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de Boo LW, Jóźwiak K, Ter Hoeve ND, van Diest PJ, Opdam M, Wang Y, Schmidt MK, de Jong V, Kleiterp S, Cornelissen S, Baars D, Koornstra RHT, Kerver ED, van Dalen T, Bins AD, Beeker A, van den Heiligenberg SM, de Jong PC, Bakker SD, Rietbroek RC, Konings IR, Blankenburgh R, Bijlsma RM, Imholz ALT, Stathonikos N, Vreuls W, Sanders J, Rosenberg EH, Koop EA, Varga Z, van Deurzen CHM, Mooyaart AL, Córdoba A, Groen E, Bart J, Willems SM, Zolota V, Wesseling J, Sapino A, Chmielik E, Ryska A, Broeks A, Voogd AC, van der Wall E, Siesling S, Salgado R, Dackus GMHE, Hauptmann M, Kok M, Linn SC. Prognostic value of histopathologic traits independent of stromal tumor-infiltrating lymphocyte levels in chemotherapy-naïve patients with triple-negative breast cancer. ESMO Open 2024; 9:102923. [PMID: 38452438 PMCID: PMC10937239 DOI: 10.1016/j.esmoop.2024.102923] [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: 09/13/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND In the absence of prognostic biomarkers, most patients with early-stage triple-negative breast cancer (eTNBC) are treated with combination chemotherapy. The identification of biomarkers to select patients for whom treatment de-escalation or escalation could be considered remains an unmet need. We evaluated the prognostic value of histopathologic traits in a unique cohort of young, (neo)adjuvant chemotherapy-naïve patients with early-stage (stage I or II), node-negative TNBC and long-term follow-up, in relation to stromal tumor-infiltrating lymphocytes (sTILs) for which the prognostic value was recently reported. MATERIALS AND METHODS We studied all 485 patients with node-negative eTNBC from the population-based PARADIGM cohort which selected women aged <40 years diagnosed between 1989 and 2000. None of the patients had received (neo)adjuvant chemotherapy according to standard practice at the time. Associations between histopathologic traits and breast cancer-specific survival (BCSS) were analyzed with Cox proportional hazard models. RESULTS With a median follow-up of 20.0 years, an independent prognostic value for BCSS was observed for lymphovascular invasion (LVI) [adjusted (adj.) hazard ratio (HR) 2.35, 95% confidence interval (CI) 1.49-3.69], fibrotic focus (adj. HR 1.61, 95% CI 1.09-2.37) and sTILs (per 10% increment adj. HR 0.75, 95% CI 0.69-0.82). In the sTILs <30% subgroup, the presence of LVI resulted in a higher cumulative incidence of breast cancer death (at 20 years, 58%; 95% CI 41% to 72%) compared with when LVI was absent (at 20 years, 32%; 95% CI 26% to 39%). In the ≥75% sTILs subgroup, the presence of LVI might be associated with poor survival (HR 11.45, 95% CI 0.71-182.36, two deaths). We confirm the lack of prognostic value of androgen receptor expression and human epidermal growth factor receptor 2 -low status. CONCLUSIONS sTILs, LVI and fibrotic focus provide independent prognostic information in young women with node-negative eTNBC. Our results are of importance for the selection of patients for de-escalation and escalation trials.
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Affiliation(s)
- L W de Boo
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - N D Ter Hoeve
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Opdam
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Y Wang
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M K Schmidt
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - V de Jong
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Kleiterp
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Cornelissen
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D Baars
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R H T Koornstra
- Department of Medical Oncology, Rijnstate Medical center, Arnhem, The Netherlands
| | - E D Kerver
- Department of Medical Oncology, OLVG, Amsterdam, The Netherlands
| | - T van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - A D Bins
- Department of Medical Oncology, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Beeker
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - P C de Jong
- Department of Medical Oncology, Sint Antonius Hospital, Utrecht, The Netherlands
| | - S D Bakker
- Department of Internal Medicine, Zaans Medical Centre, Zaandam, The Netherlands
| | - R C Rietbroek
- Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - I R Konings
- Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - R Blankenburgh
- Department of Medical Oncology, Saxenburgh Medical Center, Hardenberg, The Netherlands
| | - R M Bijlsma
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - A L T Imholz
- Department of Internal Medicine, Deventer Hospital, Deventer, The Netherlands
| | - N Stathonikos
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Vreuls
- Department of Pathology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - J Sanders
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E H Rosenberg
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E A Koop
- Department of Pathology, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
| | - Z Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - C H M van Deurzen
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A L Mooyaart
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Córdoba
- Department of Pathology, Complejo Hospitalaria de Navarra, Pamplona, Spain
| | - E Groen
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Bart
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - S M Willems
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - V Zolota
- Department of Pathology, Rion University Hospital, Patras, Greece
| | - J Wesseling
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Sapino
- Department of Medical Sciences, University of Torino, Torino, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - E Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice, Poland
| | - A Ryska
- Charles University Medical Faculty and University Hospital, Hradec Kralove, Czech Republic
| | - A Broeks
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - E van der Wall
- Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - R Salgado
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - G M H E Dackus
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - M Kok
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Tumorbiology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S C Linn
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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van den Brand AD, Rubinstein E, de Jong PC, van den Berg M, van Duursen M. Assessing anti-estrogenic effects of AHR ligands in primary human and rat endometrial epithelial cells. Reprod Toxicol 2020; 96:202-208. [PMID: 32668270 DOI: 10.1016/j.reprotox.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 02/08/2023]
Abstract
Unopposed estrogenic action in the uterus can lead to the development of endometrial cancer in both humans and rats. Aryl hydrocarbon receptor (AHR) activation gives rise to anti-estrogenic actions and may consequently reduce the development of endometrial cancer. In this study, the anti-estrogenic potential of the AHR ligands 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and DELAQ, a metabolite of the pharmaceutical laquinimod, was assessed in in primary human and rat endometrial epithelial cells (EECs) with and without co-exposure to endogenous hormones. In human EECs, estradiol and progesterone did not affect AHR gene expression, but in rat EECs, progesterone decreased Ahre xpression (1.4-fold). In accordance, AHR-mediated induction of Cyp1a1/1b1 expression by DELAQ and TCDD decreased in hormone-treated rat EECs. DELAQ was 22-fold more potent than TCDD in human EECs in inducing CYP1A1/1B1 gene expression, while DELAQ was approximately 16-33-fold less potent than TCDD in rat EECs. In human EECs, 10 nM DELAQ decreased estradiol-induced expression of growth-regulated estrogen receptor binding 1 (GREB1) by 1.8-fold. In rat EECs, both DELAQ and TCDD did not affect the expression of estradiol-induced genes. This study shows that AHR ligand DELAQ, but not TCDD, causes anti-estrogenic effects in primary human EECs. Furthermore, although AHR-mediated CYP1A1/1B1/Cyp1a1/1b1 induction by DELAQ and TCDD was stronger in rat EECs than human EECs, this did not result in apparent anti-estrogenic effects in the rat cells. This study shows that primary human and rat endometrial cells respond differently towards hormones and AHR ligands. This should be considered in human risk assessment based on rodent studies.
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Affiliation(s)
- A D van den Brand
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM Utrecht, the Netherlands.
| | - E Rubinstein
- Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - P C de Jong
- St. Antonius Hospital, Internal Medicine, Nieuwegein, the Netherlands
| | - M van den Berg
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM Utrecht, the Netherlands
| | - Mbm van Duursen
- Environmental Health & Toxicology, Vrije Universiteit, Amsterdam, the Netherlands
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van den Brand AD, Rubinstein E, de Jong PC, van den Berg M, van Duursen MBM. Primary endometrial 3D co-cultures: A comparison between human and rat endometrium. J Steroid Biochem Mol Biol 2019; 194:105458. [PMID: 31465845 DOI: 10.1016/j.jsbmb.2019.105458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/18/2019] [Accepted: 08/25/2019] [Indexed: 12/21/2022]
Abstract
Human and rat reproductive systems differ significantly with respect to hormonal cyclicity and endometrial cell behavior. However, species-differences in endometrial cell responses upon hormonal stimulation and exposure to potentially toxic compounds are poorly characterized. In this study, human and rat endometrial hormonal responses were assessed in vitro using a 3D co-culture model of primary human and rat endometrial cells. The models were exposed to the aryl hydrocarbon receptor (AHR) ligands 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), laquinimod, and its AHR active metabolite DELAQ. In both the human and rat endometrial models, estrogen receptor and progesterone receptor gene expression was modulated by the hormonal treatments, comparable to the in vivo situation. AHR gene expression in the human endometrial model did not change when exposed to hormones. In contrast, AHR expression decreased 2-fold in the rat model when exposed to predominantly progesterone, which resulted in a 2.8-fold attenuation of gene expression induction of cytochrome P450 1A1 (CYP1A1) by TCDD. TCDD and DELAQ, but not laquinimod, concentration-dependently induced CYP1A1 gene expression in both human and rat endometrial models. Interestingly, the relative degree of DELAQ to induce CYP1A1 was higher than that of TCDD in the human model, while it was lower in the rat model. These data clearly show species-differences in response to hormones and AHR ligands between human and rat endometrial cells in vitro, which might greatly affect the applicability of the rat as translational model for human endometrial effects. This warrants further development of human relevant, endometrium-specific test methods for risk assessment purposes.
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Affiliation(s)
- A D van den Brand
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM Utrecht, the Netherlands.
| | - E Rubinstein
- Teva Pharmaceutical Industries Ltd, Netanya, Israel
| | - P C de Jong
- St. Antonius Hospital, Nieuwegein, the Netherlands
| | - M van den Berg
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM Utrecht, the Netherlands
| | - M B M van Duursen
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM Utrecht, the Netherlands; Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Steenbruggen TG, Bouwer NI, Smorenburg CH, Rier HN, Jager A, Beelen K, Ten Tije AJ, de Jong PC, Drooger JC, Holterhues C, Kitzen JJEM, Levin MD, Sonke GS. Radiological complete remission in HER2-positive metastatic breast cancer patients: what to do with trastuzumab? Breast Cancer Res Treat 2019; 178:597-605. [PMID: 31493033 DOI: 10.1007/s10549-019-05427-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients with HER2-positive metastatic breast cancer (MBC) treated with trastuzumab may experience durable tumor response for many years. It is unknown if patients with durable radiological complete remission (rCR) can discontinue trastuzumab. We analyzed clinical characteristics associated with rCR and overall survival (OS) in a historic cohort of patients with HER2-positive MBC and studied the effect of stopping trastuzumab in case of rCR. METHODS We included patients with HER2-positive MBC treated with first or second-line trastuzumab-based therapy in eight Dutch hospitals between 2000 and 2014. Data were collected from medical records. We used multivariable regression models to identify independent prognostic factors for rCR and OS. Time-to-progression after achieving rCR for patients who continued and stopped trastuzumab, and breast cancer-specific survival were also evaluated. RESULTS We identified 717 patients with a median age of 53 years at MBC diagnosis. The median follow-up was 109 months (IQR 72-148). The strongest factor associated with OS was achievement of rCR, adjusted hazard ratio 0.27 (95% CI 0.18-0.40). RCR was observed in 72 patients (10%). The ten-year OS estimate for patients who achieved rCR was 52 versus 7% for patients who did not achieve rCR. Thirty patients with rCR discontinued trastuzumab, of whom 20 (67%) are alive in ongoing remission after 78 months of median follow-up since rCR. Of forty patients (58%) who continued trastuzumab since rCR, 13 (33%) are in ongoing remission after 68 months of median follow-up. Median time-to-progression in the latter group was 14 months. CONCLUSIONS Achieving rCR is the strongest predictor for improved survival in patients with HER2-positive MBC. Trastuzumab may be discontinued in selected patients with ongoing rCR. Further research is required to identify patients who have achieved rCR and in whom trastuzumab may safely be discontinued.
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Affiliation(s)
- T G Steenbruggen
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - N I Bouwer
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - C H Smorenburg
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - H N Rier
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - K Beelen
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - A J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - P C de Jong
- Department of Medical Oncology, Sint Antonius Hospital, Utrecht, Utrecht, The Netherlands
| | - J C Drooger
- Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands
| | - C Holterhues
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - J J E M Kitzen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - M -D Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Schraa SJ, Frerichs KA, Agterof MJ, Hunting JCB, Los M, de Jong PC. Relative dose intensity as a proxy measure of quality and prognosis in adjuvant chemotherapy for breast cancer in daily clinical practice. Eur J Cancer 2017; 79:152-157. [PMID: 28494406 DOI: 10.1016/j.ejca.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/03/2017] [Indexed: 11/19/2022]
Abstract
AIM Adjuvant chemotherapy treatment of women with breast cancer is frequently complicated by toxic side-effects, resulting in dose reduction and delay. In Dutch guidelines, a relative dose intensity (RDI) of at least 85% is recommended for optimal treatment. The aim was to investigate predictors of low RDI and its effect on prognosis. METHODS All patients treated in the St. Antonius Hospital with adjuvant chemotherapy for breast cancer between 2008 and 2013 were included (N = 605). RDI was calculated for each single chemotherapeutic agent and for chemotherapy regimens in total. Incidence and causes of RDI <85% were studied, as well as the effect of RDI on prognosis. RESULTS About 10% of 605 patients had RDIs <85%. Predictive factors included age, episodes of febrile neutropenia and grade III or IV hypersensitivity reaction to taxanes. Other adverse events, such as peripheral neuropathy, did not affect RDI. The incidence of febrile neutropenia in the 5-fluorouracil, epirubicin, cyclofosfamide, docetaxel (FEC-D) protocol was 24% and therefore was above the threshold set by the European Organisation for Research and Treatment of Cancer for primary granulocyte colony-stimulating factor (G-CSF) prophylaxis. No relationship between RDI and (disease-free) survival was found with a median follow-up of 38 months. Apart from the stage of disease, obesity is a predictor of poor outcome. CONCLUSIONS RDI <85% is predicted by patients' age, febrile neutropenia and hypersensitivity reactions to taxanes. The incidence of febrile neutropenia in FEC-D treatment indicates primary prophylaxis with G-CSF following docetaxel treatment. No relationship was found between RDI and (disease-free) survival, but longer follow-up is needed.
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Affiliation(s)
- S J Schraa
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - K A Frerichs
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Agterof
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J C B Hunting
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M Los
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P C de Jong
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Busweiler LAD, Schouwenburg MG, van Berge Henegouwen MI, Kolfschoten NE, de Jong PC, Rozema T, Wijnhoven BPL, van Hillegersberg R, Wouters MWJM, van Sandick JW. Textbook outcome as a composite measure in oesophagogastric cancer surgery. Br J Surg 2017; 104:742-750. [PMID: 28240357 DOI: 10.1002/bjs.10486] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/19/2016] [Accepted: 12/08/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Quality assurance is acknowledged as a crucial factor in the assessment of oncological surgical care. The aim of this study was to develop a composite measure of multiple outcome parameters defined as 'textbook outcome', to assess quality of care for patients undergoing oesophagogastric cancer surgery. METHODS Patients with oesophagogastric cancer, operated on with the intent of curative resection between 2011 and 2014, were identified from a national database (Dutch Upper Gastrointestinal Cancer Audit). Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. Hospital variation in textbook outcome was analysed after adjustment for case-mix factors. RESULTS In total, 2748 patients with oesophageal cancer and 1772 with gastric cancer were included in this study. A textbook outcome was achieved in 29·7 per cent of patients with oesophageal cancer and 32·1 per cent of those with gastric cancer. Adjusted textbook outcome rates varied from 8·5 to 52·4 per cent between hospitals. The outcome parameter 'at least 15 lymph nodes examined' had the greatest negative impact on a textbook outcome both for patients with oesophageal cancer and for those with gastric cancer. CONCLUSION Most patients did not achieve a textbook outcome and there was wide variation between hospitals.
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Affiliation(s)
- L A D Busweiler
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.,Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - M G Schouwenburg
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.,Department of General Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - N E Kolfschoten
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands
| | - P C de Jong
- Department of Medical Oncology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - T Rozema
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - B P L Wijnhoven
- Department of General Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - R van Hillegersberg
- Department of General Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J W van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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de Jong PC. The history of anesthesia in Roermond 1940-1945--a city in a war zone. Bull Anesth Hist 2010; 28:37-42. [PMID: 22849205 DOI: 10.1016/s1522-8649(10)50020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Second World War brought much grief to the world. Roermond was at the forefront of the war for a period of five months. Before the war, in this part of The Netherlands, physicians were more attuned to scientific development taking place in Germany than in the United Kingdom. It wasn't until after the war that anesthesiology developed as a separate specialty. The impression that the hospital records give is that anesthesia was practiced at a far higher level than we had always assumed, using a wide variety of drugs and techniques, in spite of the fact that there were no professional anesthesiologists at the time. That high level was maintained throughout the war in spite of all the hardships.
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Affiliation(s)
- P C de Jong
- Dept. of Anesthesiology, Laurentius Hospital, AX Roermond, The Netherlands
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de Jong PC, Wesdorp RI, Volovics A, Roufflart M, Greep JM, Soeters PB. The value of objective measurements to select patients who are malnourished. Clin Nutr 2008; 4:61-6. [PMID: 16831707 DOI: 10.1016/0261-5614(85)90043-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/1984] [Accepted: 09/04/1984] [Indexed: 12/17/2022]
Abstract
Several studies have attempted to define nutritional parameters that can be used to select malnourished hospitalised patients for nutritional support. A combination of objective nutritional parameters was evaluated in a group of 50 patients selected for total parenteral nutrition on clinical grounds only and compared with a control group. This control group consisted of 38 patients who were admitted for elective minor surgical procedures such as varicectomy and hernia repair. On a subset of 18 objective nutritional measurements, discriminant analysis was performed. In the evaluation it was shown that a combination of albumin (ALB), prealbumin (PALB), total lymphocyte count (TLC) and the percentage of ideal weight (PIW) was the most useful combination of nutritional tests in discriminating a chosen malnourished (M) group and a control group who were declared not malnourished (NM). With this combination the patients were correctly classified in 93% with a sensitivity of 93% and a specificity of 94%.
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Affiliation(s)
- P C de Jong
- Department of Surgery, St Annadal Hospital, University of Limburg, Maastricht, The Netherlands
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van Meeuwen JA, van Son O, Piersma AH, de Jong PC, van den Berg M. Aromatase inhibiting and combined estrogenic effects of parabens and estrogenic effects of other additives in cosmetics. Toxicol Appl Pharmacol 2008; 230:372-82. [PMID: 18486175 DOI: 10.1016/j.taap.2008.03.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 03/03/2008] [Accepted: 03/04/2008] [Indexed: 11/19/2022]
Abstract
There is concern widely on the increase in human exposure to exogenous (anti)estrogenic compounds. Typical are certain ingredients in cosmetic consumer products such as musks, phthalates and parabens. Monitoring a variety of human samples revealed that these ingredients, including the ones that generally are considered to undergo rapid metabolism, are present at low levels. In this in vitro research individual compounds and combinations of parabens and endogenous estradiol (E(2)) were investigated in the MCF-7 cell proliferation assay. The experimental design applied a concentration addition model (CA). Data were analyzed with the estrogen equivalency (EEQ) and method of isoboles approach. In addition, the catalytic inhibitory properties of parabens on an enzyme involved in a rate limiting step in steroid genesis (aromatase) were studied in human placental microsomes. Our results point to an additive estrogenic effect in a CA model for parabens. In addition, it was found that parabens inhibit aromatase. Noticeably, the effective levels in both our in vitro systems were far higher than the levels detected in human samples. However, estrogenic compounds may contribute in a cumulative way to the circulating estrogen burden. Our calculation for the extra estrogen burden due to exposure to parabens, phthalates and polycyclic musks indicates an insignificant estrogenic load relative to the endogenous or therapeutic estrogen burden.
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Affiliation(s)
- J A van Meeuwen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
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van Meeuwen JA, Korthagen N, de Jong PC, Piersma AH, van den Berg M. (Anti)estrogenic effects of phytochemicals on human primary mammary fibroblasts, MCF-7 cells and their co-culture. Toxicol Appl Pharmacol 2007; 221:372-83. [PMID: 17482226 DOI: 10.1016/j.taap.2007.03.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/26/2007] [Accepted: 03/15/2007] [Indexed: 11/21/2022]
Abstract
In the public opinion, phytochemicals (PCs) present in the human diet are often considered beneficial (e.g. by preventing breast cancer). Two possible mechanisms that could modulate tumor growth are via interaction with the estrogen receptor (ER) and inhibition of aromatase (CYP19). Multiple in vitro studies confirmed that these compounds act estrogenic, thus potentially induce tumor growth, as well as aromatase inhibitory, thus potentially reduce tumor growth. It is thought that in the in vivo situation breast epithelial (tumor) cells communicate with surrounding connective tissue by means of cytokines, prostaglandins and estradiol forming a complex feedback mechanism. Recently our laboratory developed an in vitro co-culture model of healthy mammary fibroblasts and MCF-7 cells that (at least partly) simulated this feedback mechanism (M. Heneweer et al., TAAP vol. 202(1): 50-58, 2005). In the present study biochanin A, chrysin, naringenin, apigenin, genistein and quercetin were studied for their estrogenic properties (cell proliferation, pS2 mRNA) and aromatase inhibition in MCF-7 breast tumor cells, healthy mammary fibroblasts and their co-culture. The proliferative potency of these compounds in the MCF-7 cells derived from their EC(50)s decreased in the following order: estadiol (4*10(-3) nM)>biochanin A (9 nM)>genistein (32 nM)>testosterone (46 nM)>naringenin (287 nM)>apigenin (440 nM)>chrysin (4 microM). The potency to inhibit aromatase derived from their IC(50)s decreased in the following order: chrysin (1.5 microM)>naringenin (2.2 microM)>genistein (3.6 microM)>apigenin (4.1 microM)>biochanin A (25 microM)>quercetin (30 microM). The results of these studies show that these PCs can induce cell proliferation or inhibit aromatase in the same concentration range (1-10 microM). Results from co-cultures did not elucidate the dominant effect of these compounds. MCF-7 cell proliferation occurs at concentrations that are not uncommon in blood of individuals using food supplements. Results also indicate that estrogenicity of these PCs is quantitatively more sensitive than aromatase inhibition. It is suggested that perhaps a more cautionary approach should be taken for these PCs before taken as food supplements.
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Affiliation(s)
- J A van Meeuwen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, PO Box 80177, 3508 TD Utrecht, The Netherlands.
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de Jong PC, Blankenstein MA, van de Ven J, Nortier JW, Blijham GH, Thijssen JH. Importance of local aromatase activity in hormone-dependent breast cancer: a review. Breast 2001; 10:91-9. [PMID: 14965567 DOI: 10.1054/brst.2000.0209] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The cytochrome P-450 enzyme complex aromatase is the rate-limiting step in the production of oestrogens. It catalyses the conversion of androgens to oestrogens. In the treatment of hormone-dependent breast cancer in postmenopausal women, aromatase is the target for treatment with aromatase inhibitors. Recently registered aromatase inhibitors like anastrozole, letrozole and exemestane have proven to be effective therapy for advanced breast cancer in postmenopausal patients failing to respond to treatment with tamoxifen. Intratumoural aromatase activity has predictive value for response to treatment with aromatase inhibitors. Attempts are being made to find an immunohistochemical technique to determine aromatase in tumour tissue, which may serve as a predictive factor. In situ oestrogen synthesis through local aromatase activity in the tumour and adjacent tissue is probably a very important growth-stimulating system in hormone-dependent breast cancer. This synthesis can be blocked with aromatase inhibitors. The regulation of aromatase activity and the cell types that contribute to this process are the subject of extensive research. There seems to be a complex interaction between malignant cells and adjacent cells in which factors such as IL-6 and its soluble receptor, TNF-alpha and prostaglandin E2 play an important role in stimulating aromatase activity.
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Affiliation(s)
- P C de Jong
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
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12
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Franssen ME, van der Wilt GJ, de Jong PC, Bos RP, Arnold WP. A retrospective study of the teratogenicity of dermatological coal tar products. Acta Derm Venereol 1999; 79:390-1. [PMID: 10494722 DOI: 10.1080/000155599750010373] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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13
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Abstract
Inhibition of the enzyme aromatase, the rate limiting step in estrogen production, is an effective endocrine treatment of advanced postmenopausal breast cancer. Recently, several new aromatase inhibitors have been developed to improve efficacy and reduce toxicity compared to the prototype aromatase inhibitor aminoglutethimide. Aromatase inhibitors can be divided into two types. The first are the non-steroidal inhibitors that have a mechanism of action similar to aminoglutethimide. The second are the steroidal inhibitors that function as a false substrate for aromatase. Of the non-steroidal aromatase inhibitors, two drugs, anastrozole and letrozole, have recently been registered for the second line endocrine treatment of advanced postmenopausal breast cancer after failure on tamoxifen. The phase III studies of these drugs indicate at least equal efficacy compared to current second line treatment with aminoglutethimide or megestrol acetate. Their toxicity profile, however, is much more favourable. This makes them the drugs of choice for the second line endocrine treatment of advanced breast cancer in postmenopausal patients, who failed during adjuvant or first line treatment with tamoxifen. Of the steroidal aromatase inhibitors, the orally active drug exemestane is still in phase III clinical study; the registration is expected in 1999.
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Affiliation(s)
- P C de Jong
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
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Blankenstein MA, van de Ven J, Maitimu-Smeele I, Donker GH, de Jong PC, Daroszewski J, Szymczak J, Milewicz A, Thijssen JH. Intratumoral levels of estrogens in breast cancer. J Steroid Biochem Mol Biol 1999; 69:293-7. [PMID: 10419005 DOI: 10.1016/s0960-0760(99)00048-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Breast cancer tissue is an endocrine organ and particularly the estrogen biosynthetic properties of this tissue have been well studied. The concentration of estradiol in breast cancer tissue from postmenopausal patients is considerably higher than that in the circulation and appears to depend largely on local production. Androgenic precursor steroids are abundantly present, but estrogen storage pools like fatty acid derivatives appear to be less important than initially thought. New, potent and highly specific aromatase inhibitors effectively inhibit peripheral conversion of androgens to estrogens (Cancer Res. 53: 4563, 1993) as well as intratumour aromatase, median aromatase activity being 89% lower in the tissue from patients pretreated with aromatase inhibitor 7 days prior to surgery (P < 0.001). Also the intratissue concentrations of estrogens were decreased (64% and 80% reduction, respectively for estrone and estradiol; P = 0.001 and <0.05; Cancer Res. 57: 2109, 1997). These results illustrate that intratissue estrogen biosynthesis is effectively inhibited by the new generation of aromatase inhibitors. The pathophysiological consequences of this finding are currently under study.
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Affiliation(s)
- M A Blankenstein
- Department of Endocrinology, University Medical Centre, Utrecht, The Netherlands.
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15
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de Jong PC, van de Ven J, Nortier HW, Maitimu-Smeele I, Donker TH, Thijssen JH, Slee PH, Blankenstein RA. Inhibition of breast cancer tissue aromatase activity and estrogen concentrations by the third-generation aromatase inhibitor vorozole. Cancer Res 1997; 57:2109-11. [PMID: 9187104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In about one-third of advanced breast cancers, estrogen deprivation causes tumor regression. Estrogen concentrations in tumor tissue seem to depend largely on local production. The aromatase enzyme complex is thought to be the key enzyme in this respect. In the present study, the effect of the new third-generation nonsteroidal aromatase inhibitor vorozole (Rivizor) on tumor tissue aromatase activity and estrogen concentrations was evaluated. During 7 days preceding mastectomy, 11 postmenopausal breast cancer patients were treated with 2.5 mg of vorozole once daily. Eight patients could be evaluated. Intratumoral aromatase activity and estrone and estradiol levels were measured and compared to the values of nine untreated postmenopausal breast cancer patients. In treated patients, median tissue aromatase activity was 89% lower than that in controls (P < 0.001). Similarly, median tissue estrone and estradiol concentrations were 64 and 80% lower, respectively, in treated patients (P = 0.001 and P < 0.05, respectively). These results support the hypothesis that depleting the tumor of estrogens, thus impairing estrogenic stimulation, is an important mechanism in the antitumor activity of aromatase inhibitors.
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Affiliation(s)
- P C de Jong
- Department of Internal Medicine, University Hospital Utrecht, the Netherlands
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16
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van de Ven PJ, de Jong PC, Jansen GH, Blijham GH. [Microscopic tumor embolisms in metastasized breast carcinoma]. Ned Tijdschr Geneeskd 1997; 141:536-40. [PMID: 9190512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In two patients, women of 54 and 46 years old, with metastatic carcinoma of the breast, multiple microscopic tumour emboli in the lungs were found at autopsy. Ante mortem, unexplained respiratory distress in the former and an atypical thrombotic thrombocytopenic purpura-like syndrome in the latter were the most characteristic clinical features. Pulmonary microscopic tumour embolism is a rare diagnosis but it may occur in all types of cancer. Clinically, thrombotic pulmonary emboli are difficult to distinguish from microscopic tumour embolism. Special attention is to be paid to typical findings on radionuclide perfusion lung scanning (multiple subsegmental perfusion defects at the periphery of the bronchopulmonary segments with a normal ventilation named "segmental contour pattern'). Microangiopathic haemolytic anaemia and consumption coagulopathy are associated disorders. Tumour-directed therapy is the treatment of choice.
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Affiliation(s)
- P J van de Ven
- Afd. Interne Geneeskunde, Academisch Ziekenhuis, Utrecht
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17
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de Jong PC, Kansen PJ. A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain. Anesth Analg 1994; 78:94-100. [PMID: 8267188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to compare the incidence of technical complications of epidural catheters with subcutaneous injection ports to percutaneous epidural catheters without ports, fixed only by adhesive dressing. We reviewed 149 patients who received 250 epidural catheters for treatment of cancer pain during a 3 1/2-yr period from January 1, 1989, to June 30, 1992. Of the 250 catheters, 52 were provided with subcutaneous injection ports and 198 were percutaneous catheters. Of the 198 percutaneous catheters, 41 were tunneled for a short distance; the remainder entered the skin at the dorsal midline. In the percutaneous group 21% of the catheters became dislodged. In the injection port group, there were no catheter dislodgements. The overall incidence of infections was similar in both groups (13.6%). When we indexed the infection rate to catheter-days, the number of infections per 1000 catheter-days in the injection port group was half that of the percutaneous group (2.86 infections versus 5.97 for percutaneous catheters). No injection port became infected during the first 70 days of treatment, whereas in the percutaneous group infections occurred as early as the first week. Within the percutaneous group the complication rate in the tunneled epidural catheters was as high as in the nontunneled. We conclude that injection ports reduce the complication rate of epidural catheters, particularly catheter dislodgement and early infections.
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Affiliation(s)
- P C de Jong
- Department of Anesthesiology, Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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18
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Dellemijn PL, de Jong PC, Vecht CJ. [More pain due to pain treatment]. Ned Tijdschr Geneeskd 1993; 137:1539-42. [PMID: 8366950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P L Dellemijn
- Afd. Neurologie, Dr. Daniel den Hoed Kliniek, Rotterdam
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19
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de Jong PC, Ahlborg G. Medication during pregnancy in Sweden over the years. Acta Obstet Gynecol Scand 1993; 72:134-5. [PMID: 8383410 DOI: 10.3109/00016349309023431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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20
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Affiliation(s)
- P C de Jong
- Dept. of Anesthesiology and Pain Management Dr. Daniel den Hoed Cancer Center 3008 AE RotterdamThe Netherlands
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21
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de Jong PC, Kansen PJ. The case for euthanasia in The Netherlands. J Pain Symptom Manage 1992; 7:381-2; author reply 383. [PMID: 1484190 DOI: 10.1016/0885-3924(92)90015-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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22
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Terhaard CH, Hordijk GJ, van den Broek P, de Jong PC, Snow GB, Hilgers FJ, Annyas BA, Tjho-Heslinga RE, de Jong JM. T3 laryngeal cancer: a retrospective study of the Dutch Head and Neck Oncology Cooperative Group: study design and general results. Clin Otolaryngol 1992; 17:393-402. [PMID: 1458620 DOI: 10.1111/j.1365-2273.1992.tb01681.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
511 Patients with T3 N0-3 M0 squamous cell carcinoma of the larynx, treated in the Netherlands from 1975 until 1984, were retrospectively analysed. Four different treatment policies were followed: primary surgery, planned combination of radiotherapy and surgery, primary radical radiotherapy, and selective radiotherapy. General results are presented. Local control rate was 72%. Regional control rate was 90% for clinically N0 patients and 78% for clinically N+ patients. Salvage therapy was overall successful in 38%. Surgical salvage for local radiation failures (with regional relapse) was successful in 69%, and for regional failures (without local relapse) in 46%. Ultimate locoregional control was 78% and, due to 8% distant metastases, 5-year actuarial corrected survival was 70%. Prognosis did not improve over the years. Corrected survival was independently correlated with tumour extension, involvement of neck nodes and treatment strategy. Corrected survival was similar for primary radiotherapy and primary surgery, but significantly better for planned combined therapy. Multiple primary tumours occurred significantly more often in male (19.5%) than in female patients (7.3%) (P = 0.05), the bronchus being most commonly affected. Cumulative actuarial risk for metachronous tumour was 15% after 5 years and 30% after 10 years so prevention and early detection of these second tumours may play the most important role in improving overall survival rates in the future.
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Affiliation(s)
- C H Terhaard
- Department of Radiotherapy, University of Utrecht, The Netherlands
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van der Zee J, Hoff AM, Oudkerk M, de Kock W, van de Merwe SA, de Jong PC. Risk of acute hypotension following epidural analgesia during deep regional hyperthermia: a case report. Int J Hyperthermia 1992; 8:625-9. [PMID: 1402139 DOI: 10.3109/02656739209037998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A potentially dangerous complication occurring during deep regional hyperthermia is described. A patient receiving epidural analgesics for pain caused by a large pelvic recurrent rectal tumour was treated by hyperthermia induced by electromagnetic radiation. The epidural infusion pump failed during heating and further analgesics were administered by bolus injections into the epidural space. Following the second bolus injection, a severe drop in arterial blood pressure was observed. The most likely multifactorial pathogenesis is discussed and measures to avoid such an event are recommended.
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Affiliation(s)
- J van der Zee
- Department of Hyperthermia, Dr Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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24
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Abstract
The validity of a questionnaire on medical drug use during pregnancy was tested against information collected 7 years previously (in 1983-1984) at the University Hospital of Nijmegen, the Netherlands. The study population consisted of women with high-risk pregnancies. The sensitivity for drug categories varied between 0% and 80%. The sensitivity was highest for drugs used during labor (77%) and was extremely low (0%) for some drug categories. Personal characteristics thought to influence the sensitivity, such as parity of the mother and method of data collection (postal questionnaire or personal interview), showed no statistically significant effect. The newly developed questionnaire needs further improvement.
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Affiliation(s)
- P C de Jong
- Department of Epidemiology, University of Nijmegen, The Netherlands
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25
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Abstract
The use of medication during low-risk pregnancy was studied prospectively in a cohort of women supervised by specialist obstetricians at a university hospital (n = 332) and a cohort of women supervised by midwives in private practice (n = 250). More women under supervision of obstetricians/gynaecologists used medication (87.7%) than women supervised by midwives (59.8%). The top-five of medication were analgesics, antacids, vitamins, antibiotics and dermatologic preparations. More research is needed to establish the risks of these medications to the offspring.
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Affiliation(s)
- P C de Jong
- Department of Epidemiology, University Hospital Nijmegen, The Netherlands
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26
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de Jong PC, Zielhuis GA, Gabreëls F. [Aspirin and pregnancy]. Ned Tijdschr Geneeskd 1990; 134:1759-60. [PMID: 2215734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Verweij J, de Jong PC, de Mulder PH, van der Broek P, Alexieva-Figusch J, van Putten WL, Schornagel JH, Ravasz LA, Snow GB, Vermorken JB. Induction chemotherapy with cisplatin and continuous infusion 5-fluorouracil in locally far-advanced head and neck cancer. Am J Clin Oncol 1989; 12:420-4. [PMID: 2801602 DOI: 10.1097/00000421-198910000-00012] [Citation(s) in RCA: 11] [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] [Indexed: 01/02/2023]
Abstract
Induction combination chemotherapy with cisplatin, 100 mg/m2 i.v. day 1, and 5-fluorouracil, 1,000 mg/m2/24-h infusion days 1-4, was applied in 76 patients with locally far advanced squamous-cell cancer of the head and neck. The treatment program consisted of 3 cycles of chemotherapy, followed by local radiotherapy and/or surgery. Hematologic side effects were leukocytopenia (50%) and thrombocytopenia (35%). Other side effects included renal toxicity (23%), nausea and/or vomiting (86%), alopecia (18%), and phlebitis (45%). Thirteen patients (17%) achieved a complete remission and 37 patients (49%) a partial remission. Median progression-free and overall survival were 8 and 11 months, respectively. Only patients achieving a complete remission had a better prognosis. Although induction chemotherapy may facilitate further local treatment in about half of the patients, on the basis of presently available data, this procedure should not be routinely applied with the aim of better survival.
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Affiliation(s)
- J Verweij
- Department of Medical Oncology, Rotterdam Cancer Institute, The Netherlands
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Abstract
Ten adults with 10 isolated ulnar-shaft fractures were treated by early exercises. The patients were followed until radiographic consolidation. The average healing time was 6 weeks. There was no delay in union, and loss of forearm rotation was negligible.
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Affiliation(s)
- T de Jong
- Department of Surgery, Diaconessenhuis, Heemstede, The Netherlands
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Pop LA, Eijkenboom WM, de Boer MF, de Jong PC, Knegt P, Levendag PC, Meeuwis CA, Reichgelt BA, van Putten WL. Evaluation of treatment results of squamous cell carcinoma of the buccal mucosa. Int J Radiat Oncol Biol Phys 1989; 16:483-7. [PMID: 2921152 DOI: 10.1016/0360-3016(89)90347-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Of the 49 patients with squamous cell carcinoma of the buccal mucosa referred to the Rotterdam Radio-Therapeutic Institute (RRTI) and Universital Hospital Dijkzigt Rotterdam (AZD) during 1970-1984, 31 patients had an advanced stage of disease, 21 patients had clinical evidence of lymph node metastasis. Forty patients were treated with curative intention. Treatment modalities were: radiation therapy, preoperative radiation followed by surgery, and primary surgery. Eighteen of the 40 patients (45%) developed a local tumor recurrence; nearly all recurrences occurred within 2 years. The incidence was equal in all treatment groups. Of the 22 patients with initial clinically negative neck, regional relapse occurred in 3 of the 14 patients, of whom the neck was not treated electively by radiation therapy; all three in combination with a local recurrence. None of the 8 patients with electively irradiated necks developed a regional relapse. Eight of the 18 patients with initial clinically enlarged lymph nodes treated either by radiotherapy or surgery, developed a regional relapse, 5 in combination with a local recurrence. Treatment of the clinically positive neck by neck dissection was superior to radiotherapy. Local recurrence carried a poor prognosis. Almost 70% died of their disease. The overall and corrected 5-year survival was 38% and 52% respectively.
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Affiliation(s)
- L A Pop
- Dept. of Radiotherapy, Dr. Daniel den Hoed Cancer Center, Rotterdam Radio-Therapeutic Institute, University Hospital Dijkzigt, The Netherlands
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30
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Voets AG, Knegt P, de Jong PC, van Andel JC, van der Schans EJ. [Juvenile angiofibroma of the nasopharynx; an overview of 20 years of management]. Ned Tijdschr Geneeskd 1988; 132:296-300. [PMID: 2831464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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32
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Soeters PB, de Jong PC, von Meyenfeldt MF. [The clinical diagnosis of "undernourished"]. Ned Tijdschr Geneeskd 1987; 131:765-8. [PMID: 3108678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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33
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Pruyn JF, de Jong PC, Bosman LJ, van Poppel JW, van Den Borne HW, Ryckman RM, de Meij K. Psychosocial aspects of head and neck cancer--a review of the literature. Clin Otolaryngol 1986; 11:469-74. [PMID: 3545557 DOI: 10.1111/j.1365-2273.1986.tb00153.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study is a systematic analysis of the literature on psychosocial aspects in head and neck cancer patients. Patients with head and neck cancer experience a variety of physical as well as psychosocial problems. Physical problems include swallowing or chewing, speech and physical appearance. Psychosocial problems include anxiety, depression, loss of self-esteem and uncertainty about the future. Because of these problems, isolation from friends typically occurs, re-employment is difficult, and there are social and sexual tensions within families. Information and support by professionals, partners and/or fellow patients are related to positive rehabilitation outcomes such as the acquisition of speech, increases in constructive social functioning and decreases in depression.
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Strijbos WE, de Jong PC, Karthaus HF, Debruyne FM. [Percutaneous removal of kidney stones]. Ned Tijdschr Geneeskd 1986; 130:538-42. [PMID: 3515207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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35
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Abstract
Diathermic coagulation and cutting in the endoscopic treatment of hypopharyngeal diverticula was replaced by CO2 laser evaporation. Endoscopic laser surgery was performed in 37 patients, with complete or almost complete relief in all cases. The rate of complications is low.
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Abstract
Sixty patients with paranasal sinus cancer were treated from January 1976 until July 1981 according to a standard protocol in which surgery is combined with a low dose of irradiation and a topically applied cytostatic drug. The local control rate was 65%. Mutilation was clearly reduced. The actuarial 2-year and 5-year survival rate was 76% and 65%, respectively. The actuarial 5-year survival rate for squamous cell carcinoma and undifferentiated carcinoma of the maxillary sinus was 52%. For adenocarcinoma of the ethmoid sinus the actuarial 5-year survival rate was 100%. The results of this prospective pilot study suggest that it may be possible to achieve better results with less aggressive treatment.
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37
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van der Schans EJ, Knegt P, de Jong PC, van Andel JG, de Boer MF, Eykenboom W. Adenoid cystic carcinoma of the upper digestive and respiratory tracts. A retrospective study of 59 cases. Clin Otolaryngol 1985; 10:63-7. [PMID: 2992849 DOI: 10.1111/j.1365-2273.1985.tb01168.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Fifty-nine cases of adenoid cystic carcinoma (ACC) in the head and neck were reviewed and the treatment and follow-up results from 1950 to 1983 are reported. Nearly all patients were treated with combined therapy, i.e. surgery and radiotherapy, and the actuarial survival rate was 68% after 5 years, 45% after 10 years, and 30% after 15 years. Modern radiotherapy seems a very valuable means of treatment, not only as a palliative measure.
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38
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van der Linden CJ, Breslau PJ, de Jong PC, Soeters PB, Timmermans F, Greep JM. Prospective study on the incidence of complications of right heart catheterization. Neth J Surg 1984; 36:127-129. [PMID: 6504383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Indications for hemodynamic assessment by right heart catheterization include shock, pulmonary edema, severe trauma and sepsis. The introduction of the catheter and the location of the tip in the pulmonary artery, however, can cause severe complications. In the present study the incidence of complications was observed in 93 consecutive right heart catheterizations in critically ill patients with no evidence of recent myocardial infarction. The low incidence of complications during introduction and with the catheter tip located in the pulmonary artery justifies right heart catheterization in patients with hemodynamic and/or respiratory instability treated in an intensive care unit.
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Abstract
Endoscopic laser surgery for hypopharyngeal diverticula was performed in 28 patients. Complete relief of symptoms was achieved in 22, whilst the remaining patients improved considerably. The rate of complications was low. This new application of laser surgery proved to be a safe and reliable method of treatment for dysphagia caused by a hypopharyngeal diverticulum.
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Abstract
From 1964 to 1980 28 patients with extensive paragangliomas were treated with radiation therapy. Nine patients had a carotid body tumour and 19 had a temporal bone tumour. During the 16 year period the radiation dose was gradually reduced from 60 Gy in 6 weeks to 40 Gy in 4 weeks. Continuous tumour control was achieved in all patients (follow-up 1.5-18 years) with no difference between glomus caroticum tumours and glomus tympanicum tumours, and complications were few, certainly when 40-50 Gy was given in 4-5 weeks.
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Meeuwis JD, Obertop H, Dijkhuis CM, Pull ter Gunne HP, de Jong PC, van Houten H, Westbroek DL. Effective reconstruction after pharyngolaryngo-oesophagectomy with an ileal autograft. Neth J Surg 1983; 35:173-7. [PMID: 6657091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Total pharyngolaryngo-oesophagectomy is performed for carcinoma of the cervical oesophagus, the piriform sinuses and the postcricoid region. A safe effective way of reconstructing the cervical oesophagus is of the utmost importance in these patients. Use of a revascularized intestinal segment for this purpose is described. Twenty-one patients who underwent reconstruction of the cervical oesophagus with an ileal autograft were studied, with a follow-up period of one to .58 months. The low postoperative mortality and morbidity, quick resumption of oral intake, short hospitalization and good functional results obtained with this method yield benefits for these patients.
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Gouma DJ, de Jong PC, Pop P, Willebrand D, Wesdorp RI, Greep JM, Soeters PB. [Total parenteral nutrition as preparation for the surgical treatment of patients with severe Crohn's disease]. Ned Tijdschr Geneeskd 1983; 127:2037-41. [PMID: 6417549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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von Meyenfeldt MM, Stapert J, de Jong PC, Soeters PB, Wesdorp RI, Greep JM. TPN catheter sepsis: lack of effect of subcutaneous tunnelling of PVC catheters on sepsis rate. JPEN J Parenter Enteral Nutr 1980; 4:514-7. [PMID: 6776316 DOI: 10.1177/014860718000400516] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In an effort to diminish the incidence of catheter related sepsis in total parenteral nutrition, the effect of a 10-cm long subcutaneous tunnel was studied in a prospective randomized manner. This tunnel created a longer anatomical distance between puncture site of the catheter and the subclavian vein. In the control group, a direct puncture technique was employed. Eighty-one catheters (group A) were inserted according to the direct technique, 69 (group B) were tunnelled. Catheter sepsis was defined as an episode of clinical sepsis for which no other cause can be identified and which resolves upon removal of the catheter. No significant differences were noted between the two groups, suggesting that tunnelling of subclavian PVC catheters does not diminish the incidence of catheter related sepsis.
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Abstract
The treatment results of the Rotterdam working group on esophageal cancer during the period January 1970-January 1978 were assessed. A total number of 328 patients were treated: 230 males and 98 females. Of the 133 patients eligible for a combined treatment modality i.e. preoperative radiotherapy and surgery, 52 showed irresectable or metastatic disease during operation. The five year actuarial survival rate of the 81 patients, in whom curative surgical resection of the tumor was performed, amounted to 21%. Females fared better than males, the five year survivals being 42% and 12% respectively. This female preponderance in survival is partly explained by the considerable postoperative mortality of the male patients: 28% vs 7.4% in females. Patients who received only radiation therapy, whether curative or palliative, had a very bad prognosis. It is concluded that preoperative irradiation followed by surgical removal of the tumor should be performed in all operable-curable patients.
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