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Keyl J, Bucher A, Jungmann F, Hosch R, Ziller A, Armbruster R, Malkomes P, Reissig TM, Koitka S, Tzianopoulos I, Keyl P, Kostbade K, Albers D, Markus P, Treckmann J, Nassenstein K, Haubold J, Makowski M, Forsting M, Baba HA, Kasper S, Siveke JT, Nensa F, Schuler M, Kaissis G, Kleesiek J, Braren R. Prognostic value of deep learning-derived body composition in advanced pancreatic cancer-a retrospective multicenter study. ESMO Open 2024; 9:102219. [PMID: 38194881 PMCID: PMC10837775 DOI: 10.1016/j.esmoop.2023.102219] [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: 09/03/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Despite the prognostic relevance of cachexia in pancreatic cancer, individual body composition has not been routinely integrated into treatment planning. In this multicenter study, we investigated the prognostic value of sarcopenia and myosteatosis automatically extracted from routine computed tomography (CT) scans of patients with advanced pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS We retrospectively analyzed clinical imaging data of 601 patients from three German cancer centers. We applied a deep learning approach to assess sarcopenia by the abdominal muscle-to-bone ratio (MBR) and myosteatosis by the ratio of abdominal inter- and intramuscular fat to muscle volume. In the pooled cohort, univariable and multivariable analyses were carried out to analyze the association between body composition markers and overall survival (OS). We analyzed the relationship between body composition markers and laboratory values during the first year of therapy in a subgroup using linear regression analysis adjusted for age, sex, and American Joint Committee on Cancer (AJCC) stage. RESULTS Deep learning-derived MBR [hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.47-0.77, P < 0.005] and myosteatosis (HR 3.73, 95% CI 1.66-8.39, P < 0.005) were significantly associated with OS in univariable analysis. In multivariable analysis, MBR (P = 0.019) and myosteatosis (P = 0.02) were associated with OS independent of age, sex, and AJCC stage. In a subgroup, MBR and myosteatosis were associated with albumin and C-reactive protein levels after initiation of therapy. Additionally, MBR was also associated with hemoglobin and total protein levels. CONCLUSIONS Our work demonstrates that deep learning can be applied across cancer centers to automatically assess sarcopenia and myosteatosis from routine CT scans. We highlight the prognostic role of our proposed markers and show a strong relationship with protein levels, inflammation, and anemia. In clinical practice, automated body composition analysis holds the potential to further personalize cancer treatment.
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Affiliation(s)
- J Keyl
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; Institute of Pathology, University Hospital Essen (AöR), Essen, Germany.
| | - A Bucher
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany; German Cancer Consortium (DKTK), Frankfurt partner site, Heidelberg, Germany
| | - F Jungmann
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; Artificial Intelligence in Healthcare and Medicine, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - R Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany
| | - A Ziller
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; Artificial Intelligence in Healthcare and Medicine, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - R Armbruster
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - P Malkomes
- Department of General, Visceral and Transplant Surgery, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - T M Reissig
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - S Koitka
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany
| | - I Tzianopoulos
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - P Keyl
- Institute of Pathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - K Kostbade
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - D Albers
- Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - P Markus
- Department of General Surgery and Traumatology, Elisabeth Hospital Essen, Essen, Germany
| | - J Treckmann
- West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany; Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - K Nassenstein
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - J Haubold
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - M Makowski
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany
| | - M Forsting
- German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - H A Baba
- Institute of Pathology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - S Kasper
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - J T Siveke
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK Partner Site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - F Nensa
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany; National Center for Tumor Diseases (NCT), NCT West, Essen, Germany
| | - G Kaissis
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; Artificial Intelligence in Healthcare and Medicine, School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - J Kleesiek
- Institute for Artificial Intelligence in Medicine, University Hospital Essen (AöR), Essen, Germany; West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - R Braren
- Institute of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Munich partner site, Heidelberg, Germany
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2
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Zurloh M, Goetz M, Herold T, Treckmann J, Markus P, Schumacher B, Albers D, Rink A, Rosery V, Zaun G, Kostbade K, Pogorzelski M, Ting S, Schmidt H, Stiens R, Wiesweg M, Schuler M, Kasper S, Virchow I. Impact of encorafenib on survival of patients with BRAF V600E-mutant metastatic colorectal cancer in a real-world setting. J Cancer Res Clin Oncol 2023; 149:12903-12912. [PMID: 37466791 PMCID: PMC10587317 DOI: 10.1007/s00432-023-05141-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Patients with BRAFV600E-mutant metastatic colorectal cancer (mCRC) have a dismal prognosis. The best strategies in these patients remain elusive. Against this background, we report the clinical course of patients with BRAFV600E-mutant mCRC to retrieve the best treatment strategy. PATIENTS AND METHODS Clinico-pathological data were extracted from the electronic health records. Kaplan-Meier method was used to estimate overall (OS) and progression-free survival (PFS). Objective response rate (ORR) was assessed according to RECIST 1.1. RESULTS In total, 51 patients were enrolled. FOLFOXIRI was administered to 12 patients; 29 patients received FOLFOX or FOLFIRI as first-line treatment. Median OS was 17.6 months. Median PFS with FOLFOXIRI (13.0 months) was significantly prolonged (HR 0.325) as compared to FOLFOX/FOLFIRI (4.3 months). However, this failed to translate into an OS benefit (p = 0.433). Interestingly, addition of a monoclonal antibody to chemotherapy associated with superior OS (HR 0.523). A total of 64.7% patients received further-line therapy, which included a BRAF inhibitor in 17 patients. Targeted therapy associated with very favourable OS (25.1 months). CONCLUSION Patients with BRAFV600E-mutated mCRC benefit from the addition of an antibody to first-line chemotherapy. Further-line treatment including a BRAF inhibitor has a dramatic impact on survival.
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Affiliation(s)
- M Zurloh
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Goetz
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
| | - T Herold
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - J Treckmann
- West German Cancer Center, Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - P Markus
- Department of General Surgery and Traumatology, Elisabeth Hospital, Essen, Germany
| | - B Schumacher
- Department of Gastroenterology, Elisabeth Hospital, Essen, Germany
| | - D Albers
- Department of Gastroenterology, Elisabeth Hospital, Essen, Germany
| | - A Rink
- West German Cancer Center, Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - V Rosery
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - G Zaun
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - K Kostbade
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Pogorzelski
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - S Ting
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
- Institute of Pathology Nordhessen, Kassel, Germany
| | - H Schmidt
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - R Stiens
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
- Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - I Virchow
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
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3
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Reissig TM, Tzianopoulos I, Liffers ST, Rosery VK, Guyot M, Ting S, Wiesweg M, Kasper S, Meister P, Herold T, Schmidt HH, Schumacher B, Albers D, Markus P, Treckmann J, Schuler M, Schildhaus HU, Siveke JT. Smaller panel, similar results: genomic profiling and molecularly informed therapy in pancreatic cancer. ESMO Open 2023; 8:101539. [PMID: 37148593 DOI: 10.1016/j.esmoop.2023.101539] [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: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Pancreatic cancer has a dismal prognosis. One reason is resistance to cytotoxic drugs. Molecularly matched therapies might overcome this resistance but the best approach to identify those patients who may benefit is unknown. Therefore, we sought to evaluate a molecularly guided treatment approach. MATERIALS AND METHODS We retrospectively analyzed the clinical outcome and mutational status of patients with pancreatic cancer who received molecular profiling at the West German Cancer Center Essen from 2016 to 2021. We carried out a 47-gene DNA next-generation sequencing (NGS) panel. Furthermore, we assessed microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) status and, sequentially and only in case of KRAS wild-type, gene fusions via RNA-based NGS. Patient data and treatment were retrieved from the electronic medical records. RESULTS Of 190 included patients, 171 had pancreatic ductal adenocarcinoma (90%). One hundred and three patients had stage IV pancreatic cancer at diagnosis (54%). MMR analysis in 94 patients (94/190, 49.5%) identified 3 patients with dMMR (3/94, 3.2%). Notably, we identified 32 patients with KRAS wild-type status (16.8%). To identify driver alterations in these patients, we conducted an RNA-based fusion assay on 13 assessable samples and identified 5 potentially actionable fusions (5/13, 38.5%). Overall, we identified 34 patients with potentially actionable alterations (34/190, 17.9%). Of these 34 patients, 10 patients (10/34, 29.4%) finally received at least one molecularly targeted treatment and 4 patients had an exceptional response (>9 months on treatment). CONCLUSIONS Here, we show that a small-sized gene panel can suffice to identify relevant therapeutic options for pancreatic cancer patients. Informally comparing with previous large-scale studies, this approach yields a similar detection rate of actionable targets. We propose molecular sequencing of pancreatic cancer as standard of care to identify KRAS wild-type and rare molecular subsets for targeted treatment strategies.
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Affiliation(s)
- T M Reissig
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - I Tzianopoulos
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - S-T Liffers
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - V K Rosery
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - M Guyot
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Department of Gastroenterology, Oncology und Hematology, Diabetology and Rheumatology, Marien-Hospital Wesel, Wesel, Germany
| | - S Ting
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - S Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - P Meister
- Department of General, Visceral and Transplantation Surgery, Hepatology, and Transplant Medicine, University Hospital Essen, Essen, Germany
| | - T Herold
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - H H Schmidt
- Department of Gastroenterology, Hepatology, and Transplant Medicine, University Hospital Essen, Essen, Germany
| | - B Schumacher
- Department of Gastroenterology, Visceral and Trauma Surgery, Elisabeth Hospital Essen, Essen, Germany
| | - D Albers
- Department of Gastroenterology, Visceral and Trauma Surgery, Elisabeth Hospital Essen, Essen, Germany
| | - P Markus
- Department of General, Visceral and Trauma Surgery, Elisabeth Hospital Essen, Essen, Germany
| | - J Treckmann
- Department of General, Visceral and Transplantation Surgery, Hepatology, and Transplant Medicine, University Hospital Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - H-U Schildhaus
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany; Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - J T Siveke
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Heidelberg, Germany; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
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4
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Keyl J, Kasper S, Wiesweg M, Götze J, Schönrock M, Sinn M, Berger A, Nasca E, Kostbade K, Schumacher B, Markus P, Albers D, Treckmann J, Schmid KW, Schildhaus HU, Siveke JT, Schuler M, Kleesiek J. Multimodal survival prediction in advanced pancreatic cancer using machine learning. ESMO Open 2022; 7:100555. [PMID: 35988455 PMCID: PMC9588888 DOI: 10.1016/j.esmoop.2022.100555] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Existing risk scores appear insufficient to assess the individual survival risk of patients with advanced pancreatic ductal adenocarcinoma (PDAC) and do not take advantage of the variety of parameters that are collected during clinical care. Methods In this retrospective study, we built a random survival forest model from clinical data of 203 patients with advanced PDAC. The parameters were assessed before initiation of systemic treatment and included age, CA19-9, C-reactive protein, metastatic status, neutrophil-to-lymphocyte ratio and total serum protein level. Separate models including imaging and molecular parameters were built for subgroups. Results Over the entire cohort, a model based on clinical parameters achieved a c-index of 0.71. Our approach outperformed the American Joint Committee on Cancer (AJCC) staging system and the modified Glasgow Prognostic Score (mGPS) in the identification of high- and low-risk subgroups. Inclusion of the KRAS p.G12D mutational status could further improve the prediction, whereas radiomics data of the primary tumor only showed little benefit. In an external validation cohort of PDAC patients with liver metastases, our model achieved a c-index of 0.67 (mGPS: 0.59). Conclusions The combination of multimodal data and machine-learning algorithms holds potential for personalized prognostication in advanced PDAC already at diagnosis. We developed a machine-learning-based prediction model that outperforms the AJCC staging system and mGPS. Applying our model to an external validation cohort demonstrates generalizability. Explainable machine learning enables to understand the decision making of our model and identifies relevant parameters. Combining clinical, imaging and genetic data holds potential for personalized prognostication in advanced PDAC.
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Affiliation(s)
- J Keyl
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany; Institute for AI in Medicine (IKIM), University Hospital Essen (AöR), Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany.
| | - S Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - J Götze
- Department of Internal Medicine II, Oncology, Hematology, BMT and Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Schönrock
- Department of Internal Medicine II, Oncology, Hematology, BMT and Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Sinn
- Department of Internal Medicine II, Oncology, Hematology, BMT and Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Berger
- Institute for AI in Medicine (IKIM), University Hospital Essen (AöR), Essen, Germany
| | - E Nasca
- Institute for AI in Medicine (IKIM), University Hospital Essen (AöR), Essen, Germany
| | - K Kostbade
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - B Schumacher
- Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - P Markus
- Department of General Surgery and Traumatology, Elisabeth Hospital Essen, Essen, Germany
| | - D Albers
- Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - J Treckmann
- Department of General, Visceral and Transplant Surgery, West German Cancer Center, University Hospital Essen (AöR), Essen, Germany
| | - K W Schmid
- Medical Faculty, University of Duisburg-Essen, Essen, Germany; Institute of Pathology, West German Cancer Center, University Hospital Essen (AöR), Essen, Germany
| | - H-U Schildhaus
- Medical Faculty, University of Duisburg-Essen, Essen, Germany; Institute of Pathology, West German Cancer Center, University Hospital Essen (AöR), Essen, Germany
| | - J T Siveke
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany; Bridge Institute of Experimental Tumor Therapy (BIT), West German Cancer Center, University Hospital Essen (AöR), Essen, Germany; Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK) Partner site Essen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - J Kleesiek
- Institute for AI in Medicine (IKIM), University Hospital Essen (AöR), Essen, Germany; Medical Faculty, University of Duisburg-Essen, Essen, Germany
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5
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Markus M, Abendroth A, Noureddine R, Paul A, Breitenbuecher S, Virchow I, Schmid KW, Markus P, Schumacher B, Wiesweg M, Wendling J, Mende B, Siveke JT, Schuler M, Kasper S. Combined systemic inflammation score (SIS) correlates with prognosis in patients with advanced pancreatic cancer receiving palliative chemotherapy. J Cancer Res Clin Oncol 2021; 147:579-591. [PMID: 32839836 PMCID: PMC7817578 DOI: 10.1007/s00432-020-03361-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The prognosis of patients with advanced pancreatic ductal adenocarcinoma (PDAC) remains dismal. New cytotoxic agents such as nab-paclitaxel and liposomal irinotecan (nal-Iri) have extended the armamentarium of therapeutic options in the last years. Nowadays, sequential therapeutic strategies with moderately toxic chemotherapeutic protocols can be administered to the patients. However, prognostic and predictive biomarkers are still missing to identify those patients, which profit most from a "continuum of care" concept rather than receiving intensive first-line protocols such as FOLFIRINOX. To this end, we retrospectively evaluated the impact of the systemic inflammation as one essential hallmark of cancer in patients with advanced PDAC treated with sequential systemic. METHODS A cohort of 193 PDAC patients treated at our center from January 2005 to August 2011 were retrospectively evaluated for the following systemic inflammatory response (SIR) markers: neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) C-reactive protein (CRP), and the modified Glasgow Prognostic Score (mGPS). SIR markers were correlated with clinico-pathological findings, response to chemotherapy and overall survival (OS) using Kaplan-Meier curves and Cox proportional models. RESULTS All evaluated SIR markers were significantly associated with OS in patients with metastatic disease but not in patients with locally advanced PDAC. Interestingly, all SIR markers were only prognostic in patients not receiving antibiotics as surrogate marker for systemic bacterial infections. Based on the evaluated SIR markers, we propose a new Systemic Inflammation Score (SIS), which significantly correlated with reduced OS (HR: 3.418 (1.802-6.488, p < 0.001)) and the likelihood of receiving further-line systemic therapies (p = 0.028). CONCLUSION Routinely assessed SIR biomarkers have potential to support therapeutic decision making in patients with metastatic PDAC.
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Affiliation(s)
- M Markus
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine (CCMCVK), Charité - University Hospital Berlin, Berlin, Germany
| | - A Abendroth
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - R Noureddine
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - A Paul
- West German Cancer Center, Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - S Breitenbuecher
- Institute for Quality Assurance, University Hospital Essen, Essen, Germany
| | - I Virchow
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - K W Schmid
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - P Markus
- Department of General Surgery and Traumatology, Elisabeth Hospital Essen, Essen, Germany
| | - B Schumacher
- Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - M Wiesweg
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - J Wendling
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - B Mende
- Central Pharmacy, University Hospital Essen, Essen, Germany
| | - J T Siveke
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- West German Cancer Center, Institute for Developmental Cancer Therapeutics, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Schuler
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - S Kasper
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
- Medical Faculty, University Duisburg-Essen, Essen, Germany.
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Abendroth A, Noureddine R, Abramczyk M, Paul A, Gerken G, Schmid KW, Markus P, Schumacher B, Wiesweg M, Köhler J, Markus M, Mende B, Dechêne A, Schuler M, Kasper S. Long-term outcome of patients with advanced pancreatic cancer treated with sequential chemotherapies before the era of modern combination therapy protocols. J Cancer Res Clin Oncol 2018; 145:445-455. [PMID: 30430229 DOI: 10.1007/s00432-018-2789-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/08/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patients (pts) with locally advanced (LAPC) or metastatic pancreatic ductal adenocarcinoma (mPDAC) have a dismal prognosis. Recently, new combination chemotherapies such as FOLFIRINOX and nab-paclitaxel/gemcitabine have demonstrated superiority over gemcitabine monotherapy. However, a substantial proportion of pts cannot tolerate these intensive front-line protocols. Moreover, the long-term superiority of multiagent protocols over less intensive strategies remains to be shown. To provide a benchmark for future studies, we analyzed the outcome of patients with LAPC or mPDAC treated at the West German Cancer Center before the FOLFIRINOX/nab-paclitaxel + gemcitabine era. METHODS This retrospective analysis included 201 consecutive pts with LAPC and mPDAC treated between 2007 and 2011. Efficacy parameters were correlated with type of chemotherapy, number of treatment lines and clinicopathological parameters. RESULTS Gemcitabine monotherapy was given as first-line therapy in 51.1%, whereas 48.9% received combination chemotherapies such as gemcitabine/oxaliplatin or FOLFOX. Patients received a median of two lines of treatment, with 54.8% receiving second-line and 37.9% receiving third- and further-line therapies. There was no significant difference between gemcitabine monotherapy and combination therapies. Despite moderate activity of first-line treatment, median overall survival for LAPC was 11.3 months and 8.7 months for mPDAC. Multivariate analysis identified age and number of treatment lines as prognostic markers. CONCLUSION The long-term outcome of unselected pts with LAPC and mPDAC treated before the introduction of aggressive multiagent chemotherapy protocols compares favorably with the results of contemporary benchmark trials. This suggests a multifactorial benefit from interdisciplinary care provided over sequential treatment lines at high volume expert centers.
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Affiliation(s)
- A Abendroth
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - R Noureddine
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Abramczyk
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - A Paul
- Department of General, Visceral and Transplant Surgery, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - G Gerken
- Department of Gastroenterology and Hepatology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - K W Schmid
- West German Cancer Center, Institute of Pathology Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - P Markus
- Department of General Surgery and Traumatology, Elisabeth Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - B Schumacher
- Department of Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - M Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - J Köhler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Markus
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - B Mende
- Central Pharmacy, University Hospital Essen, Essen, Germany
| | - A Dechêne
- Department of Gastroenterology and Hepatology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - M Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - S Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.
- Medical Faculty, University Duisburg-Essen, Essen, Germany.
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Chiarinelli J, Markus P, Bolognesi P, Avaldi L, Turco Liveri V, Calandra P. Photo-fragmentation of alkyl phosphates in the gas-phase. J Photochem Photobiol A Chem 2018. [DOI: 10.1016/j.jphotochem.2018.07.017] [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] [Indexed: 11/28/2022]
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Bolognesi P, Casavola AR, Cartoni A, Richter R, Markus P, Borocci S, Chiarinelli J, Tošić S, Sa’adeh H, Masič M, Marinković B, Prince K, Avaldi L. Communication: “Position” does matter: The photofragmentation of the nitroimidazole isomers. J Chem Phys 2016; 145:191102. [DOI: 10.1063/1.4967770] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- P. Bolognesi
- CNR-Istituto di Struttura della Materia, Area della Ricerca di Roma1, Monterotondo, Italy
| | - A. R. Casavola
- CNR-Istituto di Struttura della Materia, Area della Ricerca di Roma1, Monterotondo, Italy
| | - A. Cartoni
- CNR-Istituto di Struttura della Materia, Area della Ricerca di Roma1, Monterotondo, Italy
- Dipartimento di Chimica, Sapienza Università di Roma, Roma, Italy
| | - R. Richter
- Elettra-Sincrotrone Trieste, Basovizza, Italy
| | - P. Markus
- CNR-Istituto di Struttura della Materia, Area della Ricerca di Roma1, Monterotondo, Italy
| | - S. Borocci
- Dipartimento per l’Innovazione nei Sistemi Biologici, Agroalimentari e Forestali (DIBAF), Università della Tuscia, Viterbo, Italy
| | - J. Chiarinelli
- CNR-Istituto di Struttura della Materia, Area della Ricerca di Roma1, Monterotondo, Italy
| | - S. Tošić
- Institute of Physics Belgrade, University of Belgrade, Belgrade, Serbia
| | - H. Sa’adeh
- Department of Physics, The University of Jordan, Amman, Jordan
| | - M. Masič
- School of Chemistry, Cardiff University, Cardiff, United Kingdom
| | - B.P. Marinković
- Institute of Physics Belgrade, University of Belgrade, Belgrade, Serbia
| | - K.C. Prince
- Elettra-Sincrotrone Trieste, Basovizza, Italy
| | - L. Avaldi
- CNR-Istituto di Struttura della Materia, Area della Ricerca di Roma1, Monterotondo, Italy
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Kasper S, Meiler J, Knipp H, Höhler T, Reimer P, Steinmetz H, Berger W, Linden G, Ting S, Markus P, Paul A, Dechêne A, Schumacher B, Kostbade K, Worm K, Schmid K, Herold T, Schuler M, Trarbach T. Cetuximab biweekly (q2w) plus mFOLFOX6 as 1st line therapy in patients (pts) with KRAS wild-type (wt) (exon 2) metastatic colorectal cancer (mCRC) – Primary endpoint and subgroup analysis of the CEBIFOX trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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McClimon B, Li J, Ferguson B, Markus P, Odell L, Swanson A, Kloos Olson K, Park M. Allergist and Pharmacist Collaboration Increases β-lactam Antibiotic Use in Patients with a History of Penicillin Allergy. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.811] [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: 11/28/2022]
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Liersch T, Behr TM, Meller J, Schüler P, Markus P, Ding C, Kovacs J, Horak I, Becker H, Goldenberg D. CEA radioimmunotherapy of post-salvage resected colorectal cancer liver metastases is safe and potentially effective in extending survival. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3155] [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)
- T. Liersch
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - T. M. Behr
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - J. Meller
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - P. Schüler
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - P. Markus
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - C. Ding
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - J. Kovacs
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - I. Horak
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - H. Becker
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
| | - D. Goldenberg
- Dept. of Surgery, University of Goettingen, Germany; Dept of Nuclear Medicine, University of Marburg, Germany; Dept of Nuclear Medicine, University of Goettingen, Germany; Immunomedics, Inc., Morris Plains, NJ; Garden State Cancer Center, Molecular Medicine and Immunology, Belleville, NJ
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Langer C, Liersch T, Süss M, Siemer A, Markus P, Ghadimi BM, Füzesi L, Becker H. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 2003; 18:222-9. [PMID: 12673487 DOI: 10.1007/s00384-002-0441-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [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] [Accepted: 09/20/2002] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The minimally invasive technique of transanal endoscopic microsurgery (TEM) combines the benefits of local resections, a low complication rate and high patient comfort, with low recurrence rate and excellent survival rate after radical surgery (RS). The use of an ultrasonically activated scalpel rather than electrosurgery further improves the results of TEM. PATIENTS AND METHODS A retrospective study was performed of 182 operations on 162 patients with early rectal carcinoma (pT1, G1/2) or adenoma to compare the outcome following four different kinds of surgical resection techniques: RS (anterior or abdominoperineal resection; n=27), conventional transanal resection using Park's retractor (TP; n=76), transanal endoscopic microsurgery (TEM) with electrosurgery (TEM-ES; n=45), and TEM with UltraCision (TEM-UC; n=34). One-third of the patients with RS (33%) received either a colostomy or a protective loop-ileostomy. RESULTS Operation time with TEM-UC was significantly shorter than with TEM-ES or RS. Hospitalization was significantly longer with RS than for TEM or TP. Complication rate with TEM was significantly lower than with RS. Recurrence rate with RS and TEM was significantly lower than with TP, with a trend to TEM-UC being better than TEM-ES. Mortality rate was 3.7% with RS and 0 with TP and TEM. The 2-year survival rate was 96.3% with RS and 100% each with TP and TEM. CONCLUSION TEM using UC seems to be the technique of choice. TP leads to an unacceptable recurrence rate, and RS results in a higher incidence of complication and impairment of life quality.
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Affiliation(s)
- C Langer
- Department of General Surgery, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
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13
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Langer C, Liersch T, Markus P, Süss M, Ghadimi M, Füzesi L, Becker H. Transanal endoscopic microsurgery (TEM) for minimally invasive resection of rectal adenomas and "Low-risk" carcinomas (uT1, G1 - 2). Z Gastroenterol 2002; 40:67-72. [PMID: 11857100 DOI: 10.1055/s-2002-20210] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Transanal endoscopic microsurgery (TEM) presents a minimally invasive procedure for local removal of large rectal adenomas (>/= 2 cm) and early, so called "low-risk" carcinomas (uT1, G1 - 2) in curative as well as of advanced tumors in palliative intent. Over a 6-year period 92 TEM excisions of rectal tumors were carried out including 91 patients with 56 adenomas, 35 carcinomas (9 pTis, 17 pT1, 5 pT2, 3 pT3, 1 Ca after snare diathermy) and one neurinoma. Two patients of the carcinoma group had to be reoperated by means of anterior resection due to false preoperative rectal ultrasound examination (2 x uT1--> pT2). 4 patients required palliative therapy on account of age or high morbidity. After a mean follow-up time of 23 months (adenomas 23 months, pT1 carcinoma 26 months and advanced tumors 38 months) we encountered a total of 7 complications, of which in 5 cases surgical reintervention was necessary (5,4 %). One 86-year-old patient with a pT2-carcinoma, who was unsuitable for low anterior resection due to a high morbidity risk, died from myocardial infarction after emergency reintervention caused by postoperative bleeding. To date, overall 9 recurrences occurred (9,8 %). In the specific target group of TEM (adenomas and pT1, G1-2 carcinomas) consisting of n = 83 cases, the overall recurrence rate was 7,2 %, of which 5,3 % were due to adenomas and 11,5 % due to carcinomas. After palliative excision 2 recurrences occurred. These results of transanal endoscopic microsurgery (TEM) indicate that this technique has a useful place in curative, as well as in palliative management of rectal tumors.
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Affiliation(s)
- C Langer
- Department of General Surgery, Georg August University, Göttingen, Germany.
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Heuser M, Markus P, Obenauer S, Hüfner M, Becker H. Persistent hypocalcemia with elevated parathyroid hormone levels after long-term primary hyperparathyroidism: report of a case. Surg Today 2001; 30:1008-11. [PMID: 11110396 DOI: 10.1007/s005950070022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report herein the case of a 48-year-old man with long-term persistent primary hyperparathyroidism (pHPT) despite undergoing a parathyroidectomy in 1976, followed by a reoperation in 1978, for whom resection of a parathyroid adenoma in the upper mediastinum was eventually performed. His postoperative course was complicated by recurrent hypocalcemia refractory to oral calcium substitution and significantly elevated levels of parathyroid hormone (PTH). The radiological findings are presented, and we discuss the possible reasons for the coincidence of severe hypocalcemia with increased PTH levels in association with pHPT.
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Affiliation(s)
- M Heuser
- Department of General Surgery, Georg-August-University, Göttingen, Germany
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15
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Langer C, Markus P, Liersch T, Füzesi L, Becker H. UltraCision or high-frequency knife in transanal endoscopic microsurgery (TEM)? Advantages of a new procedure. Surg Endosc 2001; 15:513-7. [PMID: 11353972 DOI: 10.1007/s004640090015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2000] [Accepted: 09/28/2000] [Indexed: 12/19/2022]
Abstract
The potential advantages of ultrasound dissection using UltraCision (UC) an ultrasonically activated scalpel, rather than conventional electrosurgery (ES) were investigated retrospectively in 63 patients following transanal endoscopic microsurgery (TEM) in 22 cases of rectal carcinoma (16 pT1, four pT2, two pT3), 40 cases of rectal adenoma >2 cm, and one neurinoma. In all, 21 patients (13 adenomas, seven carcinomas, and one neurinoma) were operated with UltraCision (Ethicon, Norderstedt, Germany), whereas 42 patients (27 adenomas, 15 carcinomas) were treated with conventional electrocautery. All tumors were completely excised (R0) in both groups. We encountered a total of nine complications, seven after ES and two after UC use. Surgical reintervention was necessary in three cases (4.7%), exclusively following resection by ES. There were five cases of tumor recurrence (7.9%), once again only in the ES group. The advantages of ultrasound dissection are magnified under the particular conditions of minimally invasive endoscopic rectum surgery by means of TEM. In principle, all the known risks associated with the application of electric current can be avoided by using ultrasound technology.
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Affiliation(s)
- C Langer
- Department of General Surgery, Georg August University Göttingen, Robert Koch Strasse 40, 37075 Göttingen, Germany.
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Neufang T, Post S, Markus P, Becker H. [Manually assisted laparoscopic surgery--realistic evolution of the minimally invasive therapy concept? Initial experiences with the "Endohand"]. Chirurg 1996; 67:952-8. [PMID: 8991779 DOI: 10.1007/pl00002545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 02/03/2023]
Abstract
The essential limitations of laparoscopic procedures--lack of palpation, problematic retrieval of specimen and anastomosis, etc.--are abolished by the hand of the surgeon, which is inserted into the peritoneal cavity through a mini-laparotomy. While holding the pneumoperitoneum, the hand acts as an intelligent instrument performing surgical exploration, exposition of the field of operation, blunt dissection or intracorporal knot-tying. The mini-laparotomy is used to insert conventional instruments and suture material, as well as for specimen retrieval and anastomosis. Our preliminary experience (3x splenectomy, 2x sigmoid colectomy, 1x anterior resection of rectum, 1x proctocolectomy with J-pouch) shows that even extensive laparoscopic operations are accomplished much more simply. The time spent for such procedures is markedly reduced.
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Affiliation(s)
- T Neufang
- Klinik und Poliklinik für Allgemeinchirurgie, Georg-August-Universität Göttingen
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Markus P. 20. Verweilzeitverhalten, Gasgehalt und Stoffaustausch in mehrstufigen Blasensäulen unter Verwendung von Lochböden mit kaminförmigen Gaszerteilern. CHEM-ING-TECH 1994. [DOI: 10.1002/cite.330660921] [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: 11/07/2022]
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18
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Verreet P, Bösing N, Horstmann O, Markus P, Röher HD. Exstended surgery or palliation for advanced gastric cancer? Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91194-p] [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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Boggs S, Patrene K, Vecchini F, Markus P, Cooper M, Duquesnoy R, Starzl TE, Bloomer W. FK 506 has no short-term effects on endogenous or exogenous myeloid reconstitution in irradiated mice. Transplant Proc 1991; 23:3236-7. [PMID: 1721420 PMCID: PMC2964066] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Boggs
- Department of Radiation Oncology, University of Pittsburgh, PA 15261
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Markus P, Kopecky P. [Correlation between bilirubin- and protein-concentration in amniotic fluid in Rh incompatibility (author's transl)]. Z Geburtshilfe Perinatol 1973; 177:411-22. [PMID: 4788130] [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: 01/12/2023]
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Kopecky P, Markus P, Plessmann K. [Studies of amniotic fluid proteins in Rhesus incompatibility (total protein concentration and electrophoresis)]. Z Geburtshilfe Perinatol 1972; 176:28-36. [PMID: 5022636] [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: 01/13/2023]
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Markus P. [Mechanical early ileus in appendicitis]. Chirurg 1970; 41:469-71. [PMID: 5481949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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