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Heimes AS, Riedel N, Almstedt K, Krajnak S, Schwab R, Stewen K, Lebrecht A, Battista MJ, Brenner W, Hasenburg A, Schmidt M. Prognostic Impact of CD38- and IgκC-Positive Tumor-Infiltrating Plasma Cells in Triple-Negative Breast Cancer. Int J Mol Sci 2023; 24:15219. [PMID: 37894900 PMCID: PMC10607675 DOI: 10.3390/ijms242015219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Due to a higher mutational load, triple-negative breast cancer (TNBC) is characterized by a higher immunogenicity compared to other subtypes. In this context, we analyzed the prognostic significance of tumor-infiltrating plasma cells in a cohort of 107 triple-negative breast cancer patients. Tumor-infiltrating plasma cells were analyzed via immunohistochemistry using the plasma cell markers CD38 and IgκC. The prognostic impact of the CD38 and IgκC expression was evaluated using the Kaplan-Meier plots and Cox regression analyses. A Spearman-Rho correlation coefficient was used to evaluate a possible association between plasma cell infiltration and the BRCA mutation status. The study cohort consisted of 107 patients with early-stage TNBC, who were treated between 2009 and 2016 at the Department of Gynecology and Obstetrics, University Medical Center Mainz, Germany. The median follow-up was five years. The Kaplan-Meier survival analysis showed that higher tumor infiltration with CD38-positive plasma cells was associated with significantly longer metastasis-free survival (MFS) (p = 0.039 Log Rank). In the multivariate Cox regression analysis for metastasis-free survival, in which additional clinicopathological factors (age, tumor size, nodal status, and grading) were considered, CD38 was identified as an independent prognostic factor within the analyzed cohort (HR 0.438, 95% CI 0.195-0.983; p = 0.045). In addition to the CD38 expression, the nodal status was also identified as an independent prognostic factor in multivariate Cox regression. Regarding the IgκC expression, a higher IgκC expression was shown to be associated with a better outcome, although this effect was not statistically significant. Furthermore, we were able to show a significant correlation between plasma cell infiltration and the BRCA mutation status. A favorable prognostic significance of tumor-infiltrating plasma cells could be demonstrated in triple-negative breast cancer immunohistochemically analyzed for the CD38 and IgκC expression. CD38 was identified as an independent prognostic factor via multivariate Cox regression.
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Affiliation(s)
- Anne-Sophie Heimes
- Department of Obstetrics and Gynecology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (N.R.); (K.A.); (S.K.); (R.S.); (K.S.); (A.L.); (M.J.B.); (W.B.); (A.H.); (M.S.)
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van der Ven J, Linz VC, Anic K, Schmidt MW, Loewe A, Krajnak S, Schmidt M, Kommoss S, Schmalfeldt B, Sehouli J, Hasenburg A, Battista MJ. A questionnaire-based survey on the diagnostic and therapeutic approaches for patients with STIC in Germany. Arch Gynecol Obstet 2023; 308:527-534. [PMID: 36707423 PMCID: PMC10293341 DOI: 10.1007/s00404-023-06919-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/08/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Despite the growing understanding of the carcinogenesis of pelvic high-grade serous carcinoma (HGSC) of the ovary and peritoneum and its precursor lesion serous tubal intraepithelial carcinoma (STIC), evidence-based proven recommendations on the clinical management of patients with STIC are lacking so far. METHODS A questionnaire containing 21 questions was developed to explore the clinical experience with patients with the diagnosis of STICs and the diagnostic, surgical and histopathological approaches in Germany. Overall, 540 clinical heads of department in all German gynaecological centres were asked to participate. RESULTS 131 questionnaires (response rate 24.3%) were included in this survey. 45.8% of the respondents had treated one to three STIC patients during their career. 75.6% of the respondents performed opportunistic bilateral salpingectomies during other gynaecological surgeries. Most of the participants (31.3%) started with the SEE-FIM (Sectioning and Extensively Examining the FIMbria) protocol in 2014. It was requested by 39.7% centres for prophylactic salpingectomies, by 13.7% for both prophylactic and opportunistic salpingectomies and by 22.1% for neither of both. 38.2%, 1.5% and 24.4% of the participants would use the laparoscopic, transverse and midline laparotomic approach for a surgical staging procedure, respectively. 25.6% (54.7%) of the respondents recommended a hysterectomy in premenopausal (versus postmenopausal) patients with a STIC, 24.4% (88.4%) a bilateral oophorectomy and 50.0% (4.7%) an affected side oophorectomy (all p values < 0.001). Omentectomy, pelvic and para-aortic lymphadenectomy would be performed by 60.5% (64.0%), 9.3% (11.6%) and 9.3% (11.6%) of respondents in premenopausal (versus postmenopausal) patients (all p values > 0.05). CONCLUSION Our survey highlights significant inconsistency in the management of patients with STIC. Prospective data are urgently needed to elucidate the clinical impact of a STIC lesion and its clinical management.
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Affiliation(s)
- Josche van der Ven
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Valerie Catherine Linz
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany.
| | - Katharina Anic
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Mona Wanda Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Amelie Loewe
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Slavomir Krajnak
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Calwerstreet 7, 72076, Tübingen, Baden-Württemberg, Germany
| | - Barbara Schmalfeldt
- Department of Gynaecology, University Medical Centre Hamburg-Eppendorf, Martinistreet 52, 20251, Hamburg, Germany
| | - Jalid Sehouli
- Department of Gynaecology and Centre of Oncological Surgery, Charité Universitaetsmedizin Berlin Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annette Hasenburg
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
| | - Marco Johannes Battista
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstreet 1, 55131, Mainz, Rhineland-Palatinate, Germany
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Emons G, Steiner E, Vordermark D, Uleer C, Paradies K, Tempfer C, Aretz S, Cremer W, Hanf V, Mallmann P, Ortmann O, Römer T, Schmutzler RK, Horn LC, Kommoss S, Lax S, Schmoeckel E, Mokry T, Grab D, Reinhardt M, Steinke-Lange V, Brucker SY, Kiesel L, Witteler R, Fleisch MC, Friedrich M, Höcht S, Lichtenegger W, Mueller M, Runnebaum I, Feyer P, Hagen V, Juhasz-Böss I, Letsch A, Niehoff P, Zeimet AG, Battista MJ, Petru E, Widhalm S, van Oorschot B, Panke JE, Weis J, Dauelsberg T, Haase H, Beckmann MW, Jud S, Wight E, Prott FJ, Micke O, Bader W, Reents N, Henscher U, Schallenberg M, Rahner N, Mayr D, Kreißl M, Lindel K, Mustea A, Strnad V, Goerling U, Bauerschmitz GJ, Langrehr J, Neulen J, Ulrich UA, Nothacker MJ, Blödt S, Follmann M, Langer T, Wenzel G, Weber S, Erdogan S. Endometrial Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry Number 032/034-OL, September 2022). Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer, Geriatric Assessment and Supply Structures. Geburtshilfe Frauenheilkd 2023; 83:919-962. [PMID: 37588260 PMCID: PMC10427205 DOI: 10.1055/a-2066-2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/22/2023] [Indexed: 08/18/2023] Open
Abstract
Summary The S3-guideline on endometrial cancer, first published in April 2018, was reviewed in its entirety between April 2020 and January 2022 and updated. The review was carried out at the request of German Cancer Aid as part of the Oncology Guidelines Program and the lead coordinators were the German Society for Gynecology and Obstetrics (DGGG), the Gynecology Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Cancer Aid (DKH). The guideline update was based on a systematic search and assessment of the literature published between 2016 and 2020. All statements, recommendations and background texts were reviewed and either confirmed or amended. New statements and recommendations were included where necessary. Aim The use of evidence-based risk-adapted therapies to treat women with endometrial cancer of low risk prevents unnecessarily radical surgery and avoids non-beneficial adjuvant radiation therapy and/or chemotherapy. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimum level of radical surgery and indicates whether chemotherapy and/or adjuvant radiation therapy is necessary. This should improve the survival rates and quality of life of these patients. The S3-guideline on endometrial cancer and the quality indicators based on the guideline aim to provide the basis for the work of certified gynecological cancer centers. Methods The guideline was first compiled in 2018 in accordance with the requirements for S3-level guidelines and was updated in 2022. The update included an adaptation of the source guidelines identified using the German Instrument for Methodological Guideline Appraisal (DELBI). The update also used evidence reviews which were created based on selected literature obtained from systematic searches in selected literature databases using the PICO process. The Clinical Guidelines Service Group was tasked with carrying out a systematic search and assessment of the literature. Their results were used by interdisciplinary working groups as a basis for developing suggestions for recommendations and statements which were then modified during structured online consensus conferences and/or additionally amended online using the DELPHI process to achieve a consensus. Recommendations Part 1 of this short version of the guideline provides recommendations on epidemiology, screening, diagnosis, and hereditary factors. The epidemiology of endometrial cancer and the risk factors for developing endometrial cancer are presented. The options for screening and the methods used to diagnose endometrial cancer are outlined. Recommendations are given for the prevention, diagnosis, and therapy of hereditary forms of endometrial cancer. The use of geriatric assessment is considered and existing structures of care are presented.
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Affiliation(s)
- Günter Emons
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Eric Steiner
- Frauenklinik GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
| | - Dirk Vordermark
- Universität Halle (Saale), Radiotherapie, Halle (Saale), Germany
| | - Christoph Uleer
- Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Germany
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpfleger (KOK), Hamburg, Germany
| | - Clemens Tempfer
- Frauenklinik der Ruhr-Universität Bochum, Bochum/Herne, Germany
| | - Stefan Aretz
- Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Bonn, Germany
| | | | - Volker Hanf
- Frauenklinik Nathanstift – Klinikum Fürth, Fürth, Germany
| | | | - Olaf Ortmann
- Universität Regensburg, Fakultät für Medizin, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Germany
| | - Thomas Römer
- Evangelisches Klinikum Köln Weyertal, Gynäkologie Köln, Köln, Germany
| | - Rita K. Schmutzler
- Universitätsklinikum Köln, Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
| | | | - Stefan Kommoss
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Sigurd Lax
- Institut für Pathologie, LKH Graz Süd-West, Graz, Austria
| | | | - Theresa Mokry
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg, Germany
| | - Dieter Grab
- Universitätsklinikum Ulm, Frauenheilkunde und Geburtshilfe, Ulm, Germany
| | - Michael Reinhardt
- Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Verena Steinke-Lange
- MGZ – Medizinisch Genetisches Zentrum München, München, Germany
- Medizinische Klinik und Poliklinik IV, LMU München, München, Germany
| | - Sara Y. Brucker
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Ludwig Kiesel
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Ralf Witteler
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Markus C. Fleisch
- Helios, Universitätsklinikum Wuppertal, Landesfrauenklinik, Wuppertal, Germany
| | | | - Michael Friedrich
- Helios Klinikum Krefeld, Klinik für Frauenheilkunde und Geburtshilfe, Krefeld, Germany
| | - Stefan Höcht
- XCare, Praxis für Strahlentherapie Saarlouis, Saarlouis, Germany
| | - Werner Lichtenegger
- Universitätsmedizin Berlin, Frauenklinik Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Michael Mueller
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Petra Feyer
- Vivantes Klinikum Neukölln, Klinik für Strahlentherapie und Radioonkologie, Berlin, Germany
| | - Volker Hagen
- Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | | | - Anne Letsch
- Universitätsklinikum Schleswig Holstein, Campus Kiel, Innere Medizin, Kiel, Germany
| | - Peter Niehoff
- Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
| | - Alain Gustave Zeimet
- Medizinische Universität Innsbruck, Universitätsklinik für Gynäkologie und Geburtshilfe, Innsbruck, Austria
| | | | - Edgar Petru
- Med. Univ. Graz, Frauenheilkunde, Graz, Austria
| | | | - Birgitt van Oorschot
- Universitätsklinikum Würzburg, Interdisziplinäres Zentrum Palliativmedizin, Würzburg, Germany
| | - Joan Elisabeth Panke
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V. Essen, Essen, Germany
| | - Joachim Weis
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Tumorzentrum Freiburg – CCCF, Freiburg, Germany
| | - Timm Dauelsberg
- Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
| | | | | | | | - Edward Wight
- Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
| | - Franz-Josef Prott
- Facharzt für Radiologie und Strahlentherapie, Wiesbaden, Wiesbaden, Germany
| | - Oliver Micke
- Franziskus Hospital Bielefeld, Klinik für Strahlentherapie und Radioonkologie, Bielefeld, Germany
| | - Werner Bader
- Klinikum Bielefeld Mitte, Zentrum für Frauenheilkunde, Bielefeld, Germany
| | | | | | | | | | | | - Doris Mayr
- LMU München, Pathologisches Institut, München, Germany
| | - Michael Kreißl
- Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Radiologie und Nuklearmedizin, Germany
| | - Katja Lindel
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Alexander Mustea
- Universitätsklinikum Bonn, Zentrum Gynäkologie und gynäkologische Onkologie, Bonn, Germany
| | - Vratislav Strnad
- Universitätsklinikum Erlangen, Brustzentrum Franken, Erlangen, Germany
| | - Ute Goerling
- Universitätsmedizin Berlin, Campus Charité Mitte, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Gerd J. Bauerschmitz
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Jan Langrehr
- Martin-Luther-Krankenhaus, Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Berlin, Germany
| | - Joseph Neulen
- Uniklinik RWTH Aachen, Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Aachen, Germany
| | - Uwe Andreas Ulrich
- Martin-Luther-Krankenhaus, Johannesstift Diakonie, Gynäkologie, Berlin, Germany
| | | | | | - Markus Follmann
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Thomas Langer
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Gregor Wenzel
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Sylvia Weber
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Saskia Erdogan
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
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Schmidt MW, Brenner W, Gebhard S, Schmidt M, Singer S, Weidenbach L, Hahn H, Puzankova D, Blau-Schneider B, Lehnert A, Battista MJ, Almstedt K, Lütkemeyer A, Radsak MP, Mähringer-Kunz A, Krajnak S, Linz VC, Schwab R, Gabriel B, Hasenburg A, Anic K. Effects of intermittent fasting on quality of life tolerance of chemotherapy in patients with gynecological cancers: study protocol of a randomized-controlled multi-center trial. Front Oncol 2023; 13:1222573. [PMID: 37538111 PMCID: PMC10396395 DOI: 10.3389/fonc.2023.1222573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023] Open
Abstract
Fatigue is a very common side effect during intravenous chemotherapy. Unfortunately, only few effective therapeutic options are available, mostly based on daily activity. In our pilot trial we were able to demonstrate that intermittent fasting can reduce fatigue in healthy people, thus we aimed to assess the effects of the fasting dietary on quality of life during chemotherapy in patients with gynecological cancer, especially on the domain of fatigue. The IFAST trial is designed as a prospective, randomized-controlled, multi-center trial. Participation will be offered to women with gynecological cancers (breast cancer, ovarian cancer including peritoneal and fallopian tube cancers, endometrial cancer and cervical cancer) who are planned to receive intravenous chemotherapy for at least three months. Eligible patients will be randomized 1:1, stratified by tumor type and study center. Primary endpoint is the difference in mean change in fatigue, assessed with the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT- FS©). Exploratory secondary endpoints will include general Quality of Life impairment, tolerance of chemotherapy, immunological changes, peripheral cell damage in blood cells, as well as tumor response to chemotherapy. There is new evidence that prolonged fasting periods of 46-96 hours during chemotherapy can positively influence the quality of life during chemotherapy. However, these fasting regiments are not feasible for many patients. Intermittent fasting could be a feasible (manageable) option for many patients to actively improve their quality of life and tolerance to chemotherapy and possibly even enhance the effectiveness of chemotherapy. Trial Registration https://drks.de, identifier DRKS00031429.
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Affiliation(s)
- Mona Wanda Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Walburgis Brenner
- Department of Gynecology and Obstetrics, Management of the Scientific laboratories, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Susanne Gebhard
- Department of Gynecology and Obstetrics, Management of the Scientific laboratories, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Lina Weidenbach
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Harriett Hahn
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Diana Puzankova
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Bettina Blau-Schneider
- Department of Obstetrics and Gynecology, St. Josefs Hospital Wiesbaden Academic Teaching Hospital, Wiesbaden, Germany
| | - Antje Lehnert
- Department of Obstetrics and Gynecology, St. Josefs Hospital Wiesbaden Academic Teaching Hospital, Wiesbaden, Germany
| | - Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Katrin Almstedt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Anja Lütkemeyer
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Markus Philipp Radsak
- IIIrd Department of Medicine, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Aline Mähringer-Kunz
- Department of Radiology, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Valerie Cathrine Linz
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Boris Gabriel
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Katharina Anic
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
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5
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Linz VC, Schwanbeck C, Krajnak S, Anic K, Jäkel J, Schwab R, Schmidt M, Schmidberger H, Hasenburg A, Battista MJ. Comparison of cisplatin and mitomycin C/5-FU as radiosensitisers in the treatment of locally advanced vulvar cancer: results of a retrospective, observational, single-institutional cohort study. J Cancer Res Clin Oncol 2023; 149:1391-1399. [PMID: 35451700 PMCID: PMC10020277 DOI: 10.1007/s00432-022-04006-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We retrospectively investigated the widely used radiosensitisers cisplatin and mitomycin C/5-fluorouracil (5-FU) in patients with locally advanced vulvar cancer for outcome and toxicity. METHODS We screened the archive for patients treated with chemoradiation for vulvar cancer diagnosed between 01/2010 and 08/2021 at our institution. The impact of both radiosensitisers on prognosis was compared using Kaplan-Meier method and Cox-regression analysis. RESULTS One hundred and forty-three patients with vulvar cancer were screened. Twenty-nine patients received chemoradiation (mitomycin C/5-FU n = 14; cisplatin n = 12; others n = 3) as a primary, neoadjuvant or adjuvant treatment. Median follow-up was 15.5 months. Patients in the cisplatin group were older (mean age 54.4 vs. 70.7; p = 0.004). However, the mitomycin C/5-FU group had more advanced tumour stages. The 2-year recurrence-free survival (RFS) was comparable (44.5% vs. 33.3%; p = 0.932). The 2-year overall survival (OS) showed a numerical but not statistically significant difference in favour of the mitomycin C/5-FU group (59.7% vs. 31.7%; p = 0.37). 64.3% (9 out of 14) patients, who received mitomycin C/5-FU achieved clinical complete response (cCR) compared to 41.7% (5 out of 12) who received cisplatin (p = 0.505). Radiodermatitis was the most common adverse event in both groups (81%) and more severe in the mitomycin C/5-FU cohort. Myelotoxicity was frequently observed in both groups. Eighteen patients received an additional radiation boost with 10.0 (9-16) Gy and showed a significantly prolonged RFS (p = 0.027) and OS (p = 0.003). CONCLUSION Mitomycin C/5-FU may be considered in the treatment of young and healthy patients with locally advanced vulvar cancer.
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Affiliation(s)
- Valerie Catherine Linz
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Carina Schwanbeck
- Department of Radiooncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Anic
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jörg Jäkel
- Department of Pathology University Medical Center, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Roxana Schwab
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiooncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Anic K, Flohr F, Schmidt MW, Krajnak S, Schwab R, Schmidt M, Westphalen C, Eichelsbacher C, Ruckes C, Brenner W, Hasenburg A, Battista MJ. Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone: a retrospective observational cohort study. J Cancer Res Clin Oncol 2023; 149:1551-1560. [PMID: 35579719 PMCID: PMC10020300 DOI: 10.1007/s00432-022-04038-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC). METHODS Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. RESULTS 153 consecutive women ≥ 60 years with all stages of EC, who received primary elective surgery at the University Medical Center Mainz between 2008 and 2019 were classified with selected global health assessment tools according to their preoperative performance status. In contrast to conventional prognostic parameters like older age and higher BMI, increasing frailty was significantly associated with preoperative anemia and perioperative transfusions (p < 0.05). Moreover, in patients preoperatively classified as frail significantly more postoperative complications (G8 Score: frail: 20.7% vs. non-frail: 6.7%, p = 0.028; ECOG: frail: 40.9% vs. non-frail: 2.8%, p = 0.002; and CCI: frail: 25.0% vs. non-frail: 7.4%, p = 0.003) and an increased length of hospitalization were recorded. According to propensity score matching, the risk for developing postoperative complications for frail patients was approximately two-fold higher, depending on which global health assessment tool was used. CONCLUSIONS Preoperatively assessed frailty significantly predicts post-surgical morbidity rates in contrast to conventionally used single prognostic parameters such as age or BMI. A standardized preoperative assessment of frailty in the routine work-up might be beneficial in older cancer patients before major surgery to include these patients in a prehabilitation program with nutrition counseling and physiotherapy to adequately assess the perioperative risk.
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Affiliation(s)
- Katharina Anic
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Friedrich Flohr
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Mona Wanda Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Christiane Westphalen
- Department of Geriatric Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Clemens Eichelsbacher
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center Clinical Trials, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Walburgis Brenner
- Management of the Scientific Laboratories, University Medical Center of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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Krajnak S, Krajnakova J, Anic K, Almstedt K, Heimes AS, Linz VC, Loewe A, Schmidt MW, Hasenburg A, Schmidt M, Battista MJ. Real-world experience of metronomic chemotherapy in metastatic breast cancer: results of a retrospective unicenter study. Breast Care (Basel) 2023. [DOI: 10.1159/000528042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction:
Metronomic chemotherapy (MCT) is increasingly used in oncology due to its favorable therapeutic index. There is still a lack of evidence for MCT in metastatic breast cancer (MBC). In this retrospective unicenter study we demonstrated real-word data on MCT in MBC.
Methods:
MBC patients who received metronomic oral cyclophosphamide (CTX) (50 mg daily) and methotrexate (MTX) (2.5 mg every other day), CTX and capecitabine (CAPE) (500 mg thrice daily), CTX or vinorelbine (VRL) (30 mg daily) alone for at least 4 weeks between 2009 and 2021 were included. The primary endpoint was disease control rate (DCR) ≥ 24 weeks. Secondary endpoints were progression-free survival (PFS) and overall survival (OS). Patient characteristics and therapy response were analyzed using Chi-square test. For survival analyses Kaplan–Meier estimator and Log-rank test were used.
Results:
72 patients were identified. 62 patients received CTX/MTX, three CTX/CAPE, two CTX and five VRL. Median age at diagnosis MBC and at start of MCT was 59.0 years and 64.5 years, respectively. 72.2% tumors were hormone receptor-positive and 27.8% were triple-negative. 54.2% patients had more than two different metastases. 80.6% patients showed visceral involvement. 31.9% patients achieved DCR ≥ 24 weeks. Median PFS was 17.0 weeks (95% CI 14.5–19.5) and median OS was 58.0 weeks (95% CI 29.0–87.0). MCT showed similar DCR ≥ 24 weeks and clinically meaningful but not statistically significant shorter median PFS compared to prior therapy [31.9% vs. 32.8% (p=0.570) and 17.0 weeks vs. 20.0 weeks (p=0.093), respectively], and statistically significant higher DCR ≥ 24 weeks and longer median PFS compared to subsequent therapy [31.9% vs. 17.4% (p=0.038) and 17.0 weeks vs. 12.0 weeks (p=0.006), respectively]. Three (4.2%) patients terminated MCT because of toxicity.
Conclusion:
In this real-world retrospective study, MCT was effective and well tolerated, and may thus represent a valuable treatment option in selected MBC patients.
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Krajnak S, Trier JP, Heinzmann PF, Anic K, Heimes AS, Loewe A, Schmidt M, Battista MJ, Hasenburg A, Brenner W. Anti-tumor effects of low-dose metronomic vinorelbine in combination with alpelisib in breast cancer cells. EXCLI J 2023; 22:114-130. [PMID: 36998707 PMCID: PMC10043427 DOI: 10.17179/excli2022-5064] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 01/12/2023] [Indexed: 04/01/2023]
Abstract
In metastatic breast cancer (MBC), PIK3CA mutations, activating the phosphatidylinositol 3-kinase (PI3K) signaling pathway seem to be associated with chemotherapy resistance and poor outcome. Inhibition of the PI3K signaling pathway may lead to sensitization and prevention of the development of resistance to cytotoxic drugs. The present study aimed to investigate the anti-tumor activity of low-dose vinorelbine (VRL) combined with alpelisib, an α-selective PI3K inhibitor and degrader, in breast cancer (BC) cells. Human BC cell lines MCF-7, T-47D [both hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated], MDA-MB-231 and BT-549 (both triple-negative, wild-type PIK3CA) were exposed to a combination of low-dose VRL and alpelisib for 3 and 7 days. Cell viability was detected by the Alamar blue assay, and cell proliferation was determined by the BrdU incorporation. The effect of the substances on the p110α protein expression that is encoded by PIK3CA gene was investigated by Western blot. Low-dose VRL plus alpelisib showed synergistic anti-tumor effects and significantly inhibited cell viability and proliferation of MCF-7 and T-47D cells. Even lower alpelisib concentrations (10 ng/ml and 100 ng/ml) combined with low-dose metronomic VRL led to a significant reduction of cell viability of PIK3CA-mutated cells, and the anti-tumor activity was comparable with the effects at 1000 ng/ml alpelisib. Cell viability and proliferation of MDA-MB-231 and BT-549 cells were inhibited by VRL but not by alpelisib alone. This indicates that alpelisib did not significantly affect the cell growth of triple-negative, PIK3CA wild-type BC cells. The p110α expression was downregulated or not affected in PIK3CA-mutated cell lines, and not significantly upregulated in PIK3CA wild-type cell lines. In conclusion, combination of low-dose metronomic VRL and alpelisib showed synergistic anti-tumor effects and significantly inhibited the growth of HR-positive, HER2-negative, PIK3CA-mutated BC cells, providing a rationale for further efforts to evaluate this combination in vivo.
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Affiliation(s)
- Slavomir Krajnak
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Jannis Patrik Trier
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Pauline Friederike Heinzmann
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Katharina Anic
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Anne-Sophie Heimes
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Amelie Loewe
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Marcus Schmidt
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Marco Johannes Battista
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Annette Hasenburg
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
| | - Walburgis Brenner
- Clinic for Obstetrics and Women's Health, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- *To whom correspondence should be addressed: Walburgis Brenner,
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Anic K, Schmidt MW, Schmidt M, Krajnak S, Löwe A, Linz VC, Schwab R, Weikel W, Brenner W, Westphalen C, Rissel R, Hartmann EK, Conradi R, Hasenburg A, Battista MJ. Impact of perioperative red blood cell transfusion, anemia of cancer and global health status on the prognosis of elderly patients with endometrial and ovarian cancer. Front Oncol 2022; 12:967421. [PMID: 36185177 PMCID: PMC9524224 DOI: 10.3389/fonc.2022.967421] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Perioperative red blood cell (RBC) transfusions have been associated with increased morbidity and worse oncological outcome in some solid neoplasms. In order to elucidate whether RBC transfusions themselves, the preoperative anemia of cancer (AOC), or the impaired global health status might explain this impact on patients with endometrial cancer (EC) or ovarian cancer (OC), we performed a retrospective, single-institution cohort study. Materials and methods Women older than 60 years with EC or OC were included. The influence of RBC transfusions, AOC, and frailty status determined by the G8 geriatric screening tool (G8 score), as well as the clinical-pathological cancer characteristics on progression-free survival (PFS) and overall survival (OS), was determined by using the Kaplan-Meier method and the Cox regression analyses. Results In total, 263 patients with EC (n = 152) and OC (n = 111) were included in the study. Patients with EC receiving RBC transfusions were faced with a significantly shorter 5-year PFS (79.8% vs. 26.0%; p < 0.001) and 5-year OS (82.6% vs. 25.7%; p < 0.001). In multivariable analyses, besides established clinical-pathological cancer characteristics, the RBC transfusions remained the only significant prognostic parameter for PFS (HR: 1.76; 95%-CI [1.01–3.07]) and OS (HR: 2.38; 95%-CI [1.50–3.78]). In OC, the G8 score stratified the cohort in terms of PFS rates (G8-non-frail 53.4% vs. G8-frail 16.7%; p = 0.010) and AOC stratified the cohort for 5-year OS estimates (non-anemic: 36.7% vs. anemic: 10.6%; p = 0.008). Multivariable Cox regression analyses determined the G8 score and FIGO stage as independent prognostic factors in terms of PFS (HR: 2.23; 95%-CI [1.16–4.32] and HR: 6.52; 95%-CI [1.51–28.07], respectively). For OS, only the TNM tumor stage retained independent significance (HR: 3.75; 95%-CI [1.87–7.53]). Discussion The results of this trial demonstrate the negative impact of RBC transfusions on the prognosis of patients with EC. Contrastingly, the prognosis of OC is altered by the preoperative global health status rather than AOC or RBC transfusions. In summary, we suggested a cumulatively restrictive transfusion management in G8-non-frail EC patients and postulated a more moderate transfusion management based on the treatment of symptomatic anemia without survival deficits in OC patients.
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Affiliation(s)
- Katharina Anic
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- *Correspondence: Katharina Anic,
| | - Mona Wanda Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Amelie Löwe
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Valerie Catherine Linz
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wolfgang Weikel
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Walburgis Brenner
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christiane Westphalen
- Department of Geriatric Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - René Rissel
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Erik Kristoffer Hartmann
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roland Conradi
- Blood Transfusion Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Linz VC, Löwe A, van der Ven J, Hasenburg A, Battista MJ. Incidence of pelvic high-grade serous carcinoma after isolated STIC diagnosis: A systematic review of the literature. Front Oncol 2022; 12:951292. [PMID: 36119503 PMCID: PMC9472545 DOI: 10.3389/fonc.2022.951292] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion of pelvic high-grade serous carcinoma (HGSC). Information on treatment and outcome of isolated STIC is rare. Therefore, we reviewed systematically the published literature to determine the incidence of subsequent HGSC in the high- and low-risk population and to summarize the current diagnostic and therapeutic options. Methods A systematic review of the literature was conducted in MEDLINE-Ovid, Cochrane Library and Web of Science of articles published from February 2006 to July 2021. Patients with an isolated STIC diagnosis and clinical follow-up were included. Study exclusion criteria for review were the presence of synchronous gynaecological cancer and/or concurrent non-gynaecological malignancies. Results 3031 abstracts were screened. 112 isolated STIC patients out of 21 publications were included in our analysis with a pooled median follow-up of 36 (interquartile range (IQR): 25.3-84) months. 71.4% of the patients had peritoneal washings (negative: 62.5%, positive: 8%, atypic cells: 0.9%). Surgical staging was performed in 28.6% of all STICs and did not show any malignancies. 14 out of 112 (12.5%) patients received adjuvant chemotherapy with Carboplatin and Paclitaxel. Eight (7.1%) patients developed a recurrence 42.5 (IQR: 33-72) months after isolated STIC diagnosis. Cumulative incidence of HGSC after five (ten) years was 10.5% (21.6%). Recurrence occurred only in BRCA1 carriers (seven out of eight patients, one patient with unknown BRCA status). Conclusion The rate of HGSC after an isolated STIC diagnosis was 7.1% with a cumulative incidence of 10.5% (21.6%) after five (ten) years. HGSC was only observed in BRCA1 carriers. The role of adjuvant therapy and routine surveillance remains unclear, however, intense surveillance up to ten years is necessary. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021278340.
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Anic K, Schmidt MW, Droste A, Schwab R, Schmidt M, Krajnak S, Renz M, Hartmann EK, Hardt R, Hasenburg A, Battista MJ. Influence of anesthetic technique on survival after tumor debulking surgery of elderly patients with ovarian cancer: Results of a retrospective cohort study. Oncol Lett 2022; 24:361. [PMID: 36238854 PMCID: PMC9494308 DOI: 10.3892/ol.2022.13481] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 11/06/2022] Open
Abstract
Epidural analgesia could influence the postoperative oncologic outcomes in patients with specific types of non-metastatic solid neoplasms. The present study aimed to investigate the impact of anesthetic technique on survival in elderly patients with ovarian cancer (OC). The records of all women with OC older than 60 years of age undergoing tumor debulking surgery at the University Medical Center of the Johannes Gutenberg University Mainz (Mainz, Germany) between January 2008 and December 2019 were obtained. The study cohort was divided into two groups based on the use of perioperative epidural anesthesia or not. First, Kaplan-Meier analysis was performed to analyze the prognostic influence of anesthetic technique on survival. Second, multivariate Cox proportional hazards model was adjusted for multiple conventional prognostic factors concerning three main categories: i) Current clinical-pathological tumor characteristics; ii) anesthesiologic parameters, including mean age, American Society of Anesthesiologists Performance Status and preexisting comorbidities summarized in the Charlson Comorbidity Index; and iii) oncological and surgical parameters such as oncological radicality and Surgical complexity Score. A total of 110 patients were included in the study and 71 (64.5%) of them received epidural analgesia. The median survival time was 26.0 months from primary debulking surgery and no significant differences in progression-free (PFS) and overall survival (OS) were noted between the 'Epidural' and 'non-Epidural' cohorts. After adjustment for the selected risk factors from the three categories, the effects of epidural analgesia on PFS and OS remained non-significant [PFS: hazard ratio (HR), 1.26; 95% CI, 0.66-2.39; and OS: HR, 0.79; 95% CI, 0.45-1.40]. The present results did not support the independent association between epidural-supplemented anesthesia and improved PFS or OS in elderly patients with standardized ovarian cancer debulking surgery.
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Affiliation(s)
- Katharina Anic
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany,Correspondence to: Dr Katharina Anic, Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, D-55131 Mainz, Germany, E-mail:
| | - Mona Wanda Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Annika Droste
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Miriam Renz
- Department of Anesthesiology, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Erik Kristoffer Hartmann
- Department of Anesthesiology, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Roland Hardt
- Department of Geriatric Medicine, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Center of The Johannes Gutenberg University Mainz, D-55131 Mainz, Germany
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Anic K, Birkert S, Schmidt MW, Linz VC, Heimes AS, Krajnak S, Schwab R, Schmidt M, Westphalen C, Hartmann EK, Hasenburg A, Battista MJ. G-8 Geriatric Screening Tool Independently Predicts Progression-Free Survival in Older Ovarian Cancer Patients Irrespective of Maximal Surgical Effort: Results of a Retrospective Cohort Study. Gerontology 2021; 68:1101-1110. [PMID: 34875663 DOI: 10.1159/000520328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We evaluated the prognostic impact of various global health assessment tools in patients older than 60 years with ovarian cancer (OC). METHODS G-8 geriatric screening tool (G-8 score), Lee Schonberg prognostic index, Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson Comorbidity Index (CCI) were determined retrospectively in a consecutive cohort of elderly patients with OC. Univariate and multivariate Cox regression analyses and Kaplan-Meier method were performed to analyze the impact of the preoperative global health status on survival. RESULTS 116 patients entered the study. In multivariate analysis adjusted for clinical-pathological factors, only the G-8 score retained significance as a prognostic parameter of progression-free survival (PFS) (hazard ratio [HR]: 1.970; 95% confidence interval [CI] [1.056-3.677]; p = 0.033). Fifty-six patients were classified as G-8-nonfrail with an increased PFS compared to 50 G-8-frail patients (53.4% vs. 16.7%; p = 0.010). A higher CCI was associated with decreased PFS (45.1% vs. 22.2%; p = 0.012), but it did not influence the risk of recurrences or death (p = 0.360; p = 0.111). The Lee Schonberg prognostic index, the ECOG, and age were not associated with survival. CONCLUSIONS The G-8 score independently predicted PFS in elderly OC patients regardless of maximal surgical effort. Thus, it could be useful to assess surgical treatment based on frailty rather than age alone.
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Affiliation(s)
- Katharina Anic
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sophie Birkert
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mona Wanda Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Valerie Catherine Linz
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne-Sophie Heimes
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Slavomir Krajnak
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christiane Westphalen
- Department of Geriatric Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Erik Kristoffer Hartmann
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Schwab R, Stewen K, Battista MJ, Krajnak S, Anic K, Hasenburg A. P–298 High prevalence of depression and anxiety in patients with endometriosis during the SARS-CoV–2 pandemic in Germany. Hum Reprod 2021. [PMCID: PMC8385903 DOI: 10.1093/humrep/deab130.297] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Study question The aim was to assess the prevalence of self-reported symptoms of depression and anxiety and the moderating factors influencing mental symptoms during the COVID–19 pandemic. Summary answer Endometriosis patients were at risk of developing mental disorders during the pandemic. Associated risk factors were: reduction of the social network and the employment status. What is known already Endometriosis is a disease affecting up to 10% of women of fertile age. The leading symptoms are sub- or infertility and chronic pain. Additionally, the psychological impact on womeńs life is enormous. Women with endometriosis show higher rates of depression, anxiety and emotional distress, and these alterations in mental health were associated with the presence of pain rather than with the diagnosis of endometriosis. Additionally, a higher level of depression was observed in women with endometriosis. Study design, size, duration To assess the impact of the government-imposed social distancing or quarantine on mental health, an online questionnaire was placed on internet platforms of endometriosis patients support groups between 6th and 27th April 2020. Data collection and analysis were performed anonymously. Recruitment was conducted via a direct link to the survey and an invitation to participate was distributed via the internet platforms of patients support groups. Participants/materials, setting, methods 274 participants answered the Patient Health Questionnaire for Depression and Anxiety (PHQ–4), which screens for depression (PHQ–2), anxiety (GAD–2) and the level of psychological distress (PHQ–4). PHQ–2 and GAD–2 scores ≥ 3 are cut-off points between normal range and probable cases of mental disorders. A PHQ–4 score above 6 is indicative for severe symptoms. We used descriptive statistics to describe the study population. Correlates of depression and anxiety were identified using multivariate logistic regressions. Main results and the role of chance We showed that depression and anxiety were highly prevalent in endometriosis patients during the pandemic: 46.7% and 48.2% of participants showed scale scores of ≥ 3 on the PHQ–2 and GAD–2 scales, respectively. The mean PHQ–4 score was 5.72 (SD = 3.21), thus endometriosis patients were achieving significantly higher PHQ–4 sores (p < 0.001) than participants of a previously published study of the representative German population. Risk factors for higher probability of depressive disorders were the employment status (being employed, OR 2.890, p < 0.001), an important or severe reduction of the social network (OR 2.02, p < 0.05), having continuous pain (OR 1.83, p < 0.05) and high level of dysmenorrhea prior to the pandemic (OR 2.106, p < 0.05). Risk factors for higher probability of anxiety were the employment status (being employed, OR 2.697, p < 0.001), an important or severe reduction of the social network (OR 3.038, p < 0.01), and high level of dysmenorrhea prior to the pandemic (OR 1.750, p < 0.05). Endometriosis patients were at higher risk for developing mental health problems. The effective use of brief screening measures, such as PHQ–4, can be widely implemented even in the busy outpatient care of general practitioners and gynecologists and may help to reduce morbidity. Limitations, reasons for caution We used self-reports for assessment of anxiety and depression and those are susceptible to response bias, such as giving socially desirable responses. Moreover, as PHQ–4 is only a screening tool, the diagnosis must be confirmed in accordance to the appropriate DSM–V criteria. Wider implications of the findings: A better understanding of potential mental problems in endometriosis patients during stressful events, such as the COVID–19 pandemic or other comparable difficult environmental or social circumstances, is crucial for providing an optimal patient centered care in cases of upcoming stressful events. Trial registration number Not applicable
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Affiliation(s)
- R Schwab
- Mainz University Medical Center, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - K Stewen
- Mainz University Medical Center, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - M J Battista
- Mainz University Medical Center, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - S Krajnak
- Mainz University Medical Center, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - K Anic
- Mainz University Medical Center, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - A Hasenburg
- Mainz University Medical Center, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
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Krajnak S, Loewe A, Battista MJ, Hasenburg A, Heimes AS, Schmidt M, Schwab R, Brenner W. The Impact of Insulin on Low-dose Metronomic Vinorelbine and Mafosfamide in Breast Cancer Cells. Anticancer Res 2021; 41:1243-1250. [PMID: 33788715 DOI: 10.21873/anticanres.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Breast cancer (BC) may be affected by diabetes and anti-diabetic medication, as well as its therapeutic agents. Low-dose metronomic chemotherapy (LDMC) is an available treatment option in BC. We investigated the impact of insulin on low-dose metronomic vinorelbine and mafosfamide in BC cell lines. MATERIALS AND METHODS Human BC cell lines T-47D, MCF-7, MDA-MB-231, BT-549 and non-tumorigenic breast cell line MCF-10A were exposed to 0.01 μg/ml and 10 μg/ml insulin in combination with low-dose metronomic vinorelbine or mafosfamide. The cell viability was determined after 24-72 hours using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. RESULTS Insulin, especially at a concentration of 10 μg/ml, seemed to increase viability of vinorelbine-treated hormone receptor-positive BC cells, whereas low-dose mafosfamide treatment tended to be potentiated by insulin in triple-negative cells. CONCLUSION Our findings suggest that insulin may influence the cytotoxic activity of LDMC depending on insulin concentration, type of cytotoxic drug used and BC cell line.
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Affiliation(s)
- Slavomir Krajnak
- Clinic for Obstetrics and Women's Health, University Medical Center Mainz, Mainz, Germany
| | - Amelie Loewe
- Clinic for Obstetrics and Women's Health, University Medical Center Mainz, Mainz, Germany
| | | | - Annette Hasenburg
- Clinic for Obstetrics and Women's Health, University Medical Center Mainz, Mainz, Germany
| | - Anne-Sophie Heimes
- Clinic for Obstetrics and Women's Health, University Medical Center Mainz, Mainz, Germany
| | - Marcus Schmidt
- Clinic for Obstetrics and Women's Health, University Medical Center Mainz, Mainz, Germany
| | - Roxana Schwab
- Clinic for Obstetrics and Women's Health, University Medical Center Mainz, Mainz, Germany
| | - Walburgis Brenner
- Clinic for Obstetrics and Women's Health, University Medical Center Mainz, Mainz, Germany
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Alexa M, Hasenburg A, Battista MJ. The TCGA Molecular Classification of Endometrial Cancer and Its Possible Impact on Adjuvant Treatment Decisions. Cancers (Basel) 2021; 13:cancers13061478. [PMID: 33806979 PMCID: PMC8005218 DOI: 10.3390/cancers13061478] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 01/09/2021] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 12/09/2022] Open
Abstract
Simple Summary The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) is a recently developed tool to identify four distinct molecular subgroups of endometrial cancer. Patients identified as Polymerase Epsilon exonuclease domain mutated (POLE EDM) or p53-mutated have significantly altered prognosis compared to patients allocated to the mismatch repair deficient (MMRd) or p53 wt groups. The aim of this review is to give a broad overview over the initial development and refinement of the classifier as well as possible effects on the recommended adjuvant treatment. We have summarized the clinical data of 8 studies including 3650 endometrial cancer patients and analyzed the distribution of tumor stage and adjuvant treatment received in respect to the molecular subgroups. Based on the findings of the summarized studies treatment de-escalation might be feasible for POLE EDM patients while p53 abn patients should receive adjuvant (chemo-)radiotherapy. Abstract Adjuvant treatment decisions for endometrial cancer (EC) are based on stage, the histological grade of differentiation, histological subtype, and few histopathological markers. The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) identified four risk groups of EC patients using a combination of immunohistochemistry and mutation analysis: Polymerase Epsilon exonuclease domain mutated (POLE EDM), mismatch repair deficient (MMRd), p53 wild-type/copy-number-low (p53 wt), and p53-mutated/copy-number-high (p53 abn). Patients allocated to the POLE or abnormal p53 expression subtype are faced with a significantly altered outcome possibly requiring a modified adjuvant treatment decision. Within this review, we summarize the development of ProMisE, characterize the four molecular subtypes, and finally discuss its value in terms of a patient-tailored therapy in order to prevent significant under or overtreatment.
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Almstedt K, Mendoza S, Battista MJ, Steetskamp J, Heimes AS, Krajnak S, Poplawski A, Hasenburg A, Schmidt M. EndoPredict® in early hormone receptor-positive, HER2-negative breast cancer: Impact on clinical decisions and clinico-pathological factors influencing its application. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | | | | | | | | | - A Poplawski
- Institut für Medizinische Biometrie, Epidemiologie and Informatik (IMBEI)
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van der Ven J, Linz V, Schwab R, Komoss S, Schmalfeldt B, Sehouli J, Hasenburg A, Battista MJ. Management of patients with STIC lesions in Germany – First results of a questionnaire based AGO Ovar survey. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J van der Ven
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - V Linz
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - R Schwab
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - S Komoss
- Universitätsklinik Tübingen, Department für Frauengesundheit
- Arbeitsgemeinschaft Gynäkologische Onkologie e.V., Kommission Ovar
| | - B Schmalfeldt
- Arbeitsgemeinschaft Gynäkologische Onkologie e.V., Kommission Ovar
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - J Sehouli
- Arbeitsgemeinschaft Gynäkologische Onkologie e.V., Kommission Ovar
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie
| | - A Hasenburg
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
- Arbeitsgemeinschaft Gynäkologische Onkologie e.V., Kommission Ovar
| | - MJ Battista
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
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Theis S, Battista MJ, Hasenburg A, Stewen K, Weikel W, Lebrecht A. Magnetische Sentinellymphknoten (SLN)-Markierung beim Mammakarzinom. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Theis
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - MJ Battista
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - A Hasenburg
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - K Stewen
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - W Weikel
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - A Lebrecht
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
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Almstedt K, Mendoza S, Otto M, Battista MJ, Steetskamp J, Heimes AS, Krajnak S, Poplawski A, Gerhold-Ay A, Hasenburg A, Denkert C, Schmidt M. EndoPredict ® in early hormone receptor-positive, HER2-negative breast cancer. Breast Cancer Res Treat 2020; 182:137-146. [PMID: 32436145 PMCID: PMC7275019 DOI: 10.1007/s10549-020-05688-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/13/2023]
Abstract
Purpose Evaluating consecutive early breast cancer patients, we analyzed both the impact of EndoPredict® on clinical decisions as well as clinico-pathological factors influencing the decision to perform this gene expression test. Methods Hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative early breast cancer patients treated between 2011 and 2016 were included in this study to investigate the role of EndoPredict® (EPclin) in the treatment of early breast cancer. A main study aim was to analyze the changes in therapy recommendations with and without EPclin. In addition, the impact of clinico-pathological parameters for the decision to perform EPclin was examined by Pearson's chi-squared test (χ2-test) and Fisher's exact test as well as univariate and multivariate logistic regressions. Results In a cohort of 869 consecutive early HR-positive, HER-negative breast cancer patients, EPclin was utilized in 156 (18.0%) patients. EPclin led to changes in therapy recommendations in 33.3% (n = 52), with both therapy escalation in 19.2% (n = 30) and de-escalation in 14.1% (n = 22). The clinico-pathological factors influencing the use of EPclin were age (P < 0.001, odds ratio [OR] 0.498), tumor size (P = 0.011, OR 0.071), nodal status (P = 0.021, OR 1.674), histological grade (P = 0.043, OR 0.432), and Ki-67 (P < 0.001, OR 3.599). Conclusions EPclin led to a change in therapy recommendations in one third of the patients. Clinico-pathological parameters such as younger age, smaller tumor size, positive nodal status, intermediate histological grade and intermediate Ki-67 had a significant influence on the use of EndoPredict®. Electronic supplementary material The online version of this article (10.1007/s10549-020-05688-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Almstedt
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - S Mendoza
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Otto
- Institute for Molecular Pathology, Trier, Germany
| | - M J Battista
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - J Steetskamp
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A S Heimes
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - S Krajnak
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Poplawski
- Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - A Gerhold-Ay
- Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - A Hasenburg
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and UKGM Marburg, Marburg, Germany
| | - M Schmidt
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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Emons G, Tempfer C, Battista MJ, Mustea A, Vordermark D. Adjuvant Radiotherapy and/or Chemotherapy for Endometrial Cancer, Status as at 2019: Opinion of the Uterus Commission of the Gynecological Oncology Working Group (AGO). Geburtshilfe Frauenheilkd 2019; 79:1273-1277. [PMID: 31875857 PMCID: PMC6924345 DOI: 10.1055/a-1019-7720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/20/2022] Open
Abstract
The role of adjuvant radiotherapy and/or chemotherapy in the primary treatment of endometrial cancer with a high risk of recurrence has still not been conclusively determined. The results of 3 large randomized controlled studies on different aspects of this issue have been published in full in recent months, and the relevant results are analyzed here.
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Affiliation(s)
- Günter Emons
- Universitätsmedizin Göttingen, Göttingen, Germany
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Denschlag D, Ackermann S, Battista MJ, Cremer W, Egerer G, Follmann M, Haas H, Harter P, Hettmer S, Horn LC, Juhasz-Boess I, Kast K, Köhler G, Kröncke T, Lindel K, Mallmann P, Meyer-Steinacker R, Mustea A, Petru E, Reichardt P, Schmidt D, Strauss HG, Tempfer C, Thiel F, Ulrich U, Vogl T, Vordermark D, Gass P, Beckmann MW. Sarcoma of the Uterus. Guideline of the DGGG and OEGGG (S2k Level, AWMF Register Number 015/074, February 2019). Geburtshilfe Frauenheilkd 2019; 79:1043-1060. [PMID: 31656317 DOI: 10.1055/a-0882-4116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
Abstract
Aims This is an official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Because of their rarity and heterogeneous histopathology, uterine sarcomas are challenging in terms of how they should be managed clinically, and treatment requires a multidisciplinary approach. To our knowledge, there are currently no binding evidence-based recommendations for the appropriate management of this heterogeneous group of tumors. Methods This S2k guideline was first published in 2015. The update published here is the result of the consensus of a representative interdisciplinary group of experts who carried out a systematic search of the literature on uterine sarcomas in the context of the guidelines program of the DGGG, OEGGG and SGGG. Members of the participating professional societies achieved a formal consensus after a moderated structured consensus process. Recommendations The consensus-based recommendations and statements include the epidemiology, classification, staging, symptoms, general diagnostic work-up and general pathology of uterine sarcomas as well as the genetic predisposition to develop uterine sarcomas. Also included are statements on the management of leiomyosarcomas, (low and high-grade) endometrial stromal sarcomas and undifferentiated uterine sarcomas and adenosarcomas. Finally, the guideline considers the follow-up and morcellation of uterine sarcomas and the information provided to patients.
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Affiliation(s)
| | | | - Marco Johannes Battista
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | | | | | | | | | - Philipp Harter
- Klinik für Gynäkologie und Gynäkologische Onkologie, Kliniken Essen Mitte, Essen, Germany
| | | | - Lars-Christian Horn
- Abteilung für Mamma-, Urogenital, und Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ingolf Juhasz-Boess
- Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Karin Kast
- Universitätsklinik Dresden, Dresden, Germany
| | - Günter Köhler
- Deutsches klinisches Kompetenzzentrum für genitale Sarkome und Mischtumoren, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Kröncke
- Klinik für Radiologie, Klinikum Augsburg, Augsburg, Germany
| | - Katja Lindel
- Klinik für Radioonkologie, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Peter Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln, Köln, Germany
| | | | | | - Edgar Petru
- Universitäts-Frauenklinik Graz, Graz, Austria
| | - Peter Reichardt
- Klinik für interdisziplinäre Onkologie, Helios Kliniken Berlin-Buch, Berlin, Germany
| | | | - Hans-Georg Strauss
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle, Halle/Saale, Germany
| | | | - Falk Thiel
- Frauenklinik, Alb Fils Kliniken, Göppingen, Germany
| | - Uwe Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus Berlin, Paul Gerhardt Diakonie, Berlin, Germany
| | - Thomas Vogl
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle/Saale, Germany
| | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
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Battista MJ, Schnatz C, Almstedt K, Brenner W, Heimes AS, Nezi-Cahn S, Schwab R, Hasenburg A, Schmidt M, Krajnak S. Low-dose metronomic chemotherapy (LDMC) as an efficient treatment option in metastatic breast cancer: Results of an exploratory case-control study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12578] [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
e12578 Background: There is a growing importance of low-dose metronomic chemotherapy (LDMC) in metastatic breast cancer (MBC). In this retrospective case-control-analysis we compared the efficacy of LDMC and conventional chemotherapy in MBC. Methods: Each LDMC patient receiving oral cyclophosphamide (CTX) (50 mg daily) and methotrexate (MTX) (2.5 mg every other day) was matched with two patients who received conventional chemotherapy. Age, number of chemotherapy lines and metastatic lesions as well as hormone receptor (HR) status were considered as matching criteria. Primary endpoint was disease control rate greater than 24 weeks (DCR). Secondary endpoints were DCR in subgroups (number of chemotherapy lines, number of different metastatic lesions and HR status), progression-free survival (PFS) and duration of response (DoR). Results: A total of 35 cases and 70 controls entered the study. 31% patients with LDMC and 26% patients with conventional chemotherapy showed DCR (p = 0.644). Among younger patients DCR was 41% in LDMC vs. 30% in the control group (p = 0.534). In addition, DCR was achieved in 35% vs. 27% patients with ≤ 2 chemotherapy lines (p = 0.560) and in 36% vs. 20% patients with ≤ 2 different metastatic lesions (p = 0.168), respectively. In the triple negative group 30% LDMC vs. 5% control patients showed DCR (p = 0.095). PFS was 12.0 vs. 13.5 weeks (p = 0.415), DoR was 26.5 vs. 20.5 weeks (p = 0.628), respectively. Conclusions: In this retrospective case-control study we demonstrated a similar efficacy of LDMC compared to conventional chemotherapy in the treatment of MBC. Moreover, no significant differences were found in the subgroups studied. Therefore, the concept of LDMC may also be a treatment option in both younger and non-heavily pre-treated MBC patients who do not need rapid remission.
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Affiliation(s)
| | - Carola Schnatz
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Katrin Almstedt
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Walburgis Brenner
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Anne-Sophie Heimes
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Sandra Nezi-Cahn
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Roxana Schwab
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
| | - Slavomir Krajnak
- Department of Obstetrics and Gynecology University Hospital Mainz, Mainz, Germany
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Heimes AS, Schmidt M, Jäkel J, Almstedt K, Gebhard S, Weyer-Eiberich V, Elger T, Krajnak S, Brenner W, Hasenburg A, Battista MJ. A retrospective analysis of immunohistochemically determined IRF4 (interferon regulating factor 4) expression in a consecutive cohort of 114 ovarian cancer patients. Arch Gynecol Obstet 2018; 299:239-246. [DOI: 10.1007/s00404-018-4941-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/12/2018] [Indexed: 01/23/2023]
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Emons G, Tempfer C, Battista MJ, Mustea A, Vordermark D. Statement of the Uterus Committee of the Gynaecological Oncology Working Group (AGO) on the PORTEC-3 study. Geburtshilfe Frauenheilkd 2018; 78:923-926. [PMID: 30364421 PMCID: PMC6195428 DOI: 10.1055/a-0658-1918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 11/04/2022] Open
Abstract
The data on the adjuvant therapy of endometrial cancer (EC) are inconsistent. Recent studies of this topic such as PORTEC-3, GOG-258 and GOG-249 investigated the value of adjuvant radiotherapy, adjuvant chemotherapy and combined adjuvant chemoradiotherapy followed by chemotherapy in patients with endometrial cancer and an increased risk of recurrence. With this statement, the Uterus Committee of the Gynaecological Oncology Working Group (AGO) wishes therefore to interpret the new data and discuss them against the background of the new S3 guideline “Diagnosis, treatment and follow-up of patients with endometrial cancer”.
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Heimes AS, Jäkel J, Almstedt K, Weyer-Eiberich V, Elger T, Krajnak S, Brenner W, Hasenburg A, Schmidt M, Battista MJ. A retrospective analysis of immunohistochemical determined IRF4 (interferon regulating factor 4) expression in a consecutive cohort of 114 ovarian cancer patients. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- AS Heimes
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - J Jäkel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Institut für Pathologie, Mainz, Deutschland
| | - K Almstedt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - V Weyer-Eiberich
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, IMBEI, Mainz, Deutschland
| | - T Elger
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - S Krajnak
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - W Brenner
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - A Hasenburg
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - M Schmidt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - MJ Battista
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
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Hedri A, Lebrecht A, Battista MJ, Hasenburg A, Schmidt M. Male breast cancer: clinical presentation, diagnosis and therapy. A 30-year experience at the Department of Obstetrics and Gynecology, Medical Center Mainz, Germany. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Hedri
- Unifrauenklinik Mainz, Gynäkologie und Geburtshilfe, Mainz, Deutschland
| | - A Lebrecht
- Unifrauenklinik Mainz, Mainz, Deutschland
| | | | - A Hasenburg
- Unifrauenklinik Mainz, Gynäkologie und Geburtshilfe, Mainz, Deutschland
| | - M Schmidt
- Unifrauenklinik Mainz, Gynäkologie und Geburtshilfe, Mainz, Deutschland
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Makris GM, Chrelias C, Papanota A, Battista MJ, Papantoniou N. Ovarian tumors: Should the cervix be examined first? EUR J GYNAECOL ONCOL 2017; 38:462-464. [PMID: 29693893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a controversy regarding ovarian metastasis in early-stage adenocareinoma of the uterine cervix. The authors present the case of a 5 1-year-old woman that at the time of diagnosis was thought to suffer from a Stage II cervical carcinoma and a synchronous ovarian carcinoma, that turned out to be an ovarian metastasis from the endocervical adenocarcinoma, as attested morphologically, histochemically, and immunohistochemically. Radical hysterectomy with oophorectomy, excision of the omentum, lymph node excision, and cytological sampling of the peritoneal cavity were carried out. It is important to always bear in mind that even low-grade adenocarcinomas of the cervix can be metastatic to the ovaries. Clinicians have to be careful when managing those cases, while further investigation is needed in order to determine the exact mechanism of those metastases and the criteria needed in order to preserve the ovaries in young patients.
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Battista MJ, Steiner E, Schmidt M, Eichbaum M, Makris GM, Heimes AS, Almstedt K, Mallmann P, Hasenburg A. Versorgung von Patientinnen mit Endometriumkarzinom in Deutschland – Erste Ergebnisse der AGO Umfrage aus den Jahren 2006, 2009, 2013 und 2015. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Battista MJ, Schmidt M, Jakobi S, Cotarelo C, Almstedt K, Heimes AS, Makris GM, Weyer V, Lebrecht A, Hoffmann G, Eichbaum M. c-met is overexpressed in type I ovarian cancer: Results of an investigative analysis in a cohort of consecutive ovarian cancer patients. Oncol Lett 2016; 12:2001-2007. [PMID: 27602128 DOI: 10.3892/ol.2016.4895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/22/2016] [Indexed: 11/06/2022] Open
Abstract
The tyrosine kinase c-met alters signaling cascades such as the BRAF-MAPK and PI3K-PKB pathways. These alterations are involved in the carcinogenesis of type I but not type II ovarian cancer (OC). Therefore, the present study investigated the patterns of c-met expression in a cohort of consecutive patients with OC. c-met expression was determined by immunohistochemical analysis. Differences in c-met overexpression among subgroups of established clinicopathological features, including age, histological subtype, tumor stage, histological grading, post-operative tumor burden and completeness of chemotherapy, were determined by χ2 test. Cox regression analyses were performed to determine the prognostic effect of c-met. Survival rates were estimated using the Kaplan-Meier method. A total of 106 patients were enrolled into the study. c-met was overexpressed in 20.8% of the entire cohort; 35.7% of patients with type I OC and 8.6% of patients with type II OC showed overexpression (P=0.001). However, c-met overexpression was not associated with any other established clinicopathological features (all P-values >0.05). Univariate Cox regression analysis showed that overexpression of c-met was associated neither with progression-free survival (PFS) nor with disease-specific survival (DSS) (P=0.835 and P=0.414, respectively). Kaplan-Meier plots also failed to demonstrate an effect of c-met on the 5-year PFS and DSS rates (P=0.938 and P=0.412, respectively). These findings support the hypotheses that the overexpression of c-met is associated with type I but not type II OC, and that overexpression of c-met does not affect the prognosis of OC.
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Affiliation(s)
- Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Sina Jakobi
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Cristina Cotarelo
- Department of Pathology, University Medical Center Mainz, Mainz D-55131, Germany
| | - Katrin Almstedt
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Anne-Sophie Heimes
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Georgios-Marios Makris
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Veronika Weyer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Antje Lebrecht
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Gerald Hoffmann
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz D-55131, Germany
| | - Michael Eichbaum
- Department of Gynecology and Obstetrics, Marienkrankenhaus Frankfurt, Frankfurt D-60318, Germany
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Battista MJ, Goetze K, Schmidt M, Cotarelo C, Weyer-Elberich V, Hasenburg A, Mueller-Klieser W, Walenta S. Feasibility of induced metabolic bioluminescence imaging in advanced ovarian cancer patients: first results of a pilot study. J Cancer Res Clin Oncol 2016; 142:1909-16. [PMID: 27342420 DOI: 10.1007/s00432-016-2200-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/18/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE The precise determination of energy metabolites is challenged by the heterogeneity of their distribution, their rapid changes after surgical resection and the architectural complexity of malignancies. Induced metabolic bioluminescence imaging (imBI) allows to determine energy metabolites in tissue sections and to co-localize these with histological structures based on consecutive sections stained with HE. In this prospective pilot study patients with suspected advanced ovarian cancer (OC) were enrolled to prove the feasibility of imBI. METHODS During surgery, suspicious peritoneal metastases were resected and transferred in liquid nitrogen within 30 s. ATP, glucose and lactate concentrations were measured. Furthermore, the expression of monocarboxylate transporters MCT1 and MCT4 was determined by immunofluorescence staining. RESULTS 16 patients were screened, 12 entered the study. Final histological assessment revealed ten malignant and two benign peritoneal lesions. In all 12 cases high concentrations of ATP suggested that energy metabolism was not altered by the surgical and transport procedures (mean 0.56 μmol/g, range 0.24-1.21 μmol/g). The mean concentration of glucose was 1.95 μmol/g (range 0.58-4.71 μmol/g). The concentration of lactate was drastically higher in the ten OC cases (mean 24.79 μmol/g, range 17.51-37.16 μmol/g) compared to the benign samples (mean 5.98 μmol/g, range 5.43-6.54 μmol/g). Lactate concentrations seem to correlate with MCT1 (spearman rank correlation ρ = 0.624, 0.05 > p > 0.025), but not with MCT4 (spearman rank correlation ρ = 0.018, p > 0.1). CONCLUSIONS ImBI is feasible in peritoneal metastases of OC and encourages further effort to elucidate the role of glucose, lactate, MCT1 and MCT4 in OC.
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Affiliation(s)
- Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Medical Centre Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Kristina Goetze
- Institute for Pathophysiology, University Medical Centre Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Centre Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Cristina Cotarelo
- Institute of Pathology, University Medical Centre Mainz, Mainz, Germany
| | - Veronika Weyer-Elberich
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Centre Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | | | - Stefan Walenta
- Institute for Pathophysiology, University Medical Centre Mainz, Mainz, Germany
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Battista MJ, Goetze K, Schmidt M, Cotarelo C, Weyer-Elberich V, Hasenburg A, Walenta S, Mueller-Klieser W. Feasibility of an induced metabolic bioluminescence imaging technique in ovarian cancer: Results of a pilot study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Kristina Goetze
- Institute for Pathophysiology, Johannes Gutenberg University, Mainz, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | - Cristina Cotarelo
- Institute of Pathology, Johannes Gutenberg University, Mainz, Germany
| | - Veronika Weyer-Elberich
- Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University, Mainz, Germany
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | - Stefan Walenta
- Institute for Pathophysiology, Johannes Gutenberg University, Mainz, Germany
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Abstract
INTRODUCTION About one third of patients with endometrial cancer (EC) relapse and face a limited prognosis, if surgery or radiotherapy are not feasible. The remaining therapeutic options are chemotherapy and endocrine therapy. AREAS COVERED This review summarizes the development of the first selective estrogen receptor (ER) down-regulator fulvestrant. This article provides its mechanism of action, pharmacokinetics and the available preclinical and clinical data. Furthermore, this review provides an overview of the market of treatments for recurrent or metastatic EC (RMEC) while also taking into account studies of fulvestrant in metastatic breast cancer. EXPERT OPINION Even if fulvestrant showed only marginal activity in two phase II trials, it shouldn't be abandoned but instead further developed in EC. Firstly, the dose of fulvestrant used in these trials was too low from today's point of view. Secondly, the available literature on other endocrine agents is full of limitations and does not provide a gold standard. Furthermore, given the activity of mTOR inhibitors in EC, there may also be synergistic effects, given the cross-regulation of ER and the PI3K/AKT/mTOR pathway. The authors suggest that a prospective, phase II trial in ER positive RMEC would help to further explore the efficacy and tolerability of fulvestrant together with a mTOR inhibitor.
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Affiliation(s)
| | - Marcus Schmidt
- a Department of Obstetrics and Gynecology , University Hospital Mainz , Mainz , Germany
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Makris GM, Siristatidis C, Battista MJ, Chrelias C. Ovarian carcinosarcoma: a case report, diagnosis, treatment and literature review. Hippokratia 2015; 19:256-259. [PMID: 27418786 PMCID: PMC4938474] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM This report aims to present a rare case of ovarian carcinosarcoma and its current, optimal diagnosis and therapy strategy. DESCRIPTION OF CASE We report the case of a 70-year-old patient, who presented at the Obstetrics and Gynecology Department of the University Hospital of Mainz, with a short history of increased abdominal circumference. CONCLUSION The symptoms, diagnosis, and therapy of carcinosarcoma follow the pattern of a high grade epithelial ovarian cancer, fallopian cancer and primary peritoneal cancer. The rarity of this disease is a barrier to conducting prospective trials and establishing guidelines for high-quality evidence data. Hippokratia 2015; 19 (3): 256-259.
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Affiliation(s)
- G M Makris
- Department of Obstetrics and Gynecology, University Medical Center Mainz, "Johannes Gutenberg" University, Mainz, Germany
| | - C Siristatidis
- 3 Department of Obstetrics and Gynecology, University of Athens, "Attikon" General hospital, Chaidari, Athens, Greece
| | - M J Battista
- Department of Obstetrics and Gynecology, University Medical Center Mainz, "Johannes Gutenberg" University, Mainz, Germany
| | - C Chrelias
- 3 Department of Obstetrics and Gynecology, University of Athens, "Attikon" General hospital, Chaidari, Athens, Greece
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Schmidt M, van de Sandt L, Almstedt K, Battista MJ, Heimes AS, Lebrecht A, Hoffmann G, Rahnenfuehrer J, Hengstler JG. Prognostic significance of Focal Adhesion Kinase (FAK) in node-negative breast cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Antje Lebrecht
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | - Gerald Hoffmann
- Department of Obstetrics and Gynecology, University Hospital, Mainz, Germany
| | | | - Jan G Hengstler
- IfADo-Leibniz Research Centre for Working Environment and Human Factors, Dortmund University of Technology, Dortmund, Germany
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Battista MJ, Schmidt M, Rieks N, Steetskamp J, Sicking I, Lebrecht A, Koelbl H, Mallmann P, Hoffmann G, Steiner E. Erratum to: Nationwide analysis on surgical procedures for patients with endometrial cancer in Germany: Results of the AGO pattern of care studies from the years 2013, 2009, and 2006. J Cancer Res Clin Oncol 2014. [DOI: 10.1007/s00432-014-1790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Battista MJ, Schmidt M, Rieks N, Sicking I, Albrich S, Eichbaum M, Koelbl H, Mallmann P, Hoffmann G, Steiner E. Adjuvant treatment decisions for patients with endometrial cancer in Germany: results of the nationwide AGO pattern of care studies from the years 2013, 2009 and 2006. J Cancer Res Clin Oncol 2014; 141:555-62. [PMID: 25257957 DOI: 10.1007/s00432-014-1834-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/11/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE In 2013, 2009 and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated the therapeutic approaches for endometrial carcinoma and the adherence to their guideline in Germany. Here, the adjuvant treatment decisions were presented. METHODS A questionnaire was developed and sent to all 682 German gynecological departments in 2013 (775 in 2009 and 500 in 2006, respectively). The results of the questionnaires were compared with the recommendations of the guideline and with each other using Fisher's exact test. RESULTS Responses were available in 40.0 % in 2013, 33.3 % in 2009 and 35.8 % in 2006. Participants recommended external beam radiotherapy (EBRT) in 13 out of 16 requested stages and vaginal brachytherapy (VBT) in only 10 out of 16 requested stages as suggested by the guideline. Comparing the results of 2013 with 2009, less participants used EBRT and VBT in 7 out of 16 and in 6 out of 16 requested stages, respectively. Conversely, more participants offered adjuvant chemotherapy (CT) in 2013 (90.4 %) compared to 61.9 % in 2009 (p < 0.001) and 48.8 % in 2006 (p < 0.001), respectively. However, the stage-adjusted recommendations of CT were not in line with the guideline in 11 out of 15 requested stages. In total, 77.3 % of the participants use a multiple drug schedule with a platinum and a taxane compound. CONCLUSIONS The results suggest non-adherence to the guideline concerning the stage-adjusted use of VBT and CT in endometrial carcinoma. These findings emphasize great uncertainties and the need of more clarifying trials. Furthermore, a shift from radiotherapy toward CT is observable.
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Affiliation(s)
- Marco Johannes Battista
- Department of Gynecology and Obstetrics, University Hospital Mainz, Langenbeckstr. 1, 55131, Mainz, Germany,
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Sicking I, Rommens K, Battista MJ, Lebrecht A, Cotarelo C, Hoffmann G, Hengstler JG, Schmidt M. Prognostische Bedeutung von Cyclooxygenase-2 beim nodal-negativen, unbehandelten Mammakarzinom. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Battista MJ, Schmidt M, Rieks N, Steetskamp J, Sicking I, Lebrecht A, Koelbl H, Mallmann P, Hoffmann G, Steiner E. Nationwide analysis on surgical procedures for patients with endometrial cancer in Germany: results of the AGO pattern of care studies from the years 2013, 2009, and 2006. J Cancer Res Clin Oncol 2014; 140:2087-93. [PMID: 24985240 DOI: 10.1007/s00432-014-1755-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/22/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE In 2013, 2009, and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated the therapeutic approaches and the adherence to their guidelines for endometrial carcinoma (EC) in Germany. Here, we present the results concerning the surgical procedures. METHODS A questionnaire was developed and sent to 682 German gynecological departments in 2013 (775 in 2009 and 500 in 2006). The results were compared with the recommendations of the guideline and with each other. RESULTS Responses were available in 40.0 % in 2013, 33.3 % in 2009, and 35.8 % in 2006, respectively. Pelvic lymphadenectomy (LAN) was performed in accordance with the guidelines with some exceptions in 2013, 2009, and 2006, whereas paraaortic LAN was performed in accordance with the guideline only in 2009. Histological high-risk subtypes of EC received pelvic and paraaortic LAN in 2013, 2009, and 2006 in accordance with the guidelines with small exceptions. LAN for Patients, who were postoperatively upstaged or upgraded, was not conducted in accordance with the guidelines in 2013, 2009, and 2006. In 2013, 84.6 % of the participants offered the laparoscopic approach (LSA) for hysterectomy and bilateral salpingo-oophorectomy, 63.3 % for pelvic LAN, and 49.1 % for paraaortic LAN, respectively. More participants offered the LSA in 2013 compared to 2009 and 2006 (p values <0.014). CONCLUSIONS The paraaortic LAN, the LSA as well as the second operation on patients who had postoperatively been upstaged were not conducted in accordance with the guideline [CORRECTED]. Improvements concerning surgical treatment are possible and might lead to higher survival rates and a reduction of morbidity in patients with EC in Germany.
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Schmidt M, van de Sandt L, Edlund K, Sicking I, Battista MJ, Lebrecht A, Hoffmann G, Rahnenfuehrer J, Hengstler JG. Prognostic significance of interferon regulating factor 4 (IRF4) in node-negative breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | | | - Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at Dortmund TU, Dortmund, Germany
| | | | | | - Antje Lebrecht
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | - Gerald Hoffmann
- Department of Obstetrics and Gynecology, University Hospital, Mainz, Germany
| | | | - Jan G Hengstler
- IfADo-Leibniz Research Centre for Working Environment and Human Factors, Dortmund University of Technology, Dortmund, Germany
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Battista MJ, Mantai N, Sicking I, Cotarelo C, Weyer V, Lebrecht A, Solbach C, Schmidt M. Ki-67 as an independent prognostic factor in an unselected cohort of patients with ovarian cancer: results of an explorative, retrospective study. Oncol Rep 2014; 31:2213-9. [PMID: 24627004 DOI: 10.3892/or.2014.3079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/22/2014] [Indexed: 11/05/2022] Open
Abstract
The identification of prognostic markers has clinical implications in epithelial ovarian carcinoma (EOC). Here, we studied markers for proliferation (Ki-67), endocrine regulation [progesterone receptor (PR), estrogen receptor (ER)], and invasion [urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1)]. All patients with available follow-up information and EOC tissue, who were treated at our institution between 1997 and 2004, were enrolled in the present study. Expression of Ki-67, PR and ER was determined by immunohistochemical analyses. uPA and PAI-1 antigen levels were determined using enzyme‑linked immunosorbent assays. One hundred and eight patients entered the present study. The median follow-up time was 43.3 (range 11.4-68.0) months. In multivariable Cox regression analyses, Ki-67 expression showed an independent negative impact on disease-free survival (DFS) and overall survival (OS) [hazard ratio (HR) for DFS, 11.5; 95% confidence interval (CI), 2.64-49.7; p=0.001 and HR for OS, 21.2; 95% CI, 9.9-113.1; p<0.001]. After cut-off optimization, PR expression showed an independent positive impact on prognosis (HR for DFS, 0.15; 95% CI, 0.03-0.68; p=0.014 and HR for OS, 0.13; 95% CI, 0.03‑0.68; p=0.016). Furthermore, postoperative residual tumor burden and completeness of chemotherapy determined the prognosis. ER, uPA and PAI-1 were not associated with survival. PR and ER, and postoperative residual tumor burden and tumor stage showed a strong correlation in an explorative Spearman's rank correlation coefficient (rho=0.759 and rho=0.426, respectively). Ki-67 and cut-off optimized PR are independently associated with the prognosis of EOC. Further prospective studies are warranted to confirm these associations and to elucidate the underlying mechanisms.
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Affiliation(s)
- Marco Johannes Battista
- Department of Gynaecology and Obstetrics, University Medical Centre Mainz, D-55131 Mainz, Germany
| | - Nina Mantai
- Department of Gynaecology and Obstetrics, University Medical Centre Mainz, D-55131 Mainz, Germany
| | - Isabel Sicking
- Department of Gynaecology and Obstetrics, University Medical Centre Mainz, D-55131 Mainz, Germany
| | - Cristina Cotarelo
- Department of Pathology, University Medical Centre Mainz, D-55131 Mainz, Germany
| | - Veronika Weyer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, D-55131 Mainz, Germany
| | - Antje Lebrecht
- Department of Gynaecology and Obstetrics, University Medical Centre Mainz, D-55131 Mainz, Germany
| | - Christine Solbach
- Department of Gynaecology and Obstetrics, University Medical Centre Mainz, D-55131 Mainz, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre Mainz, D-55131 Mainz, Germany
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Kraetschell RW, Fotopoulou C, Dowdy SC, Fujiwara K, Yaegashi N, Lorusso D, Mahner S, Herzog TJ, Casado Herraez A, Vergote I, Miller DS, Marth C, Battista MJ, Lichtenegger W, Sehouli J. Regional differences in therapy and clinical management of endometrial cancer: Findings of an international survey by the North-eastern German Society of Gynaecological Oncology (NOGGO). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.5593] [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
5593 Background: We conducted an international survey to evaluate the differences in the systemic, radiotherapeutic and operative management of endometrial cancer (EC) in different regions of the world. Methods: In 2009 avalidated 15-item-questionnaire regarding surgical and adjuvant procedures of EC was sent to all German gynaecological clinics and in 2010 the English adapted questionnaire was set online as well as sent per post in most major gynaecological cancer societies. Results: 316 German institutions and 302 Institutions from 24 countries participated. We combined the different countries into regional groups: Central Europe (CE), southern Europe (SE), Asia and USA/UK. In Asian countries and in CE a lymph node dissection (LND) was performed routinely in 72.8% and in 55.6% of the cases, whereas in the USA/UK and in SE a LND was done mainly in selected cases when specific risk factors such as high-grade or non-endometrioid-histology applied (62.8% and 72.5%) than routinely (p < 0.001). A systematic pelvic and paraaortic LND was performed most frequently in CE 91.0%, in SE 76.9%, in Asia 70.9% and in USA/UK 68.6% (p < 0.001). A systematic LND with the intention of both adequate staging and for therapeutic value was performed in countries of central Europe to 74.6% and in Asia to 67.2%. In USA/UK the LND was seen merely as a staging instrument by 53.5% (p < 0.001). The LND was performed up to renal veins in CE in 86.8%, in Asia in 80.8%, in USA/UK in 51.2% and in SE in 45.1 %. A significant difference war found in the treatment for FIGO stage I (high risk factors (high grade, L1,V1)) and stage II disease between the countries: chemotherapy was applied in 84.8% of the participated centers in Asia,42.3% in SE, 21.2% in CE and only 13.6% in USK/UK (p<0.001).Vaginal brachytherapy was indicated as follows: USA/UK 84.1%, CE 78.8%, SE 78.8%, Asia 5.6% (p < 0.001). Conclusions: There is a large variety in the operative therapy and the clinical management of EC in different regions of the world. Future international prospective trials, will be necessary to improve and harmonize the evidence based treatment guidelines for EC- disease.
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Affiliation(s)
- Robert W. Kraetschell
- Charité-Universitätsmedizin Berlin, Department of Gynecology, Campus Virchow Clinic, Berlin, Germany
| | | | | | | | | | | | - Sven Mahner
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - David S. Miller
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Werner Lichtenegger
- Department of Gynecological Oncology, Campus Virchow, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité Campus Virchow Klinikum, Berlin, Germany
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Schmidt M, van de Sandt L, Boehm D, Sicking I, Battista MJ, Lebrecht A, Solbach C, Naumann G, Rahnenfuehrer J, Wirtz RM, Hengstler JG. Prognostic significance of the chemokine CXCL13 in node-negative breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.615] [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
615 Background: The chemokine CXCL13 is chemotactic for B cells. We examined the prognostic significance of CXCL13 mRNA expression in node-negative breast cancer. Methods: Microarray based gene-expression data for CXCL13 (205242_at) were analysed in four previously published cohorts (Mainz, Rotterdam, Transbig, Yu) of node-negative breast cancer patients not treated with adjuvant therapy (n=824). A meta-analysis of previously published cohorts was performed using a random effects model. Prognostic significance of CXCL13 on metastasis-free survival (MFS) was examined in the whole cohort and in different molecular subtypes (ER+/HER2-, ER-/HER2-, HER2+). Independent prognostic relevance was analysed using multivariate Cox regression. Results: Higher RNA expression of CXCL13 was related to better MFS in a meta-analysis of the whole cohort (HR 0.88, 95% CI 0.83-0.94, P<0.0001). Prognostic significance was most pronounced in the HER2+ positive molecular subtype (HR 0.72, 95% CI 0.59-0.87, P=0.0009) as compared to ER+/HER2- (HR 0.86, 95% CI 0.76-0.98, P=0.0024) and ER-/HER2- (HR 0.85, 95% CI 0.75-0.98), P=0.02) carcinomas of the breast. CXCL13 showed independent prognostic significance (HR 0.81, 95% CI 0.7336 0.8982, P=0.0001) in multivariate analysis. In addition to CXCL13, only histological grade of differentiation (HR 2.20, 95% CI 1.41-3.42, P=0.0005) and tumor size (HR 1.72, 95% CI 1.13-2.61, P=0.012), but neither age nor HER2 status nor hormone receptor status retained an independent prognostic association with MFS. Conclusions: The chemokine CXCL13 has independent prognostic significance in node-negative breast cancer. Higher expression of CXCL13 is associated with improved outcome.
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Affiliation(s)
- Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | | | - Daniel Boehm
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | | | | | - Antje Lebrecht
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | | | - Gert Naumann
- Department of Obstetrics and Gynecology, Mainz, Germany
| | | | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Jan G Hengstler
- IfADo-Leibniz Research Centre for Working Environment and Human Factors, Dortmund University of Technology, Dortmund, Germany
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Kraetschell RW, Fotopoulou C, Dowdy SC, Fujiwara K, Yaegashi N, Lorusso D, Casado A, Mahner S, Herzog TJ, Vergote IB, Miller DS, Marth C, Battista MJ, Lichtenegger W, Sehouli J. How is the current clinical management of endometrial cancer worldwide? An international survey by the North-Eastern German Society of Gynaecological Oncology (NOGGO). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5087] [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
5087 Background: Indication, technique and extent of lymph-node-dissection (LND) in endometrial cancer (EC) remains controversial and is strongly debated in cancer community. We conducted a national- and at a second step an international-survey evaluating the current status-quo of the surgical and medical management of EC. Methods: A validated 15-item-questionnaire regarding surgical and adjuvant procedures of EC was sent to all major gynaecological cancer societies and study groups worldwide. The questionnaire could also be answered online. Results: In a phase-I-national trial, the questionnaire was validated on basis of 316 German institutions. On the phase-II-international survey a total of 302 questionnaires were answered from 24 countries, mainly from Japan (38.7%), Spain (8.3%), Austria (7%), United-Kingdom (6.3%), Italy (6%), USA (4.3%) and Canada (4%). The vast majority of the participating clinics were academic (62.8%), while 75.2% of them belonged to gynaecology. Only 0.7% of the clinics internationally reported never performing LND in EC. 62.3% of the clinics perform both a pelvic and paraaortic lymph node dissection. 59.1% of the participants performed a systematic lymph node dissection with the intention of both adequate staging and for therapeutic value. 15.05% of the clinics perform LND up to the common-iliac-arteries, 9.03% up to the inferior-mesenteric-artery and 70.6% up to the renal-veins. The most common risk-factors to indicate LND were: high-grading (93%), non-endometrioid-histology (90.1%), lymphovascular-invasion (55.3%), blood-vessel invasion (45.4%) and tumor-diameter >2cm (38.4%). For advanced stage III&IV disease the vast majority (60% and 80%, respectively) of the physicians indicated systemic chemotherapy alone. Conclusions: This study presents the large variety in clinical management of EC worldwide, underlining so the high need of future prospective randomised trials which will establish standard and evidence based treatment guidelines for EC- disease.
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Affiliation(s)
| | - Christina Fotopoulou
- Charité University Department of Gynecology, Campus Virchow Clinic, Berlin, Germany
| | | | | | - Nobuo Yaegashi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Sven Mahner
- University Medical Center Hamburg-Eppendorf, Department of Gynecology, Hamburg, Germany
| | | | | | | | | | | | - Werner Lichtenegger
- Department of Gynecological Oncology, Campus Virchow, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité Campus Virchow Klinikum, Berlin, Germany
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Battista MJ, Steetskamp J, Mantai N, Gebhard S, Cotarelo C, Victor A, Petry I, Schmidt M, Kölbl H. Immunoreactive score of Ep-CAM might predict survival in early ovarian cancer patients. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Battista MJ, Steiner E, Zabel N, Schmidt M, Kölbl H. Ausgangslage für die S2-Leitlinie der Arbeitsgemeinschaft Gynäkologische Onkologie Kommission Uterus zur Therapie des Endometriumkarzinom in Deutschland. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Battista MJ, Maul H, Krause M, Freerksen N, Beuter P, Freerksen N, Sohn C. Gabe von Fenoterol bei Patientin mit Cervix-insuffizienz demaskiert Dystrophe Myotonie Typ I (M. Curschmann-Steinert)- case report. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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