W.H., T.D.); Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (H.W.H.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (J.G., L.K.)
| | - Thomas Decker
- From the Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany (S.W., W.H., T.D.); Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (H.W.H.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (J.G., L.K.)
| | - Joachim Gerß
- From the Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany (S.W., W.H., T.D.); Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (H.W.H.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (J.G., L.K.)
| | - Laura Kerschke
- From the Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany (S.W., W.H., T.D.); Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (H.W.H.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (J.G., L.K.)
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- From the Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany (S.W., W.H., T.D.); Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany (H.W.H.); and Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany (J.G., L.K.)
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Weigel S, Brehl AK, Heindel W, Kerschke L. Artificial Intelligence for Indication of Invasive Assessment of Calcifications in Mammography Screening. ROFO-FORTSCHR RONTG 2023; 195:38-46. [PMID: 36587613 DOI: 10.1055/a-1967-1443] [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: 01/03/2023]
Abstract
PURPOSE Lesion-related evaluation of the diagnostic performance of an individual artificial intelligence (AI) system to assess mamographically detected and histologically proven calcifications. MATERIALS AND METHODS This retrospective study included 634 women of one screening unit (July 2012 - June 2018) who completed the invasive assessment of calcifications. For each leasion, the AI-system calculated a score between 0 and 98. Lesions scored > 0 were classified as AI-positive. The performance of the system was evaluated based on its positive predictive value of invasive assessment (PPV3), the false-negative rate and the true-negative rate. RESULTS The PPV3 increased across the categories (readers: 4a: 21.2 %, 4b: 57.7 %, 5: 100 %, overall 30.3 %; AI: 4a: 20.8 %, 4b: 57.8 %, 5: 100 %, overall: 30.7 %). The AI system yielded a false-negative rate of 7.2 % (95 %-CI: 4.3 %: 11.4 %) and a true-negative rate of 9.1 % (95 %-CI: 6.6 %; 11.9 %). These rates were highest in category 4a, 12.5 % and 10.4 % retrospectively. The lowest median AI score was observed for benign lesions (61, interquartile range (IQR): 45-74). Invasive cancers yielded the highest median AI score (81, IQR: 64-86). Median AI scores for ductal carcinoma in situ were: 74 (IQR: 63-84) for low grade, 70 (IQR: 52-79) for intermediate grade and 74 (IQR: 66-83) for high grade. CONCLUSION At the lowest threshold, the AI system yielded calcification-related PPV3 values that increased across categories, similar as seen in human evaluation. The strongest loss in AI-based breast cancer detection was observed for invasively assessed calcifications with the lowest suspicion of malignancy, yet with a comparable decrease in the false-positive rate. An AI-score based stratification of malignant lesions could not be determined. KEY POINTS · The AI-based PPV3 for calcifications is comparable to human assessment.. · AI showed a lower detection performance of screen-positive and screen-negative lesions in category 4a.. · Histological subgroups could not be discriminated by AI scores.. CITATION FORMAT · Weigel S, Brehl AK, Heindel W et al. Artificial Intelligence for Indication of Invasive Assessment of Calcifications in Mammography Screening. Fortschr Röntgenstr 2023; 195: 38 - 46.
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Affiliation(s)
- Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography, University Hospital and University of Münster, Münster, Germany
| | | | - Walter Heindel
- Clinic for Radiology and Reference Center for Mammography, University Hospital and University of Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
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Franke JF, Oelmeier K, Möllers M, Möllmann U, Braun J, Kerschke L, Köster HA, Klockenbusch W, Schmitz R, Hammer K. Termination of pregnancy in the second trimester - the course of different therapy regimens. J Perinat Med 2022; 50:1053-1060. [PMID: 35532780 DOI: 10.1515/jpm-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare two prostaglandin analogs and two application intervals between mifepristone and the prostaglandin analog administration on the time to abortion in second trimester termination of pregnancy. Other endpoints were live birth rate and fetal lifetime after expulsion. METHODS Retrospective data of 373 abortions performed were evaluated. Four medical induction subgroups and two feticide subgroups were considered. The definition criteria of the subgroups were the choice of administered prostaglandin analog (misoprostol vs. sulprostone) and the time interval between mifepristone and prostaglandin analog administration (48 vs. 24 h). The outcome parameters were the time to complete uterine evacuation (TCUE), the live birth rate and duration of fetal life. RESULTS In the misoprostol subgroups, the median TCUE was 1.6 h longer in the 24-h group than in the 48-h group (p=0.950). In the sulprostone subgroups, the median TCUE was 1.9 h shorter in the 24-h group than in the 48-h group (p=0.950). The median TCUE was shorter for sulprostone than for misoprostol in all six subgroups (p<0.001). The rate of fetal live births ranged between 13.6 and 15.9% within the medical induction subgroups (p=0.969). The median fetal lifetime was slightly shorter in the sulprostone groups than in the misoprostol groups (p=0.563). CONCLUSIONS Both application intervals and prostaglandin analogs are similarly effective. The therapy regime should be adapted to the personal preferences of the woman, the situational and clinical conditions.
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Affiliation(s)
- Jana Franzis Franke
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Kathrin Oelmeier
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Ute Möllmann
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Walter Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany
| | - Kerstin Hammer
- Department of Obstetrics and Gynecology, Helios Maria Hilf Clinic, Hamburg, Germany
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Noto B, Roll W, Zinken L, Rischen R, Kerschke L, Evers G, Heindel W, Schäfers M, Büther F. Respiratory motion correction in F-18-FDG PET/CT impacts lymph node assessment in lung cancer patients. EJNMMI Res 2022; 12:61. [PMID: 36107357 PMCID: PMC9478021 DOI: 10.1186/s13550-022-00926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUNDS Elastic motion correction in PET has been shown to increase image quality and quantitative measurements of PET datasets affected by respiratory motion. However, little is known on the impact of respiratory motion correction on clinical image evaluation in oncologic PET. This study evaluated the impact of motion correction on expert readers' lymph node assessment of lung cancer patients. METHODS Forty-three patients undergoing F-18-FDG PET/CT for the staging of suspected lung cancer were included. Three different PET reconstructions were investigated: non-motion-corrected ("static"), belt gating-based motion-corrected ("BG-MC") and data-driven gating-based motion-corrected ("DDG-MC"). Assessment was conducted independently by two nuclear medicine specialists blinded to the reconstruction method on a six-point scale [Formula: see text] ranging from "certainly negative" (1) to "certainly positive" (6). Differences in [Formula: see text] between reconstruction methods, accounting for variation caused by readers, were assessed by nonparametric regression analysis of longitudinal data. From [Formula: see text], a dichotomous score for N1, N2, and N3 ("negative," "positive") and a subjective certainty score were derived. SUV and metabolic tumor volumes (MTV) were compared between reconstruction methods. RESULTS BG-MC resulted in higher scores for N1 compared to static (p = 0.001), whereas DDG-MC resulted in higher scores for N2 compared to static (p = 0.016). Motion correction resulted in the migration of N1 from tumor free to metastatic on the dichotomized score, consensually for both readers, in 3/43 cases and in 2 cases for N2. SUV was significantly higher for motion-corrected PET, while MTV was significantly lower (all p < 0.003). No significant differences in the certainty scores were noted. CONCLUSIONS PET motion correction resulted in significantly higher lymph node assessment scores of expert readers. Significant effects on quantitative PET parameters were seen; however, subjective reader certainty was not improved.
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Affiliation(s)
- Benjamin Noto
- grid.16149.3b0000 0004 0551 4246Department of Nuclear Medicine, University Hospital Münster, Münster, Germany ,grid.16149.3b0000 0004 0551 4246Clinical for Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Wolfgang Roll
- grid.16149.3b0000 0004 0551 4246Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Laura Zinken
- grid.16149.3b0000 0004 0551 4246Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Robert Rischen
- grid.16149.3b0000 0004 0551 4246Clinical for Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Laura Kerschke
- grid.5949.10000 0001 2172 9288Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Georg Evers
- grid.16149.3b0000 0004 0551 4246Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, Münster, Germany
| | - Walter Heindel
- grid.16149.3b0000 0004 0551 4246Clinical for Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany ,West German Cancer Centre (WTZ), Münster, Germany
| | - Michael Schäfers
- grid.16149.3b0000 0004 0551 4246Department of Nuclear Medicine, University Hospital Münster, Münster, Germany ,grid.5949.10000 0001 2172 9288European Institute for Molecular Imaging, University of Münster, Münster, Germany ,West German Cancer Centre (WTZ), Münster, Germany
| | - Florian Büther
- grid.16149.3b0000 0004 0551 4246Department of Nuclear Medicine, University Hospital Münster, Münster, Germany ,grid.5949.10000 0001 2172 9288European Institute for Molecular Imaging, University of Münster, Münster, Germany
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Weiss R, Saadat-Gilani K, Kerschke L, Wempe C, Meersch M, Zarbock A. EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): study protocol for a multicentre, observational trial. BMJ Open 2021; 11:e055705. [PMID: 35588372 PMCID: PMC8718477 DOI: 10.1136/bmjopen-2021-055705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. METHODS AND ANALYSIS EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. ETHICS AND DISSEMINATION EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. TRIAL REGISTRATION NUMBER NCT04165369.
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Affiliation(s)
- Raphael Weiss
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Khaschayar Saadat-Gilani
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Carola Wempe
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Melanie Meersch
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Münster, Münster, Germany
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Kim MR, Oji V, Valentin F, Traupe H, Nofer JR, Hausser I, Hennies HC, Eckl K, Wudy SA, Sánchez-Guijo A, Kerschke L, Fischer J, Süßmuth K. Vitamin D Status in Distinct Types of Ichthyosis: Importance of Genetic Type and Severity of Scaling. Acta Derm Venereol 2021; 101:adv00546. [PMID: 34396419 PMCID: PMC9425607 DOI: 10.2340/00015555-3887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Data on vitamin D status of patients with inherited ichthyosis in Europe is scarce and unspecific concerning the genetic subtype. This study determined serum levels of 25-hydroxyvitamin D3 (25(OH)D3) in 87 patients with ichthyosis; 69 patients were additionally analysed for parathyroid hormone. Vitamin D deficiency was pronounced in keratinopathic ichthyosis (n = 17; median 25(OH)D3: 10.5 ng/ml), harlequin ichthyosis (n = 2;7.0 ng/ml) and rare syndromic sub-types (n = 3; 7.0 ng/ml). Vitamin D levels were reduced in TG1-proficient lamellar ichthyosis (n = 15; 8.9 ng/ml), TG1-deficient lamellar ichthyosis (n = 12; 11.7 ng/ml), congenital ichthyosiform erythroderma (n = 13; 12.4 ng/ml), Netherton syndrome (n = 7; 10.7 ng/ml) and X-linked ichthyosis (n = 8; 13.9 ng/ml). In ichthyosis vulgaris 25(OH)D3 levels were higher (n = 10; 19.7 ng/ml). Parathyroid hormone was elevated in 12 patients. Low 25(OH)D3 levels were associated with high severity of scaling (p = 0.03) implicating scaling as a risk factor for vitamin D deficiency. Thus, this study supports our recent guidelines for ichthyoses, which recommend screening for and substituting of vitamin D deficiency.
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Affiliation(s)
- Mi-Ran Kim
- Department of Dermatology, University of Münster, Münster, Germany
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Kerschke L, Weigel S, Rodriguez-Ruiz A, Karssemeijer N, Heindel W. Using deep learning to assist readers during the arbitration process: a lesion-based retrospective evaluation of breast cancer screening performance. Eur Radiol 2021; 32:842-852. [PMID: 34383147 PMCID: PMC8794989 DOI: 10.1007/s00330-021-08217-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate if artificial intelligence (AI) can discriminate recalled benign from recalled malignant mammographic screening abnormalities to improve screening performance. Methods A total of 2257 full-field digital mammography screening examinations, obtained 2011–2013, of women aged 50–69 years which were recalled for further assessment of 295 malignant out of 305 truly malignant lesions and 2289 benign lesions after independent double-reading with arbitration, were included in this retrospective study. A deep learning AI system was used to obtain a score (0–95) for each recalled lesion, representing the likelihood of breast cancer. The sensitivity on the lesion level and the proportion of women without false-positive ratings (non-FPR) resulting under AI were estimated as a function of the classification cutoff and compared to that of human readers. Results Using a cutoff of 1, AI decreased the proportion of women with false-positives from 89.9 to 62.0%, non-FPR 11.1% vs. 38.0% (difference 26.9%, 95% confidence interval 25.1–28.8%; p < .001), preventing 30.1% of reader-induced false-positive recalls, while reducing sensitivity from 96.7 to 91.1% (5.6%, 3.1–8.0%) as compared to human reading. The positive predictive value of recall (PPV-1) increased from 12.8 to 16.5% (3.7%, 3.5–4.0%). In women with mass-related lesions (n = 900), the non-FPR was 14.2% for humans vs. 36.7% for AI (22.4%, 19.8–25.3%) at a sensitivity of 98.5% vs. 97.1% (1.5%, 0–3.5%). Conclusion The application of AI during consensus conference might especially help readers to reduce false-positive recalls of masses at the expense of a small sensitivity reduction. Prospective studies are needed to further evaluate the screening benefit of AI in practice. Key Points • Integrating the use of artificial intelligence in the arbitration process reduces benign recalls and increases the positive predictive value of recall at the expense of some sensitivity loss. • Application of the artificial intelligence system to aid the decision to recall a woman seems particularly beneficial for masses, where the system reaches comparable sensitivity to that of the readers, but with considerably reduced false-positives. • About one-fourth of all recalled malignant lesions are not automatically marked by the system such that their evaluation (AI score) must be retrieved manually by the reader. A thorough reading of screening mammograms by readers to identify suspicious lesions therefore remains mandatory.
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Affiliation(s)
- Laura Kerschke
- Institute of Biostatistics and Clinical Research, IBKF, University of Muenster, Schmeddingstrasse 56, 48149, Muenster, Germany.
| | - Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography Muenster, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | | | - Nico Karssemeijer
- ScreenPoint Medical BV, Toernooiveld 300, 6525, EC, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands
| | - Walter Heindel
- Clinic for Radiology and Reference Center for Mammography Muenster, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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9
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Oberste M, Riders A, Abbaspour B, Kerschke L, Beule AG, Rudack C. Improvement of patient stratification in human papilloma virus-associated oropharyngeal squamous cell carcinoma by defining a multivariable risk score. Head Neck 2021; 43:3314-3323. [PMID: 34337814 DOI: 10.1002/hed.26822] [Citation(s) in RCA: 3] [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: 02/04/2021] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Precise risk stratification models are necessary to determine patient selection for deintensifying treatment trials in human papilloma virus (HPV)-associated oropharyngeal squamous cell cancer (HPV+ OPSCC). METHODS We examined 526 cases with OPSCC treated at our department between 2002 and 2017. Every patient was classified after the 7th and 8th edition UICC staging manual. For HPV+ OPSCC, we calculated a simple risk score with four risk groups based on multivariable Cox regression analysis of clinical and lifestyle parameters (UICC 8th edition stage, tobacco/alcohol abuse, age, gender). RESULTS Two hundred and thirty-nine patients with OPSCC (45.4%) showed a positive histological HPV status. In comparison to UICC 8th edition stages, our proposed risk model showed a tendency for better stratification between risk strata I/III, I/IV, and II/IV (each p < 0.002) and I/II, II/III, and III/IV (each p < 0.09). CONCLUSION Age, gender, tobacco, and alcohol abuse should be added to the current UICC staging system in order to improve risk stratification in HPV+ OPSCC.
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Affiliation(s)
- Maximilian Oberste
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
| | - Armands Riders
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
| | - Bektasch Abbaspour
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Achim G Beule
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
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10
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Wiegele PN, Kabar I, Kerschke L, Froemmel C, Hüsing-Kabar A, Schmidt H, Vorona E, Vollenberg R, Tepasse PR. Symptom Diary-Based Analysis of Disease Course among Patients with Mild Coronavirus Disease, Germany, 2020. Emerg Infect Dis 2021; 27:1353-1361. [PMID: 33900166 PMCID: PMC8084503 DOI: 10.3201/eid2705.204507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Limited information is available on the clinical course of outpatients with mild coronavirus disease (COVID-19). This information is critically important to inform public health prevention strategies and to provide anticipatory guidance to patients, primary care providers, and employers. We retrospectively assessed the daily prevalence of symptoms in 313 COVID-19 outpatients for the first 20 days of illness. Generalized estimating equations were used to assess the probability of symptom occurrence over time. Fatigue (91%), cough (85%), and headache (78%) were the most common symptoms and occurred a median of 1 day from symptom onset. Neurologic symptoms, such as loss of taste (66%) and anosmia (62%), and dyspnea (51%) occurred considerably later (median 3–4 days after symptom onset). Symptoms of COVID-19 are similar to those of other respiratory pathogens, so symptomatic patients should be tested more frequently for severe acute respiratory syndrome coronavirus 2 during influenza season to prevent further spread of COVID-19.
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11
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Dhayat SA, Tamim ANJ, Jacob M, Ebeling G, Kerschke L, Kabar I, Senninger N. Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients. PLoS One 2021; 16:e0252727. [PMID: 34086792 PMCID: PMC8177431 DOI: 10.1371/journal.pone.0252727] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Postoperative pancreatic fistula (POPF) with reported incidence rates up to 45% contributes substantially to overall morbidity. In this study, we conducted a retrospective evaluation of POPF along with its potential perioperative clinical risk factors and its effect on tumor recurrence. METHODS Clinical data on patients who had received pancreatoduodenectomy (PD), distal pancreatectomy (DP), or duodenum-preserving pancreatic head resection (DPPHR) were prospectively collected between 2007 and 2016. A Picrosirius red staining score was developed to enable morphological classification of the resection margin of the pancreatic stump. The primary end point was the development of major complications. The secondary end points were overall and recurrence-free survival. RESULTS 340 patients underwent pancreatic resection including 222 (65.3%) PD, 87 (25.6%) DP, and 31 (9.1%) DPPHR. Postoperative major complications were observed in 74 patients (21.8%). In multivariable logistic regression analysis, POPF correlated with body mass index (BMI) (p = 0.025), prolonged stay in hospital (p<0.001), high Picrosirius red staining score (p = 0.049), and elevated postoperative levels of amylase or lipase in drain fluid (p≤0.001). Multivariable Cox regression analysis identified UICC stage (p<0.001), tumor differentiation (p<0.001), depth of invasion (p = 0.001), nodal invasion (p = 0.001), and the incidence of POPF grades B and C (p = 0.006) as independent prognostic markers of recurrence-free survival. CONCLUSION Besides the known clinicopathological risk factors BMI and amylase in the drain fluid, the incidence of POPF correlates with high Picrosirius red staining score in the resection margins of the pancreatic stumps of curatively resected pancreatic ductal adenocarcinoma (PDAC). Furthermore, clinically relevant POPF seems to be a prognostic factor for tumor recurrence in PDAC.
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Affiliation(s)
- Sameer A. Dhayat
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
- * E-mail:
| | - Ahmad N. J. Tamim
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Marius Jacob
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Georg Ebeling
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Iyad Kabar
- Department of Internal Medicine B, Gastroenterology and Hepatology, University Hospital Muenster, Muenster, Germany
| | - Norbert Senninger
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
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12
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Seifert R, Schäfers M, Heitplatz B, Kerschke L, Riemann B, Noto B. Minimal extrathyroid extension in papillary micro carcinoma of the thyroid is an independent risk factor for relapse through lymph node and distant metastases. J Nucl Med 2021; 62:jnumed.121.261898. [PMID: 33771902 PMCID: PMC8612207 DOI: 10.2967/jnumed.121.261898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: Minimal extrathyroid extension (mETE) is no longer considered in the new 8th edition of the AJCC/UICC staging system. Therefore, papillary thyroid microcarcinoma with mETE previously staged as pT3 will now be staged as pT1a and most likely not receive adjuvant radioiodine therapy. However, it remains unclear if mETE is associated with higher aggressiveness in papillary thyroid microcarcinoma. Therefore, the aim of this study was to investigate if mETE is associated with higher risk of lymph node or distant metastases. Methods: 721 patients with thyroid papillary microcarcinoma presenting at our department for postoperative counseling from 05/1983 to 8/2012 were included in this retrospective analysis (median follow-up time 9.30 years). The impact of mETE on the presence of lymph node metastases at thyroidectomy and relapse through lymph node and distant metastases was assessed by logistic regression and Fine-Gray model analyses. Results: 10.7% (n = 77) of patients had mETE. mETE was an independent risk factor for lymph node metastases at thyroidectomy with an adjusted odds ratio of 4.33 (95%CI: 2.02-9.60, p<0.001) in multivariable analysis. Patients with mETE had significantly more relapses through lymph node (over 5 years: 13.1% vs. 1.25%; P < 0.001) and distant metastases (over 5 years: 7.8% vs. 1.1%; P < 0.001) compared to patients without mETE. mETE was an independent risk factor for relapse through lymph node and distant metastases in multivariable analysis (hazard ratio: 7.78, 95%CI: 2.87-21.16, p< 0.001 and 4.09, 95%CI: 1.25-13.36, P = 0.020). Conclusion: mETE is a statistically significant and independent risk factor for relapse through lymph node and distant metastases in papillary microcarcinoma. Therefore, future studies should evaluate, if patients with mETE and microcarcinoma might benefit from intensified surveillance and therapy.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- West German Cancer Center, Essen, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Center, Essen, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Barbara Heitplatz
- Gerhard Domagk Institute of Pathology, University of Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany; and
| | - Burkhard Riemann
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Center, Essen, Germany
| | - Benjamin Noto
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Center, Essen, Germany
- Department of Radiology, University Hospital Münster, Münster, Germany
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13
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Pfeuffer S, Kerschke L, Ruck T, Rolfes L, Pawlitzki M, Albrecht P, Wiendl H, Meuth SG. Teriflunomide treatment is associated with optic nerve recovery in early multiple sclerosis. Ther Adv Neurol Disord 2021; 14:1756286421997372. [PMID: 33747129 PMCID: PMC7940774 DOI: 10.1177/1756286421997372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background and aims: Various attempts have been made to support recovery following optic neuritis (ON), but the respective trials have mostly been negative. The aim of this study was to determine whether disease-modifying treatment (DMT) following ON as first manifestation of relapsing-remitting multiple sclerosis influences long-term outcomes. Methods: A total of 79 patients with ON were identified and evaluated at relapse, DMT induction, and 12 months following treatment induction with either glatiramer acetate (GLAT), interferon-beta (IFN), or teriflunomide (TRF). Low-contrast letter acuity (LCLA) and full-field visual-evoked potentials (FF-VEP) were compared between treatment groups using multivariable regression models. The impact of TRF treatment induction compared with IFN or GLAT following relapses outside the optic nerves was evaluated in an independent cohort of 122 patients. Magnetic resonance imaging (MRI) outcomes and rates of confirmed improvement of relapse-related disability were evaluated. Results: TRF-treated patients exhibited higher LCLA and lower relative P100 latencies normalized to the fellow-eye. Findings were significant following covariate-adjustment by multivariable analyses. Cranial MRI lesion load as well as disability progression rates were not significantly different between groups. The cohort of patients following relapses other than ON showed no differences in confirmed improvement of disability. Conclusion: TRF treatment is associated with favorable outcomes regarding functional optic nerve recovery following ON in early multiple sclerosis.
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Affiliation(s)
- Steffen Pfeuffer
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, 48149, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Tobias Ruck
- Department of Neurology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Leoni Rolfes
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Marc Pawlitzki
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Philipp Albrecht
- Department of Neurology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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14
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Meersch M, Küllmar M, Pavenstädt H, Rossaint J, Kellum JA, Martens S, Klausmeyer P, Schmidt EA, Kerschke L, Zarbock A. Effects of Different Doses of Remote Ischemic Preconditioning on Kidney Damage Among Patients Undergoing Cardiac Surgery: A Single-Center Mechanistic Randomized Controlled Trial. Crit Care Med 2020; 48:e690-e697. [PMID: 32697510 DOI: 10.1097/ccm.0000000000004415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We have previously shown that remote ischemic preconditioning reduces acute kidney injury (acute kidney injury) in high-risk patients undergoing cardiopulmonary bypass and that the protective effect is confined to patients who exhibit an increased urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 in response to remote ischemic preconditioning. The purpose of this study was to determine the optimal intensity of remote ischemic preconditioning to induce required [tissue inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding protein 7] changes and further explore mechanisms of remote ischemic preconditioning. DESIGN Observational and randomized controlled, double-blind clinical trial. SETTING University Hospital of Muenster, Germany. PATIENTS High-risk patients undergoing cardiac surgery as defined by the Cleveland Clinic Foundation Score. INTERVENTIONS In the interventional part, patients were randomized to receive either one of four different remote ischemic preconditioning doses (3 × 5 min, 3 × 7 min, 3 × 10 min remote ischemic preconditioning, or 3 × 5 min remote ischemic preconditioning + 2 × 10 min remote ischemic preconditioning in nonresponders) or sham-remote ischemic preconditioning (control). MEASUREMENTS AND MAIN RESULTS The primary endpoint of the interventional part was change in urinary [tissue inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding protein 7] between pre- and postintervention. To examine secondary objectives including acute kidney injury incidence, we included an observational cohort. A total of 180 patients were included in the trial (n = 80 observational and n = 100 randomized controlled part [20 patients/group]). The mean age was 69.3 years (10.5 yr), 119 were men (66.1%). Absolute changes in [tissue inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding protein 7] were significantly higher in all remote ischemic preconditioning groups when compared with controls (p < 0.01). Although we did not observe a dose-response relationship on absolute changes in [tissue inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding protein 7] across the four different remote ischemic preconditioning groups, in the 15 patients failing to respond to the lowest dose, nine (60%) responded to a subsequent treatment at a higher intensity. Compared with controls, fewer patients receiving remote ischemic preconditioning developed acute kidney injury within 72 hours after surgery as defined by both Kidney Disease: Improving Global Outcomes criteria (30/80 [37.5%] vs 61/100 [61.0%]; p = 0.003). CONCLUSIONS All doses of remote ischemic preconditioning significantly increased [tissue inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding protein 7] and significantly decreased acute kidney injury compared with controls. High-dose remote ischemic preconditioning could stimulate [tissue inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding protein 7] increases in patients refractory to low-dose remote ischemic preconditioning.
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Affiliation(s)
- Melanie Meersch
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Mira Küllmar
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hermann Pavenstädt
- Department of Medicine, Division D, Nephrology, University Hospital Münster, Münster, Germany
| | - Jan Rossaint
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Sven Martens
- Department of Cardiac Surgery, University of Münster, Münster, Germany
| | - Pia Klausmeyer
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Elisa A Schmidt
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Münster, Münster, Germany
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Abstract
The one-sample log-rank test allows to compare the survival of a single sample with a prefixed reference survival curve. It naturally applies in single-arm phase IIa trials with time-to-event endpoint. Several authors have described that the original one-sample log-rank test is conservative when sample size is small and have proposed strategies to correct the conservativeness. Here, we propose an alternative approach to improve the one-sample log-rank test. Our new one-sample log-rank statistic is based on the unique transformation of the underlying counting process martingale such that the moments of the limiting normal distribution have no shared parameters. Simulation results show that the new one-sample log-rank test gives type I error rate and power close to the nominal levels also when sample size is small, while relevantly reducing the required sample size to achieve the desired power as compared to current approaches to design studies to compare the survival outcome of a sample with a reference.
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Affiliation(s)
- Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Rene Schmidt
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
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16
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Hetkamp T, Hammer K, Möllers M, Köster HA, Falkenberg MK, Kerschke L, Braun J, Oelmeier de Murcia K, Klockenbusch W, Schmitz R. Fetal adrenal gland size in gestational diabetes mellitus. J Perinat Med 2019; 47:941-946. [PMID: 31562804 DOI: 10.1515/jpm-2019-0146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/22/2019] [Indexed: 12/21/2022]
Abstract
Background The aim of this study was to compare the adrenal gland size of fetuses of women with gestational diabetes mellitus (GDM) with that of healthy control fetuses. Methods This prospective cross-sectional study included measurements of the adrenal gland size of 62 GDM fetuses (GDM group) and 370 normal controls (control group) between the 19th and 41st week of gestation. A standardized transversal plane was used to measure the total width and the medulla width. The cortex width and an adrenal gland ratio (total width/medulla width) were calculated from these data. Adrenal gland size measurements were adjusted to the week of gestation and compared between the two groups in a multivariable linear regression analysis. A variance decomposition metric was used to compare the relative importance of predictors of the different adrenal gland size measurements. Results For all the investigated parameters of the adrenal gland size, increased values were found in the case of GDM (P < 0.05), while adjusting for the week of gestation. GDM seems to have a greater impact on the size of the cortex than on the size of the medulla. Conclusion The fetal adrenal gland is enlarged in pregnancy complicated by GDM. The width of the cortex seems to be particularly affected.
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Affiliation(s)
- Tim Hetkamp
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Kerstin Hammer
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Mareike Möllers
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Helen A Köster
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Maria K Falkenberg
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Janina Braun
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Kathrin Oelmeier de Murcia
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Walter Klockenbusch
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Ralf Schmitz
- Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Brücher VC, Storp JJ, Kerschke L, Nelis P, Eter N, Alnawaiseh M. Influence of mydriasis on optical coherence tomography angiography imaging in patients with age-related macular degeneration. PLoS One 2019; 14:e0223452. [PMID: 31584983 PMCID: PMC6777775 DOI: 10.1371/journal.pone.0223452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose To evaluate the effect of topical mydriatic eye drops on optical coherence tomography angiography (OCTA) parameters in patients with age-related macular degeneration (AMD). Methods 27 eyes of 27 patients suffering from AMD were included in this cross-sectional study. Patients with ≥-4.5 diopters spherical equivalent, corneal opacities or dense cataract preventing high-quality imaging were excluded. Whole-en-face scans of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the central 3x3mm foveal region as well as whole-en-face and peripapillary scans of the radial peripapillary capillaries (RPC) were generated using OCTA (AngioVue®, Optovue). Imaging was first conducted with patients’ eyes in miosis, then in mydriasis after instillation of a dilating eye drop (0.5% tropicamide, 2.5% phenylephrine-HCl). Main outcome measures were flow density (FD), foveal avascular zone (FAZ), signal strength index (SSI) and motion artifact score (MAS). Results Our results reveal that in AMD patients there is no significant difference between FD measurements taken in miosis and those taken in mydriasis around the SCP (p = 0.198), DCP (p = 0.458), RPC whole-en-face (p = 0.275) and RPC peripapillary (p = 0.503). Measurements taken in these two states appear to be equivalent for assessment of FD (90%CI within ± 0.05). No significant difference was found either in the area of the FAZ (p = 0.338) or in the SSI (p = 0.371) before and after the instillation of tropicamide/phenylephrine. MAS was significantly lower after the application of mydriatic eye drops (p = 0.003). Conclusions Our findings reveal that neither measurements of FD nor measurements of the FAZ area changed significantly in AMD patients after the application of tropicamide/phenylephrine. Since MAS improved significantly in dilation, mydriatic examination is recommended. Nevertheless, a comparison of OCTA metrics from images taken with different pupil states (miosis versus mydriasis) is valid for clinical trials.
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Affiliation(s)
- Viktoria C. Brücher
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
- * E-mail:
| | - Jens J. Storp
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Laura Kerschke
- Department of Biometry and Clinical Research, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Pieter Nelis
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
| | - Maged Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Centre, Muenster, North Rhine-Westphalia, Germany
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18
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Müller VC, Storp JJ, Kerschke L, Nelis P, Eter N, Alnawaiseh M. Diurnal variations in flow density measured using optical coherence tomography angiography and the impact of heart rate, mean arterial pressure and intraocular pressure on flow density in primary open-angle glaucoma patients. Acta Ophthalmol 2019; 97:e844-e849. [PMID: 30900827 DOI: 10.1111/aos.14089] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/21/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To determine the diurnal variations in peripapillary and macular flow density (FD), as measured using optical coherence tomography angiography (OCTA) and to elaborate on the relationship between diurnal FD, circulatory parameters and intraocular pressure (IOP) variations in primary open-angle glaucoma (POAG). METHODS Forty eyes of 40 POAG patients were drawn into this cross-sectional study. The retinal microvasculature of the macula (superficial and deep layers) and optic nerve [radial peripapillary capillary (RPC)] was examined by OCTA (AngioVue® , Optovue). Optical coherence tomography angiography (OCTA) measurements were conducted at 08:00, 11:00, 15:00 and 20:00 over the course of two consecutive days. Intraocular pressure (IOP) and circulatory parameters were assessed accordingly. Diurnal variations in FD were analysed using linear mixed models. RESULTS While superficial macular FD and RPC FD revealed not to be affected by diurnal variations (p = 0.492, p = 0.319), FD in the deep layer of the macula increased throughout the day (p < 0.001). Superficial macular FD was influenced significantly by mean arterial pressure (MAP) (p = 0.006) and heart rate (HR) (p = 0.033), whereas FD in the RPC layer was significantly affected by HR (p = 0.010). No statistically significant effect of IOP fluctuations on FD was observed. CONCLUSION This study shows diurnal fluctuations of deep macular FD measured by OCTA and outlines the relationship between FD and hemodynamic parameters (MAP/HR) in POAG patients.
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Affiliation(s)
| | - Jens Julian Storp
- Department of Ophthalmology University of Muenster Medical Centre Muenster Germany
| | - Laura Kerschke
- Department of Biometry and Clinical Research University of Muenster Medical Centre Muenster Germany
| | - Pieter Nelis
- Department of Ophthalmology University of Muenster Medical Centre Muenster Germany
| | - Nicole Eter
- Department of Ophthalmology University of Muenster Medical Centre Muenster Germany
| | - Maged Alnawaiseh
- Department of Ophthalmology University of Muenster Medical Centre Muenster Germany
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19
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Ackermann S, Cartolano M, Hero B, Welte A, Kahlert Y, Roderwieser A, Bartenhagen C, Walter E, Gecht J, Kerschke L, Volland R, Menon R, Heuckmann JM, Gartlgruber M, Hartlieb S, Henrich KO, Okonechnikov K, Altmüller J, Nürnberg P, Lefever S, de Wilde B, Sand F, Ikram F, Rosswog C, Fischer J, Theissen J, Hertwig F, Singhi AD, Simon T, Vogel W, Perner S, Krug B, Schmidt M, Rahmann S, Achter V, Lang U, Vokuhl C, Ortmann M, Büttner R, Eggert A, Speleman F, O'Sullivan RJ, Thomas RK, Berthold F, Vandesompele J, Schramm A, Westermann F, Schulte JH, Peifer M, Fischer M. A mechanistic classification of clinical phenotypes in neuroblastoma. Science 2019; 362:1165-1170. [PMID: 30523111 DOI: 10.1126/science.aat6768] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/26/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022]
Abstract
Neuroblastoma is a pediatric tumor of the sympathetic nervous system. Its clinical course ranges from spontaneous tumor regression to fatal progression. To investigate the molecular features of the divergent tumor subtypes, we performed genome sequencing on 416 pretreatment neuroblastomas and assessed telomere maintenance mechanisms in 208 of these tumors. We found that patients whose tumors lacked telomere maintenance mechanisms had an excellent prognosis, whereas the prognosis of patients whose tumors harbored telomere maintenance mechanisms was substantially worse. Survival rates were lowest for neuroblastoma patients whose tumors harbored telomere maintenance mechanisms in combination with RAS and/or p53 pathway mutations. Spontaneous tumor regression occurred both in the presence and absence of these mutations in patients with telomere maintenance-negative tumors. On the basis of these data, we propose a mechanistic classification of neuroblastoma that may benefit the clinical management of patients.
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Affiliation(s)
- Sandra Ackermann
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Maria Cartolano
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Anne Welte
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Yvonne Kahlert
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Andrea Roderwieser
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Christoph Bartenhagen
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Esther Walter
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Judith Gecht
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Ruth Volland
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany
| | | | | | - Moritz Gartlgruber
- Division of Neuroblastoma Genomics (B087), German Cancer Research Center, and Hopp Children's Cancer Center at NCT Heidelberg (KiTZ), Heidelberg, Germany
| | - Sabine Hartlieb
- Division of Neuroblastoma Genomics (B087), German Cancer Research Center, and Hopp Children's Cancer Center at NCT Heidelberg (KiTZ), Heidelberg, Germany
| | - Kai-Oliver Henrich
- Division of Neuroblastoma Genomics (B087), German Cancer Research Center, and Hopp Children's Cancer Center at NCT Heidelberg (KiTZ), Heidelberg, Germany
| | - Konstantin Okonechnikov
- Division of Pediatric Neurooncology, German Cancer Research Center, and Hopp Children's Cancer Center at NCT Heidelberg (KiTZ), Heidelberg, Germany
| | - Janine Altmüller
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Peter Nürnberg
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Cologne Center for Genomics, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Steve Lefever
- Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Bram de Wilde
- Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Frederik Sand
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Fakhera Ikram
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Carolina Rosswog
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Janina Fischer
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Jessica Theissen
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Falk Hertwig
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Wenzel Vogel
- Pathology of the University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Research Center Borstel, Leibniz Center for Medicine and Biosciences, Borstel, Germany
| | - Sven Perner
- Pathology of the University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Research Center Borstel, Leibniz Center for Medicine and Biosciences, Borstel, Germany
| | - Barbara Krug
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Sven Rahmann
- Genome Informatics, Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Computer Science, TU Dortmund, Dortmund, Germany
| | - Viktor Achter
- Computing Center, University of Cologne, Cologne, Germany
| | - Ulrich Lang
- Computing Center, University of Cologne, Cologne, Germany.,Department of Informatics, University of Cologne, Cologne, Germany
| | - Christian Vokuhl
- Kiel Pediatric Tumor Registry, Department of Pediatric Pathology, University of Kiel, Kiel, Germany
| | - Monika Ortmann
- Department of Pathology, University of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Department of Pathology, University of Cologne, Cologne, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Frank Speleman
- Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Roderick J O'Sullivan
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Cancer Institute (UPCI), Hillman Cancer Center, Pittsburgh, PA, USA
| | - Roman K Thomas
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pathology, University of Cologne, Cologne, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Berthold
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany
| | - Jo Vandesompele
- Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - Alexander Schramm
- Department of Medical Oncology, West German Cancer Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Westermann
- Division of Neuroblastoma Genomics (B087), German Cancer Research Center, and Hopp Children's Cancer Center at NCT Heidelberg (KiTZ), Heidelberg, Germany
| | - Johannes H Schulte
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Berlin Institute of Health, Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Peifer
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Matthias Fischer
- Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty, Cologne, Germany. .,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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20
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Rolf N, Kerschke L, Braun J, Falkenberg MK, Hammer K, Köster HA, Möllers M, Oelmeier de Murcia K, Klockenbusch W, Schmitz R. Quantification of fetal myocardial function in pregnant women with diabetic diseases and in normal controls using speckle tracking echocardiography (STE). J Perinat Med 2018; 47:68-76. [PMID: 29894301 DOI: 10.1515/jpm-2018-0031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/19/2018] [Indexed: 01/12/2023]
Abstract
Background The purpose of our study was to quantify the fetal myocardial function in pregnant women with diabetic diseases (FDM) and in normal controls (FC) using speckle tracking echocardiography (STE). Methods In this prospective study, the myocardial strain and dyssynchrony were analyzed using STE in a transversal four-chamber view in 180 fetuses (53 FDM, 127 FC) between 19 and 39 weeks of gestation. The measurements of the global and segmental longitudinal strain of both chambers (2C) and of the single left chamber (1C) were executed offline via QLab 10.5 (Philips Medical Systems, Andover, MA, USA). We assessed dyssynchrony as the time difference between peaks in strain in the mid segments of both chambers (interventricular dyssynchrony, 2C_DYS) and of the single left chamber (intraventricular dyssynchrony, 1C_DYS). Results Measurements were feasible with a high median frame rate of 199 frames/s (1st quartile: 174, 3rd quartile: 199). The global and segmental myocardial longitudinal strain of 2C and 1C were decreased and 2C_DYS and 1C_DYS were increased in pregnancies with diabetes compared to normal controls. Conclusion Our study demonstrates that fetal hearts affected by maternal diabetes mellitus (DM) show low myocardial strain values and high interventricular dyssynchrony. Two-chamber interventricular dyssynchrony has the potential to become a diagnostic marker for DM.
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Affiliation(s)
- Nina Rolf
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany, Tel.: 0049-157-89373685, Fax: 0049-251-8347778
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Janina Braun
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Maria Karina Falkenberg
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Kerstin Hammer
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Helen Ann Köster
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Mareike Möllers
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Kathrin Oelmeier de Murcia
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Walter Klockenbusch
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Ralf Schmitz
- University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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21
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Radine A, Werner C, Raidt J, Dougherty GW, Kerschke L, Omran H, Grosse-Onnebrink J. Comparison of Nocturnal Cough Analysis in Healthy Subjects and in Patients with Cystic Fibrosis and Primary Ciliary Dyskinesia: A Prospective Observational Study. Respiration 2018; 97:60-69. [PMID: 30408808 DOI: 10.1159/000493323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cough is a key symptom in patients with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). OBJECTIVE The study objectives were to test whether cough is related to parameters reflecting their disease severity and whether CF and PCD differ in cough frequency. METHODS In this prospective observational study, we used a microphone-based monitoring system (LEOSound® Monitor) to count the coughs in healthy subjects (HS) and in stable patients with CF and PCD (25 subjects per group) on 2 consecutive nights. RESULTS The median number of coughs/h in the HS, CF, and PCD groups was 0.0, 1.3, and 0.5 on the first night and 0.0, 2.3, and 0.2 on the second night, respectively. Patients with CF and PCD coughed more than HS (p < 0.001 and p = 0.009, respectively) and CF patients coughed more than PCD patients (p = 0.023). A multivariable mixed model analysis revealed forced expiratory volume in 1 s as an independent risk factor for increased cough frequency in patients. The reliability for repeated measurements was higher for cough epochs/h than for coughs/h (intraclass correlation coefficient: 0.75 and 0.49, respectively). CONCLUSIONS Patients with CF cough more than patients with PCD. The cough frequency in CF and PCD is associated with parameters reflecting disease severity. Cough frequency is a possible endpoint in clinical trials and cough epochs/h may be more useful than coughs/h.
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Affiliation(s)
- Andrea Radine
- Pediatric Respiratory Medicine Unit, Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Claudius Werner
- Pediatric Respiratory Medicine Unit, Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Johanna Raidt
- Pediatric Respiratory Medicine Unit, Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Gerard W Dougherty
- Pediatric Respiratory Medicine Unit, Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Heymut Omran
- Pediatric Respiratory Medicine Unit, Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Joerg Grosse-Onnebrink
- Pediatric Respiratory Medicine Unit, Department of General Pediatrics, University Hospital Münster, Münster, Germany,
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22
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Liedtke C, Kolberg HC, Kerschke L, Görlich D, Bauerfeind I, Fehm T, Fleige B, Helms G, Lebeau A, Stäbler A, Schmatloch S, Hausschild M, Schwentner L, von Minckwitz G, Loibl S, Untch M, Kühn T. Systematic analysis of parameters predicting pathological axillary status (ypN0 vs. ypN+) in patients with breast cancer converting from cN+ to ycN0 through primary systemic therapy (PST). Clin Exp Metastasis 2018; 35:777-783. [PMID: 30324492 DOI: 10.1007/s10585-018-9938-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
Abstract
Optimization of axillary staging among patients converting from clinically node-positive disease to clinically node-negative disease through primary systemic therapy is needed. We aimed at developing a nomogram predicting the probability of positive axillary status after chemotherapy based on clinical/pathological parameters. Patients from study arm C of the SENTINA trial were included. Univariable/multivariable analyses were performed for 13 clinical/pathological parameters to predict a positive pathological axillary status after chemotherapy using logistic regression models. Odds ratios and 95%-confidence-intervals were reported. Model performance was assessed by leave-one-out cross-validation. Calculations were performed using the SAS Software (Version 9.4, SAS Institute Inc., Cary, NC, USA). 369 of 553 patients in Arm C were included in multivariable analysis. Stepwise backward variable selection based on a multivariable analysis resulted in a model including estrogen receptor (ER) status (odds ratio (OR) 3.916, 95% confidence interval (CI) 2.318-6.615, p < 0.001), multifocality (OR 2.106, 95% CI 1.203-3.689, p = 0.0092), lymphovascular invasion (OR 9.196, 95% CI 4.734-17.864, p < 0.001), and sonographic tumor diameter after PST (OR 1.034, 95% CI 1.010-1.059, p = 0.0051). When validated, our model demonstrated an accuracy of 70.2% using 0.5 as cut-point. An area under the curve of 0.81 was calculated. The use of individual parameters as predictors of lymph node status after chemotherapy resulted in an inferior accuracy. Our model was able to predict the probability of a positive axillary nodal status with a high accuracy. The use of individual parameters showed reduced predictive performance. Overall, tumor biology was the strongest parameter in our models.
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Affiliation(s)
- C Liedtke
- Department of Gynecology, Charité University Hospital Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - L Kerschke
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - D Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität, Münster, Germany
| | - I Bauerfeind
- Department of Gynecology and Obstetrics, Klinikum Landshut, Landshut, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Dusseldorf, Germany
| | - B Fleige
- Department of Pathology, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - G Helms
- Department of Gynecology and Obstetrics, University Medical Centre Tübingen, Tübingen, Germany
| | - A Lebeau
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stäbler
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | | | - M Hausschild
- Klinikum Rheinfelden, Schweiz, Rheinfelden, Switzerland
| | - L Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | | | - S Loibl
- German Breast Group, Neu Isenburg, Germany
| | - M Untch
- Department of Gynecology and Obstetrics, Multidisciplinary Breast Centre, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - T Kühn
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Centre, Klinikum Esslingen, Esslingen, Germany
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23
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Weigel S, Gerss J, Hense HW, Krischke M, Sommer A, Czwoydzinski J, Lenzen H, Kerschke L, Spieker K, Dickmaenken S, Baier S, Urban M, Hecht G, Heidinger O, Kieschke J, Heindel W. Digital breast tomosynthesis plus synthesised images versus standard full-field digital mammography in population-based screening (TOSYMA): protocol of a randomised controlled trial. BMJ Open 2018; 8:e020475. [PMID: 29764880 PMCID: PMC5961594 DOI: 10.1136/bmjopen-2017-020475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Development of digital breast tomosynthesis (DBT) provides a technology that generates three-dimensional data sets, thus reducing the pitfalls of overlapping breast tissue. Observational studies suggest that the combination of two-dimensional (2D) digital mammography and DBT increases diagnostic accuracy. However, because of duplicate exposure, this comes at the cost of an augmented radiation dose. This undesired adverse impact can be avoided by using synthesised 2D images reconstructed from the DBT data (s2D).We designed a diagnostic superiority trial on a high level of evidence with the aim of providing a comparison of screening efficacy parameters resulting from DBT+s2D versus the current screening standard 2D full-field digital mammography (FFDM) in a multicentre and multivendor setting on the basis of the quality-controlled, population-based, biennial mammography screening programme in Germany. METHODS AND ANALYSIS 80 000 women in the eligible age 50-69 years attending the routine mammography screening programme and willing to participate in the TOSYMA trial will be assigned by 1:1 randomisation to either the intervention arm (DBT+s2D) or the control arm (FFDM) during a 12-month recruitment period in screening units of North Rhine-Westphalia and Lower Saxony. State cancer registries will provide the follow-up of interval cancers.Primary endpoints are the detection rate of invasive breast cancers at screening examination and the cumulative incidence of interval cancers in the 2 years after a negative examination. Secondary endpoints are the detection rate of ductal carcinoma in situ and of tumour size T1, the recall rate for assessment, the positive predictive value of recall and the cumulative 12-month incidence of interval cancers. An adaptive statistical design with one interim analysis provides the option to modify the design. ETHICS AND DISSEMINATION This protocol has been approved by the local medical ethical committee (2016-132-f-S). Results will be submitted to international peer-reviewed journals. TRIAL REGISTRATION NCT03377036; Pre-results.
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Affiliation(s)
- Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, IBKF, University of Münster, Münster, Germany
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Miriam Krischke
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Alexander Sommer
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Jörg Czwoydzinski
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Horst Lenzen
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, IBKF, University of Münster, Münster, Germany
| | - Karin Spieker
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Stefanie Dickmaenken
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Sonja Baier
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Marc Urban
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Gerold Hecht
- Reference Center for Mammography North, Oldenburg, Germany
| | | | | | - Walter Heindel
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
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Rieder V, Schork KU, Kerschke L, Blank-Landeshammer B, Sickmann A, Rahnenführer J. Comparison and Evaluation of Clustering Algorithms for Tandem Mass Spectra. J Proteome Res 2017; 16:4035-4044. [DOI: 10.1021/acs.jproteome.7b00427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Vera Rieder
- Department
of Statistics, TU Dortmund University, 44221 Dortmund, Germany
| | - Karin U. Schork
- Department
of Statistics, TU Dortmund University, 44221 Dortmund, Germany
- Medizinische
Fakultät, Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Laura Kerschke
- Department
of Statistics, TU Dortmund University, 44221 Dortmund, Germany
- Institut für Biometrie und Klinische Forschung (IBKF) der Westfälischen Wilhelms-Universität und des Universitätsklinikums Münster, 48149 Münster, Germany
| | | | - Albert Sickmann
- Medizinische
Fakultät, Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Leibniz-Institut für Analytische Wissenschaften-ISAS - e.V., 44139 Dortmund, Germany
- Department
of Chemistry, College of Physical Sciences, University of Aberdeen, Aberdeen AB24 3FX, Scotland, United Kingdom
| | - Jörg Rahnenführer
- Department
of Statistics, TU Dortmund University, 44221 Dortmund, Germany
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Ugurel S, Loquai C, Terheyden P, Schadendorf D, Richtig E, Utikal J, Gutzmer R, Rass K, Sunderkötter C, Stein A, Fluck M, Kaatz M, Trefzer U, Kähler K, Stadler R, Berking C, Höller C, Kerschke L, Edler L, Kopp-Schneider A, Becker JC. Chemosensitivity-directed therapy compared to dacarbazine in chemo-naive advanced metastatic melanoma: a multicenter randomized phase-3 DeCOG trial. Oncotarget 2017; 8:76029-76043. [PMID: 29100289 PMCID: PMC5652683 DOI: 10.18632/oncotarget.18635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/10/2017] [Indexed: 01/26/2023] Open
Abstract
Chemotherapy still plays an important role in metastatic melanoma, particularly for patients who are not suitable or have no access to highly efficacious new therapies. Pre-therapeutic chemosensitivity testing might be useful to identify optimal chemotherapy regimens for individual patients. This multicenter randomized phase-3 trial was aimed to test for superiority of chemosensitivity-directed combination chemotherapy compared to standard dacarbazine monochemotherapy, and to demonstrate the chemosensitivity test result as prognostic in metastatic melanoma. Chemo-naive patients with advanced melanoma were biopsied from metastatic lesions. Tumor cells were isolated and tested ex-vivo for sensitivity to chemotherapeutic agents using an ATP-based viability assay. Patients with evaluable test results were randomly assigned to receive either chemosensitivity-directed combination chemotherapy (paclitaxel+cisplatin, treosulfan+gemcitabine, treosulfan+cytarabine), or dacarbazine. The primary study endpoint was overall survival (OS). After inclusion of 287 patients and a median follow-up of 26 months, the per-protocol population (n=244) showed no difference in OS between chemosensitivity-directed therapy and dacarbazine (median 9.2 vs 9.0 months, HR=1.08, p=0.64). The disease control rate (CR+PR+SD) tended to be higher in patients treated with chemosensitivity-directed therapy (32.8% vs 23.0%, p=0.088); objective response rates (CR+PR) showed no difference between groups (10.7% vs 12.3%, p=0.90). Patients whose tumors were tested chemosensitive showed no better OS or response rate than patients with chemoresistant tumors. Severe toxicities (CTC grade 3-4) were significantly more frequently observed with chemosensitivity-directed combination chemotherapy than with dacarbazine (40.2% vs 12.3%, p<0.0001). These results indicate, that chemosensitivity-directed combination chemotherapy is not superior to dacarbazine, but leads to significantly more severe toxicities.
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Affiliation(s)
- Selma Ugurel
- Department of Dermatology, University Hospital of Essen, Essen, Germany.,Department of Dermatology, University Hospital of Würzburg, Würzburg, Germany
| | - Carmen Loquai
- Department of Dermatology, University Hospital of Mainz, Mainz, Germany
| | - Patrick Terheyden
- Department of Dermatology, University Hospital of Lübeck, Lübeck, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital of Essen, Essen, Germany.,Translational Skin Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Essen, Germany
| | - Erika Richtig
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Knuth Rass
- Department of Dermatology, The Saarland University Hospital, Homburg/Saar, Germany
| | - Cord Sunderkötter
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Annette Stein
- Department of Dermatology, University Hospital of Dresden, Dresden, Germany
| | - Michael Fluck
- Department of Internal Medicine, Fachklinik Hornheide, Hornheide, Germany
| | - Martin Kaatz
- Department of Dermatology, University Hospital of Jena, Jena, Germany
| | - Uwe Trefzer
- Department of Dermatology, University Hospital Charite, Berlin, Germany
| | - Katharina Kähler
- Department of Dermatology, University Hospital of Kiel, Kiel, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Klinikum, Minden, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital of Munich, Munich, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Laura Kerschke
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany.,Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Lutz Edler
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | | | - Jürgen C Becker
- Department of Dermatology, University Hospital of Essen, Essen, Germany.,Department of Dermatology, University Hospital of Würzburg, Würzburg, Germany.,Translational Skin Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Essen, Germany.,Department of Dermatology, Medical University of Graz, Graz, Austria
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Liedtke C, Kolberg HC, Kerschke L, Goerlich D, Bauerfeind I, Fehm TN, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Staebler A, Von Minckwitz G, Loibl S, Untch M, Kuehn T. Systematic analysis of parameters predicting pathological axillary status (ypN0 vs. ypN+) in patients converting from cN+ to ycN0 through primary systemic therapy (PST). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
560 Background: Optimization of axillary staging in patients converting from cN+ to ycN0 through PST is needed. The aim of this analysis was to develop a nomogram predicting the probability of ypN+ after PST based on clinical/pathological parameters. Methods: Patients converting from cN+ to ycN0 through PST from a prospective study (SENTINA arm C) were included. Univariate/multivariate analyses were carried out for 14 clinical/pathological parameters to predict ypN+ using logistic regression models. Odds ratios and 95% confidence intervals were reported. Model performance was assessed by leave-one-out cross-validation (LOOCV at .5 cut-offs) and ROC analyses. Calculations were performed using the SAS Software (Version 9.4). Results: 553 patients were assessed. Stepwise backward variable selection based on a multivariate analysis of all significant parameters resulted in a model (5M, Table, N = 369 evaluable) including ER (3.81; 2.25-6.44), multifocality (2.22; 1.26-3.92), LVI (9.16; 4.68-17.90), detection of SLN after PST (.50; .26-.95) and ycT (1.03; 1.01-1.06). In LOOCV, this model had an area under the curve of .81. Multivariate analysis of parameters available preoperatively showed an association between ypN0/ypN+, ER and ycT. Full subset selection resulted in a model (2M, N = 414) containing only ER (4.36; 2.80, 6.81) and ycT (1.04; 1.02, 1.07). Conclusions: A prediction model including parameters evaluable before/after definitive surgery resulted in a nomogram with acceptable accuracy. Limitation to parameters evaluable before surgery (i.e. ER, ycT) showed reduced accuracy that was comparable/superior to accuracy of using individual parameters. Since tumor biology was the strongest parameter in our models, we hypothesize that modern tumor biologic parameters such as gene expression profiling might optimize prediction of axillary status after PST improving patient counseling. [Table: see text]
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Affiliation(s)
- Cornelia Liedtke
- University of Schleswig-Holstein Campus Luebeck, Lübeck, Germany
| | | | | | | | - Ingo Bauerfeind
- Department of Obstetrics and Gynecology and Interdisciplinary Breast Cancer Center, Klinikum Landshut, Landshut, Germany
| | | | | | | | - Gisela Helms
- Universitatsklinikum Tubingen, Tubingen, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr, Hamburg, Germany
| | | | | | - Lukas Schwentner
- Department of Gynecology and Obstetrics University Ulm, Ulm, Germany
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Liedtke C, Kolberg HC, Kerschke L, Goerlich D, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Staebler A, von Minckwitz G, Loibl S, Untch M, Kuehn T. Abstract P3-13-06: Development and validation of a nomogram predicting pathological axillary status (ypN0 vs. ypN+) in a subgroup of patients converting from cN+ to ycN0 through neoadjuvant therapy (NAT) – A transSENTINA substudy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-13-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Particularly among patients converting from cN+ to ycN0 status through neoadjuvant therapy (NAT) the optimal method and extent of axillary staging is unclear. The aim of this analysis was to develop a nomogram predicting the probability of positive axillary status (ypN+) after PST among these patients based on clinical and pathological parameters.
Methods:Patients converting from cN+ to ycN0 due to PST included in a prospective study (SENTINA, Arm C) were included. Univariate and multivariate analyses were carried out to evaluate the association between 14 clinical/pathological parameters and pathological axillary status (ypN0 vs ypN+) using logistic regression models. Model accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed applying leave-one-out cross-validation (LOOCV) and ROC analyses. Different cut-points were evaluated. Calculations were performed using the SAS Software (Version 9.4, SAS Institute Inc., Cary, NC, USA.).
Results: Arm C contained 553 patients, 369 patients were evaluable with respect to the above parameters. Univariate analyses revealed a significant association between pathological axillary status and ER status (odds ratio (OR) 4.05, 95% confidence interval (95%CI) 2.81-5.83), PR status (OR 3.07, 95%CI 2.16-4.36), multifocality (OR 2.37, 95%CI 1.57-3.58), lymphovascular invasion (OR 8.61, 95%CI 5.12-14.46), detection of a SLN after NAT (OR .56, 95%CI .36-.87), detection method (IHC vs routine: OR .46, 95%CI .27-.78; IHC vs serial HE: OR .72, 95%CI .49-1.07; serial hematoxylin eosin (HE) vs routine: OR .639, 95%CI .39-1.04), clinical tumor size (OR 1.051, 95%CI 1.03-1.07) and pCR-status in the breast (ypT0 and ypTis vs others, OR .11, 95%CI .08-.17). A multivariate model was fitted including significant clinical parameters. Stepwise backward variable selection was carried out resulting in a model including ER status (OR 3.81, 95%CI 2.25-6.44), multifocality (OR 2.22, 95%CI 1.26-3.92), LVI (OR 9.16, 95%CI 4.68-17.90), detection of a SLN after NAT (OR .50, 95%CI .26-.95) and clinical tumor size (OR 1.03, 95%CI 1.01-1.06). In LOOCV, this model demonstrated an accuracy of 73% (sensitivity 73%, specificity 72%, PPV 75%, NPV 70%) using .5 as cut-off. Based on the performed ROC analysis an area under the curve (AUC) of 0.81 was calculated.
Conclusion: A model using ER status, multifocality, LVI, detection of a SLN after NAT and clinical tumor size was built to predict pathological axillary status (ypN+) with a high accuracy. If successfully validated based upon an independent dataset, this nomogram could allow advising patients for / against axillary surgery in case of clinical axillary conversion after NAT.
Citation Format: Liedtke C, Kolberg H-C, Kerschke L, Goerlich D, Bauerfeind I, Fehm T, Fleige B, Hauschild M, Helms G, Lebeau A, Schmatloch S, Schrenk P, Schwentner L, Staebler A, von Minckwitz G, Loibl S, Untch M, Kuehn T. Development and validation of a nomogram predicting pathological axillary status (ypN0 vs. ypN+) in a subgroup of patients converting from cN+ to ycN0 through neoadjuvant therapy (NAT) – A transSENTINA substudy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-06.
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Affiliation(s)
- C Liedtke
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - H-C Kolberg
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - L Kerschke
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - D Goerlich
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - I Bauerfeind
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - T Fehm
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - B Fleige
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - M Hauschild
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - G Helms
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - A Lebeau
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - S Schmatloch
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - P Schrenk
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - L Schwentner
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - A Staebler
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - G von Minckwitz
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - S Loibl
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - M Untch
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
| | - T Kuehn
- University Hospital Schleswig-Holstein / Campus Luebeck, Germany; Marien-Hospital Bottrop, Germany; University Hospital Münster, Germany; Klinikum Landshut, Germany; University Hospital Duesseldorf, Germany; Helios-Klinikum Berlin-Buch, Germany; Spital Rheinfelden, Switzerland; University Hospital Tuebingen, Germany; University Hospital Hamburg-Eppendorf, Germany; Hospital Kassel, Germany; AKH Linz, Germany; University Hospital Ulm, Germany; German Breast Group, Germany; Klinikum Esslingen, Germany
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