Publications
The search can reduce the number of displayed entries.Abdalla, T. S. A.; Klinkhammer-Schalke, M.; Zeissig, S. R.; et al. (2023) Prognostic factors after resection of locally advanced non-functional pancreatic neuroendocrine neoplasm: an analysis from the German Cancer Registry Group of the Society of German Tumor Centers. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-023-04785-0
Title
Prognostic factors after resection of locally advanced non-functional pancreatic neuroendocrine neoplasm: an analysis from the German Cancer Registry Group of the Society of German Tumor Centers
Publication date
2023
Abstract
OBJECTIVE: The available literature regarding outcome after pancreatic resection in locally advanced non-functional pNEN (LA-pNEN) is sparse. Therefore, this study evaluates the current survival outcomes and prognostic factors in after resection of LA-pNEN. MATERIALS AND METHODS: This population-based analysis was derived from 17 German cancer registries from 2000 to 2019. Patients with upfront resected non-functional non-metastatic LA-pNEN were included. RESULTS: Out of 2776 patients with pNEN, 277 met the inclusion criteria. 137 (45%) of the patients were female. The median age was 63 +/- 18 years. Lymph node metastasis was present in 45%. G1, G2 and G3 pNEN were found in 39%, 47% and 14% of the patients, respectively. Resection of LA-pNEN resulted in favorable 3-, 5- and 10-year overall survival of 79%, 74%, and 47%. Positive resection margin was the only potentially modifiable independent prognostic factor for overall survival (HR 1.93, 95% CI 1.71-3.69, p value = 0.046), whereas tumor grade G3 (HR 5.26, 95% CI 2.09-13.25, p value < 0.001) and lymphangiosis (HR 2.35, 95% CI 1.20-4.59, p value = 0.012) were the only independent prognostic factors for disease-free survival. CONCLUSION: Resection of LA-pNEN is feasible and associated with favorable overall survival. G1 LA-pNEN with negative resection margins and absence of lymph node metastasis and lymphangiosis might be considered as cured, while those not fulfilling these criteria might be considered as a high-risk group for disease progression. Herein, negative resection margins represent the only potentially modifiable prognostic factor in LA-pNEN but seem to be influenced by tumor grade.
DOI
https://www.doi.org/10.1007/s00432-023-04785-0
Keywords
Humans; Female; Middle Aged; Aged; Aged, 80 and over; Male; Prognosis; Lymphatic Metastasis; Margins of Excision; Retrospective Studies; *Neuroendocrine Tumors/pathology; *Pancreatic Neoplasms/pathology; Registries; Neoplasm Staging; Pancreatic neuroendocrine neoplasms; Population-based analysis; Prognostic factors; Resection margin
Prognostic factors after resection of locally advanced non-functional pancreatic neuroendocrine neoplasm: an analysis from the German Cancer Registry Group of the Society of German Tumor Centers
Publication date
2023
Abstract
OBJECTIVE: The available literature regarding outcome after pancreatic resection in locally advanced non-functional pNEN (LA-pNEN) is sparse. Therefore, this study evaluates the current survival outcomes and prognostic factors in after resection of LA-pNEN. MATERIALS AND METHODS: This population-based analysis was derived from 17 German cancer registries from 2000 to 2019. Patients with upfront resected non-functional non-metastatic LA-pNEN were included. RESULTS: Out of 2776 patients with pNEN, 277 met the inclusion criteria. 137 (45%) of the patients were female. The median age was 63 +/- 18 years. Lymph node metastasis was present in 45%. G1, G2 and G3 pNEN were found in 39%, 47% and 14% of the patients, respectively. Resection of LA-pNEN resulted in favorable 3-, 5- and 10-year overall survival of 79%, 74%, and 47%. Positive resection margin was the only potentially modifiable independent prognostic factor for overall survival (HR 1.93, 95% CI 1.71-3.69, p value = 0.046), whereas tumor grade G3 (HR 5.26, 95% CI 2.09-13.25, p value < 0.001) and lymphangiosis (HR 2.35, 95% CI 1.20-4.59, p value = 0.012) were the only independent prognostic factors for disease-free survival. CONCLUSION: Resection of LA-pNEN is feasible and associated with favorable overall survival. G1 LA-pNEN with negative resection margins and absence of lymph node metastasis and lymphangiosis might be considered as cured, while those not fulfilling these criteria might be considered as a high-risk group for disease progression. Herein, negative resection margins represent the only potentially modifiable prognostic factor in LA-pNEN but seem to be influenced by tumor grade.
DOI
https://www.doi.org/10.1007/s00432-023-04785-0
Keywords
Humans; Female; Middle Aged; Aged; Aged, 80 and over; Male; Prognosis; Lymphatic Metastasis; Margins of Excision; Retrospective Studies; *Neuroendocrine Tumors/pathology; *Pancreatic Neoplasms/pathology; Registries; Neoplasm Staging; Pancreatic neuroendocrine neoplasms; Population-based analysis; Prognostic factors; Resection margin
Abdalla, T. S. A.; Pieper, L.; Kist, M.; et al. (2023) Gastrointestinal stromal tumors of the upper GI tract: population-based analysis of epidemiology, treatment and outcome based on data from the German Clinical Cancer Registry Group. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-023-04690-6
Title
Gastrointestinal stromal tumors of the upper GI tract: population-based analysis of epidemiology, treatment and outcome based on data from the German Clinical Cancer Registry Group
Publication date
2023
Abstract
BACKGROUND: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. They are most frequently located in the stomach but are also found in the esophagus and the gastroesophageal junction (GEJ). Information regarding the prognostic factors associated with upper gastrointestinal GIST is still scarse. METHODS: In this study, datasets provided by the German Clinical Cancer Registry Group, including a total of 93,069 patients with malignant tumors in the upper GI tract (C15, C16) between 2000 and 2016 were analyzed to investigate clinical outcomes of GIST in the entire upper GI tract. RESULTS: We identified 1361 patients with GIST of the upper GI tract. Tumors were located in the esophagus in 37(2.7%) patients, at the GEJ in 70 (5.1%) patients, and in the stomach in 1254 (91.2%) patients. The incidence of GIST increased over time, reaching 5% of all UGI tumors in 2015. The median age was 69 years. The incidence of GIST was similar between males and females (53% vs 47%, respectively). However, the proportion of GIST in female patients increased continuously with advancing age, ranging from 34.7% (41-50 years) to 71.4% (91-100 years). Male patients were twice as likely to develop tumors in the esophagus and GEJ compared to females (3.4% vs. 1.9% and 6.7% vs. 3.4%, respectively). The median overall survival of upper gastrointestinal GIST was 129 months. The 1-year, 5-year, and 10-year OS was 93%, 79%, and 52% respectively. Nevertheless, tumors located in the esophagus and GEJ were associated with shorter OS compared to gastric GIST (130 vs. 111 months, p = 0.001). The incidence of documented distant metastasis increased with more proximal location of GIST (gastric vs. GEJ vs. esophagus: 13% vs. 16% vs. 27%) at presentation. CONCLUSION: GIST of the esophagus and GEJ are rare soft tissue sarcomas with increasing incidence in Germany. They are characterized by worse survival outcomes and increased risk of metastasis compared to gastric GIST.
DOI
https://www.doi.org/10.1007/s00432-023-04690-6
Keywords
Humans; Male; Female; Aged; Adult; Middle Aged; *Gastrointestinal Stromal Tumors/epidemiology/therapy; *Stomach Neoplasms/epidemiology/therapy; Registries; Esophagogastric Junction/pathology; Retrospective Studies; Treatment Outcome; Prognosis; Esophagus; Gastroesophageal junction; Gastrointestinal stromal tumors; Population-based
Gastrointestinal stromal tumors of the upper GI tract: population-based analysis of epidemiology, treatment and outcome based on data from the German Clinical Cancer Registry Group
Publication date
2023
Abstract
BACKGROUND: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. They are most frequently located in the stomach but are also found in the esophagus and the gastroesophageal junction (GEJ). Information regarding the prognostic factors associated with upper gastrointestinal GIST is still scarse. METHODS: In this study, datasets provided by the German Clinical Cancer Registry Group, including a total of 93,069 patients with malignant tumors in the upper GI tract (C15, C16) between 2000 and 2016 were analyzed to investigate clinical outcomes of GIST in the entire upper GI tract. RESULTS: We identified 1361 patients with GIST of the upper GI tract. Tumors were located in the esophagus in 37(2.7%) patients, at the GEJ in 70 (5.1%) patients, and in the stomach in 1254 (91.2%) patients. The incidence of GIST increased over time, reaching 5% of all UGI tumors in 2015. The median age was 69 years. The incidence of GIST was similar between males and females (53% vs 47%, respectively). However, the proportion of GIST in female patients increased continuously with advancing age, ranging from 34.7% (41-50 years) to 71.4% (91-100 years). Male patients were twice as likely to develop tumors in the esophagus and GEJ compared to females (3.4% vs. 1.9% and 6.7% vs. 3.4%, respectively). The median overall survival of upper gastrointestinal GIST was 129 months. The 1-year, 5-year, and 10-year OS was 93%, 79%, and 52% respectively. Nevertheless, tumors located in the esophagus and GEJ were associated with shorter OS compared to gastric GIST (130 vs. 111 months, p = 0.001). The incidence of documented distant metastasis increased with more proximal location of GIST (gastric vs. GEJ vs. esophagus: 13% vs. 16% vs. 27%) at presentation. CONCLUSION: GIST of the esophagus and GEJ are rare soft tissue sarcomas with increasing incidence in Germany. They are characterized by worse survival outcomes and increased risk of metastasis compared to gastric GIST.
DOI
https://www.doi.org/10.1007/s00432-023-04690-6
Keywords
Humans; Male; Female; Aged; Adult; Middle Aged; *Gastrointestinal Stromal Tumors/epidemiology/therapy; *Stomach Neoplasms/epidemiology/therapy; Registries; Esophagogastric Junction/pathology; Retrospective Studies; Treatment Outcome; Prognosis; Esophagus; Gastroesophageal junction; Gastrointestinal stromal tumors; Population-based
Achajew, A.; Brecht, I. B.; Radespiel-Tröger, M.; et al. (2022) Rare pediatric tumors in Germany - not as rare as expected: a study based on data from the Bavarian Cancer Registry and the German Childhood Cancer Registry. Eur J Pediatr. https://www.doi.org/10.1007/s00431-022-04484-x
Title
Rare pediatric tumors in Germany - not as rare as expected: a study based on data from the Bavarian Cancer Registry and the German Childhood Cancer Registry
Publication date
2022
Abstract
Very rare pediatric tumors (VRTs) pose a challenge for treating physicians as little is known about the best diagnostic assessment and therapeutic decision-making in these malignancies. A large proportion of these cancers occur in adolescence. Therefore, the established structures of pediatric oncology including cancer registration may partly be circumvented. This may lead to an underregistration in clinical cancer registries of yet unclear extent. The aim of this study is to increase the knowledge on the occurrence of VRTs in pediatric patients in Germany. Pseudonymized data of cases recorded in the Bavarian Cancer Registry (BCR) between 2002 and 2014 were retrieved. VRTs according to the definition of the European Cooperative Study Group for Pediatric Rare Tumors were identified using the ICD and ICD-O classification. The numbers of registered patients were compared to those reported to the German Childhood Cancer Registry (GCCR). 6.3% (n = 290) of all malignancies (n = 4615) in the age below 18 years were classified as VRTs. Median age at diagnosis was 15 years (range 0-17 years). The most common tumor types included malignant melanoma, skin carcinoma, and gonadal tumors. During the same period, 49 pediatric patients from Bavaria with matchable VRTs were reported to the GCCR, accounting for 17% of cases reported to the BCR. CONCLUSIONS: The frequency of VRTs in Germany is underestimated in the national GCCR. With this study, we present population-based data on the incidence of VRTs in Germany for the first time. In order to gain additional knowledge about these malignancies, registration of VRTs must be improved through enhanced data exchange between the GCCR, the public cancer registries, and the clinical Registry for Rare Pediatric Tumors (STEP). WHAT IS KNOWN: * Rare pediatric tumors pose a challenge for treating physicians as limited knowledge is available on these malignancies for diagnostic and therapeutic decision-making. * Little is known about the frequency of these rare tumors in pediatric patients. WHAT IS NEW: * The frequency of rare pediatric tumors in Germany is distinctly underestimated in the German Childhood Cancer Registry. * We present population-based data on the incidence of these rare pediatric cancers for the first time.
DOI
https://www.doi.org/10.1007/s00431-022-04484-x
Keywords
Adolescent; Child; Child, Preschool; Germany/epidemiology; Humans; Incidence; Infant; Infant, Newborn; Medical Oncology; *Neoplasms/diagnosis/epidemiology/therapy; Rare Diseases/epidemiology; Registries; Bavaria; Cancer registry; Germany; Pediatric cancers; Rare tumors
Rare pediatric tumors in Germany - not as rare as expected: a study based on data from the Bavarian Cancer Registry and the German Childhood Cancer Registry
Publication date
2022
Abstract
Very rare pediatric tumors (VRTs) pose a challenge for treating physicians as little is known about the best diagnostic assessment and therapeutic decision-making in these malignancies. A large proportion of these cancers occur in adolescence. Therefore, the established structures of pediatric oncology including cancer registration may partly be circumvented. This may lead to an underregistration in clinical cancer registries of yet unclear extent. The aim of this study is to increase the knowledge on the occurrence of VRTs in pediatric patients in Germany. Pseudonymized data of cases recorded in the Bavarian Cancer Registry (BCR) between 2002 and 2014 were retrieved. VRTs according to the definition of the European Cooperative Study Group for Pediatric Rare Tumors were identified using the ICD and ICD-O classification. The numbers of registered patients were compared to those reported to the German Childhood Cancer Registry (GCCR). 6.3% (n = 290) of all malignancies (n = 4615) in the age below 18 years were classified as VRTs. Median age at diagnosis was 15 years (range 0-17 years). The most common tumor types included malignant melanoma, skin carcinoma, and gonadal tumors. During the same period, 49 pediatric patients from Bavaria with matchable VRTs were reported to the GCCR, accounting for 17% of cases reported to the BCR. CONCLUSIONS: The frequency of VRTs in Germany is underestimated in the national GCCR. With this study, we present population-based data on the incidence of VRTs in Germany for the first time. In order to gain additional knowledge about these malignancies, registration of VRTs must be improved through enhanced data exchange between the GCCR, the public cancer registries, and the clinical Registry for Rare Pediatric Tumors (STEP). WHAT IS KNOWN: * Rare pediatric tumors pose a challenge for treating physicians as limited knowledge is available on these malignancies for diagnostic and therapeutic decision-making. * Little is known about the frequency of these rare tumors in pediatric patients. WHAT IS NEW: * The frequency of rare pediatric tumors in Germany is distinctly underestimated in the German Childhood Cancer Registry. * We present population-based data on the incidence of these rare pediatric cancers for the first time.
DOI
https://www.doi.org/10.1007/s00431-022-04484-x
Keywords
Adolescent; Child; Child, Preschool; Germany/epidemiology; Humans; Incidence; Infant; Infant, Newborn; Medical Oncology; *Neoplasms/diagnosis/epidemiology/therapy; Rare Diseases/epidemiology; Registries; Bavaria; Cancer registry; Germany; Pediatric cancers; Rare tumors
Acs, M.; Gerken, M.; Gajic, I.; et al. (2022) Ten-year single-center experience with treatment of primary diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Langenbecks Arch Surg. https://www.doi.org/10.1007/s00423-022-02594-6
Title
Ten-year single-center experience with treatment of primary diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
Publication date
2022
Abstract
PURPOSE: This single-center study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM). METHODS: Prospectively collected data from a single institution data registry was retrospectively investigated. Eighty-four patients with primary malignant peritoneal mesothelioma underwent CRS and HIPEC with cisplatin and doxorubicin either for 60 min or 90 min of duration from 2011 to 2021. The primary endpoint was overall survival. The secondary endpoint was the evaluation of prognostic factors for overall survival. The tertiary endpoint was to assess the effect of neoadjuvant chemotherapy on survival. RESULTS: The median follow-up was 5.0 years (95%-CI 4.6-5.5). The median age was 59.2 years (IQR: 47-66). Eighty-two patients (97.6%) had epithelioid tumors. The median peritoneal cancer index was 18.0 (IQR: 13-27). Sixty-six patients (78.6%) had complete or near-complete cytoreduction (CCR 0 or CCR 1). Seventy patients (83.3%) received HIPEC for 60 min and 14 patients (16.7%) received it for 90 min. Twenty-two patients (26.2%) had grade 3 to 4 complications. Acute kidney injury (AKI) stage I-III occurred in 30 (35.7%) patients. Three patients (3.6%) died perioperatively. The overall median survival was 38.4 months (95%-CI 23.6-54.3), and the 5-year survival rate was 42%. Survival was independently associated with age, female gender, and thrombocytosis. Preoperative chemotherapy did not emerge as an adverse prognostic factor. CONCLUSION: In well-selected patients with DMPM, prolonged survival is achievable with CRS and HIPEC in specialized centers.
DOI
https://www.doi.org/10.1007/s00423-022-02594-6
Keywords
Humans; Female; Middle Aged; Cytoreduction Surgical Procedures; Hyperthermic Intraperitoneal Chemotherapy; *Mesothelioma/drug therapy/pathology; Retrospective Studies; *Hyperthermia, Induced; *Lung Neoplasms/pathology; *Mesothelioma, Malignant; *Peritoneal Neoplasms/surgery; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Combined Modality Therapy; Survival Rate; Cytoreductive surgery; Hipec; Malignant peritoneal mesothelioma
Ten-year single-center experience with treatment of primary diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
Publication date
2022
Abstract
PURPOSE: This single-center study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM). METHODS: Prospectively collected data from a single institution data registry was retrospectively investigated. Eighty-four patients with primary malignant peritoneal mesothelioma underwent CRS and HIPEC with cisplatin and doxorubicin either for 60 min or 90 min of duration from 2011 to 2021. The primary endpoint was overall survival. The secondary endpoint was the evaluation of prognostic factors for overall survival. The tertiary endpoint was to assess the effect of neoadjuvant chemotherapy on survival. RESULTS: The median follow-up was 5.0 years (95%-CI 4.6-5.5). The median age was 59.2 years (IQR: 47-66). Eighty-two patients (97.6%) had epithelioid tumors. The median peritoneal cancer index was 18.0 (IQR: 13-27). Sixty-six patients (78.6%) had complete or near-complete cytoreduction (CCR 0 or CCR 1). Seventy patients (83.3%) received HIPEC for 60 min and 14 patients (16.7%) received it for 90 min. Twenty-two patients (26.2%) had grade 3 to 4 complications. Acute kidney injury (AKI) stage I-III occurred in 30 (35.7%) patients. Three patients (3.6%) died perioperatively. The overall median survival was 38.4 months (95%-CI 23.6-54.3), and the 5-year survival rate was 42%. Survival was independently associated with age, female gender, and thrombocytosis. Preoperative chemotherapy did not emerge as an adverse prognostic factor. CONCLUSION: In well-selected patients with DMPM, prolonged survival is achievable with CRS and HIPEC in specialized centers.
DOI
https://www.doi.org/10.1007/s00423-022-02594-6
Keywords
Humans; Female; Middle Aged; Cytoreduction Surgical Procedures; Hyperthermic Intraperitoneal Chemotherapy; *Mesothelioma/drug therapy/pathology; Retrospective Studies; *Hyperthermia, Induced; *Lung Neoplasms/pathology; *Mesothelioma, Malignant; *Peritoneal Neoplasms/surgery; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Combined Modality Therapy; Survival Rate; Cytoreductive surgery; Hipec; Malignant peritoneal mesothelioma
Acs, M.; Gerken, M.; Schmitt, V.; et al. (2023) Role of HIPEC after Complete Cytoreductive Surgery (CRS) in Peritoneal Recurrence of Platinum-Sensitive Recurrent Ovarian Cancer (OC): The Aim for Standardization at Two Reference Centers for CRS. Cancers (Basel). https://www.doi.org/10.3390/cancers15020405
Title
Role of HIPEC after Complete Cytoreductive Surgery (CRS) in Peritoneal Recurrence of Platinum-Sensitive Recurrent Ovarian Cancer (OC): The Aim for Standardization at Two Reference Centers for CRS
Publication date
2023
Abstract
BACKGROUND: This bicentric study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for platinum-sensitive recurrent ovarian cancer patients. METHODS: The data of 88 patients with the first peritoneal recurrence of platinum-sensitive epithelial ovarian cancer who underwent CRS and HIPEC from a prospective HIPEC registry were retrospectively investigated. Endpoints were feasibility, chemotherapeutic compound, time of exposure, complications, and overall survival. RESULTS: The median follow-up was 4.7 years (95%-CI 4.6-5.5). The median age was 55.8 years (IQR: 50.3-66.2). Eighty-four patients (95.5%) had high-grade serous histology. The median peritoneal cancer index was 12.0 (IQR: 7.0-20.5). Sixty-five patients (73.9%) had complete cytoreduction (CCR 0). Thirty-eight patients (43.2%) received HIPEC for 60 min, and fifty patients (56.8%) for 90 min. Eighteen patients (20.5%) had grade III to IV complications. One patient (1.1%) died perioperatively. The overall median survival was 43.1 months (95%-CI 34.1-52.2), and the 5-year survival rate was 39.7%. Only 90 min HIPEC and cisplatin were associated with survival. CONCLUSION: In well-selected patients with platinum-sensitive recurrent ovarian cancer, survival may correlate with complete CRS and 90 min cisplatin-based HIPEC. We confirmed the results of primary OC studies; therefore, this combination should be used for further analysis in the recurrent situation.
DOI
https://www.doi.org/10.3390/cancers15020405
Keywords
Hipec; cytoreductive surgery; platinum-sensitive; recurrent ovarian cancer
Role of HIPEC after Complete Cytoreductive Surgery (CRS) in Peritoneal Recurrence of Platinum-Sensitive Recurrent Ovarian Cancer (OC): The Aim for Standardization at Two Reference Centers for CRS
Publication date
2023
Abstract
BACKGROUND: This bicentric study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for platinum-sensitive recurrent ovarian cancer patients. METHODS: The data of 88 patients with the first peritoneal recurrence of platinum-sensitive epithelial ovarian cancer who underwent CRS and HIPEC from a prospective HIPEC registry were retrospectively investigated. Endpoints were feasibility, chemotherapeutic compound, time of exposure, complications, and overall survival. RESULTS: The median follow-up was 4.7 years (95%-CI 4.6-5.5). The median age was 55.8 years (IQR: 50.3-66.2). Eighty-four patients (95.5%) had high-grade serous histology. The median peritoneal cancer index was 12.0 (IQR: 7.0-20.5). Sixty-five patients (73.9%) had complete cytoreduction (CCR 0). Thirty-eight patients (43.2%) received HIPEC for 60 min, and fifty patients (56.8%) for 90 min. Eighteen patients (20.5%) had grade III to IV complications. One patient (1.1%) died perioperatively. The overall median survival was 43.1 months (95%-CI 34.1-52.2), and the 5-year survival rate was 39.7%. Only 90 min HIPEC and cisplatin were associated with survival. CONCLUSION: In well-selected patients with platinum-sensitive recurrent ovarian cancer, survival may correlate with complete CRS and 90 min cisplatin-based HIPEC. We confirmed the results of primary OC studies; therefore, this combination should be used for further analysis in the recurrent situation.
DOI
https://www.doi.org/10.3390/cancers15020405
Keywords
Hipec; cytoreductive surgery; platinum-sensitive; recurrent ovarian cancer
Acs, M.; Halmy, L.; Isgandarova, S.; et al. (2022) Hyperthermic Intraperitoneal Chemotherapy With Cisplatin and Doxorubicin for 90 Minutes Versus 60 Minutes After Cytoreductive Surgery (CRS). Does the 30-Minute Difference Matter? A Comparative Study in a High Volume Centre. Anticancer Res. https://www.doi.org/10.21873/anticanres.15563
Title
Hyperthermic Intraperitoneal Chemotherapy With Cisplatin and Doxorubicin for 90 Minutes Versus 60 Minutes After Cytoreductive Surgery (CRS). Does the 30-Minute Difference Matter? A Comparative Study in a High Volume Centre
Publication date
2022
Abstract
BACKGROUND/AIM: This study compared the perioperative outcomes after the same combination of hyperthermic intraperitoneal chemotherapy (HIPEC) compounds when administered for 90 min vs. 60 min, while all other therapy variables remained constant. PATIENTS AND METHODS: A total of 120 patients were included with peritoneal surface malignancy who underwent cisplatin (75 mg/m(2)) and doxorubicin (15 mg/m(2)) closed HIPEC after cytoreductive surgery. RESULTS: Sixty-five patients (54.2%) in the 60 min and 55 patients (45.8%) in the 90 min HIPEC group were compared. Patients, tumor characteristics, and postoperative complications were comparable. The only significant difference was the rate of chest drain/pleural puncture with an incidence of 18.5% and 34.5% in the 60 min and 90 min group, respectively (p=0.045). After adjustment in a multi-variable regression analysis, the odds for patients with HIPEC 90 min of having chest drain or pleural puncture in comparison to patients with HIPEC 60 min was still higher, but not significant with an OR of 2.238 (95%CI=0.932-5.373; p=0.071). CONCLUSION: HIPEC administered for 90 min is safe and does not increase perioperative morbidity and mortality compared to the 60-min administration.
DOI
https://www.doi.org/10.21873/anticanres.15563
Keywords
Adult; Aged; Antineoplastic Agents/administration & dosage/adverse effects; Cisplatin/*administration & dosage/adverse effects; Combined Modality Therapy; *Cytoreduction Surgical Procedures; Doxorubicin/*administration & dosage/adverse effects; Drug Administration Schedule; Female; Germany/epidemiology; Hospitals, High-Volume; Humans; Hyperthermic Intraperitoneal Chemotherapy/adverse effects/*methods; Male; Middle Aged; Perioperative Period; Peritoneal Neoplasms/epidemiology/pathology/*therapy; Postoperative Care/adverse effects/methods; Postoperative Complications/epidemiology/etiology; Survival Analysis; Time Factors; Treatment Outcome; HIPEC duration; cisplatin; cytoreductive surgery; intraperitoneal chemotherapy
Hyperthermic Intraperitoneal Chemotherapy With Cisplatin and Doxorubicin for 90 Minutes Versus 60 Minutes After Cytoreductive Surgery (CRS). Does the 30-Minute Difference Matter? A Comparative Study in a High Volume Centre
Publication date
2022
Abstract
BACKGROUND/AIM: This study compared the perioperative outcomes after the same combination of hyperthermic intraperitoneal chemotherapy (HIPEC) compounds when administered for 90 min vs. 60 min, while all other therapy variables remained constant. PATIENTS AND METHODS: A total of 120 patients were included with peritoneal surface malignancy who underwent cisplatin (75 mg/m(2)) and doxorubicin (15 mg/m(2)) closed HIPEC after cytoreductive surgery. RESULTS: Sixty-five patients (54.2%) in the 60 min and 55 patients (45.8%) in the 90 min HIPEC group were compared. Patients, tumor characteristics, and postoperative complications were comparable. The only significant difference was the rate of chest drain/pleural puncture with an incidence of 18.5% and 34.5% in the 60 min and 90 min group, respectively (p=0.045). After adjustment in a multi-variable regression analysis, the odds for patients with HIPEC 90 min of having chest drain or pleural puncture in comparison to patients with HIPEC 60 min was still higher, but not significant with an OR of 2.238 (95%CI=0.932-5.373; p=0.071). CONCLUSION: HIPEC administered for 90 min is safe and does not increase perioperative morbidity and mortality compared to the 60-min administration.
DOI
https://www.doi.org/10.21873/anticanres.15563
Keywords
Adult; Aged; Antineoplastic Agents/administration & dosage/adverse effects; Cisplatin/*administration & dosage/adverse effects; Combined Modality Therapy; *Cytoreduction Surgical Procedures; Doxorubicin/*administration & dosage/adverse effects; Drug Administration Schedule; Female; Germany/epidemiology; Hospitals, High-Volume; Humans; Hyperthermic Intraperitoneal Chemotherapy/adverse effects/*methods; Male; Middle Aged; Perioperative Period; Peritoneal Neoplasms/epidemiology/pathology/*therapy; Postoperative Care/adverse effects/methods; Postoperative Complications/epidemiology/etiology; Survival Analysis; Time Factors; Treatment Outcome; HIPEC duration; cisplatin; cytoreductive surgery; intraperitoneal chemotherapy
Albertsmeier, M.; Altendorf-Hofmann, A.; Lindner, L. H.; et al. (2020) Cancer Testis Antigens and Immunotherapy: Expression of PRAME Is Associated with Prognosis in Soft Tissue Sarcoma. Cancers (Basel). https://www.doi.org/10.3390/cancers12123612
Title
Cancer Testis Antigens and Immunotherapy: Expression of PRAME Is Associated with Prognosis in Soft Tissue Sarcoma
Publication date
2020
Abstract
(1) Background: PRAME, NY-ESO-1, and SSX2 are cancer testis antigens (CTAs), which are expressed in testicular germ cells with re-expression in numerous cancer types. Their ability to elicit humoral and cellular immune responses have rendered them promising targets for cancer immunotherapy, but they have never been studied in a large and well-characterised cohort of soft tissue sarcomas (STS). (2) Methods: On a protein level, we examined PRAME, NY-ESO-1, and SSX2 expression in tumour tissues of 249 high-risk STS using immunohistochemistry. We correlated expression levels with clinicopathological parameters including tumour-infiltrating lymphocyte (TIL) counts, grading, and long-term survival. (3) Results: Expression of PRAME, NY-ESO-1, and SSX2 was observed in 25 (10%), 19 (8%), and 11 (4%) of 249 specimens with distinct patterns for histo-subtypes. Expression of PRAME was associated with shorter patient survival (p = 0.005) and higher grade (G2 vs. G3, p = 0.001), while NY-ESO-1 expression was correlated with more favourable survival (p = 0.037) and lower grade (G2 vs. G3, p = 0.029). Both PRAME and NY-ESO-1 expression were more frequent in STS with low TIL counts. In multivariate analysis, high PRAME and low SSX2 expression levels as well as metastatic disease and non-radical resections were independent predictors of shorter overall survival. (4) Conclusions: CTAs PRAME, NY-ESO-1, and SSX2 show distinct expression patterns in different STS subtypes. These results demonstrate their prognostic relevance and may guide future immunotherapeutic approaches in STS.
DOI
https://www.doi.org/10.3390/cancers12123612
Keywords
Ny-eso-1; Prame; Ssx2; biomarker; cancer/testis antigens; human; immunohistochemistry; soft tissue sarcoma; tumour infiltrating lymphocytes
Cancer Testis Antigens and Immunotherapy: Expression of PRAME Is Associated with Prognosis in Soft Tissue Sarcoma
Publication date
2020
Abstract
(1) Background: PRAME, NY-ESO-1, and SSX2 are cancer testis antigens (CTAs), which are expressed in testicular germ cells with re-expression in numerous cancer types. Their ability to elicit humoral and cellular immune responses have rendered them promising targets for cancer immunotherapy, but they have never been studied in a large and well-characterised cohort of soft tissue sarcomas (STS). (2) Methods: On a protein level, we examined PRAME, NY-ESO-1, and SSX2 expression in tumour tissues of 249 high-risk STS using immunohistochemistry. We correlated expression levels with clinicopathological parameters including tumour-infiltrating lymphocyte (TIL) counts, grading, and long-term survival. (3) Results: Expression of PRAME, NY-ESO-1, and SSX2 was observed in 25 (10%), 19 (8%), and 11 (4%) of 249 specimens with distinct patterns for histo-subtypes. Expression of PRAME was associated with shorter patient survival (p = 0.005) and higher grade (G2 vs. G3, p = 0.001), while NY-ESO-1 expression was correlated with more favourable survival (p = 0.037) and lower grade (G2 vs. G3, p = 0.029). Both PRAME and NY-ESO-1 expression were more frequent in STS with low TIL counts. In multivariate analysis, high PRAME and low SSX2 expression levels as well as metastatic disease and non-radical resections were independent predictors of shorter overall survival. (4) Conclusions: CTAs PRAME, NY-ESO-1, and SSX2 show distinct expression patterns in different STS subtypes. These results demonstrate their prognostic relevance and may guide future immunotherapeutic approaches in STS.
DOI
https://www.doi.org/10.3390/cancers12123612
Keywords
Ny-eso-1; Prame; Ssx2; biomarker; cancer/testis antigens; human; immunohistochemistry; soft tissue sarcoma; tumour infiltrating lymphocytes
Albertsmeier, M.; Riedl, K.; Stephan, A. J.; et al. (2020) Improved survival after resection of colorectal liver metastases in patients with unresectable lung metastases. HPB (Oxford). https://www.doi.org/10.1016/j.hpb.2019.07.004
Title
Improved survival after resection of colorectal liver metastases in patients with unresectable lung metastases
Publication date
2020
Abstract
BACKGROUND: Modern systemic therapies considerably improve tumour control and thus open the possibility of new surgical approaches in metastatic colorectal cancer. In this retrospective clinical cohort with a comparison group, we investigated whether liver resection in a combined liver-lung-metastasised stage is justified if pulmonary disease is not resected. METHODS: From 283 patients treated in our institution between 2000 and 2014 for combined colorectal liver- and lung metastases, 35 patients had their pulmonary metastases left in situ while they were eligible for both treatment options: resection versus non-resection of liver metastases. Effectively, 15 of these patients received whereas 20 did not receive a liver resection. In these patients, we compared overall survival and determined risk factors that are associated with poor survival, applying a Cox-Proportional Hazards model. RESULTS: Patients whose liver metastases were resected showed significantly longer median survival compared to patients who did not undergo hepatic surgery (median 2.6 vs 1.5 years, P = 0.0182). The Cox-Proportional Hazards model revealed hepatic metastasectomy to be the strongest determinant of patient survival (HR 5.27; CI: (1.89, 14.65)). CONCLUSION: Our results suggest that surgical removal of liver metastases may be beneficial in selected patients even if concomitant lung metastases cannot be resected.
DOI
https://www.doi.org/10.1016/j.hpb.2019.07.004
Keywords
Adult; Aged; Colorectal Neoplasms/mortality/*pathology/surgery; Female; *Hepatectomy; Humans; Liver Neoplasms/mortality/secondary/*surgery; Lung Neoplasms/mortality/*secondary; Male; *Metastasectomy; Middle Aged; Patient Selection; Proportional Hazards Models; Retrospective Studies; Survival Rate; Treatment Outcome
Improved survival after resection of colorectal liver metastases in patients with unresectable lung metastases
Publication date
2020
Abstract
BACKGROUND: Modern systemic therapies considerably improve tumour control and thus open the possibility of new surgical approaches in metastatic colorectal cancer. In this retrospective clinical cohort with a comparison group, we investigated whether liver resection in a combined liver-lung-metastasised stage is justified if pulmonary disease is not resected. METHODS: From 283 patients treated in our institution between 2000 and 2014 for combined colorectal liver- and lung metastases, 35 patients had their pulmonary metastases left in situ while they were eligible for both treatment options: resection versus non-resection of liver metastases. Effectively, 15 of these patients received whereas 20 did not receive a liver resection. In these patients, we compared overall survival and determined risk factors that are associated with poor survival, applying a Cox-Proportional Hazards model. RESULTS: Patients whose liver metastases were resected showed significantly longer median survival compared to patients who did not undergo hepatic surgery (median 2.6 vs 1.5 years, P = 0.0182). The Cox-Proportional Hazards model revealed hepatic metastasectomy to be the strongest determinant of patient survival (HR 5.27; CI: (1.89, 14.65)). CONCLUSION: Our results suggest that surgical removal of liver metastases may be beneficial in selected patients even if concomitant lung metastases cannot be resected.
DOI
https://www.doi.org/10.1016/j.hpb.2019.07.004
Keywords
Adult; Aged; Colorectal Neoplasms/mortality/*pathology/surgery; Female; *Hepatectomy; Humans; Liver Neoplasms/mortality/secondary/*surgery; Lung Neoplasms/mortality/*secondary; Male; *Metastasectomy; Middle Aged; Patient Selection; Proportional Hazards Models; Retrospective Studies; Survival Rate; Treatment Outcome
Bastiaannet, E.; Charman, J.; Johannesen, T. B.; et al. (2018) A European, Observational Study of Endocrine Therapy Administration in Patients With an Initial Diagnosis of Hormone Receptor-Positive Advanced Breast Cancer. Clin Breast Cancer. https://www.doi.org/10.1016/j.clbc.2017.11.019
Title
A European, Observational Study of Endocrine Therapy Administration in Patients With an Initial Diagnosis of Hormone Receptor-Positive Advanced Breast Cancer
Publication date
2018
Abstract
BACKGROUND: Despite guideline recommendations, reports suggest that a proportion of patients with hormone receptor (HR)-positive locally advanced or metastatic breast cancer (LA/MBC) might not receive endocrine therapy. The aims of this study were to estimate the proportion of postmenopausal patients with an initial (primary) diagnosis of HR-positive LA/MBC in Europe, and to assess the administration of endocrine treatment in these patients. MATERIALS AND METHODS: Fourteen national and regional cancer registries across Europe were invited to participate in this observational study. Six registries each provided anonymized clinical information on > 5000 postmenopausal women with breast cancer diagnosed between January 2000 and December 2014, including age at diagnosis, estrogen and/or progesterone receptor status, disease stage, and receipt of endocrine therapy. The proportion of patients with an initial diagnosis of HR-positive LA/MBC and, of these, the proportion who received endocrine therapy, was calculated. RESULTS: Registries from Belgium, England, Ireland, Norway, The Netherlands, and Munich, Germany provided data. In total, 316,680 postmenopausal women were diagnosed with breast cancer, including 244,268 with known HR status and disease stage. Of these patients, 19,002 (7.8%) had a primary diagnosis of HR-positive LA/MBC. This proportion ranged from 5.4% (N = 4484) in England to 12.7% (N = 4085) in Germany. Most of these patients (n = 14,157; 74.5%) received endocrine treatment, ranging from 55.5% (n = 445) in Norway to 88.1% (n = 443) in Belgium. CONCLUSION: These results indicate that a sizeable proportion of postmenopausal patients in Europe received a primary diagnosis of HR-positive LA/MBC, and that almost three-quarters received subsequent endocrine therapy as per guideline recommendations.
DOI
https://www.doi.org/10.1016/j.clbc.2017.11.019
Keywords
Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal/standards/*therapeutic use; Breast Neoplasms/*diagnosis/*drug therapy/metabolism/pathology; Europe; Female; Guideline Adherence/statistics & numerical data; Humans; Middle Aged; Neoplasm Metastasis; Postmenopause; Practice Guidelines as Topic; Receptors, Estrogen/metabolism; Receptors, Progesterone/metabolism; Registries; Retrospective Studies; *Endocrine treatment; *European comparison; *Locally advanced/metastatic breast cancer; *Population-based cancer registries
A European, Observational Study of Endocrine Therapy Administration in Patients With an Initial Diagnosis of Hormone Receptor-Positive Advanced Breast Cancer
Publication date
2018
Abstract
BACKGROUND: Despite guideline recommendations, reports suggest that a proportion of patients with hormone receptor (HR)-positive locally advanced or metastatic breast cancer (LA/MBC) might not receive endocrine therapy. The aims of this study were to estimate the proportion of postmenopausal patients with an initial (primary) diagnosis of HR-positive LA/MBC in Europe, and to assess the administration of endocrine treatment in these patients. MATERIALS AND METHODS: Fourteen national and regional cancer registries across Europe were invited to participate in this observational study. Six registries each provided anonymized clinical information on > 5000 postmenopausal women with breast cancer diagnosed between January 2000 and December 2014, including age at diagnosis, estrogen and/or progesterone receptor status, disease stage, and receipt of endocrine therapy. The proportion of patients with an initial diagnosis of HR-positive LA/MBC and, of these, the proportion who received endocrine therapy, was calculated. RESULTS: Registries from Belgium, England, Ireland, Norway, The Netherlands, and Munich, Germany provided data. In total, 316,680 postmenopausal women were diagnosed with breast cancer, including 244,268 with known HR status and disease stage. Of these patients, 19,002 (7.8%) had a primary diagnosis of HR-positive LA/MBC. This proportion ranged from 5.4% (N = 4484) in England to 12.7% (N = 4085) in Germany. Most of these patients (n = 14,157; 74.5%) received endocrine treatment, ranging from 55.5% (n = 445) in Norway to 88.1% (n = 443) in Belgium. CONCLUSION: These results indicate that a sizeable proportion of postmenopausal patients in Europe received a primary diagnosis of HR-positive LA/MBC, and that almost three-quarters received subsequent endocrine therapy as per guideline recommendations.
DOI
https://www.doi.org/10.1016/j.clbc.2017.11.019
Keywords
Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal/standards/*therapeutic use; Breast Neoplasms/*diagnosis/*drug therapy/metabolism/pathology; Europe; Female; Guideline Adherence/statistics & numerical data; Humans; Middle Aged; Neoplasm Metastasis; Postmenopause; Practice Guidelines as Topic; Receptors, Estrogen/metabolism; Receptors, Progesterone/metabolism; Registries; Retrospective Studies; *Endocrine treatment; *European comparison; *Locally advanced/metastatic breast cancer; *Population-based cancer registries
Bielska-Lasota, M.; Rossi, S.; Krzyzak, M.; et al. (2020) Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-019-05412-5
Title
Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study
Publication date
2020
Abstract
PURPOSE: With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age. METHODS: We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed. RESULTS: EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women. CONCLUSION: Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.
DOI
https://www.doi.org/10.1007/s00404-019-05412-5
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; European Union; Female; Humans; Male; Middle Aged; Retrospective Studies; Survival Rate; Uterine Cervical Neoplasms/*epidemiology/mortality; *Cervical cancer; *Europe; *Morphology; *Population-based study; *Stage at diagnosis; *Survival
Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study
Publication date
2020
Abstract
PURPOSE: With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age. METHODS: We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed. RESULTS: EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women. CONCLUSION: Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.
DOI
https://www.doi.org/10.1007/s00404-019-05412-5
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; European Union; Female; Humans; Male; Middle Aged; Retrospective Studies; Survival Rate; Uterine Cervical Neoplasms/*epidemiology/mortality; *Cervical cancer; *Europe; *Morphology; *Population-based study; *Stage at diagnosis; *Survival
Bobeth, C.; Tol, K. K.; Rössler, M.; et al. (2023) [Methodology and Attribution Success of a Data Linkage of Clinical Registry Data with Health Insurance Data]. Gesundheitswesen. https://www.doi.org/10.1055/a-1984-0085
Title
[Methodology and Attribution Success of a Data Linkage of Clinical Registry Data with Health Insurance Data]
Publication date
2023
Abstract
BACKGROUND: The aim of the project "Effectiveness of care in oncological centres" (WiZen), funded by the innovation fund of the federal joint committee, is to investigate the effectiveness of certification in oncology. The project uses nationwide data from the statuory health insurance AOK and data from clinical cancer registries from three different federal states from 2006-2017. To combine the strengths of both data sources, these will be linked for eight different cancer entities in compliance with data protection regulations. METHODS: Data linkage was performed using indirect identifiers and validated using the health insurance's patient ID ("Krankenversichertennummer") as a direct identifier and gold standard. This enables quantification of the quality of different linkage variants. Sensitivity and specificity as well as hit accuracy and a score addressing the quality of the linkage were used as evaluation criteria. The distributions of relevant variables resulting from the linkage were validated against the original distributions in the individual datasets. RESULTS: Depending on the combination of indirect identifiers, we found a range of 22,125 to 3,092,401 linkage hits. An almost perfect linkage could be achieved by combining information on cancer type, date of birth, gender and postal code. A total of 74,586 one-to-one linkages were achieved with these characteristics. The median hit quality for the different entities was more than 98%. In addition, both the age and sex distributions and the dates of death, if any, showed a high degree of agreement. DISCUSSION AND CONCLUSION: SHI and cancer registry data can be linked with high internal and external validity at the individual level. This robust linkage enables completely new possibilities for analysis through simultaneous access to variables from both data sets ("the best of both worlds"): Information on the UICC stage that stems from the registries can now be combined, for instance, with comorbidities from the SHI data at the individual level. Due to the use of readily available variables and the high success of the linkage, our procedure constitutes a promising method for future linkage processes in health care research.
DOI
https://www.doi.org/10.1055/a-1984-0085
Keywords
Humans; *Routinely Collected Health Data; Germany/epidemiology; Registries; Information Storage and Retrieval; Insurance, Health; *Neoplasms/epidemiology; Medical Record Linkage/methods
[Methodology and Attribution Success of a Data Linkage of Clinical Registry Data with Health Insurance Data]
Publication date
2023
Abstract
BACKGROUND: The aim of the project "Effectiveness of care in oncological centres" (WiZen), funded by the innovation fund of the federal joint committee, is to investigate the effectiveness of certification in oncology. The project uses nationwide data from the statuory health insurance AOK and data from clinical cancer registries from three different federal states from 2006-2017. To combine the strengths of both data sources, these will be linked for eight different cancer entities in compliance with data protection regulations. METHODS: Data linkage was performed using indirect identifiers and validated using the health insurance's patient ID ("Krankenversichertennummer") as a direct identifier and gold standard. This enables quantification of the quality of different linkage variants. Sensitivity and specificity as well as hit accuracy and a score addressing the quality of the linkage were used as evaluation criteria. The distributions of relevant variables resulting from the linkage were validated against the original distributions in the individual datasets. RESULTS: Depending on the combination of indirect identifiers, we found a range of 22,125 to 3,092,401 linkage hits. An almost perfect linkage could be achieved by combining information on cancer type, date of birth, gender and postal code. A total of 74,586 one-to-one linkages were achieved with these characteristics. The median hit quality for the different entities was more than 98%. In addition, both the age and sex distributions and the dates of death, if any, showed a high degree of agreement. DISCUSSION AND CONCLUSION: SHI and cancer registry data can be linked with high internal and external validity at the individual level. This robust linkage enables completely new possibilities for analysis through simultaneous access to variables from both data sets ("the best of both worlds"): Information on the UICC stage that stems from the registries can now be combined, for instance, with comorbidities from the SHI data at the individual level. Due to the use of readily available variables and the high success of the linkage, our procedure constitutes a promising method for future linkage processes in health care research.
DOI
https://www.doi.org/10.1055/a-1984-0085
Keywords
Humans; *Routinely Collected Health Data; Germany/epidemiology; Registries; Information Storage and Retrieval; Insurance, Health; *Neoplasms/epidemiology; Medical Record Linkage/methods
Bolm, L.; Zemskov, S.; Zeller, M.; et al. (2022) Concepts and Outcomes of Perioperative Therapy in Stage IA-III Pancreatic Cancer-A Cross-Validation of the National Cancer Database (NCDB) and the German Cancer Registry Group of the Society of German Tumor Centers (GCRG/ADT). Cancers (Basel). https://www.doi.org/10.3390/cancers14040868
Title
Concepts and Outcomes of Perioperative Therapy in Stage IA-III Pancreatic Cancer-A Cross-Validation of the National Cancer Database (NCDB) and the German Cancer Registry Group of the Society of German Tumor Centers (GCRG/ADT)
Publication date
2022
Abstract
(1) Background: The aim of this study is to assess perioperative therapy in stage IA-III pancreatic cancer cross-validating the German Cancer Registry Group of the Society of German Tumor Centers-Network for Care, Quality, and Research in Oncology, Berlin (GCRG/ADT) and the National Cancer Database (NCDB). (2) Methods: Patients with clinical stage IA-III PDAC undergoing surgery alone (OP), neoadjuvant therapy (TX) + surgery (neo + OP), surgery+adjuvantTX (OP + adj) and neoadjuvantTX + surgery + adjuvantTX (neo + OP + adj) were identified. Baseline characteristics, histopathological parameters, and overall survival (OS) were evaluated. (3) Results: 1392 patients from the GCRG/ADT and 29,081 patients from the NCDB were included. Patient selection and strategies of perioperative therapy remained consistent across the registries for stage IA-III pancreatic cancer. Combined neo + OP + adj was associated with prolonged OS as compared to neo + OP alone (17.8 m vs. 21.3 m, p = 0.012) across all stages in the GCRG/ADT registry. Similarly, OS with neo + OP + adj was improved as compared to neo + OP in the NCDB registry (26.4 m vs. 35.4 m, p < 0.001). (4) Conclusion: The cross-validation study demonstrated similar concepts and patient selection criteria of perioperative therapy across clinical stages of PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to either therapy alone.
DOI
https://www.doi.org/10.3390/cancers14040868
Keywords
neoadjuvant therapy; pancreatic cancer; pancreatic surgery; perioperative therapy
Concepts and Outcomes of Perioperative Therapy in Stage IA-III Pancreatic Cancer-A Cross-Validation of the National Cancer Database (NCDB) and the German Cancer Registry Group of the Society of German Tumor Centers (GCRG/ADT)
Publication date
2022
Abstract
(1) Background: The aim of this study is to assess perioperative therapy in stage IA-III pancreatic cancer cross-validating the German Cancer Registry Group of the Society of German Tumor Centers-Network for Care, Quality, and Research in Oncology, Berlin (GCRG/ADT) and the National Cancer Database (NCDB). (2) Methods: Patients with clinical stage IA-III PDAC undergoing surgery alone (OP), neoadjuvant therapy (TX) + surgery (neo + OP), surgery+adjuvantTX (OP + adj) and neoadjuvantTX + surgery + adjuvantTX (neo + OP + adj) were identified. Baseline characteristics, histopathological parameters, and overall survival (OS) were evaluated. (3) Results: 1392 patients from the GCRG/ADT and 29,081 patients from the NCDB were included. Patient selection and strategies of perioperative therapy remained consistent across the registries for stage IA-III pancreatic cancer. Combined neo + OP + adj was associated with prolonged OS as compared to neo + OP alone (17.8 m vs. 21.3 m, p = 0.012) across all stages in the GCRG/ADT registry. Similarly, OS with neo + OP + adj was improved as compared to neo + OP in the NCDB registry (26.4 m vs. 35.4 m, p < 0.001). (4) Conclusion: The cross-validation study demonstrated similar concepts and patient selection criteria of perioperative therapy across clinical stages of PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to either therapy alone.
DOI
https://www.doi.org/10.3390/cancers14040868
Keywords
neoadjuvant therapy; pancreatic cancer; pancreatic surgery; perioperative therapy
Bösch, F.; Brüwer, K.; Altendorf-Hofmann, A.; et al. (2019) Immune checkpoint markers in gastroenteropancreatic neuroendocrine neoplasia. Endocr Relat Cancer. https://www.doi.org/10.1530/ERC-18-0494
Title
Immune checkpoint markers in gastroenteropancreatic neuroendocrine neoplasia
Publication date
2019
Abstract
Cancer immunotherapy has evolved major breakthroughs in the last years. The cell-surface receptor programmed death-1 (PD-1) and its ligand, programmed death ligand-1 (PD-L1), have been detected in various cancer types. However, the analysis on gastroenteropancreatic neoplasia (GEP-NENs) is limited. Therefore, the aim of this study was to characterize GEP-NENs with regard to PD-1/PD-L1 pathway and tumor-infiltrating lymphocytes (TILs). On protein level, we examined TILs, PD-1 and PD-L1 expression in tumor tissue of 244 GEP-NENs using immunohistochemistry. Expression levels were correlated with clinicopathological parameters including long-term survival in an observational study. In total, 244 patients could be included. Most of the patients had a NEN of the small intestine (52.5%) or the pancreas (29.5%). All tumors could be graded by their morphology and Ki67 index, with 57.8% G1, 34% G2 and 8.2% G3 tumors. High TILs (19.6%) and high PD-1 (16.1%) expression showed a significant correlation with shorter patient survival (P < 0.05) and with a higher grading. Furthermore, expression of PD-L1 (8.7%) showed a trend to shorter patient survival. High TILs and PD-1 expression are significantly associated with shorter patient survival and higher grading in GEP-NENs. PD-L1 expression showed a trend to shorter patient survival. Immunotherapy might be a promising therapeutic approach in GEP-NENs especially in tumors with high TILs.
DOI
https://www.doi.org/10.1530/ERC-18-0494
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; B7-H1 Antigen/*metabolism; Biomarkers, Tumor/*metabolism; Female; Gene Expression Regulation, Neoplastic; Humans; Intestinal Neoplasms/diagnosis/*immunology/mortality/pathology; Lymphocytes, Tumor-Infiltrating/*metabolism; Male; Middle Aged; Neoplasm Grading; Neuroendocrine Tumors/diagnosis/*immunology/mortality/pathology; Observational Studies as Topic; Pancreatic Neoplasms/diagnosis/*immunology/mortality/pathology; Programmed Cell Death 1 Receptor/*metabolism; Stomach Neoplasms/diagnosis/*immunology/mortality/pathology; Survival Analysis; Young Adult; *pd-l1; *til; *checkpoint inhibitors; *microarray; *neuroendocrine tumor
Immune checkpoint markers in gastroenteropancreatic neuroendocrine neoplasia
Publication date
2019
Abstract
Cancer immunotherapy has evolved major breakthroughs in the last years. The cell-surface receptor programmed death-1 (PD-1) and its ligand, programmed death ligand-1 (PD-L1), have been detected in various cancer types. However, the analysis on gastroenteropancreatic neoplasia (GEP-NENs) is limited. Therefore, the aim of this study was to characterize GEP-NENs with regard to PD-1/PD-L1 pathway and tumor-infiltrating lymphocytes (TILs). On protein level, we examined TILs, PD-1 and PD-L1 expression in tumor tissue of 244 GEP-NENs using immunohistochemistry. Expression levels were correlated with clinicopathological parameters including long-term survival in an observational study. In total, 244 patients could be included. Most of the patients had a NEN of the small intestine (52.5%) or the pancreas (29.5%). All tumors could be graded by their morphology and Ki67 index, with 57.8% G1, 34% G2 and 8.2% G3 tumors. High TILs (19.6%) and high PD-1 (16.1%) expression showed a significant correlation with shorter patient survival (P < 0.05) and with a higher grading. Furthermore, expression of PD-L1 (8.7%) showed a trend to shorter patient survival. High TILs and PD-1 expression are significantly associated with shorter patient survival and higher grading in GEP-NENs. PD-L1 expression showed a trend to shorter patient survival. Immunotherapy might be a promising therapeutic approach in GEP-NENs especially in tumors with high TILs.
DOI
https://www.doi.org/10.1530/ERC-18-0494
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; B7-H1 Antigen/*metabolism; Biomarkers, Tumor/*metabolism; Female; Gene Expression Regulation, Neoplastic; Humans; Intestinal Neoplasms/diagnosis/*immunology/mortality/pathology; Lymphocytes, Tumor-Infiltrating/*metabolism; Male; Middle Aged; Neoplasm Grading; Neuroendocrine Tumors/diagnosis/*immunology/mortality/pathology; Observational Studies as Topic; Pancreatic Neoplasms/diagnosis/*immunology/mortality/pathology; Programmed Cell Death 1 Receptor/*metabolism; Stomach Neoplasms/diagnosis/*immunology/mortality/pathology; Survival Analysis; Young Adult; *pd-l1; *til; *checkpoint inhibitors; *microarray; *neuroendocrine tumor
Braisch, U.; Geiss, K.; Radespiel-Tröger, M.; et al. (2012) Population-Based Effects of Mammography Screening in Bavaria on the Distribution of TNM-T Categories with Respect to Different Histological Subgroups. Breast Care (Basel). https://www.doi.org/10.1159/000341369
Title
Population-Based Effects of Mammography Screening in Bavaria on the Distribution of TNM-T Categories with Respect to Different Histological Subgroups
Publication date
2012
Abstract
BACKGROUND: Organized mammography screening was implemented in Bavaria in 2003, with a target population of about 1.5 million women (aged 50-69 years). We evaluated the population-based effects of mammography screening on the distribution of tumor-node-metastasis (TNM)-T categories with regard to different histological subgroups of breast cancer. PATIENTS AND METHODS: Women diagnosed with breast cancer between 2002 and 2008 were included. The annual age-specific incidence rates separated by T category were calculated for different histological subgroups and plotted against time. Time trends were analyzed not only in the screening population but also based on women aged 15-49 and >/=70 years, respectively. Furthermore, correlation coefficients were calculated in order to evaluate the possible association between participation rate and incidence of certain TNM-T categories. RESULTS: With ductal carcinomas, the incidence of early-stage tumors shows a strong increase in the screening population and a significant correlation with the participation rate, whereas with lobular carcinomas there is a stagnation of incidence in women aged 50-69 years irrespective of TNM-T category. CONCLUSIONS: Short-term effects of mammography screening can already be demonstrated. However, depending on breast cancer type, not all women appear to benefit from screening. The expected long-term reduction of breast cancer mortality remains to be seen.
DOI
https://www.doi.org/10.1159/000341369
Keywords
Breast cancer; Histological types; Mammography; Screening
Population-Based Effects of Mammography Screening in Bavaria on the Distribution of TNM-T Categories with Respect to Different Histological Subgroups
Publication date
2012
Abstract
BACKGROUND: Organized mammography screening was implemented in Bavaria in 2003, with a target population of about 1.5 million women (aged 50-69 years). We evaluated the population-based effects of mammography screening on the distribution of tumor-node-metastasis (TNM)-T categories with regard to different histological subgroups of breast cancer. PATIENTS AND METHODS: Women diagnosed with breast cancer between 2002 and 2008 were included. The annual age-specific incidence rates separated by T category were calculated for different histological subgroups and plotted against time. Time trends were analyzed not only in the screening population but also based on women aged 15-49 and >/=70 years, respectively. Furthermore, correlation coefficients were calculated in order to evaluate the possible association between participation rate and incidence of certain TNM-T categories. RESULTS: With ductal carcinomas, the incidence of early-stage tumors shows a strong increase in the screening population and a significant correlation with the participation rate, whereas with lobular carcinomas there is a stagnation of incidence in women aged 50-69 years irrespective of TNM-T category. CONCLUSIONS: Short-term effects of mammography screening can already be demonstrated. However, depending on breast cancer type, not all women appear to benefit from screening. The expected long-term reduction of breast cancer mortality remains to be seen.
DOI
https://www.doi.org/10.1159/000341369
Keywords
Breast cancer; Histological types; Mammography; Screening
Braisch, U.; Meyer, M.; Radespiel-Tröger, M.. (2012) Risk of tobacco-related multiple primary cancers in Bavaria, Germany. BMC Cancer. https://www.doi.org/10.1186/1471-2407-12-250
Title
Risk of tobacco-related multiple primary cancers in Bavaria, Germany
Publication date
2012
Abstract
BACKGROUND: With the prospect of increasing prevalence of cancer, the issue of multiple primary cancers becomes more relevant. The aim of this study was to estimate the risk of developing a tobacco-related subsequent primary cancer (TRSPC) in persons with a tobacco-related first primary cancer (TRFPC) compared with the general population in Bavaria, Germany. METHODS: Using data from the Population-Based Cancer Registry Bavaria, we analyzed TRFPC and TRSPC diagnosed in Bavaria between 2002 and 2008 to estimate the relative and absolute risk of developing TRSPC using standardized incidence ratios (SIR) and excess absolute risks (EAR). RESULTS: 121,631 TRFPC in men and 75,886 respective cancers in women were registered, which in 2.5% of male and 1.2% of female cancer patients were followed by at least one TRSPC. In both males and females, the highest increased risks compared to the general population were found within the group of cancer in the mouth/pharynx, oesophagus, larynx, and lung/bronchus. CONCLUSIONS: With respect to cancer in the mouth/pharynx, oesophagus, larynx, lung/bronchus, kidney, urinary bladder and urinary tract, smoking was confirmed as a shared risk factor based on our finding of mutually significantly increased risks of TRSPC. The results of this study illustrate the importance of smoking cessation and of continued follow-up care especially of smokers with the aforementioned TRFPC to detect TRSPC at an early stage.
DOI
https://www.doi.org/10.1186/1471-2407-12-250
Keywords
Aged; Cohort Studies; Female; Germany/epidemiology; Humans; Male; Middle Aged; Neoplasms/*epidemiology/etiology; Registries; Risk Factors; Smoking/adverse effects/*epidemiology
Risk of tobacco-related multiple primary cancers in Bavaria, Germany
Publication date
2012
Abstract
BACKGROUND: With the prospect of increasing prevalence of cancer, the issue of multiple primary cancers becomes more relevant. The aim of this study was to estimate the risk of developing a tobacco-related subsequent primary cancer (TRSPC) in persons with a tobacco-related first primary cancer (TRFPC) compared with the general population in Bavaria, Germany. METHODS: Using data from the Population-Based Cancer Registry Bavaria, we analyzed TRFPC and TRSPC diagnosed in Bavaria between 2002 and 2008 to estimate the relative and absolute risk of developing TRSPC using standardized incidence ratios (SIR) and excess absolute risks (EAR). RESULTS: 121,631 TRFPC in men and 75,886 respective cancers in women were registered, which in 2.5% of male and 1.2% of female cancer patients were followed by at least one TRSPC. In both males and females, the highest increased risks compared to the general population were found within the group of cancer in the mouth/pharynx, oesophagus, larynx, and lung/bronchus. CONCLUSIONS: With respect to cancer in the mouth/pharynx, oesophagus, larynx, lung/bronchus, kidney, urinary bladder and urinary tract, smoking was confirmed as a shared risk factor based on our finding of mutually significantly increased risks of TRSPC. The results of this study illustrate the importance of smoking cessation and of continued follow-up care especially of smokers with the aforementioned TRFPC to detect TRSPC at an early stage.
DOI
https://www.doi.org/10.1186/1471-2407-12-250
Keywords
Aged; Cohort Studies; Female; Germany/epidemiology; Humans; Male; Middle Aged; Neoplasms/*epidemiology/etiology; Registries; Risk Factors; Smoking/adverse effects/*epidemiology
Braisch, U.; Meyer, M.; Radespiel-Tröger, M.. (2012) Risk of subsequent primary cancer among prostate cancer patients in Bavaria, Germany. Eur J Cancer Prev. https://www.doi.org/10.1097/CEJ.0b013e328351c748
Title
Risk of subsequent primary cancer among prostate cancer patients in Bavaria, Germany
Publication date
2012
Abstract
As the prevalence of prostate cancer in Germany is increasing, the issue of subsequent primary cancer (SPC) becomes more relevant. The aim of this study was to estimate the risk and its changes over time of developing SPC among prostate cancer patients compared with the general male population in Bavaria, southern Germany. Utilizing data from the Population-Based Cancer Registry Bavaria, the risk of SPC was evaluated in 59 259 men with prostate cancer diagnosed between 2002 and 2008 who contributed 159 892 person-years. The relative and absolute risk of developing SPC were calculated using the standardized incidence ratio (SIR) and the excess absolute risk. Changes in the risk were examined by plotting the SIR and its 95% confidence interval against time after the diagnosis of prostate cancer. The overall risk of SPC was significantly increased by 14% compared with the general male population. With regard to specific cancer types, a significantly increased risk of SPC was found for the urinary bladder, kidney, pancreas, melanoma of skin, leukemia, myeloma, brain/nervous system, renal pelvis/ureter, thyroid, and the small intestine. The absolute risk of SPC for most cancer types, however, was below 10 cases per 10 000 person-years. A significantly decreased risk of SPC was found in the lung/bronchus and the liver. Although detection bias cannot be excluded as a contributing factor for our results, we recommend continuing follow-up care of prostate cancer patients particularly with respect to SPC of the urinary system as a precaution.
DOI
https://www.doi.org/10.1097/CEJ.0b013e328351c748
Keywords
Germany/epidemiology; Humans; Incidence; Male; Neoplasms, Second Primary/diagnosis/epidemiology/*etiology; Prognosis; Prostatic Neoplasms/*complications/epidemiology; Risk Factors
Risk of subsequent primary cancer among prostate cancer patients in Bavaria, Germany
Publication date
2012
Abstract
As the prevalence of prostate cancer in Germany is increasing, the issue of subsequent primary cancer (SPC) becomes more relevant. The aim of this study was to estimate the risk and its changes over time of developing SPC among prostate cancer patients compared with the general male population in Bavaria, southern Germany. Utilizing data from the Population-Based Cancer Registry Bavaria, the risk of SPC was evaluated in 59 259 men with prostate cancer diagnosed between 2002 and 2008 who contributed 159 892 person-years. The relative and absolute risk of developing SPC were calculated using the standardized incidence ratio (SIR) and the excess absolute risk. Changes in the risk were examined by plotting the SIR and its 95% confidence interval against time after the diagnosis of prostate cancer. The overall risk of SPC was significantly increased by 14% compared with the general male population. With regard to specific cancer types, a significantly increased risk of SPC was found for the urinary bladder, kidney, pancreas, melanoma of skin, leukemia, myeloma, brain/nervous system, renal pelvis/ureter, thyroid, and the small intestine. The absolute risk of SPC for most cancer types, however, was below 10 cases per 10 000 person-years. A significantly decreased risk of SPC was found in the lung/bronchus and the liver. Although detection bias cannot be excluded as a contributing factor for our results, we recommend continuing follow-up care of prostate cancer patients particularly with respect to SPC of the urinary system as a precaution.
DOI
https://www.doi.org/10.1097/CEJ.0b013e328351c748
Keywords
Germany/epidemiology; Humans; Incidence; Male; Neoplasms, Second Primary/diagnosis/epidemiology/*etiology; Prognosis; Prostatic Neoplasms/*complications/epidemiology; Risk Factors
Braun, R.; Klinkhammer-Schalke, M.; Zeissig, S. R.; et al. (2022) Clinical Outcome and Prognostic Factors of Pancreatic Adenosquamous Carcinoma Compared to Ductal Adenocarcinoma-Results from the German Cancer Registry Group. Cancers (Basel). https://www.doi.org/10.3390/cancers14163946
Title
Clinical Outcome and Prognostic Factors of Pancreatic Adenosquamous Carcinoma Compared to Ductal Adenocarcinoma-Results from the German Cancer Registry Group
Publication date
2022
Abstract
BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCP) is a rare malignancy and its pathophysiology is poorly understood. Sparse clinical data suggest that clinical outcome and overall survival is worse in comparison to common pancreatic ductal adenocarcinoma (PDAC). METHODS: We evaluated clinical outcome and prognostic factors for overall survival of patients with ASCP in comparison to patients with PDAC recorded between 2000 and 2019 in 17 population-based clinical cancer registries at certified cancer centers within the Association of German Tumor Centers (ADT). RESULTS: We identified 278 (0.5%) patients with ASCP in the entire cohort of 52,518 patients with pancreatic cancer. Significantly, more patients underwent surgical resection in the cohort of ASCP patients in comparison to patients with PDAC (p < 0.001). In the cohort of 142 surgically resected patients with ASCP, the majority of patients was treated by pancreatoduodenectomy (44.4%). However, compared to the cohort of PDAC patients, significantly more patients underwent distal pancreatectomy (p < 0.001), suggesting that a significantly higher proportion of ASCP tumors was located in the pancreatic body/tail. ASCPs were significantly more often poorly differentiated (G3) (p < 0.001) and blood vessel invasion (V1) was detected more frequently (p = 0.01) in comparison with PDAC. Median overall survival was 6.13 months (95% CI 5.20-7.06) for ASCP and 8.10 months (95% CI 7.93-8.22) for PDAC patients, respectively (p = 0.094). However, when comparing only those patients who underwent surgical resection, overall survival of ASCP patients was significantly shorter (11.80; 95% CI 8.20-15.40 months) compared to PDAC patients (16.17; 95% CI 15.78-16.55 months) (p = 0.007). ASCP was a highly significant prognostic factor for overall survival in univariable regression analysis (p = 0.007) as well as in multivariable Cox regression analysis (HR 1.303; 95% CI 1.013-1.677; p = 0.039). CONCLUSIONS: In conclusion, ASCP showed poorer differentiation and higher frequency of blood vessel invasion indicative of a more aggressive tumor biology. ASCP was a significant prognostic factor for overall survival in a multivariable analysis. Overall survival of resected ASCP patients was significantly shorter compared to resected PDAC patients. However, surgical resection still improved survival significantly.
DOI
https://www.doi.org/10.3390/cancers14163946
Keywords
adenosquamous carcinoma; ductal adenocarcinoma; overall survival; pancreatic cancer
Clinical Outcome and Prognostic Factors of Pancreatic Adenosquamous Carcinoma Compared to Ductal Adenocarcinoma-Results from the German Cancer Registry Group
Publication date
2022
Abstract
BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCP) is a rare malignancy and its pathophysiology is poorly understood. Sparse clinical data suggest that clinical outcome and overall survival is worse in comparison to common pancreatic ductal adenocarcinoma (PDAC). METHODS: We evaluated clinical outcome and prognostic factors for overall survival of patients with ASCP in comparison to patients with PDAC recorded between 2000 and 2019 in 17 population-based clinical cancer registries at certified cancer centers within the Association of German Tumor Centers (ADT). RESULTS: We identified 278 (0.5%) patients with ASCP in the entire cohort of 52,518 patients with pancreatic cancer. Significantly, more patients underwent surgical resection in the cohort of ASCP patients in comparison to patients with PDAC (p < 0.001). In the cohort of 142 surgically resected patients with ASCP, the majority of patients was treated by pancreatoduodenectomy (44.4%). However, compared to the cohort of PDAC patients, significantly more patients underwent distal pancreatectomy (p < 0.001), suggesting that a significantly higher proportion of ASCP tumors was located in the pancreatic body/tail. ASCPs were significantly more often poorly differentiated (G3) (p < 0.001) and blood vessel invasion (V1) was detected more frequently (p = 0.01) in comparison with PDAC. Median overall survival was 6.13 months (95% CI 5.20-7.06) for ASCP and 8.10 months (95% CI 7.93-8.22) for PDAC patients, respectively (p = 0.094). However, when comparing only those patients who underwent surgical resection, overall survival of ASCP patients was significantly shorter (11.80; 95% CI 8.20-15.40 months) compared to PDAC patients (16.17; 95% CI 15.78-16.55 months) (p = 0.007). ASCP was a highly significant prognostic factor for overall survival in univariable regression analysis (p = 0.007) as well as in multivariable Cox regression analysis (HR 1.303; 95% CI 1.013-1.677; p = 0.039). CONCLUSIONS: In conclusion, ASCP showed poorer differentiation and higher frequency of blood vessel invasion indicative of a more aggressive tumor biology. ASCP was a significant prognostic factor for overall survival in a multivariable analysis. Overall survival of resected ASCP patients was significantly shorter compared to resected PDAC patients. However, surgical resection still improved survival significantly.
DOI
https://www.doi.org/10.3390/cancers14163946
Keywords
adenosquamous carcinoma; ductal adenocarcinoma; overall survival; pancreatic cancer
Corradini, S.; Pazos, M.; Schonecker, S.; et al. (2018) Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases. Radiat Oncol. https://www.doi.org/10.1186/s13014-018-0964-7
Title
Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases
Publication date
2018
Abstract
BACKGROUND: The objective of the present study was to evaluate the effectiveness of postoperative radiotherapy after breast conserving surgery (BCS) in DCIS in a large patient population treated in clinical practice. METHODS: Data were provided by the population-based Munich Cancer Registry. Between 1998 and 2014, 1048 female patients with diagnosis of DCIS and treated at two Breast Care Centres were included in this observational study. The effectiveness of postoperative radiotherapy and variables predicting the use of radiotherapy were retrospectively analysed. RESULTS: After adjusting for age, tumour characteristics and therapies, Cox regression analysis for local recurrence-free survival identified RT as an independent predictor for improved local control (HR: 0.579; 95%CI: 0.384-0.872, p = 0.008). Ten-year cumulative incidence of in-breast recurrences was 20.0% following BCS, compared to 13.6% in patients receiving postoperative radiotherapy (p = 0.012). As an estimate for disease-specific survival, 10-year relative survival was 105.4% for patients receiving postoperative radiotherapy and 101.6% without radiotherapy. On multivariate analysis, postoperative radiotherapy was not associated with improved overall survival (HR 0.526; 95%CI: 0.263-1.052, p = 0.069). Over time, a significant increase of RT was registered: while 1998 only 42.9% of patients received postoperative radiotherapy, the proportion rose to 91.2% in 2014. Women aged < 50 years (OR: 2.559, 95%CI: 1.416-4.625, p < 0.001) or with negative hormone receptor status (OR: 2.625, 95%CI: 1.458-4.728, p = 0.001) or receiving endocrine therapy (OR: 1.762, 95%CI: 1.060-2.927, p = 0.029) were more likely to receive postoperative radiotherapy after BCS. CONCLUSIONS: In conclusion, this study provides insights regarding the adoption and treatment pattern of postoperative RT following BCS for DCIS in a large cohort reflecting "real-life" clinical practice in this setting. Postoperative RT was found to be associated with a reduced risk of ipsilateral recurrence and no survival benefit compared to observation alone.
DOI
https://www.doi.org/10.1186/s13014-018-0964-7
Keywords
Aged; Breast Neoplasms/pathology/*radiotherapy/surgery; Carcinoma, Ductal, Breast/pathology/*radiotherapy/surgery; Carcinoma, Intraductal, Noninfiltrating/pathology/*radiotherapy/surgery; Female; Follow-Up Studies; Humans; Male; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local/*prevention & control; Prognosis; Retrospective Studies; Breast conserving surgery; Ductal carcinoma in situ; In-breast recurrence; Local control; Outcome; Radiotherapy; Survival
Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases
Publication date
2018
Abstract
BACKGROUND: The objective of the present study was to evaluate the effectiveness of postoperative radiotherapy after breast conserving surgery (BCS) in DCIS in a large patient population treated in clinical practice. METHODS: Data were provided by the population-based Munich Cancer Registry. Between 1998 and 2014, 1048 female patients with diagnosis of DCIS and treated at two Breast Care Centres were included in this observational study. The effectiveness of postoperative radiotherapy and variables predicting the use of radiotherapy were retrospectively analysed. RESULTS: After adjusting for age, tumour characteristics and therapies, Cox regression analysis for local recurrence-free survival identified RT as an independent predictor for improved local control (HR: 0.579; 95%CI: 0.384-0.872, p = 0.008). Ten-year cumulative incidence of in-breast recurrences was 20.0% following BCS, compared to 13.6% in patients receiving postoperative radiotherapy (p = 0.012). As an estimate for disease-specific survival, 10-year relative survival was 105.4% for patients receiving postoperative radiotherapy and 101.6% without radiotherapy. On multivariate analysis, postoperative radiotherapy was not associated with improved overall survival (HR 0.526; 95%CI: 0.263-1.052, p = 0.069). Over time, a significant increase of RT was registered: while 1998 only 42.9% of patients received postoperative radiotherapy, the proportion rose to 91.2% in 2014. Women aged < 50 years (OR: 2.559, 95%CI: 1.416-4.625, p < 0.001) or with negative hormone receptor status (OR: 2.625, 95%CI: 1.458-4.728, p = 0.001) or receiving endocrine therapy (OR: 1.762, 95%CI: 1.060-2.927, p = 0.029) were more likely to receive postoperative radiotherapy after BCS. CONCLUSIONS: In conclusion, this study provides insights regarding the adoption and treatment pattern of postoperative RT following BCS for DCIS in a large cohort reflecting "real-life" clinical practice in this setting. Postoperative RT was found to be associated with a reduced risk of ipsilateral recurrence and no survival benefit compared to observation alone.
DOI
https://www.doi.org/10.1186/s13014-018-0964-7
Keywords
Aged; Breast Neoplasms/pathology/*radiotherapy/surgery; Carcinoma, Ductal, Breast/pathology/*radiotherapy/surgery; Carcinoma, Intraductal, Noninfiltrating/pathology/*radiotherapy/surgery; Female; Follow-Up Studies; Humans; Male; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local/*prevention & control; Prognosis; Retrospective Studies; Breast conserving surgery; Ductal carcinoma in situ; In-breast recurrence; Local control; Outcome; Radiotherapy; Survival
Czogalla, B.; Pham, D.; Trillsch, F.; et al. (2020) PD-L1 expression and survival in p16-negative and -positive squamous cell carcinomas of the vulva. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-020-03126-9
Title
PD-L1 expression and survival in p16-negative and -positive squamous cell carcinomas of the vulva
Publication date
2020
Abstract
AIM: Programmed death-ligand 1 (PD-L1) has become a widely used predictive biomarker for therapy with checkpoint inhibitors in a variety of cancers. Here, we studied the expression of PD-L1 in squamous cell carcinomas of the vulva (SCCV) with regard to HPV status via its surrogate marker p16. Additionally, the status of PD-L1 and p16 were analyzed for prognostic information and potential correlation to tumor-infiltrating lymphocytes (TILs). METHODS: PD-L1 was analyzed in 128 cases of SCCV using the tumor proportion score (TPS), the immune cell score (ICS) and the combined positive score (CPS). Cases were immunostained for p16 and analyzed for stromal TILs. PD-L1, p16, and TILs were compared to clinico-pathological parameters and patient's survival. RESULTS: TPS >/= 50% and CPS >/= 50 were correlated to a worse grading (p = 0.028 and p = 0.031), but not to FIGO-stage. CPS >/= 50 was associated to a worse prognosis with overall survival (p = 0.021) but was not correlated to the progression-free survival. P16-positivity was correlated to a longer progression-free survival (p = 0.006) and overall survival (p = 0.023). PD-L1 expression was independent from p16 status. TILs >/= 50% were present in 24% of the cases and were strongly correlated to PD-L1 (TPS p = 0.02, ICS p < 0.001, CPS p = 0.001). CONCLUSION: Our data demonstrate that PD-L1 expression is frequent in SCCV and independent from p16 status. High PD-L1 expression was associated with an unfavorable outcome whereas p16-positivity turned out to be an independent positive prognostic factor.
DOI
https://www.doi.org/10.1007/s00432-020-03126-9
Keywords
Adult; Aged; Aged, 80 and over; B7-H1 Antigen/*biosynthesis; Biomarkers, Tumor/analysis; Carcinoma, Squamous Cell/metabolism/*pathology/virology; Cyclin-Dependent Kinase Inhibitor p16/biosynthesis; Female; Humans; Lymphocytes, Tumor-Infiltrating/immunology; Middle Aged; Papillomavirus Infections/complications; Prognosis; Survival Analysis; Vulvar Neoplasms/metabolism/*pathology/virology; Young Adult; Pd-l1; Squamous cell carcinoma of the vulva; Tils; p16
PD-L1 expression and survival in p16-negative and -positive squamous cell carcinomas of the vulva
Publication date
2020
Abstract
AIM: Programmed death-ligand 1 (PD-L1) has become a widely used predictive biomarker for therapy with checkpoint inhibitors in a variety of cancers. Here, we studied the expression of PD-L1 in squamous cell carcinomas of the vulva (SCCV) with regard to HPV status via its surrogate marker p16. Additionally, the status of PD-L1 and p16 were analyzed for prognostic information and potential correlation to tumor-infiltrating lymphocytes (TILs). METHODS: PD-L1 was analyzed in 128 cases of SCCV using the tumor proportion score (TPS), the immune cell score (ICS) and the combined positive score (CPS). Cases were immunostained for p16 and analyzed for stromal TILs. PD-L1, p16, and TILs were compared to clinico-pathological parameters and patient's survival. RESULTS: TPS >/= 50% and CPS >/= 50 were correlated to a worse grading (p = 0.028 and p = 0.031), but not to FIGO-stage. CPS >/= 50 was associated to a worse prognosis with overall survival (p = 0.021) but was not correlated to the progression-free survival. P16-positivity was correlated to a longer progression-free survival (p = 0.006) and overall survival (p = 0.023). PD-L1 expression was independent from p16 status. TILs >/= 50% were present in 24% of the cases and were strongly correlated to PD-L1 (TPS p = 0.02, ICS p < 0.001, CPS p = 0.001). CONCLUSION: Our data demonstrate that PD-L1 expression is frequent in SCCV and independent from p16 status. High PD-L1 expression was associated with an unfavorable outcome whereas p16-positivity turned out to be an independent positive prognostic factor.
DOI
https://www.doi.org/10.1007/s00432-020-03126-9
Keywords
Adult; Aged; Aged, 80 and over; B7-H1 Antigen/*biosynthesis; Biomarkers, Tumor/analysis; Carcinoma, Squamous Cell/metabolism/*pathology/virology; Cyclin-Dependent Kinase Inhibitor p16/biosynthesis; Female; Humans; Lymphocytes, Tumor-Infiltrating/immunology; Middle Aged; Papillomavirus Infections/complications; Prognosis; Survival Analysis; Vulvar Neoplasms/metabolism/*pathology/virology; Young Adult; Pd-l1; Squamous cell carcinoma of the vulva; Tils; p16
De Toni, E. N.; Schlesinger-Raab, A.; Fuchs, M.; et al. (2020) Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study. Gut. https://www.doi.org/10.1136/gutjnl-2018-318193
Title
Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study
Publication date
2020
Abstract
OBJECTIVE: Hepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients. DESIGN: 4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables. RESULTS: While incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998-2002, 22.4% in 2003-2007, 30.6% in 2008-2012 up to 31.0% in 2013-2016. Median OS increased from 6 months in 1998-2002 to 12 months in 2008-2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged. CONCLUSION: These real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age.
DOI
https://www.doi.org/10.1136/gutjnl-2018-318193
Keywords
Aged; Aged, 80 and over; Carcinoma, Hepatocellular/diagnosis/*mortality/*secondary/therapy; Early Detection of Cancer/*mortality; Female; Germany/epidemiology; Humans; Incidence; Kaplan-Meier Estimate; Liver Neoplasms/diagnosis/*mortality/*pathology/therapy; Male; Middle Aged; Neoplasm Staging; Prognosis; Proportional Hazards Models; Survival Rate/trends; *hepatocellular carcinoma; *real-life-data; *survival; *tumor stage
Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study
Publication date
2020
Abstract
OBJECTIVE: Hepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients. DESIGN: 4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables. RESULTS: While incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998-2002, 22.4% in 2003-2007, 30.6% in 2008-2012 up to 31.0% in 2013-2016. Median OS increased from 6 months in 1998-2002 to 12 months in 2008-2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged. CONCLUSION: These real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age.
DOI
https://www.doi.org/10.1136/gutjnl-2018-318193
Keywords
Aged; Aged, 80 and over; Carcinoma, Hepatocellular/diagnosis/*mortality/*secondary/therapy; Early Detection of Cancer/*mortality; Female; Germany/epidemiology; Humans; Incidence; Kaplan-Meier Estimate; Liver Neoplasms/diagnosis/*mortality/*pathology/therapy; Male; Middle Aged; Neoplasm Staging; Prognosis; Proportional Hazards Models; Survival Rate/trends; *hepatocellular carcinoma; *real-life-data; *survival; *tumor stage
Deichmann, S.; Dworschak, O.; Kulemann, B.; et al. (2022) [Incidence, Treatment and Survival in Pancreatic Cancer- Data of the Nationwide Oncological Quality Conference from a Surgical Perspective]. Zentralbl Chir. https://www.doi.org/10.1055/a-1768-1012
Title
[Incidence, Treatment and Survival in Pancreatic Cancer- Data of the Nationwide Oncological Quality Conference from a Surgical Perspective]
Publication date
2022
Abstract
BACKGROUND: In recent years, there have been changes in the treatment of ductal pancreatic carcinoma with regard to multimodal therapy and also surgical therapy. These changes have not yet been explored in large nationwide studies in Germany. The present work gives an initial overview from a surgical perspective of the developments in diagnosis, therapy and survival of pancreatic cancer within the last 19 years in Germany. METHODS: In this cohort of 18 clinical cancer registries in Germany, patients with a diagnosis of ductal pancreatic cancer from 2000-2018 were included. The patients were categorised according to the years of diagnosis (2000-2009 vs. 2010-2018) and treatment modalities and compared. RESULTS: In the cohort of approx. 48000 patients with ductal pancreatic cancer, the number of newly diagnosed cases increased from approx. 18000 to 30000 patients in the two ten-year periods. The median overall survival increased slightly but statistically significantly from 7.1 to 7.9 months (p < 0.001). The resection rate increased from 25% to 32%, with the proportion of patients for whom no specific therapy was reported decreased by 11%. The rate of palliative chemotherapy and neoadjuvant chemotherapy also increased from 16% to 20% of the patients and from less than 1% to 2% of the patients, respectively. The median survival in the curatively treated subgroups was up to 24 months. SUMMARY: The cancer registry data appear to confirm the known increase in the incidence of pancreatic cancer in the western world. Resection rates and the rates of treatment with neoadjuvant and palliative intent also increased. The overall survival of all patients with ductal pancreatic cancer only increased marginally. In the subgroups of patients who were treated with curative intent, however, significantly longer survival times were found.
DOI
https://www.doi.org/10.1055/a-1768-1012
Keywords
*Carcinoma, Pancreatic Ductal/epidemiology/surgery; Humans; Incidence; Pancreatectomy; *Pancreatic Neoplasms/epidemiology/surgery
[Incidence, Treatment and Survival in Pancreatic Cancer- Data of the Nationwide Oncological Quality Conference from a Surgical Perspective]
Publication date
2022
Abstract
BACKGROUND: In recent years, there have been changes in the treatment of ductal pancreatic carcinoma with regard to multimodal therapy and also surgical therapy. These changes have not yet been explored in large nationwide studies in Germany. The present work gives an initial overview from a surgical perspective of the developments in diagnosis, therapy and survival of pancreatic cancer within the last 19 years in Germany. METHODS: In this cohort of 18 clinical cancer registries in Germany, patients with a diagnosis of ductal pancreatic cancer from 2000-2018 were included. The patients were categorised according to the years of diagnosis (2000-2009 vs. 2010-2018) and treatment modalities and compared. RESULTS: In the cohort of approx. 48000 patients with ductal pancreatic cancer, the number of newly diagnosed cases increased from approx. 18000 to 30000 patients in the two ten-year periods. The median overall survival increased slightly but statistically significantly from 7.1 to 7.9 months (p < 0.001). The resection rate increased from 25% to 32%, with the proportion of patients for whom no specific therapy was reported decreased by 11%. The rate of palliative chemotherapy and neoadjuvant chemotherapy also increased from 16% to 20% of the patients and from less than 1% to 2% of the patients, respectively. The median survival in the curatively treated subgroups was up to 24 months. SUMMARY: The cancer registry data appear to confirm the known increase in the incidence of pancreatic cancer in the western world. Resection rates and the rates of treatment with neoadjuvant and palliative intent also increased. The overall survival of all patients with ductal pancreatic cancer only increased marginally. In the subgroups of patients who were treated with curative intent, however, significantly longer survival times were found.
DOI
https://www.doi.org/10.1055/a-1768-1012
Keywords
*Carcinoma, Pancreatic Ductal/epidemiology/surgery; Humans; Incidence; Pancreatectomy; *Pancreatic Neoplasms/epidemiology/surgery
Ditsch, N.; Heublein, S.; Jeschke, U.; et al. (2020) Cytoplasmic versus nuclear THR alpha expression determines survival of ovarian cancer patients. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-020-03241-7
Title
Cytoplasmic versus nuclear THR alpha expression determines survival of ovarian cancer patients
Publication date
2020
Abstract
PURPOSE: Thyroid hormone receptors (THR) have manifold functions and are involved in the carcinogenesis of several tumor types. Within this study, we aimed to investigate the expression pattern (nuclear versus cytoplasmic) of the THR alpha and its impact on patients survival in ovarian cancer (OvCa). METHODS: The presence of the thyroid hormone receptors THRalpha, THRalpha1 and - 2 was investigated in 156 ovarian cancer samples using immunohistochemistry (IHC) using semi-quantitative immunoreactivity (IR) scores and correlated with clinical, pathological data, subtype of ovarian cancer, clinical data, staining of 20 already described OvCa marker proteins and overall survival (OS). RESULTS: Among all subtypes of OvCa, clear cell carcinomas showed the highest THRalpha expression. Furthermore, nuclear THRalpha was associated with a reduced survival in this subtype. However, nuclear expressed THRalpha1 turned out to be a positive prognosticator for all subtypes of OvCa patients. Nuclear THRalpha2 is a positive prognosticator for OvCa patients of the serous subtype. In contrast, cytoplasmic expression THRalpha2 was associated with a reduced OS in all subtypes of OvCa patients; while, cytoplasmic expression of THRalpha1 is associated with reduced OS in mucinous OvCa patients only. In addition, THRalpha expression correlates with gonadotropin receptors, steroid hormone receptors, TA-MUC1 and glycodelin. CONCLUSION: Depending on nuclear or cytoplasmic expression, our study shows that THRalpha and its isoforms 1 and 2 provide different prognostic information for ovarian cancer patients. Further investigations should analyze if THRs may represent new endocrine targets for the treatment of ovarian cancer.
DOI
https://www.doi.org/10.1007/s00432-020-03241-7
Keywords
Aged; Aged, 80 and over; Carcinoma, Ovarian Epithelial/*metabolism; Cell Nucleus/metabolism; Cytoplasm/metabolism; Female; Humans; Immunohistochemistry; Middle Aged; Ovarian Neoplasms/*metabolism; Survival Rate; Thyroid Hormone Receptors alpha/*biosynthesis; Nuclear versus cytoplasmic; Ovarian cancer; Overall survival; Thyroid hormone receptor
Cytoplasmic versus nuclear THR alpha expression determines survival of ovarian cancer patients
Publication date
2020
Abstract
PURPOSE: Thyroid hormone receptors (THR) have manifold functions and are involved in the carcinogenesis of several tumor types. Within this study, we aimed to investigate the expression pattern (nuclear versus cytoplasmic) of the THR alpha and its impact on patients survival in ovarian cancer (OvCa). METHODS: The presence of the thyroid hormone receptors THRalpha, THRalpha1 and - 2 was investigated in 156 ovarian cancer samples using immunohistochemistry (IHC) using semi-quantitative immunoreactivity (IR) scores and correlated with clinical, pathological data, subtype of ovarian cancer, clinical data, staining of 20 already described OvCa marker proteins and overall survival (OS). RESULTS: Among all subtypes of OvCa, clear cell carcinomas showed the highest THRalpha expression. Furthermore, nuclear THRalpha was associated with a reduced survival in this subtype. However, nuclear expressed THRalpha1 turned out to be a positive prognosticator for all subtypes of OvCa patients. Nuclear THRalpha2 is a positive prognosticator for OvCa patients of the serous subtype. In contrast, cytoplasmic expression THRalpha2 was associated with a reduced OS in all subtypes of OvCa patients; while, cytoplasmic expression of THRalpha1 is associated with reduced OS in mucinous OvCa patients only. In addition, THRalpha expression correlates with gonadotropin receptors, steroid hormone receptors, TA-MUC1 and glycodelin. CONCLUSION: Depending on nuclear or cytoplasmic expression, our study shows that THRalpha and its isoforms 1 and 2 provide different prognostic information for ovarian cancer patients. Further investigations should analyze if THRs may represent new endocrine targets for the treatment of ovarian cancer.
DOI
https://www.doi.org/10.1007/s00432-020-03241-7
Keywords
Aged; Aged, 80 and over; Carcinoma, Ovarian Epithelial/*metabolism; Cell Nucleus/metabolism; Cytoplasm/metabolism; Female; Humans; Immunohistochemistry; Middle Aged; Ovarian Neoplasms/*metabolism; Survival Rate; Thyroid Hormone Receptors alpha/*biosynthesis; Nuclear versus cytoplasmic; Ovarian cancer; Overall survival; Thyroid hormone receptor
Doege, D.; Thong, M. S. Y.; Koch-Gallenkamp, L.; et al. (2022) Clinical and sociodemographic determinants of disease-specific health-related quality of life in long-term breast cancer survivors. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-022-04204-w
Title
Clinical and sociodemographic determinants of disease-specific health-related quality of life in long-term breast cancer survivors
Publication date
2022
Abstract
PURPOSE: It is important to monitor disease-specific health-related quality of life (HRQoL) in breast cancer (BC) survivors to identify potential unmet supportive care needs. However, previous studies were characterized by small samples of mostly short-term survivors and were limited to certain age ranges, stages and/or treatments. METHODS: We used data from 3045 long-term BC survivors (5-15 years post-diagnosis) recruited in a German multi-regional population-based study. We assessed disease-specific HRQoL with the EORTC QLQ-BR23, scoring from 0 to 100. Differences in functioning and symptoms according to age at survey, self-reported treatments, stage, and disease status (disease-free vs. active disease) were assessed with multiple regression. Active disease was defined as any self-report of recurrence, metastasis or second primary cancer after the index cancer. RESULTS: Older BC survivors reported a higher body image and a better future perspective, but lower sexual functioning. Survivors aged 30-49 years who had breast-conserving therapy or mastectomy with breast reconstruction reported a better body image compared to those who had mastectomy only. We also found differences in symptoms according to treatments in some age groups. Stage at diagnosis was not associated with HRQoL overall and in most age subgroups. Disease-free BC survivors aged 30-79 years reported a better future perspective and less systemic therapy side effects than those with active disease. CONCLUSION: Several treatment-associated symptoms and functioning detriments were found 5-15 years after diagnosis. The results emphasize the need of a comprehensive, individualized survivorship care, recognizing differential needs of long-term BC survivors according to age, treatment modalities, and disease status.
DOI
https://www.doi.org/10.1007/s00432-022-04204-w
Keywords
Humans; Female; *Cancer Survivors; Quality of Life; *Breast Neoplasms/epidemiology/therapy/pathology; Mastectomy; Mastectomy, Segmental; Surveys and Questionnaires; Adverse effects; Body image; Breast cancer survivors; Disease-specific issues; Hair loss; Sexuality
Clinical and sociodemographic determinants of disease-specific health-related quality of life in long-term breast cancer survivors
Publication date
2022
Abstract
PURPOSE: It is important to monitor disease-specific health-related quality of life (HRQoL) in breast cancer (BC) survivors to identify potential unmet supportive care needs. However, previous studies were characterized by small samples of mostly short-term survivors and were limited to certain age ranges, stages and/or treatments. METHODS: We used data from 3045 long-term BC survivors (5-15 years post-diagnosis) recruited in a German multi-regional population-based study. We assessed disease-specific HRQoL with the EORTC QLQ-BR23, scoring from 0 to 100. Differences in functioning and symptoms according to age at survey, self-reported treatments, stage, and disease status (disease-free vs. active disease) were assessed with multiple regression. Active disease was defined as any self-report of recurrence, metastasis or second primary cancer after the index cancer. RESULTS: Older BC survivors reported a higher body image and a better future perspective, but lower sexual functioning. Survivors aged 30-49 years who had breast-conserving therapy or mastectomy with breast reconstruction reported a better body image compared to those who had mastectomy only. We also found differences in symptoms according to treatments in some age groups. Stage at diagnosis was not associated with HRQoL overall and in most age subgroups. Disease-free BC survivors aged 30-79 years reported a better future perspective and less systemic therapy side effects than those with active disease. CONCLUSION: Several treatment-associated symptoms and functioning detriments were found 5-15 years after diagnosis. The results emphasize the need of a comprehensive, individualized survivorship care, recognizing differential needs of long-term BC survivors according to age, treatment modalities, and disease status.
DOI
https://www.doi.org/10.1007/s00432-022-04204-w
Keywords
Humans; Female; *Cancer Survivors; Quality of Life; *Breast Neoplasms/epidemiology/therapy/pathology; Mastectomy; Mastectomy, Segmental; Surveys and Questionnaires; Adverse effects; Body image; Breast cancer survivors; Disease-specific issues; Hair loss; Sexuality
Draeger, T.; Völkel, V.; Schnitzbauer, V.; et al. (2019) Laparoscopic and open resection of rectal cancer-is age an effect modifier for short- and long-term survival?. Int J Colorectal Dis. https://www.doi.org/10.1007/s00384-019-03265-7
Title
Laparoscopic and open resection of rectal cancer-is age an effect modifier for short- and long-term survival?
Publication date
2019
Abstract
INTRODUCTION: Rectal cancer is a frequently diagnosed tumor worldwide. Various studies have shown the noninferiority or even slight superiority of laparoscopic resection. However, there is no clear recommendation on whether age should influence the choice of surgical approach. MATERIALS AND METHODS: This study compared outcomes of laparoscopic and open surgery in rectal cancer patients. Perioperative mortality and 5-year overall, relative, and recurrence-free survival rates were analyzed separately for three age groups. Data originate from 30 regional German cancer registries that cover approximately one quarter of the German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were used; a sensitivity analysis assessed bias by exclusion. RESULTS: Ten thousand seven hundred fifty-four patients were included in the analysis. The mean laparoscopy rate was 23.0% and increased over time. Analysis of 30-day postoperative mortality rates revealed advantages for laparoscopically treated patients, although the significance level was not reached in any age group. Regarding 5-year overall survival, laparoscopy generally seems to be the superior approach, whereas for recurrence-free survival, an age-dependent gradient in effect size was observed: with a hazard ratio (HR) of 0.703 for laparoscopy, patients under 60 years benefitted more from the minimally invasive approach than older patients (septuagenarians, HR 0.923). CONCLUSION: Laparoscopy shows similar results to the open approach in terms of postoperative survival in all age groups. Concerning long-term outcomes, younger patients benefitted most from the minimally invasive approach.
DOI
https://www.doi.org/10.1007/s00384-019-03265-7
Keywords
Age Factors; Aged; Disease-Free Survival; Female; Humans; *Laparoscopy; Male; Middle Aged; Rectal Neoplasms/*epidemiology/mortality/*surgery; Survival Analysis; Time Factors; Age groups; Bowel cancer; Health services research; Minimally invasive surgery; Registries
Laparoscopic and open resection of rectal cancer-is age an effect modifier for short- and long-term survival?
Publication date
2019
Abstract
INTRODUCTION: Rectal cancer is a frequently diagnosed tumor worldwide. Various studies have shown the noninferiority or even slight superiority of laparoscopic resection. However, there is no clear recommendation on whether age should influence the choice of surgical approach. MATERIALS AND METHODS: This study compared outcomes of laparoscopic and open surgery in rectal cancer patients. Perioperative mortality and 5-year overall, relative, and recurrence-free survival rates were analyzed separately for three age groups. Data originate from 30 regional German cancer registries that cover approximately one quarter of the German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were used; a sensitivity analysis assessed bias by exclusion. RESULTS: Ten thousand seven hundred fifty-four patients were included in the analysis. The mean laparoscopy rate was 23.0% and increased over time. Analysis of 30-day postoperative mortality rates revealed advantages for laparoscopically treated patients, although the significance level was not reached in any age group. Regarding 5-year overall survival, laparoscopy generally seems to be the superior approach, whereas for recurrence-free survival, an age-dependent gradient in effect size was observed: with a hazard ratio (HR) of 0.703 for laparoscopy, patients under 60 years benefitted more from the minimally invasive approach than older patients (septuagenarians, HR 0.923). CONCLUSION: Laparoscopy shows similar results to the open approach in terms of postoperative survival in all age groups. Concerning long-term outcomes, younger patients benefitted most from the minimally invasive approach.
DOI
https://www.doi.org/10.1007/s00384-019-03265-7
Keywords
Age Factors; Aged; Disease-Free Survival; Female; Humans; *Laparoscopy; Male; Middle Aged; Rectal Neoplasms/*epidemiology/mortality/*surgery; Survival Analysis; Time Factors; Age groups; Bowel cancer; Health services research; Minimally invasive surgery; Registries
Eichberger, J.; Weber, F.; Spanier, G.; et al. (2022) Loss of MMP-27 Predicts Mandibular Bone Invasion in Oral Squamous Cell Carcinoma. Cancers (Basel). https://www.doi.org/10.3390/cancers14164044
Title
Loss of MMP-27 Predicts Mandibular Bone Invasion in Oral Squamous Cell Carcinoma
Publication date
2022
Abstract
Invasion of the mandibular bone is frequent in oral squamous cell carcinoma (OSCC), which often results in extensive ablative and reconstructive procedures for the patient. The purpose of this single-center, retrospective study was to identify and evaluate potential biomarkers and risk factors for bone invasion in OSCC. Initially, in silico gene expression analysis was performed for different HNSCC tumor T-stages to find factors associated with invasive (T4a) tumor growth. Afterwards, the protein expression of bone-metabolizing MMP-27, TNFRSF11B (Osteoprotegerin, OPG), and TNFSF11 (RANKL) was investigated via Tissue Microarrays (TMAs) for their impact on mandibular bone invasion. TMAs were assembled from the bone-tumor interface of primary OSCCs of the floor of the mouth and gingiva from 119 patients. Sixty-four carcinomas with patho-histological jaw invasion (pT4a) were compared to 55 carcinomas growing along the mandible without invasion (pT2, pT3). Tissue samples were additionally evaluated for patterns of invasion using the WPOI grading system. Statistical analysis of in silico data revealed decreased MMP-27 mRNA expression to be strongly associated with the pT4a-stage in OSCC, indicating invasive tumor growth with infiltration of adjacent anatomical structures. Our own clinico-pathological data on OSCCs presented a significant decrease of MMP-27 in tumors invading the nearby mandible (pT4a), compared to pT2 and pT3 tumors without bone invasion. Loss of MMP27 evolved as the strongest predictor of mandibular bone invasion in binary logistic regression analysis. To our knowledge, this is the first study investigating the role of MMP-27 expression in OSCC and demonstrating the importance of the loss of MMP-27 in mandibular bone invasion.
DOI
https://www.doi.org/10.3390/cancers14164044
Keywords
Mmp-27; Opg; Oscc; Rankl; mandibular bone invasion; oral squamous cell carcinoma
Loss of MMP-27 Predicts Mandibular Bone Invasion in Oral Squamous Cell Carcinoma
Publication date
2022
Abstract
Invasion of the mandibular bone is frequent in oral squamous cell carcinoma (OSCC), which often results in extensive ablative and reconstructive procedures for the patient. The purpose of this single-center, retrospective study was to identify and evaluate potential biomarkers and risk factors for bone invasion in OSCC. Initially, in silico gene expression analysis was performed for different HNSCC tumor T-stages to find factors associated with invasive (T4a) tumor growth. Afterwards, the protein expression of bone-metabolizing MMP-27, TNFRSF11B (Osteoprotegerin, OPG), and TNFSF11 (RANKL) was investigated via Tissue Microarrays (TMAs) for their impact on mandibular bone invasion. TMAs were assembled from the bone-tumor interface of primary OSCCs of the floor of the mouth and gingiva from 119 patients. Sixty-four carcinomas with patho-histological jaw invasion (pT4a) were compared to 55 carcinomas growing along the mandible without invasion (pT2, pT3). Tissue samples were additionally evaluated for patterns of invasion using the WPOI grading system. Statistical analysis of in silico data revealed decreased MMP-27 mRNA expression to be strongly associated with the pT4a-stage in OSCC, indicating invasive tumor growth with infiltration of adjacent anatomical structures. Our own clinico-pathological data on OSCCs presented a significant decrease of MMP-27 in tumors invading the nearby mandible (pT4a), compared to pT2 and pT3 tumors without bone invasion. Loss of MMP27 evolved as the strongest predictor of mandibular bone invasion in binary logistic regression analysis. To our knowledge, this is the first study investigating the role of MMP-27 expression in OSCC and demonstrating the importance of the loss of MMP-27 in mandibular bone invasion.
DOI
https://www.doi.org/10.3390/cancers14164044
Keywords
Mmp-27; Opg; Oscc; Rankl; mandibular bone invasion; oral squamous cell carcinoma
Elmasry, M.; Brandl, L.; Engel, J.; et al. (2019) RBP7 is a clinically prognostic biomarker and linked to tumor invasion and EMT in colon cancer. J Cancer. https://www.doi.org/10.7150/jca.35180
Title
RBP7 is a clinically prognostic biomarker and linked to tumor invasion and EMT in colon cancer
Publication date
2019
Abstract
RBP7 is a member of the cellular retinol-binding protein (CRBP) family and previous data suggested a link between CRBPs and the malignant transformation of colon cancer cells. Here, we investigated the potential of RBP7 as a predictive biomarker for patients with colon cancer and determined its functional relevance for tumor progression. We analyzed RBP7 protein and mRNA expression in independent tissue collections of colon cancers with recorded follow-up data, including data from TCGA. We used gene set enrichment analyses to characterize its functional role. Effects of RBP7 on migration and invasion were determined in transwell assays. High expression of RBP7 was an independent biomarker of poor cancer specific survival in early and late stage colon cancer, and linked to colon cancer progression. Gene set enrichment analysis revealed a strong association of RBP7, colon cancer invasion and epithelial mesenchymal transition (EMT). Ectopic expression of RBP7 increased migration and invasion of colon cancer cells. Our findings demonstrate that RBP7 is a strong prognostic biomarker in colon cancer that functionally contributes to the malignant phenotype of colon cancer cells. This may aid in risk stratification for the therapeutic management of patients with colorectal cancer.
DOI
https://www.doi.org/10.7150/jca.35180
Keywords
Emt; Rbp7; colon cancer; invasion; prognosis
RBP7 is a clinically prognostic biomarker and linked to tumor invasion and EMT in colon cancer
Publication date
2019
Abstract
RBP7 is a member of the cellular retinol-binding protein (CRBP) family and previous data suggested a link between CRBPs and the malignant transformation of colon cancer cells. Here, we investigated the potential of RBP7 as a predictive biomarker for patients with colon cancer and determined its functional relevance for tumor progression. We analyzed RBP7 protein and mRNA expression in independent tissue collections of colon cancers with recorded follow-up data, including data from TCGA. We used gene set enrichment analyses to characterize its functional role. Effects of RBP7 on migration and invasion were determined in transwell assays. High expression of RBP7 was an independent biomarker of poor cancer specific survival in early and late stage colon cancer, and linked to colon cancer progression. Gene set enrichment analysis revealed a strong association of RBP7, colon cancer invasion and epithelial mesenchymal transition (EMT). Ectopic expression of RBP7 increased migration and invasion of colon cancer cells. Our findings demonstrate that RBP7 is a strong prognostic biomarker in colon cancer that functionally contributes to the malignant phenotype of colon cancer cells. This may aid in risk stratification for the therapeutic management of patients with colorectal cancer.
DOI
https://www.doi.org/10.7150/jca.35180
Keywords
Emt; Rbp7; colon cancer; invasion; prognosis
Engler, J.; Adami, S.; Adam, Y.; et al. (2016) Using others' experiences. Cancer patients' expectations and navigation of a website providing narratives on prostate, breast and colorectal cancer. Patient Educ Couns. https://www.doi.org/10.1016/j.pec.2016.03.015
Title
Using others' experiences. Cancer patients' expectations and navigation of a website providing narratives on prostate, breast and colorectal cancer
Publication date
2016
Abstract
OBJECTIVE: To understand what cancer patients expect and may learn from other patients' experiences, as analyzed and sorted for presentation on a website called krankheitserfahrungen.de (meaning "illness experiences"). METHODS: Mixed methods approach including log file analyses, survey data analyses and thematic analysis of focus group discussions. RESULTS: Users highly valued the wide range of patient experiences presented. The academic leadership of krankheitserfahrungen.de made them trust the information quality. Reading, watching and listening to other cancer patients' experiences gave users a feeling of hope and confidence. Searching for persons with similar experiences was a major way of navigating the website. CONCLUSION: Patient narratives as presented on krankheitserfahrungen.de provide a helpful resource, supporting cancer patients' engagement with their disease. Having access to such research-informed accounts of everyday cancer experiences was seen as a great contribution to existing available patient information. PRACTICE IMPLICATIONS: When health information websites include experiences, they should adhere to quality standards of qualitative research and encompass a wide range, so that users are able to find patients similar to themselves. Filter options are a helpful tool. A mix of written text and videos is beneficial, as users have different preferences. The inclusion of patient photographs and video interviews facilitates authenticity and closeness.
DOI
https://www.doi.org/10.1016/j.pec.2016.03.015
Keywords
Aged; Breast Neoplasms/*psychology; Colorectal Neoplasms/*psychology; Female; Focus Groups; Humans; *Internet; Male; Middle Aged; *Narration; Patient Satisfaction; Prostatic Neoplasms/*psychology; Qualitative Research; Cancer; Coping; Health information; Illness experiences; Patient narratives
Using others' experiences. Cancer patients' expectations and navigation of a website providing narratives on prostate, breast and colorectal cancer
Publication date
2016
Abstract
OBJECTIVE: To understand what cancer patients expect and may learn from other patients' experiences, as analyzed and sorted for presentation on a website called krankheitserfahrungen.de (meaning "illness experiences"). METHODS: Mixed methods approach including log file analyses, survey data analyses and thematic analysis of focus group discussions. RESULTS: Users highly valued the wide range of patient experiences presented. The academic leadership of krankheitserfahrungen.de made them trust the information quality. Reading, watching and listening to other cancer patients' experiences gave users a feeling of hope and confidence. Searching for persons with similar experiences was a major way of navigating the website. CONCLUSION: Patient narratives as presented on krankheitserfahrungen.de provide a helpful resource, supporting cancer patients' engagement with their disease. Having access to such research-informed accounts of everyday cancer experiences was seen as a great contribution to existing available patient information. PRACTICE IMPLICATIONS: When health information websites include experiences, they should adhere to quality standards of qualitative research and encompass a wide range, so that users are able to find patients similar to themselves. Filter options are a helpful tool. A mix of written text and videos is beneficial, as users have different preferences. The inclusion of patient photographs and video interviews facilitates authenticity and closeness.
DOI
https://www.doi.org/10.1016/j.pec.2016.03.015
Keywords
Aged; Breast Neoplasms/*psychology; Colorectal Neoplasms/*psychology; Female; Focus Groups; Humans; *Internet; Male; Middle Aged; *Narration; Patient Satisfaction; Prostatic Neoplasms/*psychology; Qualitative Research; Cancer; Coping; Health information; Illness experiences; Patient narratives
Engler, J.; Guthlin, C.; Dahlhaus, A.; et al. (2017) Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data. Eur J Cancer Care (Engl). https://www.doi.org/10.1111/ecc.12675
Title
Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data
Publication date
2017
Abstract
The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards.
DOI
https://www.doi.org/10.1111/ecc.12675
Keywords
*Ambulatory Care; *Attitude of Health Personnel; *Cooperative Behavior; *General Practitioners; Germany; Humans; Interdisciplinary Communication; Neoplasms/*therapy; *Oncologists; Patient Care Team; Qualitative Research; *Urologists; cancer care; community; cooperation; multidisciplinary care; outpatient; qualitative study
Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data
Publication date
2017
Abstract
The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards.
DOI
https://www.doi.org/10.1111/ecc.12675
Keywords
*Ambulatory Care; *Attitude of Health Personnel; *Cooperative Behavior; *General Practitioners; Germany; Humans; Interdisciplinary Communication; Neoplasms/*therapy; *Oncologists; Patient Care Team; Qualitative Research; *Urologists; cancer care; community; cooperation; multidisciplinary care; outpatient; qualitative study
Fante, M. A.; Felsenstein, M.; Mayer, S.; et al. (2022) All-Oral Low-Dose Chemotherapy TEPIP is Effective and Well-Tolerated in Relapsed/Refractory Patients With Aggressive B-Cell Lymphoma. Front Oncol. https://www.doi.org/10.3389/fonc.2022.852987
Title
All-Oral Low-Dose Chemotherapy TEPIP is Effective and Well-Tolerated in Relapsed/Refractory Patients With Aggressive B-Cell Lymphoma
Publication date
2022
Abstract
PURPOSE: Treatment options in patients (pts.) with advanced relapsed and refractory aggressive B-cell lymphoma are limited. Palliative all-oral chemotherapy regimens reduce in-patient visits and contribute to quality of life. The all-oral low-dose chemotherapy regimen TEPIP comprises the conventional chemotherapy agents trofosfamide, etoposide, procarbazine, idarubicin and prednisolone. METHODS: Safety and efficacy of TEPIP was evaluated in an observational retrospective, single-center study at the University Medical Center Regensburg between 2010 and 2020. Treatment with TEPIP was applied for 7 or 10 days during a 28-days period. In a subgroup of fit and therapy-motivated pts. rituximab was added. End points were overall survival (OS) and progression free survival (PFS). Adverse events >/= CTCAE grade III were reported. RESULTS: 35 highly pre-treated pts. with aggressive B-cell lymphoma were enrolled. Median age at TEPIP start was 67 years and 85% of pts. received TEPIP as >/= third treatment line. Overall response rate (ORR) was 23% (CR 17%). Pts. benefited from additional rituximab administration (ORR 67%) and a lower number of pre-treatments (ORR 41%). The OS was 3.3 months (m) with a 1y-OS of 25.7% and the PFS amounted to 1.3 m with a 1y-PFS of 8.8%. OS and PFS were significantly prolonged in pts. that responded to treatment or additionally received rituximab. Adverse events were mainly hematological and occurred in 49% of pts. CONCLUSION: TEPIP was well-tolerated and induced respectable response in a difficult-to-treat patient cohort. In particular, the all-oral administration enables out-patient use with palliative intent.
DOI
https://www.doi.org/10.3389/fonc.2022.852987
Keywords
aggressive B-cell lymphoma; all-oral treatment; low-dose chemotherapy; metronomic chemotherapy; relapsed/refractory DLBCL
All-Oral Low-Dose Chemotherapy TEPIP is Effective and Well-Tolerated in Relapsed/Refractory Patients With Aggressive B-Cell Lymphoma
Publication date
2022
Abstract
PURPOSE: Treatment options in patients (pts.) with advanced relapsed and refractory aggressive B-cell lymphoma are limited. Palliative all-oral chemotherapy regimens reduce in-patient visits and contribute to quality of life. The all-oral low-dose chemotherapy regimen TEPIP comprises the conventional chemotherapy agents trofosfamide, etoposide, procarbazine, idarubicin and prednisolone. METHODS: Safety and efficacy of TEPIP was evaluated in an observational retrospective, single-center study at the University Medical Center Regensburg between 2010 and 2020. Treatment with TEPIP was applied for 7 or 10 days during a 28-days period. In a subgroup of fit and therapy-motivated pts. rituximab was added. End points were overall survival (OS) and progression free survival (PFS). Adverse events >/= CTCAE grade III were reported. RESULTS: 35 highly pre-treated pts. with aggressive B-cell lymphoma were enrolled. Median age at TEPIP start was 67 years and 85% of pts. received TEPIP as >/= third treatment line. Overall response rate (ORR) was 23% (CR 17%). Pts. benefited from additional rituximab administration (ORR 67%) and a lower number of pre-treatments (ORR 41%). The OS was 3.3 months (m) with a 1y-OS of 25.7% and the PFS amounted to 1.3 m with a 1y-PFS of 8.8%. OS and PFS were significantly prolonged in pts. that responded to treatment or additionally received rituximab. Adverse events were mainly hematological and occurred in 49% of pts. CONCLUSION: TEPIP was well-tolerated and induced respectable response in a difficult-to-treat patient cohort. In particular, the all-oral administration enables out-patient use with palliative intent.
DOI
https://www.doi.org/10.3389/fonc.2022.852987
Keywords
aggressive B-cell lymphoma; all-oral treatment; low-dose chemotherapy; metronomic chemotherapy; relapsed/refractory DLBCL
Fernandez-Pacheco, M.; Gerken, M.; Ortmann, O.; et al. (2022) Impact of cavity shaving on residual tumor rates in patients with primary invasive carcinoma and carcinoma in situ in breast conserving surgery. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-022-06803-x
Title
Impact of cavity shaving on residual tumor rates in patients with primary invasive carcinoma and carcinoma in situ in breast conserving surgery
Publication date
2022
Abstract
BACKGROUND: Several international studies reported relatively high re-excision rates due to residual tumor in breast conserving surgery (BCS). Cavity shaving (CS) is a surgical strategy to reduce re-excision rates. This study aimed to investigate the effect of circumferential cavity shaving during BCS to reduce residual tumor. MATERIAL AND METHODS: A total of 591 patients with early invasive carcinoma or carcinoma in situ of the breast (ICD-10, C50 or D05) who were diagnosed between 01/01/2017 and 31/12/2019 and underwent BCS in a certified breast cancer center of the University Regensburg were analyzed regarding surgical excision methods. Patients with CS during BCS and patients with targeted re-excision in a specific direction depending on the result of intraoperative mammography or sonography during BCS were compared. The risk of pathologic residual tumor (R1) was compared between both groups by means of a multivariable binary logistic regression model to determine if there is a benefit of a certain surgical method to avoid a second intervention for re-excision. We adjusted for age, tumor size, nodal status, histologic type, surgeon, breast side, and neoadjuvant chemotherapy. RESULTS: 80 (n = 13.54%) patients had CS and 511 (n = 86.46%) had a targeted re-excision in a specific direction during BCS according to intraoperative mammography or sonography. After comparing both techniques in a multivariable regression model, there was no significant difference regarding risk of residual tumor (p = 0.738) in the total cohort. However, CS showed a tendency to be favorable regarding rates of residual tumor in patients with invasive breast cancer between 60 and 70 years (p = 0.072) and smaller T1-tumors (p = 0.057) compared to targeted intraoperative re-excision following mammographic or sonographic assessment. CONCLUSION: CS showed a tendency to reduce residual tumor compared to the standard technique of intraoperative re-excision in specific subgroups, although no statistical significance was reached. Further studies are needed to overcome potential limitations like surgeon-based bias and missing standardized definitions of CS to reduce residual tumor rates.
DOI
https://www.doi.org/10.1007/s00404-022-06803-x
Keywords
Breast conserving surgery; Cavity shaving; Invasive breast cancer; Re-excision rates; Residual tumor
Impact of cavity shaving on residual tumor rates in patients with primary invasive carcinoma and carcinoma in situ in breast conserving surgery
Publication date
2022
Abstract
BACKGROUND: Several international studies reported relatively high re-excision rates due to residual tumor in breast conserving surgery (BCS). Cavity shaving (CS) is a surgical strategy to reduce re-excision rates. This study aimed to investigate the effect of circumferential cavity shaving during BCS to reduce residual tumor. MATERIAL AND METHODS: A total of 591 patients with early invasive carcinoma or carcinoma in situ of the breast (ICD-10, C50 or D05) who were diagnosed between 01/01/2017 and 31/12/2019 and underwent BCS in a certified breast cancer center of the University Regensburg were analyzed regarding surgical excision methods. Patients with CS during BCS and patients with targeted re-excision in a specific direction depending on the result of intraoperative mammography or sonography during BCS were compared. The risk of pathologic residual tumor (R1) was compared between both groups by means of a multivariable binary logistic regression model to determine if there is a benefit of a certain surgical method to avoid a second intervention for re-excision. We adjusted for age, tumor size, nodal status, histologic type, surgeon, breast side, and neoadjuvant chemotherapy. RESULTS: 80 (n = 13.54%) patients had CS and 511 (n = 86.46%) had a targeted re-excision in a specific direction during BCS according to intraoperative mammography or sonography. After comparing both techniques in a multivariable regression model, there was no significant difference regarding risk of residual tumor (p = 0.738) in the total cohort. However, CS showed a tendency to be favorable regarding rates of residual tumor in patients with invasive breast cancer between 60 and 70 years (p = 0.072) and smaller T1-tumors (p = 0.057) compared to targeted intraoperative re-excision following mammographic or sonographic assessment. CONCLUSION: CS showed a tendency to reduce residual tumor compared to the standard technique of intraoperative re-excision in specific subgroups, although no statistical significance was reached. Further studies are needed to overcome potential limitations like surgeon-based bias and missing standardized definitions of CS to reduce residual tumor rates.
DOI
https://www.doi.org/10.1007/s00404-022-06803-x
Keywords
Breast conserving surgery; Cavity shaving; Invasive breast cancer; Re-excision rates; Residual tumor
Fernandez-Pacheco, M.; Gerken, M.; Ortmann, O.; et al. (2023) Impact of cavity shaving on residual tumor rates in patients with primary invasive carcinoma and carcinoma in situ in breast conserving surgery. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-022-06803-x
Title
Impact of cavity shaving on residual tumor rates in patients with primary invasive carcinoma and carcinoma in situ in breast conserving surgery
Publication date
2023
Abstract
BACKGROUND: Several international studies reported relatively high re-excision rates due to residual tumor in breast conserving surgery (BCS). Cavity shaving (CS) is a surgical strategy to reduce re-excision rates. This study aimed to investigate the effect of circumferential cavity shaving during BCS to reduce residual tumor. MATERIAL AND METHODS: A total of 591 patients with early invasive carcinoma or carcinoma in situ of the breast (ICD-10, C50 or D05) who were diagnosed between 01/01/2017 and 31/12/2019 and underwent BCS in a certified breast cancer center of the University Regensburg were analyzed regarding surgical excision methods. Patients with CS during BCS and patients with targeted re-excision in a specific direction depending on the result of intraoperative mammography or sonography during BCS were compared. The risk of pathologic residual tumor (R1) was compared between both groups by means of a multivariable binary logistic regression model to determine if there is a benefit of a certain surgical method to avoid a second intervention for re-excision. We adjusted for age, tumor size, nodal status, histologic type, surgeon, breast side, and neoadjuvant chemotherapy. RESULTS: 80 (n = 13.54%) patients had CS and 511 (n = 86.46%) had a targeted re-excision in a specific direction during BCS according to intraoperative mammography or sonography. After comparing both techniques in a multivariable regression model, there was no significant difference regarding risk of residual tumor (p = 0.738) in the total cohort. However, CS showed a tendency to be favorable regarding rates of residual tumor in patients with invasive breast cancer between 60 and 70 years (p = 0.072) and smaller T1-tumors (p = 0.057) compared to targeted intraoperative re-excision following mammographic or sonographic assessment. CONCLUSION: CS showed a tendency to reduce residual tumor compared to the standard technique of intraoperative re-excision in specific subgroups, although no statistical significance was reached. Further studies are needed to overcome potential limitations like surgeon-based bias and missing standardized definitions of CS to reduce residual tumor rates.
DOI
https://www.doi.org/10.1007/s00404-022-06803-x
Keywords
Humans; Female; Mastectomy, Segmental/methods; *Carcinoma, Ductal, Breast/pathology/surgery; Neoplasm, Residual/pathology; Reoperation; *Breast Neoplasms/diagnostic imaging/surgery/pathology; *Carcinoma in Situ/surgery; Retrospective Studies; Breast conserving surgery; Cavity shaving; Invasive breast cancer; Re-excision rates; Residual tumor
Impact of cavity shaving on residual tumor rates in patients with primary invasive carcinoma and carcinoma in situ in breast conserving surgery
Publication date
2023
Abstract
BACKGROUND: Several international studies reported relatively high re-excision rates due to residual tumor in breast conserving surgery (BCS). Cavity shaving (CS) is a surgical strategy to reduce re-excision rates. This study aimed to investigate the effect of circumferential cavity shaving during BCS to reduce residual tumor. MATERIAL AND METHODS: A total of 591 patients with early invasive carcinoma or carcinoma in situ of the breast (ICD-10, C50 or D05) who were diagnosed between 01/01/2017 and 31/12/2019 and underwent BCS in a certified breast cancer center of the University Regensburg were analyzed regarding surgical excision methods. Patients with CS during BCS and patients with targeted re-excision in a specific direction depending on the result of intraoperative mammography or sonography during BCS were compared. The risk of pathologic residual tumor (R1) was compared between both groups by means of a multivariable binary logistic regression model to determine if there is a benefit of a certain surgical method to avoid a second intervention for re-excision. We adjusted for age, tumor size, nodal status, histologic type, surgeon, breast side, and neoadjuvant chemotherapy. RESULTS: 80 (n = 13.54%) patients had CS and 511 (n = 86.46%) had a targeted re-excision in a specific direction during BCS according to intraoperative mammography or sonography. After comparing both techniques in a multivariable regression model, there was no significant difference regarding risk of residual tumor (p = 0.738) in the total cohort. However, CS showed a tendency to be favorable regarding rates of residual tumor in patients with invasive breast cancer between 60 and 70 years (p = 0.072) and smaller T1-tumors (p = 0.057) compared to targeted intraoperative re-excision following mammographic or sonographic assessment. CONCLUSION: CS showed a tendency to reduce residual tumor compared to the standard technique of intraoperative re-excision in specific subgroups, although no statistical significance was reached. Further studies are needed to overcome potential limitations like surgeon-based bias and missing standardized definitions of CS to reduce residual tumor rates.
DOI
https://www.doi.org/10.1007/s00404-022-06803-x
Keywords
Humans; Female; Mastectomy, Segmental/methods; *Carcinoma, Ductal, Breast/pathology/surgery; Neoplasm, Residual/pathology; Reoperation; *Breast Neoplasms/diagnostic imaging/surgery/pathology; *Carcinoma in Situ/surgery; Retrospective Studies; Breast conserving surgery; Cavity shaving; Invasive breast cancer; Re-excision rates; Residual tumor
Filippini Velazquez, G.; Schiele, S.; Gerken, M.; et al. (2022) Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer. ESMO Open. https://www.doi.org/10.1016/j.esmoop.2022.100470
Title
Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer
Publication date
2022
Abstract
BACKGROUND: Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential. PATIENTS AND METHODS: In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC). RESULTS: Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC. CONCLUSIONS: Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice.
DOI
https://www.doi.org/10.1016/j.esmoop.2022.100470
Keywords
*Colorectal Neoplasms/pathology; Humans; *Liver Neoplasms/surgery; Prognosis; Risk Factors; clinical score; colorectal cancer; liver metastases; oligometastases; overall survival; predictive score; surgical resection
Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer
Publication date
2022
Abstract
BACKGROUND: Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential. PATIENTS AND METHODS: In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC). RESULTS: Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC. CONCLUSIONS: Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice.
DOI
https://www.doi.org/10.1016/j.esmoop.2022.100470
Keywords
*Colorectal Neoplasms/pathology; Humans; *Liver Neoplasms/surgery; Prognosis; Risk Factors; clinical score; colorectal cancer; liver metastases; oligometastases; overall survival; predictive score; surgical resection
Finke, I.; Behrens, G.; Maier, W.; et al. (2021) Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany. Int J Cancer. https://www.doi.org/10.1002/ijc.33553
Title
Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany
Publication date
2021
Abstract
Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5-year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5-year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14-1.19). For some cancer sites, this association was stronger during short-term follow-up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.
DOI
https://www.doi.org/10.1002/ijc.33553
Keywords
Aged; Female; Follow-Up Studies; Germany/epidemiology; *Health Status Disparities; *Healthcare Disparities; Humans; Male; Neoplasms/economics/epidemiology/*mortality; Prognosis; Registries/*statistics & numerical data; Risk Factors; *Small-Area Analysis; *Socioeconomic Factors; Survival Rate; Germany; area-based socioeconomic deprivation; cancer registry; survival
Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany
Publication date
2021
Abstract
Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5-year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5-year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14-1.19). For some cancer sites, this association was stronger during short-term follow-up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.
DOI
https://www.doi.org/10.1002/ijc.33553
Keywords
Aged; Female; Follow-Up Studies; Germany/epidemiology; *Health Status Disparities; *Healthcare Disparities; Humans; Male; Neoplasms/economics/epidemiology/*mortality; Prognosis; Registries/*statistics & numerical data; Risk Factors; *Small-Area Analysis; *Socioeconomic Factors; Survival Rate; Germany; area-based socioeconomic deprivation; cancer registry; survival
Finke, I.; Behrens, G.; Schwettmann, L.; et al. (2020) Socioeconomic differences and lung cancer survival in Germany: Investigation based on population-based clinical cancer registration. Lung Cancer. https://www.doi.org/10.1016/j.lungcan.2020.01.021
Title
Socioeconomic differences and lung cancer survival in Germany: Investigation based on population-based clinical cancer registration
Publication date
2020
Abstract
OBJECTIVES: Studies from several countries reported socioeconomic inequalities in lung cancer survival. Hypothesized reasons are differences in cancer care or tumor characteristics. We investigated associations of small-area deprivation and lung cancer survival in Germany and the possible impact of differences in patient, tumor or treatment factors. MATERIALS AND METHODS: Patients registered with a primary tumor of the lung between 2000-2015 in three German population-based clinical cancer registries were included. Area-based socioeconomic deprivation on municipality level was measured with the categorized German Index of Multiple Deprivation. Association of deprivation with overall survival was investigated with Cox regression models. RESULTS: Overall, 22,905 patients were included. Five-year overall survival from the least to the most deprived quintile were 17.2%, 15.9%, 16.7%, 15.7%, and 14.4%. After adjustment for patient and tumor factors, the most deprived group had a lower survival compared to the least deprived group (Hazard Ratio (HR) 1.06, 95% confidence interval (CI) 1.01-1.11). Subgroup analyses revealed lower survival in the most deprived compared to the least deprived quintile in patients with stage I-III [HR: 1.14, 95% CI: 1.06-1.22]. The association persisted when restricting to patients receiving surgery but was attenuated for subgroups receiving either chemotherapy or radiotherapy. CONCLUSION: Our results indicate differences in lung cancer survival according to area deprivation in Germany, which were more pronounced in patients with I-III stage cancer. Future research should address in more detail the underlying reasons for the observed inequalities and possible approaches to overcome them.
DOI
https://www.doi.org/10.1016/j.lungcan.2020.01.021
Keywords
*Area-based socioeconomic deprivation; *Germany; *Lung cancer; *Stage at diagnosis; *Survival; *Treatment; Brenner, Dr. Pritzkuleit, and Dr. Holleczek report grants from German Cancer Aid,; during the conduct of the study; Dr. Gerken and Dr. Schwettmann have nothing to; disclose.
Socioeconomic differences and lung cancer survival in Germany: Investigation based on population-based clinical cancer registration
Publication date
2020
Abstract
OBJECTIVES: Studies from several countries reported socioeconomic inequalities in lung cancer survival. Hypothesized reasons are differences in cancer care or tumor characteristics. We investigated associations of small-area deprivation and lung cancer survival in Germany and the possible impact of differences in patient, tumor or treatment factors. MATERIALS AND METHODS: Patients registered with a primary tumor of the lung between 2000-2015 in three German population-based clinical cancer registries were included. Area-based socioeconomic deprivation on municipality level was measured with the categorized German Index of Multiple Deprivation. Association of deprivation with overall survival was investigated with Cox regression models. RESULTS: Overall, 22,905 patients were included. Five-year overall survival from the least to the most deprived quintile were 17.2%, 15.9%, 16.7%, 15.7%, and 14.4%. After adjustment for patient and tumor factors, the most deprived group had a lower survival compared to the least deprived group (Hazard Ratio (HR) 1.06, 95% confidence interval (CI) 1.01-1.11). Subgroup analyses revealed lower survival in the most deprived compared to the least deprived quintile in patients with stage I-III [HR: 1.14, 95% CI: 1.06-1.22]. The association persisted when restricting to patients receiving surgery but was attenuated for subgroups receiving either chemotherapy or radiotherapy. CONCLUSION: Our results indicate differences in lung cancer survival according to area deprivation in Germany, which were more pronounced in patients with I-III stage cancer. Future research should address in more detail the underlying reasons for the observed inequalities and possible approaches to overcome them.
DOI
https://www.doi.org/10.1016/j.lungcan.2020.01.021
Keywords
*Area-based socioeconomic deprivation; *Germany; *Lung cancer; *Stage at diagnosis; *Survival; *Treatment; Brenner, Dr. Pritzkuleit, and Dr. Holleczek report grants from German Cancer Aid,; during the conduct of the study; Dr. Gerken and Dr. Schwettmann have nothing to; disclose.
Fischl, A.; Gerken, M.; Roos, P.; et al. (2023) Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study. Neurooncol Pract. https://www.doi.org/10.1093/nop/npad023
Title
Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study
Publication date
2023
Abstract
BACKGROUND: Malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas impose a high symptomatic and psychological burden. Wide distances from patients' homes to cancer centers may affect the delivery of psycho-oncological care. Here, we investigated, in a large brain tumor center with a rural outreach, the initiation of psycho-oncological care depending on spatial distance and impact of psycho-oncological care on emergency visits. METHODS: Electronic patient charts, the regional tumor registry, and interviews with the primary care physicians were used to investigate clinical data, psycho-oncological care, and emergency unit visits. Interrelations with socio-demographic, clinical, and treatment aspects were investigated using univariable and multivariable binary logistic regression analysis and the Pearson's Chi-square test. RESULTS: Of 491, 229 adult patients of this retrospective cohort fulfilled the inclusion criteria for analysis. During the last three months of their lives, 48.9% received at least one psycho-oncological consultation, and 37.1% visited the emergency unit at least once. The distance from the cancer center did neither affect the initiation of psycho-oncological care nor the rate of emergency unit visits. Receiving psycho-oncological care did not correlate with the frequency of emergency unit visits in the last three months of life. CONCLUSION: We conclude that the distance of IDHwt glioma patients' homes from their cancer center, even in a rural area, does not significantly influence the rate of psycho-oncological care.
DOI
https://www.doi.org/10.1093/nop/npad023
Keywords
brain tumor; emergency; glioblastoma; psycho-oncology; spatial distance
Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study
Publication date
2023
Abstract
BACKGROUND: Malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas impose a high symptomatic and psychological burden. Wide distances from patients' homes to cancer centers may affect the delivery of psycho-oncological care. Here, we investigated, in a large brain tumor center with a rural outreach, the initiation of psycho-oncological care depending on spatial distance and impact of psycho-oncological care on emergency visits. METHODS: Electronic patient charts, the regional tumor registry, and interviews with the primary care physicians were used to investigate clinical data, psycho-oncological care, and emergency unit visits. Interrelations with socio-demographic, clinical, and treatment aspects were investigated using univariable and multivariable binary logistic regression analysis and the Pearson's Chi-square test. RESULTS: Of 491, 229 adult patients of this retrospective cohort fulfilled the inclusion criteria for analysis. During the last three months of their lives, 48.9% received at least one psycho-oncological consultation, and 37.1% visited the emergency unit at least once. The distance from the cancer center did neither affect the initiation of psycho-oncological care nor the rate of emergency unit visits. Receiving psycho-oncological care did not correlate with the frequency of emergency unit visits in the last three months of life. CONCLUSION: We conclude that the distance of IDHwt glioma patients' homes from their cancer center, even in a rural area, does not significantly influence the rate of psycho-oncological care.
DOI
https://www.doi.org/10.1093/nop/npad023
Keywords
brain tumor; emergency; glioblastoma; psycho-oncology; spatial distance
Gatta, G.; Trama, A.; Capocaccia, R.; et al. (2019) Epidemiology of rare cancers and inequalities in oncologic outcomes. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2017.08.018
Title
Epidemiology of rare cancers and inequalities in oncologic outcomes
Publication date
2019
Abstract
Rare cancers epidemiology is better known compared to the other rare diseases. Thanks to the long history of the European population-based cancer registries and to the EUROCARE huge database, the burden of rare cancers has been estimated the European (EU28) population. A considerable fraction of all cancers is represented by rare cancers (24%). They are a heterogeneous group of diseases, but they share similar problems: uncertainty of diagnosis, lack of therapies, poor research opportunities, difficulties in clinical trials, lack of expertise and of centres of reference. This paper analyses the major epidemiological indicators of frequency (incidence and prevalence) and outcome (5-year survival) of all rare cancers combined and of selected rare cancers that will be in depth treated in this monographic issue. Source of the results is the RARECAREnet search tool, a database publicly available. Disparities both in incidence and survival, and consequently in prevalence of rare cancers were reported across European countries. Major differences were shown in outcome: 5-year relative survival for all rare cancers together, adjusted by age and case-mix, varied from 55% or more (Italy, Germany, Belgium and Iceland) and less than 40% (Bulgaria, Lithuania and Slovakia). Similarly, for all the analyzed rare cancers, a large survival gap was observed between the Eastern and the Nordic and Central European regions. Dramatic geographical variations were assessed for curable cancers like testicular and non epithelial ovarian cancers. Geographical difference in the annual age-adjusted incidence rates for all rare cancers together varied between >140 per 100,000 (Italy, Scotland, France, Germany, and Switzerland) and <100 (Finland, Portugal, Malta, and Poland). Prevalence, the major indicator of public health resources needs, was about 7-8 times larger than incidence. Most of rare cancers require complex surgical treatment, thus a multidisciplinary approach is essential and treatment should be provided in centres of expertise and/or in networks including expert centres. Networking is the most appropriate answer to the issues pertaining to rare cancers. Actually, in Europe, an opportunity to improve outcome and reduce disparities is provided by the creation of the European Reference Networks for rare diseases (ERNs). The Joint Action of rare cancers (JARC) is a major European initiative aimed to support the mission of the ERNs. The role of population based cancer registries still remains crucial to describe rare cancers management and outcome in the real word and to evaluate progresses made at the country and at the European level.
DOI
https://www.doi.org/10.1016/j.ejso.2017.08.018
Keywords
Adolescent; Adult; Age Distribution; Aged; Child; Child, Preschool; Europe/epidemiology; Female; Healthcare Disparities; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Neoplasms/*epidemiology; Prevalence; Rare Diseases/*epidemiology; Sex Distribution; Survival Rate; Young Adult; *Europe; *Population-based cancer registry; *Rare cancers
Epidemiology of rare cancers and inequalities in oncologic outcomes
Publication date
2019
Abstract
Rare cancers epidemiology is better known compared to the other rare diseases. Thanks to the long history of the European population-based cancer registries and to the EUROCARE huge database, the burden of rare cancers has been estimated the European (EU28) population. A considerable fraction of all cancers is represented by rare cancers (24%). They are a heterogeneous group of diseases, but they share similar problems: uncertainty of diagnosis, lack of therapies, poor research opportunities, difficulties in clinical trials, lack of expertise and of centres of reference. This paper analyses the major epidemiological indicators of frequency (incidence and prevalence) and outcome (5-year survival) of all rare cancers combined and of selected rare cancers that will be in depth treated in this monographic issue. Source of the results is the RARECAREnet search tool, a database publicly available. Disparities both in incidence and survival, and consequently in prevalence of rare cancers were reported across European countries. Major differences were shown in outcome: 5-year relative survival for all rare cancers together, adjusted by age and case-mix, varied from 55% or more (Italy, Germany, Belgium and Iceland) and less than 40% (Bulgaria, Lithuania and Slovakia). Similarly, for all the analyzed rare cancers, a large survival gap was observed between the Eastern and the Nordic and Central European regions. Dramatic geographical variations were assessed for curable cancers like testicular and non epithelial ovarian cancers. Geographical difference in the annual age-adjusted incidence rates for all rare cancers together varied between >140 per 100,000 (Italy, Scotland, France, Germany, and Switzerland) and <100 (Finland, Portugal, Malta, and Poland). Prevalence, the major indicator of public health resources needs, was about 7-8 times larger than incidence. Most of rare cancers require complex surgical treatment, thus a multidisciplinary approach is essential and treatment should be provided in centres of expertise and/or in networks including expert centres. Networking is the most appropriate answer to the issues pertaining to rare cancers. Actually, in Europe, an opportunity to improve outcome and reduce disparities is provided by the creation of the European Reference Networks for rare diseases (ERNs). The Joint Action of rare cancers (JARC) is a major European initiative aimed to support the mission of the ERNs. The role of population based cancer registries still remains crucial to describe rare cancers management and outcome in the real word and to evaluate progresses made at the country and at the European level.
DOI
https://www.doi.org/10.1016/j.ejso.2017.08.018
Keywords
Adolescent; Adult; Age Distribution; Aged; Child; Child, Preschool; Europe/epidemiology; Female; Healthcare Disparities; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Neoplasms/*epidemiology; Prevalence; Rare Diseases/*epidemiology; Sex Distribution; Survival Rate; Young Adult; *Europe; *Population-based cancer registry; *Rare cancers
Geiss, K.; Meyer, M.. (2013) A Windows application for computing standardized mortality ratios and standardized incidence ratios in cohort studies based on calculation of exact person-years at risk. Comput Methods Programs Biomed. https://www.doi.org/10.1016/j.cmpb.2013.05.028
Title
A Windows application for computing standardized mortality ratios and standardized incidence ratios in cohort studies based on calculation of exact person-years at risk
Publication date
2013
Abstract
Standardized mortality ratios and standardized incidence ratios are widely used in cohort studies to compare mortality or incidence in a study population to that in the general population on a age-time-specific basis, but their computation is not included in standard statistical software packages. Here we present a user-friendly Microsoft Windows program for computing standardized mortality ratios and standardized incidence ratios based on calculation of exact person-years at risk stratified by sex, age and calendar time. The program offers flexible import of different file formats for input data and easy handling of general population reference rate tables, such as mortality or incidence tables exported from cancer registry databases. The application of the program is illustrated with two examples using empirical data from the Bavarian Cancer Registry.
DOI
https://www.doi.org/10.1016/j.cmpb.2013.05.028
Keywords
Cohort Studies; Humans; Incidence; *Mortality; *Risk Assessment; *Software; Person-years; Software; Standardized incidence ratio; Standardized mortality ratio
A Windows application for computing standardized mortality ratios and standardized incidence ratios in cohort studies based on calculation of exact person-years at risk
Publication date
2013
Abstract
Standardized mortality ratios and standardized incidence ratios are widely used in cohort studies to compare mortality or incidence in a study population to that in the general population on a age-time-specific basis, but their computation is not included in standard statistical software packages. Here we present a user-friendly Microsoft Windows program for computing standardized mortality ratios and standardized incidence ratios based on calculation of exact person-years at risk stratified by sex, age and calendar time. The program offers flexible import of different file formats for input data and easy handling of general population reference rate tables, such as mortality or incidence tables exported from cancer registry databases. The application of the program is illustrated with two examples using empirical data from the Bavarian Cancer Registry.
DOI
https://www.doi.org/10.1016/j.cmpb.2013.05.028
Keywords
Cohort Studies; Humans; Incidence; *Mortality; *Risk Assessment; *Software; Person-years; Software; Standardized incidence ratio; Standardized mortality ratio
Geiss, K.; Meyer, M.; Radespiel-Tröger, M.; et al. (2009) SURVSOFT-Software for nonparametric survival analysis. Comput Methods Programs Biomed. https://www.doi.org/10.1016/j.cmpb.2009.04.002
Title
SURVSOFT-Software for nonparametric survival analysis
Publication date
2009
Abstract
Long-term observed and relative survival are important outcome measures of cancer patient care reported routinely by many cancer registries, but no commercial statistical software exists for estimating relative survival or performing period survival analysis. The programs publicly available focus only on certain methods, require specific input data formats and often are macros or functions which require underlying software packages. Here we introduce SURVSOFT, a comprehensive, user-friendly Windows program with graphical user interface. It can handle different input data formats and incorporates a variety of nonparametric statistical methods for survival data analysis. SURVSOFT produces high-resolution graphs, which can be printed, saved or exported to be used with standard graphics editors. The use of SURVSOFT is illustrated by the analysis of survival data from the Bavarian Cancer Registry.
DOI
https://www.doi.org/10.1016/j.cmpb.2009.04.002
Keywords
Humans; Neoplasms; Registries; *Software; *Statistics, Nonparametric; *Survival Analysis; User-Computer Interface
SURVSOFT-Software for nonparametric survival analysis
Publication date
2009
Abstract
Long-term observed and relative survival are important outcome measures of cancer patient care reported routinely by many cancer registries, but no commercial statistical software exists for estimating relative survival or performing period survival analysis. The programs publicly available focus only on certain methods, require specific input data formats and often are macros or functions which require underlying software packages. Here we introduce SURVSOFT, a comprehensive, user-friendly Windows program with graphical user interface. It can handle different input data formats and incorporates a variety of nonparametric statistical methods for survival data analysis. SURVSOFT produces high-resolution graphs, which can be printed, saved or exported to be used with standard graphics editors. The use of SURVSOFT is illustrated by the analysis of survival data from the Bavarian Cancer Registry.
DOI
https://www.doi.org/10.1016/j.cmpb.2009.04.002
Keywords
Humans; Neoplasms; Registries; *Software; *Statistics, Nonparametric; *Survival Analysis; User-Computer Interface
Gennari, P.; Gerken, M.; Meszaros, J.; et al. (2021) Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-020-05947-y
Title
Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters
Publication date
2021
Abstract
PURPOSE: The aim of the study was to compare recurrence-free survival (RFS) and overall survival (OS) of patients with early stage cervical cancer in dependence of surgical approach and treatment center. PATIENTS AND METHODS: A population-based cohort study including women with early stage IA1-IIB2 cervical cancer treated by radical hysterectomy between January 2010 and December 2015 was performed. RESULTS: The median follow-up time was 5.6 years. After exclusions, 413 patients were eligible for analysis: 111 (26.9%) underwent minimal-invasive surgery (MIS) and 302 (73.1%) open surgery. Both treatment groups were well balanced regarding the clinical and pathological characteristics. The mean age of the patients was 51.0 years. MIS was associated with improved RFS and OS compared with the open surgery. The 5-year RFS rates were 89.2% in the MIS group and 73.4% in the open surgery group (p = 0.004). The 5-year OS rates were 93.7% in the MIS group and 81.8% in the open surgery group (p = 0.016). After adjustment for other prognostic covariates, the MIS was further associated with improved RFS (HR = 0.45, 95% CI 0.24-0.86; p = 0.015) but not with OS. Nevertheless, after adjustment for treatment center, the surgical approach was not associated with significant difference in RFS (HR = 0.61, 95% CI 0.31-1.19; p = 0.143). Overall survival of patients treated in university cancer centers was significantly increased compared to patients treated in non-university cancer centers. The treatment center remains a strong prognostic factor regarding RFS (HR = 0.49, 95% CI 0.28-0.83; p = 0.009) and OS (HR = 0.50, 95% CI 0.26-0.94; p = 0.031). CONCLUSIONS: The treatment center but not the surgical approach was associated with the survival of patients treated with radical hysterectomy for early stage cervical cancer.
DOI
https://www.doi.org/10.1007/s00404-020-05947-y
Keywords
*Cervical cancer; *Minimal-invasive surgery; *Open surgery; *Radical hysterectomy
Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters
Publication date
2021
Abstract
PURPOSE: The aim of the study was to compare recurrence-free survival (RFS) and overall survival (OS) of patients with early stage cervical cancer in dependence of surgical approach and treatment center. PATIENTS AND METHODS: A population-based cohort study including women with early stage IA1-IIB2 cervical cancer treated by radical hysterectomy between January 2010 and December 2015 was performed. RESULTS: The median follow-up time was 5.6 years. After exclusions, 413 patients were eligible for analysis: 111 (26.9%) underwent minimal-invasive surgery (MIS) and 302 (73.1%) open surgery. Both treatment groups were well balanced regarding the clinical and pathological characteristics. The mean age of the patients was 51.0 years. MIS was associated with improved RFS and OS compared with the open surgery. The 5-year RFS rates were 89.2% in the MIS group and 73.4% in the open surgery group (p = 0.004). The 5-year OS rates were 93.7% in the MIS group and 81.8% in the open surgery group (p = 0.016). After adjustment for other prognostic covariates, the MIS was further associated with improved RFS (HR = 0.45, 95% CI 0.24-0.86; p = 0.015) but not with OS. Nevertheless, after adjustment for treatment center, the surgical approach was not associated with significant difference in RFS (HR = 0.61, 95% CI 0.31-1.19; p = 0.143). Overall survival of patients treated in university cancer centers was significantly increased compared to patients treated in non-university cancer centers. The treatment center remains a strong prognostic factor regarding RFS (HR = 0.49, 95% CI 0.28-0.83; p = 0.009) and OS (HR = 0.50, 95% CI 0.26-0.94; p = 0.031). CONCLUSIONS: The treatment center but not the surgical approach was associated with the survival of patients treated with radical hysterectomy for early stage cervical cancer.
DOI
https://www.doi.org/10.1007/s00404-020-05947-y
Keywords
*Cervical cancer; *Minimal-invasive surgery; *Open surgery; *Radical hysterectomy
Gennari, P.; Tchaikovski, S.; Meszaros, J.; et al. (2022) Protective effect of pre-operative conization in patients undergoing surgical treatment for early-stage cervical cancer. Gynecol Oncol. https://www.doi.org/10.1016/j.ygyno.2022.05.014
Title
Protective effect of pre-operative conization in patients undergoing surgical treatment for early-stage cervical cancer
Publication date
2022
Abstract
OBJECTIVE: The aim of this study was to investigate the impact of pre-operative conization on disease-free survival (DFS) in early-stage cervical cancer. METHODS: In this population-based cohort study we analysed from clinical cancer registries to determine DFS of women with International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IB1 cervical cancer with respect to conization preceding radical hysterectomy performed between January 2010 and December 2015. RESULTS: Out of 993 datasets available for the analysis, 235 patients met the inclusion criteria of the current study. The median follow-up was 5.4 years. During the study period, 28 (11.9%) recurrences were observed. All of these occurred in patients with FIGO stage IB1. For further evaluation, patients with FIGO IB1 tumors <2 cm were further analysed and divided into two groups, based on pre-operative conization. Pre-operative conization was associated with a reduced rate of recurrence (p = 0.007), with only three (5.2%) recurrences in this group (CO) compared to 25 recurrences (21.0%) in the group without conization (NCO) preceding radical hysterectomy. DFS was estimated at 79.0% and 94.8% in NCO and CO, respectively (p = 0.008). After adjustment for other prognostic covariates, conization remained a favourable prognostic factor for DFS (HR 0.27; 95% CI 0.08-0.93, p = 0.037). Lymph node involvement was the only unfavourable factor (HR 4.38; 95% CI 1.36-14.14, p = 0.014) in the multivariable analysis. CONCLUSIONS: Pre-operative conization is associated with improved DFS in early-stage cervical cancer independently of the surgical approach.
DOI
https://www.doi.org/10.1016/j.ygyno.2022.05.014
Keywords
Cohort Studies; *Conization/methods; Female; Humans; Neoplasm Staging; Pregnancy; Recurrence; *Uterine Cervical Neoplasms/pathology; Cervical cancer; Conization; Radical hysterectomy
Protective effect of pre-operative conization in patients undergoing surgical treatment for early-stage cervical cancer
Publication date
2022
Abstract
OBJECTIVE: The aim of this study was to investigate the impact of pre-operative conization on disease-free survival (DFS) in early-stage cervical cancer. METHODS: In this population-based cohort study we analysed from clinical cancer registries to determine DFS of women with International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IB1 cervical cancer with respect to conization preceding radical hysterectomy performed between January 2010 and December 2015. RESULTS: Out of 993 datasets available for the analysis, 235 patients met the inclusion criteria of the current study. The median follow-up was 5.4 years. During the study period, 28 (11.9%) recurrences were observed. All of these occurred in patients with FIGO stage IB1. For further evaluation, patients with FIGO IB1 tumors <2 cm were further analysed and divided into two groups, based on pre-operative conization. Pre-operative conization was associated with a reduced rate of recurrence (p = 0.007), with only three (5.2%) recurrences in this group (CO) compared to 25 recurrences (21.0%) in the group without conization (NCO) preceding radical hysterectomy. DFS was estimated at 79.0% and 94.8% in NCO and CO, respectively (p = 0.008). After adjustment for other prognostic covariates, conization remained a favourable prognostic factor for DFS (HR 0.27; 95% CI 0.08-0.93, p = 0.037). Lymph node involvement was the only unfavourable factor (HR 4.38; 95% CI 1.36-14.14, p = 0.014) in the multivariable analysis. CONCLUSIONS: Pre-operative conization is associated with improved DFS in early-stage cervical cancer independently of the surgical approach.
DOI
https://www.doi.org/10.1016/j.ygyno.2022.05.014
Keywords
Cohort Studies; *Conization/methods; Female; Humans; Neoplasm Staging; Pregnancy; Recurrence; *Uterine Cervical Neoplasms/pathology; Cervical cancer; Conization; Radical hysterectomy
Gödde, K.; Fügemann, H.; Müller-Nordhorn, J.; et al. (2020) [Structured Collection of Data on Support Offers for Lung Cancer and Stroke Patients in Berlin]. Gesundheitswesen. https://www.doi.org/10.1055/a-1179-5487
Title
[Structured Collection of Data on Support Offers for Lung Cancer and Stroke Patients in Berlin]
Publication date
2020
Abstract
OBJECTIVES: The aim of this study was to investigate available offers of support for stroke and lung cancer patients and their caregivers in the Berlin region besides direct medical or therapeutic care and to identify barriers in the use of available support from the perspective of care experts. METHODS: A structured search of different sources, including an internet search, print information as well as interviews with experts and a group discussion, was conducted on support services available to lung cancer and stroke patients and their caregivers in Berlin for managing their altered health and life situation. Target groups of identified offers were verified and further information was gathered by a questionnaire. Further, barriers for utilization of support services were analyzed from conducted interviews and the group discussion with health care experts. RESULTS: A total of 150 support services were identified for lung cancer and stroke patients and their caregivers in Berlin. There were many different forms of such offers, including, but not limited to, providing information and counseling, helping with the organization and coordination of the new life situation as well as giving psychosocial support. Missing information or information that was not adjusted to the patients' education level about care entitlements, lack of knowledge about as well as spatial distance to facilities were stated as barriers for utilization. CONCLUSIONS: A variety of support services is available in Berlin for lung cancer and stroke patients and their caregivers regarding different needs that might arise from their altered health and living situation. Providing information on existing offers more broadly to the target group and improving local availability may optimize utilization of such services by patients.
DOI
https://www.doi.org/10.1055/a-1179-5487
[Structured Collection of Data on Support Offers for Lung Cancer and Stroke Patients in Berlin]
Publication date
2020
Abstract
OBJECTIVES: The aim of this study was to investigate available offers of support for stroke and lung cancer patients and their caregivers in the Berlin region besides direct medical or therapeutic care and to identify barriers in the use of available support from the perspective of care experts. METHODS: A structured search of different sources, including an internet search, print information as well as interviews with experts and a group discussion, was conducted on support services available to lung cancer and stroke patients and their caregivers in Berlin for managing their altered health and life situation. Target groups of identified offers were verified and further information was gathered by a questionnaire. Further, barriers for utilization of support services were analyzed from conducted interviews and the group discussion with health care experts. RESULTS: A total of 150 support services were identified for lung cancer and stroke patients and their caregivers in Berlin. There were many different forms of such offers, including, but not limited to, providing information and counseling, helping with the organization and coordination of the new life situation as well as giving psychosocial support. Missing information or information that was not adjusted to the patients' education level about care entitlements, lack of knowledge about as well as spatial distance to facilities were stated as barriers for utilization. CONCLUSIONS: A variety of support services is available in Berlin for lung cancer and stroke patients and their caregivers regarding different needs that might arise from their altered health and living situation. Providing information on existing offers more broadly to the target group and improving local availability may optimize utilization of such services by patients.
DOI
https://www.doi.org/10.1055/a-1179-5487
Gödde, K.; Siegerink, B.; Fügemann, H.; et al. (2021) Can routine register data be used to identify vulnerable lung cancer patients of suboptimal care in a German comprehensive cancer centre?. Eur J Cancer Care (Engl). https://www.doi.org/10.1111/ecc.13398
Title
Can routine register data be used to identify vulnerable lung cancer patients of suboptimal care in a German comprehensive cancer centre?
Publication date
2021
Abstract
OBJECTIVES: Several patient factors have been described to influence access to optimal cancer care like socioeconomic factors or place of residence. In this study, we investigate whether data routinely collected in a clinical cancer registry can be used to identify populations of lung cancer patients with increased risk of not receiving optimal cancer care. METHODS: We analysed data of 837 lung cancer patients extracted from the clinical cancer registry of a German university hospital. We compared patient populations by two indicators of optimal care, namely implementation of tumour board meeting recommendations as well as the timeliness of care. RESULTS: There was a high rate of implementation of tumour board meeting recommendations of 94.4%. Reasons for non-implementation were mainly a patient's own wish or a worsening of the health situation. Of all patient parameters, only tumour stage was associated with the two optimal care indicators. CONCLUSION: Using routine data from a clinical cancer registry, we were not able to identify patient populations at risk of not getting optimal care and the implementation of guideline-conform care appeared to be very high in this setting. However, limitations were the ambiguity of optimal care indicators and availability of parameters predictive for patients' vulnerability.
DOI
https://www.doi.org/10.1111/ecc.13398
Keywords
Humans; *Lung Neoplasms/therapy; Registries; cancer care; cancer registry; care indicators; lung cancer; optimal care; vulnerable patients
Can routine register data be used to identify vulnerable lung cancer patients of suboptimal care in a German comprehensive cancer centre?
Publication date
2021
Abstract
OBJECTIVES: Several patient factors have been described to influence access to optimal cancer care like socioeconomic factors or place of residence. In this study, we investigate whether data routinely collected in a clinical cancer registry can be used to identify populations of lung cancer patients with increased risk of not receiving optimal cancer care. METHODS: We analysed data of 837 lung cancer patients extracted from the clinical cancer registry of a German university hospital. We compared patient populations by two indicators of optimal care, namely implementation of tumour board meeting recommendations as well as the timeliness of care. RESULTS: There was a high rate of implementation of tumour board meeting recommendations of 94.4%. Reasons for non-implementation were mainly a patient's own wish or a worsening of the health situation. Of all patient parameters, only tumour stage was associated with the two optimal care indicators. CONCLUSION: Using routine data from a clinical cancer registry, we were not able to identify patient populations at risk of not getting optimal care and the implementation of guideline-conform care appeared to be very high in this setting. However, limitations were the ambiguity of optimal care indicators and availability of parameters predictive for patients' vulnerability.
DOI
https://www.doi.org/10.1111/ecc.13398
Keywords
Humans; *Lung Neoplasms/therapy; Registries; cancer care; cancer registry; care indicators; lung cancer; optimal care; vulnerable patients
Grundmann, N.; Meisinger, C.; Trepel, M.; et al. (2020) Trends in cancer incidence and survival in the Augsburg study region-results from the Augsburg cancer registry. BMJ Open. https://www.doi.org/10.1136/bmjopen-2019-036176
Title
Trends in cancer incidence and survival in the Augsburg study region-results from the Augsburg cancer registry
Publication date
2020
Abstract
OBJECTIVES: Knowledge about time trends of cancer incidence and cancer survival in a defined region is an essential prerequisite for the planning of regional healthcare infrastructure. The aim of the study was to provide population-based analyses of all common tumour sites to assess the cancer burden in the Augsburg study region. SETTING: Total population of the study region of Augsburg (668 522 residents), Southern Germany. PARTICIPANTS: The data obtained from the Cancer Registry Augsburg comprised 37 487 incident cases of malignant tumours (19 313 men and 18 174 women) diagnosed between 2005 and 2016 in the Augsburg region's resident population. PRIMARY AND SECONDARY OUTCOME MEASURES: We calculated sex-specific, age-standardised incidence rates and annual percent change to assess time trends. In men and in women, 3-year and 5-year relative survival was calculated and results were compared with the latest German estimates. Survival trends were presented for the most common cancers only. RESULTS: Decreasing age-standardised incidence rates were observed for prostate cancer and for colorectal cancer in men. For oropharyngeal cancer, rates declined in men, but significantly increased in women. Incidence for female breast cancer remained stable. Five-year relative survival ranged between 6.4% (95% CI: 4.1% to 10.1%) for pancreatic cancer and 97.7% (95% CI: 96.0% to 99.4%) for prostate cancer in men and between 10.2% (95% CI: 7.1% to 14.6%) for pancreatic cancer and 96.6% (95% CI: 93.6% to 99.6%) for malignant melanoma in women. Trends in 3-year survival of the five most common tumour sites in men showed a significant increase for lung and oropharyngeal cancer. In women, continuously rising survival trends were observed for breast cancer. CONCLUSIONS: Survival of cancer patients in the Augsburg study region was largely concordant with the situation in Germany as a whole, while incidence showed slight deviations in some cancer sites. Regional evaluations on cancer survival are a valuable instrument for identifying deficits and determining advances in oncological health management.
DOI
https://www.doi.org/10.1136/bmjopen-2019-036176
Keywords
Adolescent; Adult; Age Factors; Aged; Female; Germany/epidemiology; Humans; Incidence; Male; Middle Aged; Neoplasms/*epidemiology/mortality; Registries; Sex Factors; Survival Analysis; Young Adult; *epidemiology; *health policy; *public health; *quality in health care
Trends in cancer incidence and survival in the Augsburg study region-results from the Augsburg cancer registry
Publication date
2020
Abstract
OBJECTIVES: Knowledge about time trends of cancer incidence and cancer survival in a defined region is an essential prerequisite for the planning of regional healthcare infrastructure. The aim of the study was to provide population-based analyses of all common tumour sites to assess the cancer burden in the Augsburg study region. SETTING: Total population of the study region of Augsburg (668 522 residents), Southern Germany. PARTICIPANTS: The data obtained from the Cancer Registry Augsburg comprised 37 487 incident cases of malignant tumours (19 313 men and 18 174 women) diagnosed between 2005 and 2016 in the Augsburg region's resident population. PRIMARY AND SECONDARY OUTCOME MEASURES: We calculated sex-specific, age-standardised incidence rates and annual percent change to assess time trends. In men and in women, 3-year and 5-year relative survival was calculated and results were compared with the latest German estimates. Survival trends were presented for the most common cancers only. RESULTS: Decreasing age-standardised incidence rates were observed for prostate cancer and for colorectal cancer in men. For oropharyngeal cancer, rates declined in men, but significantly increased in women. Incidence for female breast cancer remained stable. Five-year relative survival ranged between 6.4% (95% CI: 4.1% to 10.1%) for pancreatic cancer and 97.7% (95% CI: 96.0% to 99.4%) for prostate cancer in men and between 10.2% (95% CI: 7.1% to 14.6%) for pancreatic cancer and 96.6% (95% CI: 93.6% to 99.6%) for malignant melanoma in women. Trends in 3-year survival of the five most common tumour sites in men showed a significant increase for lung and oropharyngeal cancer. In women, continuously rising survival trends were observed for breast cancer. CONCLUSIONS: Survival of cancer patients in the Augsburg study region was largely concordant with the situation in Germany as a whole, while incidence showed slight deviations in some cancer sites. Regional evaluations on cancer survival are a valuable instrument for identifying deficits and determining advances in oncological health management.
DOI
https://www.doi.org/10.1136/bmjopen-2019-036176
Keywords
Adolescent; Adult; Age Factors; Aged; Female; Germany/epidemiology; Humans; Incidence; Male; Middle Aged; Neoplasms/*epidemiology/mortality; Registries; Sex Factors; Survival Analysis; Young Adult; *epidemiology; *health policy; *public health; *quality in health care
Grundmann, N.; Voigtländer, S.; Hakimhashemi, A.; et al. (2023) Site-specific trends in gastroenteropancreatic neuroendocrine neoplasms in Bavaria, Germany. Cancer Med. https://www.doi.org/10.1002/cam4.6510
Title
Site-specific trends in gastroenteropancreatic neuroendocrine neoplasms in Bavaria, Germany
Publication date
2023
Abstract
INTRODUCTION: Neuroendocrine neoplasms (NEN) are rare and heterogeneous epithelial tumors, occurring throughout the body. For gastroenteropancreatic (GEP)-NEN, rising incidence rates were reported for the last decades, with underlying causes remaining largely unexplained. We evaluated NEN trends stratifying by their histologic subtypes. METHODS: Incident cases of GEP-NEN diagnosed between 2005 and 2019 were retrieved from the prospective, population-based Bavarian Cancer Registry. GEP-NEN were divided in their histologic subtypes, that is, neuroendocrine tumors (NET) G1, NET G2/G3, other NET versus small-cell neuroendocrine carcinoma (NEC), large-cell NEC, and other NEC. We calculated annual age-standardized incidence rates (ASIRs) per 100,000 persons for the total of GEP-NEN, NEN histologic subtypes, and tumor sites. We used an annual percentage change (APC) approach including a joinpoint analysis to investigate NEN incidence trends. RESULTS: ASIR of GEP-NEN rose from 2.2 in 2005 to 4.8 in 2019, characterized by a significant increase until 2012 (APC 2005-2012: 10.1%), followed by modest rise (APC 2012-2019: 1.5%). In the last decade, this increase was mainly driven by the rise of NET G1 and G2/G3, while incidence for NEC declined. Over the study period, ASIR increased significantly for all GEP-sites except the colon. APCs were largest for the stomach, the appendix, the pancreas, and the rectum. CONCLUSIONS: This study found a significant increase in the incidence of GEP-NET. Though this development may partially be attributable to the increased use of advanced detection techniques and changes in NEN classification, further research should also focus on the identification of NEN risk factors.
DOI
https://www.doi.org/10.1002/cam4.6510
Keywords
Humans; Prospective Studies; *Neuroendocrine Tumors/pathology; *Pancreatic Neoplasms/pathology; *Intestinal Neoplasms/epidemiology/pathology; *Stomach Neoplasms/epidemiology/pathology; *Carcinoma, Neuroendocrine/pathology; gastroenteropancreatic neuroendocrine tumor; gastrointestinal neoplasms; incidence; neuroendocrine carcinoma; neuroendocrine tumors
Site-specific trends in gastroenteropancreatic neuroendocrine neoplasms in Bavaria, Germany
Publication date
2023
Abstract
INTRODUCTION: Neuroendocrine neoplasms (NEN) are rare and heterogeneous epithelial tumors, occurring throughout the body. For gastroenteropancreatic (GEP)-NEN, rising incidence rates were reported for the last decades, with underlying causes remaining largely unexplained. We evaluated NEN trends stratifying by their histologic subtypes. METHODS: Incident cases of GEP-NEN diagnosed between 2005 and 2019 were retrieved from the prospective, population-based Bavarian Cancer Registry. GEP-NEN were divided in their histologic subtypes, that is, neuroendocrine tumors (NET) G1, NET G2/G3, other NET versus small-cell neuroendocrine carcinoma (NEC), large-cell NEC, and other NEC. We calculated annual age-standardized incidence rates (ASIRs) per 100,000 persons for the total of GEP-NEN, NEN histologic subtypes, and tumor sites. We used an annual percentage change (APC) approach including a joinpoint analysis to investigate NEN incidence trends. RESULTS: ASIR of GEP-NEN rose from 2.2 in 2005 to 4.8 in 2019, characterized by a significant increase until 2012 (APC 2005-2012: 10.1%), followed by modest rise (APC 2012-2019: 1.5%). In the last decade, this increase was mainly driven by the rise of NET G1 and G2/G3, while incidence for NEC declined. Over the study period, ASIR increased significantly for all GEP-sites except the colon. APCs were largest for the stomach, the appendix, the pancreas, and the rectum. CONCLUSIONS: This study found a significant increase in the incidence of GEP-NET. Though this development may partially be attributable to the increased use of advanced detection techniques and changes in NEN classification, further research should also focus on the identification of NEN risk factors.
DOI
https://www.doi.org/10.1002/cam4.6510
Keywords
Humans; Prospective Studies; *Neuroendocrine Tumors/pathology; *Pancreatic Neoplasms/pathology; *Intestinal Neoplasms/epidemiology/pathology; *Stomach Neoplasms/epidemiology/pathology; *Carcinoma, Neuroendocrine/pathology; gastroenteropancreatic neuroendocrine tumor; gastrointestinal neoplasms; incidence; neuroendocrine carcinoma; neuroendocrine tumors
Hackl, C.; Neumann, P.; Gerken, M.; et al. (2014) Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma. BMC Cancer. https://www.doi.org/10.1186/1471-2407-14-810
Title
Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma
Publication date
2014
Abstract
BACKGROUND: Purpose of this study was to analyse the surgical management and long-term clinical outcome of patients diagnosed with colorectal liver metastases (CLM) over a period of 10 years using data from a German tumour registry. METHODS: Retrospective analysis of 5772 patients diagnosed with colorectal adenocarcinoma between 2002 and 2007. Follow-up was continued until 2012. RESULTS: 1426 patients (24.7%) had CLM; 1019 patients (71%) had synchronous, 407 patients (29%) developed metachronous CLM. Hepatic resection was performed in 374 of the 1426 CLM patients (26%). A significant increase in liver resection rate from 16.6% for the 2002 cohort to 32% in later cohorts was observed. In centers specialized in liver surgery, CLM resection rates reached 46.6%. However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM. Univariate and multivariate analyses adjusted for age, sex, year of resection, time of CLM diagnosis and number of CLM revealed a significant survival benefit for CLM resection (HR =0.355; CI 0.305-0.414). Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM. CONCLUSIONS: We here present the first long-term, population-based analysis of the surgical management of CLM in Germany. Significant increase in hepatic resection rates, translating to a significant benefit in OS, was seen over years. However, we still see a striking potential for further improvements in interdisciplinary CLM management.
DOI
https://www.doi.org/10.1186/1471-2407-14-810
Keywords
Adenocarcinoma/epidemiology/*pathology; Adult; Aged; Aged, 80 and over; Colorectal Neoplasms/epidemiology/*pathology; Combined Modality Therapy; Female; Germany/epidemiology; Humans; Incidence; Liver Neoplasms/epidemiology/*secondary/*therapy; Male; Middle Aged; Population Surveillance; Registries; Treatment Outcome; Young Adult
Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma
Publication date
2014
Abstract
BACKGROUND: Purpose of this study was to analyse the surgical management and long-term clinical outcome of patients diagnosed with colorectal liver metastases (CLM) over a period of 10 years using data from a German tumour registry. METHODS: Retrospective analysis of 5772 patients diagnosed with colorectal adenocarcinoma between 2002 and 2007. Follow-up was continued until 2012. RESULTS: 1426 patients (24.7%) had CLM; 1019 patients (71%) had synchronous, 407 patients (29%) developed metachronous CLM. Hepatic resection was performed in 374 of the 1426 CLM patients (26%). A significant increase in liver resection rate from 16.6% for the 2002 cohort to 32% in later cohorts was observed. In centers specialized in liver surgery, CLM resection rates reached 46.6%. However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM. Univariate and multivariate analyses adjusted for age, sex, year of resection, time of CLM diagnosis and number of CLM revealed a significant survival benefit for CLM resection (HR =0.355; CI 0.305-0.414). Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM. CONCLUSIONS: We here present the first long-term, population-based analysis of the surgical management of CLM in Germany. Significant increase in hepatic resection rates, translating to a significant benefit in OS, was seen over years. However, we still see a striking potential for further improvements in interdisciplinary CLM management.
DOI
https://www.doi.org/10.1186/1471-2407-14-810
Keywords
Adenocarcinoma/epidemiology/*pathology; Adult; Aged; Aged, 80 and over; Colorectal Neoplasms/epidemiology/*pathology; Combined Modality Therapy; Female; Germany/epidemiology; Humans; Incidence; Liver Neoplasms/epidemiology/*secondary/*therapy; Male; Middle Aged; Population Surveillance; Registries; Treatment Outcome; Young Adult
Hager, B.; Kraywinkel, K.; Keck, B.; et al. (2015) Integrated prostate cancer centers might cause an overutilization of radiotherapy for low-risk prostate cancer: A comparison of treatment trends in the United States and Germany from 2004 to 2011. Radiother Oncol. https://www.doi.org/10.1016/j.radonc.2015.02.024
Title
Integrated prostate cancer centers might cause an overutilization of radiotherapy for low-risk prostate cancer: A comparison of treatment trends in the United States and Germany from 2004 to 2011
Publication date
2015
Abstract
INTRODUCTION: Aim of the study was to analyze changes in primary treatment for low-risk prostate cancer across different healthcare systems. MATERIALS AND METHODS: We compared "Surveillance Epidemiology and End Results" data (USA) with data from four German federal epidemiological cancer registries, both from 2004 to 2011. We excluded metastatic disease and patients aged 80 years. Thereof, we identified 132,506 (USA) and 54,159 (Germany) patients with low-risk according to the 2014 EAU guidelines. We tested treatment trends for statistical significance with a linear regression model. RESULTS: Active treatment was radical prostatectomy (RP) in 36.1% vs. 66.2% and radiotherapy (RT) in 38.4% vs. 11.8%. No active treatment (NAT) was reported in 24.2% vs. 16.2% (p<0.001 each). Through the study period the use of RP decreased from 37.1% to 34.2% in the USA (p=0.04) and was constant at a mean of 66.2% in Germany (p=0.8). The use of RT in the USA decreased from 42.8% to 31.8% (p<0.001), while it was stable in Germany (p=0.09). The NAT group grew from 18.0% to 33.2% in the USA (p<0.001), while it was stable in Germany until 2009 (p=0.3). From 2009 to 2011 there also was an increase of the NAT group in Germany from 15.2% to 19.4% (p=0.001). CONCLUSION: In contrast to former evidence we found the relative use of RT for low-risk prostate cancer much higher in the USA compared to Germany. The implementation of integrated prostate cancer centers in the USA might explain this observation. Deferred and defensive treatment strategies showed a steady increase in the USA. This development seems delayed in Germany by several years.
DOI
https://www.doi.org/10.1016/j.radonc.2015.02.024
Keywords
Aged; Germany; Humans; Male; Middle Aged; Prostatectomy; Prostatic Neoplasms/*radiotherapy; Risk Factors; United States; Health services research; Internationality; Physician's practice patterns; Prostatic neoplasms; SEER program
Integrated prostate cancer centers might cause an overutilization of radiotherapy for low-risk prostate cancer: A comparison of treatment trends in the United States and Germany from 2004 to 2011
Publication date
2015
Abstract
INTRODUCTION: Aim of the study was to analyze changes in primary treatment for low-risk prostate cancer across different healthcare systems. MATERIALS AND METHODS: We compared "Surveillance Epidemiology and End Results" data (USA) with data from four German federal epidemiological cancer registries, both from 2004 to 2011. We excluded metastatic disease and patients aged 80 years. Thereof, we identified 132,506 (USA) and 54,159 (Germany) patients with low-risk according to the 2014 EAU guidelines. We tested treatment trends for statistical significance with a linear regression model. RESULTS: Active treatment was radical prostatectomy (RP) in 36.1% vs. 66.2% and radiotherapy (RT) in 38.4% vs. 11.8%. No active treatment (NAT) was reported in 24.2% vs. 16.2% (p<0.001 each). Through the study period the use of RP decreased from 37.1% to 34.2% in the USA (p=0.04) and was constant at a mean of 66.2% in Germany (p=0.8). The use of RT in the USA decreased from 42.8% to 31.8% (p<0.001), while it was stable in Germany (p=0.09). The NAT group grew from 18.0% to 33.2% in the USA (p<0.001), while it was stable in Germany until 2009 (p=0.3). From 2009 to 2011 there also was an increase of the NAT group in Germany from 15.2% to 19.4% (p=0.001). CONCLUSION: In contrast to former evidence we found the relative use of RT for low-risk prostate cancer much higher in the USA compared to Germany. The implementation of integrated prostate cancer centers in the USA might explain this observation. Deferred and defensive treatment strategies showed a steady increase in the USA. This development seems delayed in Germany by several years.
DOI
https://www.doi.org/10.1016/j.radonc.2015.02.024
Keywords
Aged; Germany; Humans; Male; Middle Aged; Prostatectomy; Prostatic Neoplasms/*radiotherapy; Risk Factors; United States; Health services research; Internationality; Physician's practice patterns; Prostatic neoplasms; SEER program
Han, N.; Heublein, S.; Jeschke, U.; et al. (2021) The G-Protein-Coupled Estrogen Receptor (GPER) Regulates Trimethylation of Histone H3 at Lysine 4 and Represses Migration and Proliferation of Ovarian Cancer Cells In Vitro. Cells. https://www.doi.org/10.3390/cells10030619
Title
The G-Protein-Coupled Estrogen Receptor (GPER) Regulates Trimethylation of Histone H3 at Lysine 4 and Represses Migration and Proliferation of Ovarian Cancer Cells In Vitro
Publication date
2021
Abstract
Histone H3 lysine 4 trimethylation (H3K4me3) is one of the most recognized epigenetic regulators of transcriptional activity representing, an epigenetic modification of Histone H3. Previous reports have suggested that the broad H3K4me3 domain can be considered as an epigenetic signature for tumor-suppressor genes in human cells. G-protein-coupled estrogen receptor (GPER), a new membrane-bound estrogen receptor, acts as an inhibitor on cell growth via epigenetic regulation in breast and ovarian cancer cells. This study was conducted to evaluate the relationship of GPER and H3K4me3 in ovarian cancer tissue samples as well as in two different cell lines (Caov3 and Caov4). Silencing of GPER by a specific siRNA and two selective regulators with agonistic (G1) and antagonistic (G15) activity were applied for consecutive in vitro studies to investigate their impacts on tumor cell growth and the changes in phosphorylated ERK1/2 (p-ERK1/2) and H3K4me3. We found a positive correlation between GPER and H3K4me3 expression in ovarian cancer patients. Patients overexpressing GPER as well as H3K4me3 had significantly improved overall survival. Increased H3K4me3 and p-ERK1/2 levels and attenuated cell proliferation and migration were observed in Caov3 and Caov4 cells via activation of GPER by G1. Conversely, antagonizing GPER activity by G15 resulted in opposite effects in the Caov4 cell line. In conclusion, interaction of GPER and H3K4me3 appears to be of prognostic significance for ovarian cancer patients. The results of the in vitro analyses confirm the biological rationale for their interplay and identify GPER agonists, such as G1, as a potential therapeutic approach for future investigations.
DOI
https://www.doi.org/10.3390/cells10030619
Keywords
Antineoplastic Agents/pharmacology; Cell Line, Tumor; *Cell Movement/drug effects; *Cell Proliferation/drug effects; *DNA Methylation; *Epigenesis, Genetic; Extracellular Signal-Regulated MAP Kinases/metabolism; Female; Gene Expression Regulation, Neoplastic; Histones/*metabolism; Humans; Lysine; Neoplasm Invasiveness; Ovarian Neoplasms/drug therapy/genetics/*metabolism/pathology; Phosphorylation; Receptors, Estrogen/genetics/*metabolism; Receptors, G-Protein-Coupled/agonists/genetics/*metabolism; Signal Transduction; *g15; *gper; *GPER agonist G1; *H3K4me3; *cell migration and proliferation; *ovarian cancer; *p-ERK1/2
The G-Protein-Coupled Estrogen Receptor (GPER) Regulates Trimethylation of Histone H3 at Lysine 4 and Represses Migration and Proliferation of Ovarian Cancer Cells In Vitro
Publication date
2021
Abstract
Histone H3 lysine 4 trimethylation (H3K4me3) is one of the most recognized epigenetic regulators of transcriptional activity representing, an epigenetic modification of Histone H3. Previous reports have suggested that the broad H3K4me3 domain can be considered as an epigenetic signature for tumor-suppressor genes in human cells. G-protein-coupled estrogen receptor (GPER), a new membrane-bound estrogen receptor, acts as an inhibitor on cell growth via epigenetic regulation in breast and ovarian cancer cells. This study was conducted to evaluate the relationship of GPER and H3K4me3 in ovarian cancer tissue samples as well as in two different cell lines (Caov3 and Caov4). Silencing of GPER by a specific siRNA and two selective regulators with agonistic (G1) and antagonistic (G15) activity were applied for consecutive in vitro studies to investigate their impacts on tumor cell growth and the changes in phosphorylated ERK1/2 (p-ERK1/2) and H3K4me3. We found a positive correlation between GPER and H3K4me3 expression in ovarian cancer patients. Patients overexpressing GPER as well as H3K4me3 had significantly improved overall survival. Increased H3K4me3 and p-ERK1/2 levels and attenuated cell proliferation and migration were observed in Caov3 and Caov4 cells via activation of GPER by G1. Conversely, antagonizing GPER activity by G15 resulted in opposite effects in the Caov4 cell line. In conclusion, interaction of GPER and H3K4me3 appears to be of prognostic significance for ovarian cancer patients. The results of the in vitro analyses confirm the biological rationale for their interplay and identify GPER agonists, such as G1, as a potential therapeutic approach for future investigations.
DOI
https://www.doi.org/10.3390/cells10030619
Keywords
Antineoplastic Agents/pharmacology; Cell Line, Tumor; *Cell Movement/drug effects; *Cell Proliferation/drug effects; *DNA Methylation; *Epigenesis, Genetic; Extracellular Signal-Regulated MAP Kinases/metabolism; Female; Gene Expression Regulation, Neoplastic; Histones/*metabolism; Humans; Lysine; Neoplasm Invasiveness; Ovarian Neoplasms/drug therapy/genetics/*metabolism/pathology; Phosphorylation; Receptors, Estrogen/genetics/*metabolism; Receptors, G-Protein-Coupled/agonists/genetics/*metabolism; Signal Transduction; *g15; *gper; *GPER agonist G1; *H3K4me3; *cell migration and proliferation; *ovarian cancer; *p-ERK1/2
Han, N.; Jeschke, U.; Kuhn, C.; et al. (2020) H3K4me3 Is a Potential Mediator for Antiproliferative Effects of Calcitriol (1alpha,25(OH)2D3) in Ovarian Cancer Biology. Int J Mol Sci. https://www.doi.org/10.3390/ijms21062151
Title
H3K4me3 Is a Potential Mediator for Antiproliferative Effects of Calcitriol (1alpha,25(OH)2D3) in Ovarian Cancer Biology
Publication date
2020
Abstract
Posttranslational histone modification plays an important role in tumorigenesis. Histone modification is a dynamic response of chromatin to various signals, such as the exposure to calcitriol (1alpha,25(OH)2D3). Recent studies suggested that histone modification levels could be used to predict patient outcomes in various cancers. Our study evaluated the expression level of histone 3 lysine 4 trimethylation (H3K4me3) in a cohort of 156 epithelial ovarian cancer (EOC) cases by immunohistochemical staining and analyzed its correlation to patient prognosis. The influence of 1alpha,25(OH)2D3 on the proliferation of ovarian cancer cells was measured by BrdU proliferation assay in vitro. We could show that higher levels of H3K4me3 were correlated with improved overall survival (median overall survival (OS) not reached vs. 37.0 months, p = 0.047) and identified H3K4me3 as a potential prognostic factor for the present cohort. Ovarian cancer cell 1alpha,25(OH)2D3 treatment induced H3K4me3 protein expression and exhibited antiproliferative effects. By this, the study suggests a possible impact of H3K4me3 expression on EOC progression as well as its relation to calcitriol (1alpha,25(OH)2D3) treatment. These results may serve as an explanation on how 1alpha,25(OH)2D3 mediates its known antiproliferative effects. In addition, they further underline the potential benefit of 1alpha,25(OH)2D3 supplementation in context of ovarian cancer care.
DOI
https://www.doi.org/10.3390/ijms21062151
Keywords
1alpha,25(OH)2D3; calcitriol; cell proliferation; histone 3 lysine 4 trimethylation (H3K4me3); histone modification; ovarian cancer; prognosis; vitamin D receptor
H3K4me3 Is a Potential Mediator for Antiproliferative Effects of Calcitriol (1alpha,25(OH)2D3) in Ovarian Cancer Biology
Publication date
2020
Abstract
Posttranslational histone modification plays an important role in tumorigenesis. Histone modification is a dynamic response of chromatin to various signals, such as the exposure to calcitriol (1alpha,25(OH)2D3). Recent studies suggested that histone modification levels could be used to predict patient outcomes in various cancers. Our study evaluated the expression level of histone 3 lysine 4 trimethylation (H3K4me3) in a cohort of 156 epithelial ovarian cancer (EOC) cases by immunohistochemical staining and analyzed its correlation to patient prognosis. The influence of 1alpha,25(OH)2D3 on the proliferation of ovarian cancer cells was measured by BrdU proliferation assay in vitro. We could show that higher levels of H3K4me3 were correlated with improved overall survival (median overall survival (OS) not reached vs. 37.0 months, p = 0.047) and identified H3K4me3 as a potential prognostic factor for the present cohort. Ovarian cancer cell 1alpha,25(OH)2D3 treatment induced H3K4me3 protein expression and exhibited antiproliferative effects. By this, the study suggests a possible impact of H3K4me3 expression on EOC progression as well as its relation to calcitriol (1alpha,25(OH)2D3) treatment. These results may serve as an explanation on how 1alpha,25(OH)2D3 mediates its known antiproliferative effects. In addition, they further underline the potential benefit of 1alpha,25(OH)2D3 supplementation in context of ovarian cancer care.
DOI
https://www.doi.org/10.3390/ijms21062151
Keywords
1alpha,25(OH)2D3; calcitriol; cell proliferation; histone 3 lysine 4 trimethylation (H3K4me3); histone modification; ovarian cancer; prognosis; vitamin D receptor
Hatzipanagiotou, M. E.; Pigerl, M.; Gerken, M.; et al. (2023) Does timing of neoadjuvant chemotherapy influence the prognosis in patients with early triple negative breast cancer?. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-023-05060-y
Title
Does timing of neoadjuvant chemotherapy influence the prognosis in patients with early triple negative breast cancer?
Publication date
2023
Abstract
PURPOSE: For patients with triple negative breast cancer (TNBC), the optimal time to initiate neoadjuvant chemotherapy (TTNC) is unknown. This study evaluates the association between TTNC and survival in patients with early TNBC. METHODS: A retrospective study using data from of a cohort of TNBC patients diagnosed between January 1, 2010 to December 31, 2018 registered in the Tumor Centre Regensburg was performed. Data included demographics, pathology, treatment, recurrence, and survival. Interval to treatment was defined as days from pathology diagnosis of TNBC to first dose of neoadjuvant chemotherapy (NACT). The Kaplan-Meier and Cox regression methods were used to evaluate the impact of TTNC on overall survival (OS) and 5 year OS. RESULTS: A total of 270 patients were included. Median follow up was 3.5 years. The 5-year OS estimates according to TTNC were 77.4%, 66.9%, 82.3%, 80.6%, 88.3%, 58.3%, 71.1% and 66.7% in patients who received NACT within 0-14, 15-21, 22-28, 29-35, 36-42, 43-49, 50-56 and > 56 days after diagnosis. Patients who received systemic therapy early had the highest estimated mean OS of 8.4 years, while patients who received systemic therapy after more than 56 days survived an estimated 3.3 years. CONCLUSION: The optimal time interval between diagnosis and NACT remains to be determined. However, starting NACT more than 42 days after diagnosis of TNBC seems to reduce survival. Therefore, it is strongly recommended to carry out the treatment in a certified breast center with appropriate structures, in order to enable an adequate and timely care.
DOI
https://www.doi.org/10.1007/s00432-023-05060-y
Keywords
Humans; Female; Neoadjuvant Therapy; *Triple Negative Breast Neoplasms/pathology; Retrospective Studies; *Breast Neoplasms/pathology; Neoplasm Staging; Antineoplastic Combined Chemotherapy Protocols; Prognosis; Chemotherapy, Adjuvant; Clinical cancer registry data; Neoadjuvant chemotherapy; Time to systemic therapy; Triple negative breast cancer
Does timing of neoadjuvant chemotherapy influence the prognosis in patients with early triple negative breast cancer?
Publication date
2023
Abstract
PURPOSE: For patients with triple negative breast cancer (TNBC), the optimal time to initiate neoadjuvant chemotherapy (TTNC) is unknown. This study evaluates the association between TTNC and survival in patients with early TNBC. METHODS: A retrospective study using data from of a cohort of TNBC patients diagnosed between January 1, 2010 to December 31, 2018 registered in the Tumor Centre Regensburg was performed. Data included demographics, pathology, treatment, recurrence, and survival. Interval to treatment was defined as days from pathology diagnosis of TNBC to first dose of neoadjuvant chemotherapy (NACT). The Kaplan-Meier and Cox regression methods were used to evaluate the impact of TTNC on overall survival (OS) and 5 year OS. RESULTS: A total of 270 patients were included. Median follow up was 3.5 years. The 5-year OS estimates according to TTNC were 77.4%, 66.9%, 82.3%, 80.6%, 88.3%, 58.3%, 71.1% and 66.7% in patients who received NACT within 0-14, 15-21, 22-28, 29-35, 36-42, 43-49, 50-56 and > 56 days after diagnosis. Patients who received systemic therapy early had the highest estimated mean OS of 8.4 years, while patients who received systemic therapy after more than 56 days survived an estimated 3.3 years. CONCLUSION: The optimal time interval between diagnosis and NACT remains to be determined. However, starting NACT more than 42 days after diagnosis of TNBC seems to reduce survival. Therefore, it is strongly recommended to carry out the treatment in a certified breast center with appropriate structures, in order to enable an adequate and timely care.
DOI
https://www.doi.org/10.1007/s00432-023-05060-y
Keywords
Humans; Female; Neoadjuvant Therapy; *Triple Negative Breast Neoplasms/pathology; Retrospective Studies; *Breast Neoplasms/pathology; Neoplasm Staging; Antineoplastic Combined Chemotherapy Protocols; Prognosis; Chemotherapy, Adjuvant; Clinical cancer registry data; Neoadjuvant chemotherapy; Time to systemic therapy; Triple negative breast cancer
Heckl, M.; Schmoeckel, E.; Hertlein, L.; et al. (2018) The ARID1A, p53 and ss-Catenin statuses are strong prognosticators in clear cell and endometrioid carcinoma of the ovary and the endometrium. PLoS One. https://www.doi.org/10.1371/journal.pone.0192881
Title
The ARID1A, p53 and ss-Catenin statuses are strong prognosticators in clear cell and endometrioid carcinoma of the ovary and the endometrium
Publication date
2018
Abstract
AIM: The objective of this study was to evaluate the prognostic value of ARID1A, p53, p21, p16 and ss-Catenin in endometrioid and clear cell ovarian and endometrial carcinomas. MATERIALS AND METHODS: 97 tumors were available for analysis of ARID1A, p53, p21, p16 and ss-Catenin with the techniques of tissue microarray and immunohistochemistry. 32 were ovarian carcinomas and 65 were endometrial carcinomas. RESULTS: Endometrioid ovarian carcinomas showed negative staining for ARID1A (a) and p21 (b), aberrant expression of p53 (c) and p16 (d) and ss-Catenin positive nuclear expression (e) respectively in 19% (a), 100% (b), 28.6% (c), 52.4% (d) and 4.8% (e) of all cases. In the group of clear cell ovarian carcinomas it was 63.6% (a), 100% (b), 81.8% (c), 54.5% (d) and 0% (e). For endometrioid uterine carcinomas it was 75.7% (a), 94.9% (b), 30.5% (c), 52.1% (d) and 6.8% (e) and for clear cell uterine carcinomas it was 8.6% (a), 100% (b), 50% (c), 100% (d) and 0% (e). Survival analysis showed that negative expression of ARID1A, p53 aberrant expression and ss-Catenin nuclear positive staining are independent negative prognosticators in both, clear cell and endometrioid carcinoma, regardless of ovarian or uterine origin. Cox-Regression analysis showed them again as negative prognostic factors. Furthermore, we found a significant correlation between ARID1A and ss-Catenin expression in endometrioid uterine tumors. CONCLUSION: The analyzed gynaecological carcinoma showed a distinct expression scheme of proteins that are associated with tumor suppression. We may conclude that ARID1A, p53 and ss-Catenin are the strongest prognostic factors by analyzing a subgroup of tumor suppressor genes in clear cell and endometrioid subtypes of ovarian and endometrial cancer and may be used along with traditional morphological and clinical characteristics for prognosis.
DOI
https://www.doi.org/10.1371/journal.pone.0192881
Keywords
Adenocarcinoma, Clear Cell/metabolism/*pathology; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor/metabolism; Carcinoma, Ovarian Epithelial; Endometrial Neoplasms/metabolism/*pathology; Female; Gene Expression Regulation, Neoplastic; Humans; Middle Aged; Neoplasms, Glandular and Epithelial/metabolism/*pathology; Nuclear Proteins/*metabolism; Ovarian Neoplasms/metabolism/*pathology; Prognosis; Survival Rate; Transcription Factors/*metabolism; Tumor Suppressor Protein p53/*metabolism; Uterine Neoplasms/metabolism/*pathology; beta Catenin/*metabolism
The ARID1A, p53 and ss-Catenin statuses are strong prognosticators in clear cell and endometrioid carcinoma of the ovary and the endometrium
Publication date
2018
Abstract
AIM: The objective of this study was to evaluate the prognostic value of ARID1A, p53, p21, p16 and ss-Catenin in endometrioid and clear cell ovarian and endometrial carcinomas. MATERIALS AND METHODS: 97 tumors were available for analysis of ARID1A, p53, p21, p16 and ss-Catenin with the techniques of tissue microarray and immunohistochemistry. 32 were ovarian carcinomas and 65 were endometrial carcinomas. RESULTS: Endometrioid ovarian carcinomas showed negative staining for ARID1A (a) and p21 (b), aberrant expression of p53 (c) and p16 (d) and ss-Catenin positive nuclear expression (e) respectively in 19% (a), 100% (b), 28.6% (c), 52.4% (d) and 4.8% (e) of all cases. In the group of clear cell ovarian carcinomas it was 63.6% (a), 100% (b), 81.8% (c), 54.5% (d) and 0% (e). For endometrioid uterine carcinomas it was 75.7% (a), 94.9% (b), 30.5% (c), 52.1% (d) and 6.8% (e) and for clear cell uterine carcinomas it was 8.6% (a), 100% (b), 50% (c), 100% (d) and 0% (e). Survival analysis showed that negative expression of ARID1A, p53 aberrant expression and ss-Catenin nuclear positive staining are independent negative prognosticators in both, clear cell and endometrioid carcinoma, regardless of ovarian or uterine origin. Cox-Regression analysis showed them again as negative prognostic factors. Furthermore, we found a significant correlation between ARID1A and ss-Catenin expression in endometrioid uterine tumors. CONCLUSION: The analyzed gynaecological carcinoma showed a distinct expression scheme of proteins that are associated with tumor suppression. We may conclude that ARID1A, p53 and ss-Catenin are the strongest prognostic factors by analyzing a subgroup of tumor suppressor genes in clear cell and endometrioid subtypes of ovarian and endometrial cancer and may be used along with traditional morphological and clinical characteristics for prognosis.
DOI
https://www.doi.org/10.1371/journal.pone.0192881
Keywords
Adenocarcinoma, Clear Cell/metabolism/*pathology; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor/metabolism; Carcinoma, Ovarian Epithelial; Endometrial Neoplasms/metabolism/*pathology; Female; Gene Expression Regulation, Neoplastic; Humans; Middle Aged; Neoplasms, Glandular and Epithelial/metabolism/*pathology; Nuclear Proteins/*metabolism; Ovarian Neoplasms/metabolism/*pathology; Prognosis; Survival Rate; Transcription Factors/*metabolism; Tumor Suppressor Protein p53/*metabolism; Uterine Neoplasms/metabolism/*pathology; beta Catenin/*metabolism
Hetterich, M.; Gerken, M.; Ortmann, O.; et al. (2021) Adjuvant chemotherapy for breast cancer patients with axillary lymph node micrometastases. Breast Cancer Res Treat. https://www.doi.org/10.1007/s10549-021-06162-2
Title
Adjuvant chemotherapy for breast cancer patients with axillary lymph node micrometastases
Publication date
2021
Abstract
BACKGROUND: The axillary lymph node status is one of the most important prognostic factors in patients with early breast cancer. However, the impact of axillary lymph node micrometastases on survival remains unclear. There are no consistent recommendations for adjuvant chemotherapy (CHT). In this context, we aimed to investigate the impact of micrometastases on the clinical outcome of breast cancer patients according to the adjuvant CHT performed. PATIENTS AND METHODS: We conducted a retrospective population-based registry study of 26,465 patients aged between 24 and 97 years with primary breast cancer diagnosed between 2003 and 2017. Of these patients, 8856 with early breast cancer were eligible for analysis: 8316 (93.9%) were node negative and 540 (6.1%) had lymph node micrometastases. RESULTS: The median follow-up was 7.2 years, with a confidence interval (CI) of 7.1-7.3 years. Patients with lymph node micrometastases (pN1mi) without adjuvant CHT have reduced 10-year overall survival (OS) and recurrence-free survival (RFS) compared to patients who had axillary lymph node micrometastases and received an adjuvant CHT. However, this effect disappeared after adjustment for age, tumor size and tumor grading. Furthermore, in the group of patients with lymph node micrometastases, the administration of adjuvant CHT did not improve OS or RFS, compared to patients with lymph node micrometastases without adjuvant CHT: hazard ratio for treated patients was 1.51 (95% CI 0.80-2.85, p = 0.208) for OS and 1.12 (95% CI 0.63-1.97, p = 0.705) for RFS. CONCLUSION: Patients with axillary lymph node micrometastases showed a comparable outcome to node negative patients and their outcome was not significantly improved with CHT. Thus, axillary lymph node micrometastases should not be considered in the treatment decision.
DOI
https://www.doi.org/10.1007/s10549-021-06162-2
Keywords
Adult; Aged; Aged, 80 and over; Axilla; *Breast Neoplasms/drug therapy/surgery; Chemotherapy, Adjuvant; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; *Neoplasm Micrometastasis; Retrospective Studies; Sentinel Lymph Node Biopsy; Young Adult; Adjuvant chemotherapy; Breast cancer; Lymph node; Micrometastases; Survival
Adjuvant chemotherapy for breast cancer patients with axillary lymph node micrometastases
Publication date
2021
Abstract
BACKGROUND: The axillary lymph node status is one of the most important prognostic factors in patients with early breast cancer. However, the impact of axillary lymph node micrometastases on survival remains unclear. There are no consistent recommendations for adjuvant chemotherapy (CHT). In this context, we aimed to investigate the impact of micrometastases on the clinical outcome of breast cancer patients according to the adjuvant CHT performed. PATIENTS AND METHODS: We conducted a retrospective population-based registry study of 26,465 patients aged between 24 and 97 years with primary breast cancer diagnosed between 2003 and 2017. Of these patients, 8856 with early breast cancer were eligible for analysis: 8316 (93.9%) were node negative and 540 (6.1%) had lymph node micrometastases. RESULTS: The median follow-up was 7.2 years, with a confidence interval (CI) of 7.1-7.3 years. Patients with lymph node micrometastases (pN1mi) without adjuvant CHT have reduced 10-year overall survival (OS) and recurrence-free survival (RFS) compared to patients who had axillary lymph node micrometastases and received an adjuvant CHT. However, this effect disappeared after adjustment for age, tumor size and tumor grading. Furthermore, in the group of patients with lymph node micrometastases, the administration of adjuvant CHT did not improve OS or RFS, compared to patients with lymph node micrometastases without adjuvant CHT: hazard ratio for treated patients was 1.51 (95% CI 0.80-2.85, p = 0.208) for OS and 1.12 (95% CI 0.63-1.97, p = 0.705) for RFS. CONCLUSION: Patients with axillary lymph node micrometastases showed a comparable outcome to node negative patients and their outcome was not significantly improved with CHT. Thus, axillary lymph node micrometastases should not be considered in the treatment decision.
DOI
https://www.doi.org/10.1007/s10549-021-06162-2
Keywords
Adult; Aged; Aged, 80 and over; Axilla; *Breast Neoplasms/drug therapy/surgery; Chemotherapy, Adjuvant; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; *Neoplasm Micrometastasis; Retrospective Studies; Sentinel Lymph Node Biopsy; Young Adult; Adjuvant chemotherapy; Breast cancer; Lymph node; Micrometastases; Survival
Hintschich, C. A.; Gerken, M.; Spoerl, S.; et al. (2023) Primary Diagnoses of Squamous Cell Carcinoma of the Head and Neck During the COVID-19 Pandemic. Dtsch Arztebl Int. https://www.doi.org/10.3238/arztebl.m2023.0177
Title
Primary Diagnoses of Squamous Cell Carcinoma of the Head and Neck During the COVID-19 Pandemic
Publication date
2023
DOI
https://www.doi.org/10.3238/arztebl.m2023.0177
Keywords
Humans; Squamous Cell Carcinoma of Head and Neck; Pandemics; *covid-19; *Carcinoma, Squamous Cell/diagnosis/epidemiology/therapy; *Head and Neck Neoplasms/diagnosis/epidemiology/therapy
Primary Diagnoses of Squamous Cell Carcinoma of the Head and Neck During the COVID-19 Pandemic
Publication date
2023
DOI
https://www.doi.org/10.3238/arztebl.m2023.0177
Keywords
Humans; Squamous Cell Carcinoma of Head and Neck; Pandemics; *covid-19; *Carcinoma, Squamous Cell/diagnosis/epidemiology/therapy; *Head and Neck Neoplasms/diagnosis/epidemiology/therapy
Hossann, Martin; Hirschberger, Johannes; Schmidt, Rebecca; et al. (2021) A Heat-Activated Drug-Delivery Platform Based on Phosphatidyl-(oligo)-glycerol Nanocarrier for Effective Cancer Treatment. Advanced NanoBiomed Research. https://www.doi.org/https://doi.org/10.1002/anbr.202000089
Title
A Heat-Activated Drug-Delivery Platform Based on Phosphatidyl-(oligo)-glycerol Nanocarrier for Effective Cancer Treatment
Publication date
2021
Abstract
The potential of cancer drugs is not fully exploited due to low tumor uptake and occurrence of systemic side effects, limiting maximum tolerated dose. Actively targeted nanocarriers improve efficacy while minimizing off-target toxicity. Herein, it is the first time a drug-delivery platform for heat-triggered intravascular drug release is described, based on synthetic phosphatidyl-(oligo)-glycerols from organic synthesis to preclinical investigation in feline patients. For the nanocarrier formulated doxorubicin (DOX), superior tumor drug delivery and antitumor activity compared with free DOX, conventional liposomal DOX (Caelyx), and temperature-sensitive lysolipid-containing DOX-liposomes in rat sarcoma are demonstrated. In a comparative oncological study with neoadjuvant treatment of feline sarcoma, a metabolic response determined with 18 F-FDG-positron emission tomography/magnetic resonance imaging (PET/MRI) and histopathological response after tumor resection are significantly better compared with free DOX, potentially by overcoming drug resistance based on improved intratumoral drug distribution. This novel drug-delivery platform has great potential for the treatment of locally advanced tumors in humans.
DOI
https://www.doi.org/https://doi.org/10.1002/anbr.202000089
A Heat-Activated Drug-Delivery Platform Based on Phosphatidyl-(oligo)-glycerol Nanocarrier for Effective Cancer Treatment
Publication date
2021
Abstract
The potential of cancer drugs is not fully exploited due to low tumor uptake and occurrence of systemic side effects, limiting maximum tolerated dose. Actively targeted nanocarriers improve efficacy while minimizing off-target toxicity. Herein, it is the first time a drug-delivery platform for heat-triggered intravascular drug release is described, based on synthetic phosphatidyl-(oligo)-glycerols from organic synthesis to preclinical investigation in feline patients. For the nanocarrier formulated doxorubicin (DOX), superior tumor drug delivery and antitumor activity compared with free DOX, conventional liposomal DOX (Caelyx), and temperature-sensitive lysolipid-containing DOX-liposomes in rat sarcoma are demonstrated. In a comparative oncological study with neoadjuvant treatment of feline sarcoma, a metabolic response determined with 18 F-FDG-positron emission tomography/magnetic resonance imaging (PET/MRI) and histopathological response after tumor resection are significantly better compared with free DOX, potentially by overcoming drug resistance based on improved intratumoral drug distribution. This novel drug-delivery platform has great potential for the treatment of locally advanced tumors in humans.
DOI
https://www.doi.org/https://doi.org/10.1002/anbr.202000089
Imbimbo, M.; Maury, J. M.; Garassino, M.; et al. (2019) Mesothelioma and thymic tumors: Treatment challenges in (outside) a network setting. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2018.01.078
Title
Mesothelioma and thymic tumors: Treatment challenges in (outside) a network setting
Publication date
2019
Abstract
The management of patients with mesothelioma and thymic malignancy requires continuous multidisciplinary expertise at any step of the disease. A dramatic improvement in our knowledge has occurred in the last few years, through the development of databases, translational research programs, and clinical trials. Access to innovative strategies represents a major challenge, as there is a lack of funding for clinical research in rare cancers and their rarity precludes the design of robust clinical trials that could lead to specific approval of drugs. In this context, patient-centered initiatives, such as the establishment of dedicated networks, are warranted. International societies, such as IMIG (International Mesothelioma Interest Group) and ITMIG (International Thymic Malignancy Interest Group) provide infrastructure for global collaboration, and there are many advantages to having strong regional groups working on the same issues. There may be regional differences in risk factors, susceptibility, management and outcomes. The ability to address questions both regionally as well as globally is ideal to develop a full understanding of mesothelioma and thymic malignancies. In Europe, through the integration of national networks with EURACAN, the collaboration with academic societies and international groups, the development of networks in thoracic oncology provides multiplex integration of clinical care and research, ultimately ensuring equal access to high quality care to all patients, with the opportunity of conducting high level clinical and translational research projects.
DOI
https://www.doi.org/10.1016/j.ejso.2018.01.078
Keywords
Delivery of Health Care/organization & administration; Europe/epidemiology; Humans; International Cooperation; Mesothelioma/diagnosis/epidemiology/*therapy; Pleural Neoplasms/diagnosis/epidemiology/*therapy; Social Networking; Survival Rate; Thymus Neoplasms/diagnosis/epidemiology/*therapy
Mesothelioma and thymic tumors: Treatment challenges in (outside) a network setting
Publication date
2019
Abstract
The management of patients with mesothelioma and thymic malignancy requires continuous multidisciplinary expertise at any step of the disease. A dramatic improvement in our knowledge has occurred in the last few years, through the development of databases, translational research programs, and clinical trials. Access to innovative strategies represents a major challenge, as there is a lack of funding for clinical research in rare cancers and their rarity precludes the design of robust clinical trials that could lead to specific approval of drugs. In this context, patient-centered initiatives, such as the establishment of dedicated networks, are warranted. International societies, such as IMIG (International Mesothelioma Interest Group) and ITMIG (International Thymic Malignancy Interest Group) provide infrastructure for global collaboration, and there are many advantages to having strong regional groups working on the same issues. There may be regional differences in risk factors, susceptibility, management and outcomes. The ability to address questions both regionally as well as globally is ideal to develop a full understanding of mesothelioma and thymic malignancies. In Europe, through the integration of national networks with EURACAN, the collaboration with academic societies and international groups, the development of networks in thoracic oncology provides multiplex integration of clinical care and research, ultimately ensuring equal access to high quality care to all patients, with the opportunity of conducting high level clinical and translational research projects.
DOI
https://www.doi.org/10.1016/j.ejso.2018.01.078
Keywords
Delivery of Health Care/organization & administration; Europe/epidemiology; Humans; International Cooperation; Mesothelioma/diagnosis/epidemiology/*therapy; Pleural Neoplasms/diagnosis/epidemiology/*therapy; Social Networking; Survival Rate; Thymus Neoplasms/diagnosis/epidemiology/*therapy
Inwald, E.; Klinkhammer-Schalke, M.; Müller-Nordhorn, J.; et al. (2023) Auswirkungen der COVID-19-Pandemie auf das Krebsgeschehen in Deutschland. Die Gynäkologie. https://www.doi.org/10.1007/s00129-023-05177-8
Title
Auswirkungen der COVID-19-Pandemie auf das Krebsgeschehen in Deutschland
Publication date
2023
Abstract
Die COVID(„coronavirus disease“)-19-Pandemie hatte und hat noch immer sowohl deutschlandweit als auch weltweit gravierende Auswirkungen auf die medizinische Versorgung. Vorerkrankte Personen, insbesondere Krebspatient*innen, stellen dabei eine besonders vulnerable Gruppe dar. Sowohl national als auch international zeigten sich beträchtliche Auswirkungen auf die Diagnostik und Therapie von Krebserkrankungen. Bereits zu Beginn der Pandemie gab es gravierende Einschränkungen bei der Abklärung von Krebserkrankungen sowie bei Früherkennungs- und Screeninguntersuchungen. Es zeigten sich Verzögerungen bei der Diagnostik bestimmter Krebserkrankungen und ein erheblicher Rückgang der Zahl diagnostizierter Krebsfälle. Aus Sorge vor einer Ansteckung vermieden Patient*innen es, medizinische Versorgung in Anspruch zu nehmen. Es kam zu Einschränkungen von Versorgungskapazitäten und Verzögerungen von Krebstherapien. Diese Therapiemodifikationen können den Verlauf und das Überleben onkologischer Patient*innen langfristig beeinflussen.
DOI
https://www.doi.org/10.1007/s00129-023-05177-8
Auswirkungen der COVID-19-Pandemie auf das Krebsgeschehen in Deutschland
Publication date
2023
Abstract
Die COVID(„coronavirus disease“)-19-Pandemie hatte und hat noch immer sowohl deutschlandweit als auch weltweit gravierende Auswirkungen auf die medizinische Versorgung. Vorerkrankte Personen, insbesondere Krebspatient*innen, stellen dabei eine besonders vulnerable Gruppe dar. Sowohl national als auch international zeigten sich beträchtliche Auswirkungen auf die Diagnostik und Therapie von Krebserkrankungen. Bereits zu Beginn der Pandemie gab es gravierende Einschränkungen bei der Abklärung von Krebserkrankungen sowie bei Früherkennungs- und Screeninguntersuchungen. Es zeigten sich Verzögerungen bei der Diagnostik bestimmter Krebserkrankungen und ein erheblicher Rückgang der Zahl diagnostizierter Krebsfälle. Aus Sorge vor einer Ansteckung vermieden Patient*innen es, medizinische Versorgung in Anspruch zu nehmen. Es kam zu Einschränkungen von Versorgungskapazitäten und Verzögerungen von Krebstherapien. Diese Therapiemodifikationen können den Verlauf und das Überleben onkologischer Patient*innen langfristig beeinflussen.
DOI
https://www.doi.org/10.1007/s00129-023-05177-8
Inwald, E.; Klinkhammer-Schalke, M.; Müller-Nordhorn, J.; et al. (2022) Auswirkungen der COVID-19-Pandemie auf die Inzidenz und Therapie von Krebserkrankungen. Forum. https://www.doi.org/10.1007/s12312-022-01068-6
Title
Auswirkungen der COVID-19-Pandemie auf die Inzidenz und Therapie von Krebserkrankungen
Publication date
2022
DOI
https://www.doi.org/10.1007/s12312-022-01068-6
Auswirkungen der COVID-19-Pandemie auf die Inzidenz und Therapie von Krebserkrankungen
Publication date
2022
DOI
https://www.doi.org/10.1007/s12312-022-01068-6
Issels, R. D.; Noessner, E.; Lindner, L. H.; et al. (2021) Immune infiltrates in patients with localised high-risk soft tissue sarcoma treated with neoadjuvant chemotherapy without or with regional hyperthermia: A translational research program of the EORTC 62961-ESHO 95 randomised clinical trial. Eur J Cancer. https://www.doi.org/10.1016/j.ejca.2021.09.015
Title
Immune infiltrates in patients with localised high-risk soft tissue sarcoma treated with neoadjuvant chemotherapy without or with regional hyperthermia: A translational research program of the EORTC 62961-ESHO 95 randomised clinical trial
Publication date
2021
Abstract
BACKGROUND: The EORTC 62961-ESHO 95 randomised trial showed improved long-term survival of patients with high-risk soft-tissue sarcoma by adding regional hyperthermia to neoadjuvant chemotherapy. We hypothesised that immune infiltrate of patients treated with neoadjuvant therapy associate with clinical outcome. METHODS: Tumour infiltrating lymphocytes (TILs) and CD8, FOXP3, PD-1, and PD-L1 were evaluated in sequential biopsies of patients after four cycles of therapy. RESULTS: From a subgroup of 109 patients who had been randomised between July 1997 and November 2006 to neoadjuvant chemotherapy (53 patients) or neoadjuvant chemotherapy with regional hyperthermia (56 patients), 137 biopsies were obtained. TILs increased in paired second biopsies independent of treatment allocation (p < 0.001). FOXP3 regulatory T cells decreased (p = 0.002), and PD-L1 expression of tumours became undetectable. In the multivariate analysis, post-treatment high TILs correlated to LPFS (HR: 0.34; 95% CI 0.15-0.75; p = 0.008) and DFS (HR: 0.38; 95% CI 0.17-0.82; p = 0.015). In comparing post-treatment immune infiltrate between treatment arms, tumour response was associated with neoadjuvant chemotherapy with regional hyperthermia (p = 0.013) and high TILs (p = 0.064). High CD8 cell infiltration was associated with improved LPFS (HR: 0.27; 95% CI 0.09-0.79; Log-rank p = 0.011) and DFS (HR: 0.25; 95% CI 0.09-0.73; Log-rank p = 0.006). Improved survival at 10 years was associated with immune infiltrate after neoadjuvant chemotherapy with regional hyperthermia. CONCLUSION: Preoperative therapy re-programs a non-inflamed tumour at baseline into an inflamed tumour. The post-treatment immune infiltrate became predictive for clinical outcomes. The combination with regional hyperthermia primes the tumour microenvironment, enabling enhanced anti-tumour immune activity in high-risk soft tissue sarcomas. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00003052.
DOI
https://www.doi.org/10.1016/j.ejca.2021.09.015
Keywords
Checkpoint blockade; Chemotherapy; Hyperthermia; Immune infiltrate; Immunology; Neoadjuvant; Soft tissue sarcoma; interests/personal relationships which may be considered as potential competing; interests: R.D.I. received travel support and honoraria from Pyrexar, PharmaMar,; MedTherm, and Bayer. E.N. received travel support and honoraria from Roche; Pharma, AstraZeneca, Novartis, IPSEN, Definiens AG, Visiopharm, Hexal, Solutions; Akademie GmbH, Phio Pharmaceuticals Corp, and Medigene Immunotherapeutics GmbH.; M.A. received travel support and honoraria from PharmaMar and Aesculap AG. L.H.L.; received travel support from Dr. Sennewald Medizintechnik, PharmaMar, and; honoraria from Novartis, Lilly, Eisai, and EL Medconsult. V.B. received research; support from Gilead, Roche, and Celgene, travel support from Gilead and Novartis,; and honoraria from Gilead, Pfizer and Amgen. S.A.-R. received travel support and; honoraria from Pyrexar and MedTherm. M.v.B.-B. received honoraria and research; grants from Novartis, Kite/Gilead, Miltenyi, Astellas, MSD, Mologen, and Amgen.; All other authors declare no competing interests.
Immune infiltrates in patients with localised high-risk soft tissue sarcoma treated with neoadjuvant chemotherapy without or with regional hyperthermia: A translational research program of the EORTC 62961-ESHO 95 randomised clinical trial
Publication date
2021
Abstract
BACKGROUND: The EORTC 62961-ESHO 95 randomised trial showed improved long-term survival of patients with high-risk soft-tissue sarcoma by adding regional hyperthermia to neoadjuvant chemotherapy. We hypothesised that immune infiltrate of patients treated with neoadjuvant therapy associate with clinical outcome. METHODS: Tumour infiltrating lymphocytes (TILs) and CD8, FOXP3, PD-1, and PD-L1 were evaluated in sequential biopsies of patients after four cycles of therapy. RESULTS: From a subgroup of 109 patients who had been randomised between July 1997 and November 2006 to neoadjuvant chemotherapy (53 patients) or neoadjuvant chemotherapy with regional hyperthermia (56 patients), 137 biopsies were obtained. TILs increased in paired second biopsies independent of treatment allocation (p < 0.001). FOXP3 regulatory T cells decreased (p = 0.002), and PD-L1 expression of tumours became undetectable. In the multivariate analysis, post-treatment high TILs correlated to LPFS (HR: 0.34; 95% CI 0.15-0.75; p = 0.008) and DFS (HR: 0.38; 95% CI 0.17-0.82; p = 0.015). In comparing post-treatment immune infiltrate between treatment arms, tumour response was associated with neoadjuvant chemotherapy with regional hyperthermia (p = 0.013) and high TILs (p = 0.064). High CD8 cell infiltration was associated with improved LPFS (HR: 0.27; 95% CI 0.09-0.79; Log-rank p = 0.011) and DFS (HR: 0.25; 95% CI 0.09-0.73; Log-rank p = 0.006). Improved survival at 10 years was associated with immune infiltrate after neoadjuvant chemotherapy with regional hyperthermia. CONCLUSION: Preoperative therapy re-programs a non-inflamed tumour at baseline into an inflamed tumour. The post-treatment immune infiltrate became predictive for clinical outcomes. The combination with regional hyperthermia primes the tumour microenvironment, enabling enhanced anti-tumour immune activity in high-risk soft tissue sarcomas. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00003052.
DOI
https://www.doi.org/10.1016/j.ejca.2021.09.015
Keywords
Checkpoint blockade; Chemotherapy; Hyperthermia; Immune infiltrate; Immunology; Neoadjuvant; Soft tissue sarcoma; interests/personal relationships which may be considered as potential competing; interests: R.D.I. received travel support and honoraria from Pyrexar, PharmaMar,; MedTherm, and Bayer. E.N. received travel support and honoraria from Roche; Pharma, AstraZeneca, Novartis, IPSEN, Definiens AG, Visiopharm, Hexal, Solutions; Akademie GmbH, Phio Pharmaceuticals Corp, and Medigene Immunotherapeutics GmbH.; M.A. received travel support and honoraria from PharmaMar and Aesculap AG. L.H.L.; received travel support from Dr. Sennewald Medizintechnik, PharmaMar, and; honoraria from Novartis, Lilly, Eisai, and EL Medconsult. V.B. received research; support from Gilead, Roche, and Celgene, travel support from Gilead and Novartis,; and honoraria from Gilead, Pfizer and Amgen. S.A.-R. received travel support and; honoraria from Pyrexar and MedTherm. M.v.B.-B. received honoraria and research; grants from Novartis, Kite/Gilead, Miltenyi, Astellas, MSD, Mologen, and Amgen.; All other authors declare no competing interests.
Jansen, L.; Behrens, G.; Finke, I.; et al. (2020) Area-Based Socioeconomic Inequalities in Colorectal Cancer Survival in Germany: Investigation Based on Population-Based Clinical Cancer Registration. Front Oncol. https://www.doi.org/10.3389/fonc.2020.00857
Title
Area-Based Socioeconomic Inequalities in Colorectal Cancer Survival in Germany: Investigation Based on Population-Based Clinical Cancer Registration
Publication date
2020
Abstract
Background: Socioeconomic inequalities in colorectal cancer survival have been observed in many countries. To overcome these inequalities, the underlying reasons must be disclosed. Methods: Using data from three population-based clinical cancer registries in Germany, we investigated whether associations between area-based socioeconomic deprivation and survival after colorectal cancer depended on patient-, tumor- or treatment-related factors. Patients with a diagnosis of colorectal cancer in 2000-2015 were assigned to one of five deprivation groups according to the municipality of the place of residence using the German Index of Multiple Deprivation. Cox proportional hazards regression models with various levels of adjustment and stratifications were applied. Results: Among 38,130 patients, overall 5-year survival was 4.8% units lower in the most compared to the least deprived areas. Survival disparities were strongest in younger patients, in rectal cancer patients, in stage I cancer, in the latest period, and with longer follow-up. Disparities persisted after adjustment for stage, utilization of surgery and screening colonoscopy uptake rates. They were mostly still present when restricting to patients receiving treatment according to guidelines. Conclusion: We observed socioeconomic inequalities in colorectal cancer survival in Germany. Further studies accounting for potential differences in non-cancer mortality and exploring treatment patterns in detail are needed.
DOI
https://www.doi.org/10.3389/fonc.2020.00857
Keywords
Germany; area-based socioeconomic deprivation; colorectal cancer; survival; treatment
Area-Based Socioeconomic Inequalities in Colorectal Cancer Survival in Germany: Investigation Based on Population-Based Clinical Cancer Registration
Publication date
2020
Abstract
Background: Socioeconomic inequalities in colorectal cancer survival have been observed in many countries. To overcome these inequalities, the underlying reasons must be disclosed. Methods: Using data from three population-based clinical cancer registries in Germany, we investigated whether associations between area-based socioeconomic deprivation and survival after colorectal cancer depended on patient-, tumor- or treatment-related factors. Patients with a diagnosis of colorectal cancer in 2000-2015 were assigned to one of five deprivation groups according to the municipality of the place of residence using the German Index of Multiple Deprivation. Cox proportional hazards regression models with various levels of adjustment and stratifications were applied. Results: Among 38,130 patients, overall 5-year survival was 4.8% units lower in the most compared to the least deprived areas. Survival disparities were strongest in younger patients, in rectal cancer patients, in stage I cancer, in the latest period, and with longer follow-up. Disparities persisted after adjustment for stage, utilization of surgery and screening colonoscopy uptake rates. They were mostly still present when restricting to patients receiving treatment according to guidelines. Conclusion: We observed socioeconomic inequalities in colorectal cancer survival in Germany. Further studies accounting for potential differences in non-cancer mortality and exploring treatment patterns in detail are needed.
DOI
https://www.doi.org/10.3389/fonc.2020.00857
Keywords
Germany; area-based socioeconomic deprivation; colorectal cancer; survival; treatment
Jansen, L.; Schwettmann, L.; Behr, C.; et al. (2023) Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: An ecological registry-based study. Int J Cancer. https://www.doi.org/10.1002/ijc.34662
Title
Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: An ecological registry-based study
Publication date
2023
Abstract
Age-standardized cancer incidence has decreased over the last years for many cancer sites in developed countries. Whether these trends led to narrowing or widening socioeconomic inequalities in cancer incidence is unknown. Using cancer registry data covering 48 million inhabitants in Germany, the ecological association between age-standardized total and site specific (colorectal, lung, prostate and breast) cancer incidence in 2007 to 2018 and a deprivation index on district level (aggregated to quintiles) was investigated. Incidence in the most and least deprived districts were compared using Poisson models. Average annual percentage changes (AAPCs) and differences in AAPCs between deprivation quintiles were assessed using Joinpoint regression analyses. Age-standardized incidence decreased strongly between 2007 and 2018 for total cancer and all cancer sites (except female lung cancer), irrespective of the level of deprivation. However, differences in the magnitude of trends across deprivation quintiles resulted in increasing inequalities over time for total cancer, colorectal and lung cancer. For total cancer, the incidence rate ratio between the most and least deprived quintile increased from 1.07 (95% confidence interval: 1.01-1.12) to 1.23 (1.12-1.32) in men and from 1.07 (1.01-1.13) to 1.20 (1.14-1.26) in women. Largest inequalities were observed for lung cancer with 82% (men) and 88% (women) higher incidence in the most vs the least deprived regions in 2018. The observed increase in inequalities in cancer incidence is in alignment with trends in inequalities in risk factor prevalence and partly utilization of screening. Intervention programs targeted at socioeconomically deprived and urban regions are highly needed.
DOI
https://www.doi.org/10.1002/ijc.34662
Keywords
Germany; cancer; deprivation; incidence; trends
Trends in cancer incidence by socioeconomic deprivation in Germany in 2007 to 2018: An ecological registry-based study
Publication date
2023
Abstract
Age-standardized cancer incidence has decreased over the last years for many cancer sites in developed countries. Whether these trends led to narrowing or widening socioeconomic inequalities in cancer incidence is unknown. Using cancer registry data covering 48 million inhabitants in Germany, the ecological association between age-standardized total and site specific (colorectal, lung, prostate and breast) cancer incidence in 2007 to 2018 and a deprivation index on district level (aggregated to quintiles) was investigated. Incidence in the most and least deprived districts were compared using Poisson models. Average annual percentage changes (AAPCs) and differences in AAPCs between deprivation quintiles were assessed using Joinpoint regression analyses. Age-standardized incidence decreased strongly between 2007 and 2018 for total cancer and all cancer sites (except female lung cancer), irrespective of the level of deprivation. However, differences in the magnitude of trends across deprivation quintiles resulted in increasing inequalities over time for total cancer, colorectal and lung cancer. For total cancer, the incidence rate ratio between the most and least deprived quintile increased from 1.07 (95% confidence interval: 1.01-1.12) to 1.23 (1.12-1.32) in men and from 1.07 (1.01-1.13) to 1.20 (1.14-1.26) in women. Largest inequalities were observed for lung cancer with 82% (men) and 88% (women) higher incidence in the most vs the least deprived regions in 2018. The observed increase in inequalities in cancer incidence is in alignment with trends in inequalities in risk factor prevalence and partly utilization of screening. Intervention programs targeted at socioeconomically deprived and urban regions are highly needed.
DOI
https://www.doi.org/10.1002/ijc.34662
Keywords
Germany; cancer; deprivation; incidence; trends
Jesinghaus, M.; Schmitt, M.; Lang, C.; et al. (2021) Morphology Matters: A Critical Reappraisal of the Clinical Relevance of Morphologic Criteria From the 2019 WHO Classification in a Large Colorectal Cancer Cohort Comprising 1004 Cases. Am J Surg Pathol. https://www.doi.org/10.1097/PAS.0000000000001692
Title
Morphology Matters: A Critical Reappraisal of the Clinical Relevance of Morphologic Criteria From the 2019 WHO Classification in a Large Colorectal Cancer Cohort Comprising 1004 Cases
Publication date
2021
Abstract
The 2019 World Health Organization (WHO) classification of colorectal carcinoma (CRC) profoundly reclassified CRC subtypes and introduces tumor budding as a second major grading criterion, while condensing conventional grade into a 2-tiered system. So far it remains largely unexplored how these parameters interact with each other and whether they truly have an independent impact on patient prognosis. We reclassified a large single-center cohort of 1004 CRCs spanning 2 decades for adjusted WHO grade (low vs. high), tumor budding (Bd1/Bd2/Bd3), and CRC subtype (adenocarcinoma not otherwise specified, micropapillary, mucinous, serrated, medullary, adenoma-like, signet-ring cell, mixed adenoneuroendocrine carcinoma/neuroendocrine carcinoma, undifferentiated) according to the criteria of the 2019 WHO classification. We investigated the interaction of these parameters, their connection to stage/microsatellite status, and their significance for patient survival in the different subgroups. Specific subtypes other than adenocarcinoma not otherwise specified represented one third of all CRCs and were unevenly distributed throughout stage and microsatellite subgroups. Subtypes, WHO grade and tumor budding profoundly impacted all survival parameters (P<0.001 for all analyses), with CRC subtypes and tumor budding-but not WHO grade-being stage-independent prognosticators for all survival comparisons. WHO grade had very limited prognostic value in CRC subtypes, while tumor budding retained its strong prognostic impact in most scenarios. Accurate delineation of CRC subtypes introduced in the 2019 WHO classification provides strong stage-independent prognostic information, arguing that they should be considered in pathology reports and in clinical trials. Of the morphology-based grading schemes included in the 2019 WHO, tumor budding outperforms WHO grade.
DOI
https://www.doi.org/10.1097/PAS.0000000000001692
Keywords
Aged; Biopsy; Carcinoma/classification/mortality/*pathology/surgery; *Cell Movement; Colectomy; Colorectal Neoplasms/classification/mortality/*pathology/surgery; Disease-Free Survival; Female; Humans; Male; Microsatellite Instability; Neoplasm Grading; Neoplasm Staging; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; World Health Organization; Forschungsgemeinschaft (DFG, German Research Foundation): Project-ID; 360372040-SFB 1335 to W.W. and K.S. Project-ID 39535707-SFB 1371. The authors; have disclosed that they have no significant relationships with, or financial; interest in, any commercial companies pertaining to this article.
Morphology Matters: A Critical Reappraisal of the Clinical Relevance of Morphologic Criteria From the 2019 WHO Classification in a Large Colorectal Cancer Cohort Comprising 1004 Cases
Publication date
2021
Abstract
The 2019 World Health Organization (WHO) classification of colorectal carcinoma (CRC) profoundly reclassified CRC subtypes and introduces tumor budding as a second major grading criterion, while condensing conventional grade into a 2-tiered system. So far it remains largely unexplored how these parameters interact with each other and whether they truly have an independent impact on patient prognosis. We reclassified a large single-center cohort of 1004 CRCs spanning 2 decades for adjusted WHO grade (low vs. high), tumor budding (Bd1/Bd2/Bd3), and CRC subtype (adenocarcinoma not otherwise specified, micropapillary, mucinous, serrated, medullary, adenoma-like, signet-ring cell, mixed adenoneuroendocrine carcinoma/neuroendocrine carcinoma, undifferentiated) according to the criteria of the 2019 WHO classification. We investigated the interaction of these parameters, their connection to stage/microsatellite status, and their significance for patient survival in the different subgroups. Specific subtypes other than adenocarcinoma not otherwise specified represented one third of all CRCs and were unevenly distributed throughout stage and microsatellite subgroups. Subtypes, WHO grade and tumor budding profoundly impacted all survival parameters (P<0.001 for all analyses), with CRC subtypes and tumor budding-but not WHO grade-being stage-independent prognosticators for all survival comparisons. WHO grade had very limited prognostic value in CRC subtypes, while tumor budding retained its strong prognostic impact in most scenarios. Accurate delineation of CRC subtypes introduced in the 2019 WHO classification provides strong stage-independent prognostic information, arguing that they should be considered in pathology reports and in clinical trials. Of the morphology-based grading schemes included in the 2019 WHO, tumor budding outperforms WHO grade.
DOI
https://www.doi.org/10.1097/PAS.0000000000001692
Keywords
Aged; Biopsy; Carcinoma/classification/mortality/*pathology/surgery; *Cell Movement; Colectomy; Colorectal Neoplasms/classification/mortality/*pathology/surgery; Disease-Free Survival; Female; Humans; Male; Microsatellite Instability; Neoplasm Grading; Neoplasm Staging; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; World Health Organization; Forschungsgemeinschaft (DFG, German Research Foundation): Project-ID; 360372040-SFB 1335 to W.W. and K.S. Project-ID 39535707-SFB 1371. The authors; have disclosed that they have no significant relationships with, or financial; interest in, any commercial companies pertaining to this article.
Katalinic, A.; Halber, M.; Meyer, M.; et al. (2023) Population-Based Clinical Cancer Registration in Germany. Cancers (Basel). https://www.doi.org/10.3390/cancers15153934
Title
Population-Based Clinical Cancer Registration in Germany
Publication date
2023
Abstract
INTRODUCTION: In 2013, a new federal law obligated all German federal states to collect additional clinical data in population-based cancer registries as an active tool for monitoring and improving the quality of cancer care, increasing transparency and promoting health research. Now, 10 years later, the current status of the expanded cancer registration is presented, including current figures on cancer in Germany. METHODS: Reporting of cancer is mandatory for physicians, and about 5 to 10 reports from different healthcare providers are expected for each case. A uniform national dataset of about 130 items is used, and reports are usually sent electronically to the registry. We used the most recent data available from cancer registries up to the year of diagnosis in 2019. We calculated incidence rates and 5-year relative survival (5YRS) for common cancers. Data on clinical outcomes and benchmarking based on quality indicators (QIs) from guidelines were provided by the Cancer Registry Schleswig-Holstein (CR SH). RESULTS: All federal state cancer registries met most of the previously defined national eligibility criteria. Approximately 505,000 cancer cases were registered in 2019, with breast, prostate, colorectal and lung cancer being the most common cancers. The age-standardised cancer incidence has slightly decreased during the last decade. and spatial heterogeneity can be observed within Germany. 5YRS for all cancers was 67% and 63% for women and men, respectively. Therapy data for rectal cancer in 2019-2021 from the CR SH are shown as an example: 69% of the registered patients underwent surgery, mostly with curative intent (84%) and tumour-free resection (91%). Radiotherapy was given to 33% of the patients, and chemotherapy was given to 40%. Three selected QIs showed differences between involved healthcare providers. DISCUSSION: The implementation of population-based clinical cancer registration can be considered a success. Comprehensive recording of diagnosis, treatment and disease progression and the use of registry data for quality assurance, benchmarking and feedback have been implemented.
DOI
https://www.doi.org/10.3390/cancers15153934
Keywords
Germany; benchmarking; cancer; cancer registration; incidence; quality assurance
Population-Based Clinical Cancer Registration in Germany
Publication date
2023
Abstract
INTRODUCTION: In 2013, a new federal law obligated all German federal states to collect additional clinical data in population-based cancer registries as an active tool for monitoring and improving the quality of cancer care, increasing transparency and promoting health research. Now, 10 years later, the current status of the expanded cancer registration is presented, including current figures on cancer in Germany. METHODS: Reporting of cancer is mandatory for physicians, and about 5 to 10 reports from different healthcare providers are expected for each case. A uniform national dataset of about 130 items is used, and reports are usually sent electronically to the registry. We used the most recent data available from cancer registries up to the year of diagnosis in 2019. We calculated incidence rates and 5-year relative survival (5YRS) for common cancers. Data on clinical outcomes and benchmarking based on quality indicators (QIs) from guidelines were provided by the Cancer Registry Schleswig-Holstein (CR SH). RESULTS: All federal state cancer registries met most of the previously defined national eligibility criteria. Approximately 505,000 cancer cases were registered in 2019, with breast, prostate, colorectal and lung cancer being the most common cancers. The age-standardised cancer incidence has slightly decreased during the last decade. and spatial heterogeneity can be observed within Germany. 5YRS for all cancers was 67% and 63% for women and men, respectively. Therapy data for rectal cancer in 2019-2021 from the CR SH are shown as an example: 69% of the registered patients underwent surgery, mostly with curative intent (84%) and tumour-free resection (91%). Radiotherapy was given to 33% of the patients, and chemotherapy was given to 40%. Three selected QIs showed differences between involved healthcare providers. DISCUSSION: The implementation of population-based clinical cancer registration can be considered a success. Comprehensive recording of diagnosis, treatment and disease progression and the use of registry data for quality assurance, benchmarking and feedback have been implemented.
DOI
https://www.doi.org/10.3390/cancers15153934
Keywords
Germany; benchmarking; cancer; cancer registration; incidence; quality assurance
Keller, A. K.; Uter, W.; Pfahlberg, A. B.; et al. (2015) Replacing surrogate measures by direct quantification of ultraviolet radiation exposure in registry-based analyses of seasonality of melanoma diagnoses. Melanoma Res. https://www.doi.org/10.1097/CMR.0000000000000205
Title
Replacing surrogate measures by direct quantification of ultraviolet radiation exposure in registry-based analyses of seasonality of melanoma diagnoses
Publication date
2015
Abstract
Seasonal variation in melanoma diagnoses has been observed in numerous studies that used calendar time indicators. Depending on the latitude (and altitude) of the study region, the magnitude of seasonal and year-to-year variation of ultraviolet radiation (UVR) is neglected in these studies. An alternative approach comprises the direct incorporation of UVR measurements into such analyses. The aim of this investigation is a comparative evaluation of these approaches. The population-based Bavarian cancer registry recorded 11 901 incident melanoma cases between 2003 and 2008 that were used for the analysis. UVR intensity data for the same period were available from the solar radiation station at Munich-Neuherberg. Negative binomial regression modelling yielded adjusted relative risks (RR) controlled for year of diagnosis and age in 16 subgroups defined by sex, Breslow thickness and localization. Overall, the analyses showed slightly differing yet consistent results for exposure effects in subgroups. Melanoma evolving on the extremities showed the most pronounced association with increasing level of the UV index among men [e.g. RR=1.086, 95% confidence interval (CI) 1.054-1.119, and RR=1.102, 95% CI 1.046-1.161, for thin and thick melanoma on the upper limbs, respectively] and women (e.g. RR=1.088, 95% CI 1.058-1.119, and RR=1.056, 95% CI 1.010-1.103, for thin and thick melanoma on the lower limbs, respectively). Our analysis provides a benchmark for international comparisons and synthesis of epidemiologic evidence of seasonal variability in melanoma diagnoses. Future studies should use direct UVR measures to enable pooling of risk estimates and resolve remaining inconsistencies potentially resulting from latitudinal differences in exposure between international studies.
DOI
https://www.doi.org/10.1097/CMR.0000000000000205
Keywords
Adult; Female; Humans; Incidence; Male; Melanoma/*epidemiology; Middle Aged; Radiation Exposure/*analysis; Registries; Risk Factors; *Seasons; Skin Neoplasms/*epidemiology; Solar System; Ultraviolet Rays
Replacing surrogate measures by direct quantification of ultraviolet radiation exposure in registry-based analyses of seasonality of melanoma diagnoses
Publication date
2015
Abstract
Seasonal variation in melanoma diagnoses has been observed in numerous studies that used calendar time indicators. Depending on the latitude (and altitude) of the study region, the magnitude of seasonal and year-to-year variation of ultraviolet radiation (UVR) is neglected in these studies. An alternative approach comprises the direct incorporation of UVR measurements into such analyses. The aim of this investigation is a comparative evaluation of these approaches. The population-based Bavarian cancer registry recorded 11 901 incident melanoma cases between 2003 and 2008 that were used for the analysis. UVR intensity data for the same period were available from the solar radiation station at Munich-Neuherberg. Negative binomial regression modelling yielded adjusted relative risks (RR) controlled for year of diagnosis and age in 16 subgroups defined by sex, Breslow thickness and localization. Overall, the analyses showed slightly differing yet consistent results for exposure effects in subgroups. Melanoma evolving on the extremities showed the most pronounced association with increasing level of the UV index among men [e.g. RR=1.086, 95% confidence interval (CI) 1.054-1.119, and RR=1.102, 95% CI 1.046-1.161, for thin and thick melanoma on the upper limbs, respectively] and women (e.g. RR=1.088, 95% CI 1.058-1.119, and RR=1.056, 95% CI 1.010-1.103, for thin and thick melanoma on the lower limbs, respectively). Our analysis provides a benchmark for international comparisons and synthesis of epidemiologic evidence of seasonal variability in melanoma diagnoses. Future studies should use direct UVR measures to enable pooling of risk estimates and resolve remaining inconsistencies potentially resulting from latitudinal differences in exposure between international studies.
DOI
https://www.doi.org/10.1097/CMR.0000000000000205
Keywords
Adult; Female; Humans; Incidence; Male; Melanoma/*epidemiology; Middle Aged; Radiation Exposure/*analysis; Registries; Risk Factors; *Seasons; Skin Neoplasms/*epidemiology; Solar System; Ultraviolet Rays
Kist, M.; Thomaschewski, M.; Keck, Y.; et al. (2022) Specifics of Young Gastric Cancer Patients: A Population-Based Analysis of 46,110 Patients with Gastric Cancer from the German Clinical Cancer Registry Group. Cancers (Basel). https://www.doi.org/10.3390/cancers14235927
Title
Specifics of Young Gastric Cancer Patients: A Population-Based Analysis of 46,110 Patients with Gastric Cancer from the German Clinical Cancer Registry Group
Publication date
2022
Abstract
Introduction: 2-8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers-Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000-2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.
DOI
https://www.doi.org/10.3390/cancers14235927
Keywords
early-onset gastric cancer patients; gastric cancer in young patients; german clinical cancer registry group
Specifics of Young Gastric Cancer Patients: A Population-Based Analysis of 46,110 Patients with Gastric Cancer from the German Clinical Cancer Registry Group
Publication date
2022
Abstract
Introduction: 2-8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers-Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000-2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.
DOI
https://www.doi.org/10.3390/cancers14235927
Keywords
early-onset gastric cancer patients; gastric cancer in young patients; german clinical cancer registry group
Kollhorst, B.; Reinders, T.; Grill, S.; et al. (2022) Record linkage of claims and cancer registries data - evaluation of a deterministic linkage approach based on indirect personal identifiers. Pharmacoepidemiol Drug Saf. https://www.doi.org/10.1002/pds.5545
Title
Record linkage of claims and cancer registries data - evaluation of a deterministic linkage approach based on indirect personal identifiers
Publication date
2022
Abstract
PURPOSE: In Germany, record linkage of claims and cancer registry data is cost- and time-consuming, since up until recently no unique personal identifier was available in both data sources. The aim of this study was to evaluate the feasibility and performance of a deterministic linkage procedure based on indirect personal identifiers included in the data sources. METHODS: We identified users of glucose-lowering drugs with residence in four federal states in Northern and Southern Germany (Bavaria, Bremen, Hamburg, Lower Saxony) in the German Pharmacoepidemiological Research Database (GePaRD) and assessed colorectal and thyroid cancer cases. Cancer registries of the federal states selected all colorectal and thyroid cancer cases between 2004 and 2015. A deterministic linkage approach was performed based on indirect personal identifiers such as year of birth, sex, area of residence, type of cancer and an absolute difference between the dates of cancer diagnosis in both data sources of at most 90 days. Results were compared to a probabilistic linkage using 'direct' personal identifiers (gold standard). RESULTS: The deterministic linkage procedure yielded a sensitivity of 71.8% for colorectal cancer and 66.6% for thyroid cancer. For thyroid cancer, the sensitivity improved when using only inpatient diagnosis to define cancer in GePaRD (71.4%). Specificity was always above 99%. Using the probabilistic linkage to define cancer cases, the risk for colorectal cancer was estimated 10 percentage points lower than when using the deterministic approach. CONCLUSIONS: Sensitivity of the deterministic linkage approach appears to be too low to be considered as reasonable alternative to the probabilistic linkage procedure. This article is protected by copyright. All rights reserved.
DOI
https://www.doi.org/10.1002/pds.5545
Record linkage of claims and cancer registries data - evaluation of a deterministic linkage approach based on indirect personal identifiers
Publication date
2022
Abstract
PURPOSE: In Germany, record linkage of claims and cancer registry data is cost- and time-consuming, since up until recently no unique personal identifier was available in both data sources. The aim of this study was to evaluate the feasibility and performance of a deterministic linkage procedure based on indirect personal identifiers included in the data sources. METHODS: We identified users of glucose-lowering drugs with residence in four federal states in Northern and Southern Germany (Bavaria, Bremen, Hamburg, Lower Saxony) in the German Pharmacoepidemiological Research Database (GePaRD) and assessed colorectal and thyroid cancer cases. Cancer registries of the federal states selected all colorectal and thyroid cancer cases between 2004 and 2015. A deterministic linkage approach was performed based on indirect personal identifiers such as year of birth, sex, area of residence, type of cancer and an absolute difference between the dates of cancer diagnosis in both data sources of at most 90 days. Results were compared to a probabilistic linkage using 'direct' personal identifiers (gold standard). RESULTS: The deterministic linkage procedure yielded a sensitivity of 71.8% for colorectal cancer and 66.6% for thyroid cancer. For thyroid cancer, the sensitivity improved when using only inpatient diagnosis to define cancer in GePaRD (71.4%). Specificity was always above 99%. Using the probabilistic linkage to define cancer cases, the risk for colorectal cancer was estimated 10 percentage points lower than when using the deterministic approach. CONCLUSIONS: Sensitivity of the deterministic linkage approach appears to be too low to be considered as reasonable alternative to the probabilistic linkage procedure. This article is protected by copyright. All rights reserved.
DOI
https://www.doi.org/10.1002/pds.5545
Konukiewitz, B.; Schmitt, M.; Silva, M.; et al. (2021) Loss of CDX2 in colorectal cancer is associated with histopathologic subtypes and microsatellite instability but is prognostically inferior to hematoxylin-eosin-based morphologic parameters from the WHO classification. Br J Cancer. https://www.doi.org/10.1038/s41416-021-01553-0
Title
Loss of CDX2 in colorectal cancer is associated with histopathologic subtypes and microsatellite instability but is prognostically inferior to hematoxylin-eosin-based morphologic parameters from the WHO classification
Publication date
2021
Abstract
BACKGROUND: Immunohistochemical loss of CDX2 has been proposed as a biomarker of dismal survival in colorectal carcinoma (CRC), especially in UICC Stage II/III. However, it remains unclear, how CDX2 expression is related to central hematoxylin-eosin (HE)-based morphologic parameters defined by 2019 WHO classification and how its prognostic relevance is compared to these parameters. METHODS: We evaluated CDX2 expression in 1003 CRCs and explored its prognostic relevance compared to CRC subtypes, tumour budding and WHO grade in the overall cohort and in specific subgroups. RESULTS: CDX2-low/absent CRCs were enriched in specific morphologic subtypes, right-sided and microsatellite-instable (MSI-H) CRCs (P < 0.001) and showed worse survival characteristics in the overall cohort/UICC Stage II/III (e.g. DFS: P = 0.005) and in microsatellite stable and left-sided CRCs, but not in MSI-H or right-sided CRCs. Compared with CDX2, all HE-based markers showed a significantly better prognostic discrimination in all scenarios. In multivariate analyses including all morphologic parameters, CDX2 was not an independent prognostic factor. CONCLUSION: CDX2 loss has some prognostic impact in univariate analyses, but its prognostic relevance is considerably lower compared to central HE-based morphologic parameters defined by the WHO classification and vanishes in multivariate analyses incorporating these factors.
DOI
https://www.doi.org/10.1038/s41416-021-01553-0
Loss of CDX2 in colorectal cancer is associated with histopathologic subtypes and microsatellite instability but is prognostically inferior to hematoxylin-eosin-based morphologic parameters from the WHO classification
Publication date
2021
Abstract
BACKGROUND: Immunohistochemical loss of CDX2 has been proposed as a biomarker of dismal survival in colorectal carcinoma (CRC), especially in UICC Stage II/III. However, it remains unclear, how CDX2 expression is related to central hematoxylin-eosin (HE)-based morphologic parameters defined by 2019 WHO classification and how its prognostic relevance is compared to these parameters. METHODS: We evaluated CDX2 expression in 1003 CRCs and explored its prognostic relevance compared to CRC subtypes, tumour budding and WHO grade in the overall cohort and in specific subgroups. RESULTS: CDX2-low/absent CRCs were enriched in specific morphologic subtypes, right-sided and microsatellite-instable (MSI-H) CRCs (P < 0.001) and showed worse survival characteristics in the overall cohort/UICC Stage II/III (e.g. DFS: P = 0.005) and in microsatellite stable and left-sided CRCs, but not in MSI-H or right-sided CRCs. Compared with CDX2, all HE-based markers showed a significantly better prognostic discrimination in all scenarios. In multivariate analyses including all morphologic parameters, CDX2 was not an independent prognostic factor. CONCLUSION: CDX2 loss has some prognostic impact in univariate analyses, but its prognostic relevance is considerably lower compared to central HE-based morphologic parameters defined by the WHO classification and vanishes in multivariate analyses incorporating these factors.
DOI
https://www.doi.org/10.1038/s41416-021-01553-0
Kraywinkel, Klaus; Imhoff, Maren; Voigtländer, Sven; et al. (2023) Krebsneuerkrankungen in Pandemiezeiten. Die Onkologie. https://www.doi.org/10.1007/s00761-023-01444-4
Title
Krebsneuerkrankungen in Pandemiezeiten
Publication date
2023
Abstract
Hintergrund Die Ausbreitung von COVID 19 in Deutschland hat gesundheitliche Versorgungsangebote und das individuelle Inanspruchnahmeverhalten verändert. Auch in der Krebsregistrierung kam es zu zeitweisen Einbrüchen der Meldezahlen. Fragestellung Wie hat sich die COVID-19-Pandemie im Jahr 2020 auf das Meldeaufkommen in deutschen Krebsregistern ausgewirkt? Material und Methoden Die Autoren fassen hier die ihnen bekannten, von deutschen Krebsregistern veröffentlichten Analysen zur Inzidenzentwicklung im Jahr 2020 zusammen und ergänzen diese um eigene Auswertungen unter Verwendung des bundesweiten Datensatzes des Zentrums für Krebsregisterdaten (ZfKD) am Robert Koch-Institut. Zur internationalen Einordnung werden Ergebnisse aus nordamerikanischen und europäischen Krebsregistern herangezogen. Ergebnisse Insbesondere im Frühjahr 2020 kam es zu deutlichen Rückgängen der registrierten Krebsneuerkrankungen gegenüber dem Vorjahr. Trotz Ausgleichseffekten in den Sommermonaten lag ihre Zahl in den Krebsregistern zum Jahresende insgesamt um 6–7 % unter den Vergleichs- bzw. Erwartungswerten. Die stärksten Rückgänge von bundesweit ; −; 13,4 % bzw. ; −; 10,6 % wurden für nichtmelanotischen Hautkrebs bzw. für Darmkrebs dokumentiert. Die Fallzahlrückgänge bei anderen ausgewählten Diagnosen waren weniger ausgeprägt. Schlussfolgerung Mit einem Rückgang der altersstandardisierten Inzidenzrate über alle Krebsarten um ; −; 6,5 % gegenüber 2019 ist die Fallzahlentwicklung in Deutschland etwa vergleichbar mit derjenigen anderer west- und nordeuropäischer Länder. Ein pandemiebedingter Meldeverzug und die verringerte Durchführung von Früherkennungsuntersuchungen können nach aktuellem Kenntnisstand nur einen Teil der beobachteten Inzidenzrückgänge erklären.
DOI
https://www.doi.org/10.1007/s00761-023-01444-4
Krebsneuerkrankungen in Pandemiezeiten
Publication date
2023
Abstract
Hintergrund Die Ausbreitung von COVID 19 in Deutschland hat gesundheitliche Versorgungsangebote und das individuelle Inanspruchnahmeverhalten verändert. Auch in der Krebsregistrierung kam es zu zeitweisen Einbrüchen der Meldezahlen. Fragestellung Wie hat sich die COVID-19-Pandemie im Jahr 2020 auf das Meldeaufkommen in deutschen Krebsregistern ausgewirkt? Material und Methoden Die Autoren fassen hier die ihnen bekannten, von deutschen Krebsregistern veröffentlichten Analysen zur Inzidenzentwicklung im Jahr 2020 zusammen und ergänzen diese um eigene Auswertungen unter Verwendung des bundesweiten Datensatzes des Zentrums für Krebsregisterdaten (ZfKD) am Robert Koch-Institut. Zur internationalen Einordnung werden Ergebnisse aus nordamerikanischen und europäischen Krebsregistern herangezogen. Ergebnisse Insbesondere im Frühjahr 2020 kam es zu deutlichen Rückgängen der registrierten Krebsneuerkrankungen gegenüber dem Vorjahr. Trotz Ausgleichseffekten in den Sommermonaten lag ihre Zahl in den Krebsregistern zum Jahresende insgesamt um 6–7 % unter den Vergleichs- bzw. Erwartungswerten. Die stärksten Rückgänge von bundesweit ; −; 13,4 % bzw. ; −; 10,6 % wurden für nichtmelanotischen Hautkrebs bzw. für Darmkrebs dokumentiert. Die Fallzahlrückgänge bei anderen ausgewählten Diagnosen waren weniger ausgeprägt. Schlussfolgerung Mit einem Rückgang der altersstandardisierten Inzidenzrate über alle Krebsarten um ; −; 6,5 % gegenüber 2019 ist die Fallzahlentwicklung in Deutschland etwa vergleichbar mit derjenigen anderer west- und nordeuropäischer Länder. Ein pandemiebedingter Meldeverzug und die verringerte Durchführung von Früherkennungsuntersuchungen können nach aktuellem Kenntnisstand nur einen Teil der beobachteten Inzidenzrückgänge erklären.
DOI
https://www.doi.org/10.1007/s00761-023-01444-4
Kuznetsov, L.; Maier, W.; Hunger, M.; et al. (2011) Associations between regional socioeconomic deprivation and cancer risk: Analysis of population-based Cancer Registry data from Bavaria, Germany. Prev Med. https://www.doi.org/10.1016/j.ypmed.2011.07.021
Title
Associations between regional socioeconomic deprivation and cancer risk: Analysis of population-based Cancer Registry data from Bavaria, Germany
Publication date
2011
Abstract
OBJECTIVE: Previous research from other countries shows a positive association between cancer risk and regional deprivation. This study explores this association for lung and colorectal cancers in Germany. METHOD: Regional deprivation was assessed by the 'Bavarian Index of Multiple Deprivation'. Cancer data were provided by the Cancer Registry of Bavaria (2003-2006). The association between cancer risk and regional deprivation was evaluated by multilevel Poisson regression analysis. RESULTS: Crude incidence and mortality rates (per 1000 people) in the least deprived areas were 1.46 and 0.92 for lung cancer, 2.82 and 0.69 for colorectal cancer. For lung cancer, the age-adjusted relative risk (RR) for incidence in the most deprived districts (compared with the least deprived) in men was 1.41 (95% CI: 1.28-1.54), for mortality 1.59 (95% CI: 1.40-1.80); in women, an elevated RR was seen for mortality (1.24, 95% CI: 1.06-1.46). For colorectal cancer, the RR for incidence (men: 1.31, 95% CI: 1.17-1.46; women: 1.25, 95% CI: 1.12-1.40) and mortality (men: 1.51, 95% CI: 1.28-1.80; women: 1.49, 95% CI: 1.26-1.77) was always highest in the most deprived districts. CONCLUSION: At the district level in Bavaria, the risk for lung and colorectal cancers mostly increases with increasing regional deprivation.
DOI
https://www.doi.org/10.1016/j.ypmed.2011.07.021
Keywords
Colorectal Neoplasms/*epidemiology/mortality; Female; Germany/epidemiology; Humans; Incidence; Lung Neoplasms/*epidemiology/mortality; Male; *Poverty Areas; Registries; Risk Factors; Sex Factors; Socioeconomic Factors
Associations between regional socioeconomic deprivation and cancer risk: Analysis of population-based Cancer Registry data from Bavaria, Germany
Publication date
2011
Abstract
OBJECTIVE: Previous research from other countries shows a positive association between cancer risk and regional deprivation. This study explores this association for lung and colorectal cancers in Germany. METHOD: Regional deprivation was assessed by the 'Bavarian Index of Multiple Deprivation'. Cancer data were provided by the Cancer Registry of Bavaria (2003-2006). The association between cancer risk and regional deprivation was evaluated by multilevel Poisson regression analysis. RESULTS: Crude incidence and mortality rates (per 1000 people) in the least deprived areas were 1.46 and 0.92 for lung cancer, 2.82 and 0.69 for colorectal cancer. For lung cancer, the age-adjusted relative risk (RR) for incidence in the most deprived districts (compared with the least deprived) in men was 1.41 (95% CI: 1.28-1.54), for mortality 1.59 (95% CI: 1.40-1.80); in women, an elevated RR was seen for mortality (1.24, 95% CI: 1.06-1.46). For colorectal cancer, the RR for incidence (men: 1.31, 95% CI: 1.17-1.46; women: 1.25, 95% CI: 1.12-1.40) and mortality (men: 1.51, 95% CI: 1.28-1.80; women: 1.49, 95% CI: 1.26-1.77) was always highest in the most deprived districts. CONCLUSION: At the district level in Bavaria, the risk for lung and colorectal cancers mostly increases with increasing regional deprivation.
DOI
https://www.doi.org/10.1016/j.ypmed.2011.07.021
Keywords
Colorectal Neoplasms/*epidemiology/mortality; Female; Germany/epidemiology; Humans; Incidence; Lung Neoplasms/*epidemiology/mortality; Male; *Poverty Areas; Registries; Risk Factors; Sex Factors; Socioeconomic Factors
Kuznetsov, L.; Maier, W.; Hunger, M.; et al. (2012) Regional deprivation in Bavaria, Germany: linking a new deprivation score with registry data for lung and colorectal cancer. Int J Public Health. https://www.doi.org/10.1007/s00038-012-0342-4
Title
Regional deprivation in Bavaria, Germany: linking a new deprivation score with registry data for lung and colorectal cancer
Publication date
2012
Abstract
OBJECTIVE: This study aimed to examine the differences in cancer risk by regional deprivation in Bavaria, Germany. METHODS: Multilevel Poisson regression analysis was used to evaluate the association between lung and colorectal cancer risk and community deprivation level based on data from the Cancer Registry of Bavaria (2003-2006). The communities (n=1,408) were classified according to the Bavarian Index of Multiple Deprivation (BIMD), differentiated into quintiles ranging from lowest to highest deprivation. RESULTS: Increased lung cancer risk in men and colorectal cancer risk in both genders were associated with increasing BIMD. Comparing the most deprived with the least deprived communities, the relative risk for lung cancer incidence in men was 1.39 (95% CI 1.29-1.49), for mortality risk 1.54 (95% CI 1.41-1.68). The relative risk for colorectal cancer incidence in men was 1.30 (95% CI 1.22-1.38) and in women 1.19 (95% CI 1.11-1.27); for mortality risk we found 1.57 (95% CI 1.40-1.76) in men and 1.34 (95% CI 1.19-1.51) in women. CONCLUSION: Area-based deprivation is significantly associated with cancer risk in Bavaria.
DOI
https://www.doi.org/10.1007/s00038-012-0342-4
Keywords
Causality; Colorectal Neoplasms/*epidemiology/mortality; Female; Germany/epidemiology; Humans; Incidence; Lung Neoplasms/*epidemiology/mortality; Male; *Poverty Areas; Registries/*statistics & numerical data; Sex Distribution; Sex Factors; Survival Rate
Regional deprivation in Bavaria, Germany: linking a new deprivation score with registry data for lung and colorectal cancer
Publication date
2012
Abstract
OBJECTIVE: This study aimed to examine the differences in cancer risk by regional deprivation in Bavaria, Germany. METHODS: Multilevel Poisson regression analysis was used to evaluate the association between lung and colorectal cancer risk and community deprivation level based on data from the Cancer Registry of Bavaria (2003-2006). The communities (n=1,408) were classified according to the Bavarian Index of Multiple Deprivation (BIMD), differentiated into quintiles ranging from lowest to highest deprivation. RESULTS: Increased lung cancer risk in men and colorectal cancer risk in both genders were associated with increasing BIMD. Comparing the most deprived with the least deprived communities, the relative risk for lung cancer incidence in men was 1.39 (95% CI 1.29-1.49), for mortality risk 1.54 (95% CI 1.41-1.68). The relative risk for colorectal cancer incidence in men was 1.30 (95% CI 1.22-1.38) and in women 1.19 (95% CI 1.11-1.27); for mortality risk we found 1.57 (95% CI 1.40-1.76) in men and 1.34 (95% CI 1.19-1.51) in women. CONCLUSION: Area-based deprivation is significantly associated with cancer risk in Bavaria.
DOI
https://www.doi.org/10.1007/s00038-012-0342-4
Keywords
Causality; Colorectal Neoplasms/*epidemiology/mortality; Female; Germany/epidemiology; Humans; Incidence; Lung Neoplasms/*epidemiology/mortality; Male; *Poverty Areas; Registries/*statistics & numerical data; Sex Distribution; Sex Factors; Survival Rate
Lauseker, M.; Bachl, K.; Turkina, A.; et al. (2019) Prognosis of patients with chronic myeloid leukemia presenting in advanced phase is defined mainly by blast count, but also by age, chromosomal aberrations and hemoglobin. Am J Hematol. https://www.doi.org/10.1002/ajh.25628
Title
Prognosis of patients with chronic myeloid leukemia presenting in advanced phase is defined mainly by blast count, but also by age, chromosomal aberrations and hemoglobin
Publication date
2019
Abstract
Chronic myeloid leukemia (CML) is usually diagnosed in chronic phase, yet there is a small percentage of patients that is diagnosed in accelerated phase or blast crisis. Due to this rarity, little is known about the prognosis of these patients. Our aim was to identify prognostic factors for this cohort. We identified 283 patients in the EUTOS population-based and out-study registries that were diagnosed in advanced phase. Nearly all patients were treated with tyrosine kinase inhibitors. Median survival in this heterogeneous cohort was 8.2 years. When comparing patients with more than 30% blasts to those with 20-29% blasts, the hazard ratio (HR) was 1.32 (95%-confidence interval (CI): [0.7-2.6]). Patients with 20-29% blasts had a significantly higher risk than patients with less than 20% blasts (HR: 2.24, 95%-CI: [1.2-4.0], P = .008). We found that the blast count was the most important prognostic factor; however, age, hemoglobin, basophils and other chromosomal aberrations should be considered as well. The ELTS score was able to define two groups (high risk vs non-high risk) with an HR of 3.01 (95%-CI: [1.81-5.00], P < .001). Regarding the contrasting definitions of blast crisis, our data clearly supported the 20% cut-off over the 30% cut-off in this cohort. Based on our results, we conclude that a one-phase rather than a two-phase categorization of de novo advanced phase CML patients is appropriate.
DOI
https://www.doi.org/10.1002/ajh.25628
Keywords
Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Blast Crisis/blood/diagnosis/genetics/*mortality; Bone Marrow/pathology; Cell Count; Chromosome Aberrations; Europe/epidemiology; Female; Follow-Up Studies; Hemoglobins/analysis; Humans; Kaplan-Meier Estimate; Leukemia, Myeloid, Accelerated Phase/blood/diagnosis/genetics/*mortality; Male; Middle Aged; Neoplasm Staging/methods; Neoplastic Stem Cells; Prognosis; Proportional Hazards Models; Registries; Young Adult
Prognosis of patients with chronic myeloid leukemia presenting in advanced phase is defined mainly by blast count, but also by age, chromosomal aberrations and hemoglobin
Publication date
2019
Abstract
Chronic myeloid leukemia (CML) is usually diagnosed in chronic phase, yet there is a small percentage of patients that is diagnosed in accelerated phase or blast crisis. Due to this rarity, little is known about the prognosis of these patients. Our aim was to identify prognostic factors for this cohort. We identified 283 patients in the EUTOS population-based and out-study registries that were diagnosed in advanced phase. Nearly all patients were treated with tyrosine kinase inhibitors. Median survival in this heterogeneous cohort was 8.2 years. When comparing patients with more than 30% blasts to those with 20-29% blasts, the hazard ratio (HR) was 1.32 (95%-confidence interval (CI): [0.7-2.6]). Patients with 20-29% blasts had a significantly higher risk than patients with less than 20% blasts (HR: 2.24, 95%-CI: [1.2-4.0], P = .008). We found that the blast count was the most important prognostic factor; however, age, hemoglobin, basophils and other chromosomal aberrations should be considered as well. The ELTS score was able to define two groups (high risk vs non-high risk) with an HR of 3.01 (95%-CI: [1.81-5.00], P < .001). Regarding the contrasting definitions of blast crisis, our data clearly supported the 20% cut-off over the 30% cut-off in this cohort. Based on our results, we conclude that a one-phase rather than a two-phase categorization of de novo advanced phase CML patients is appropriate.
DOI
https://www.doi.org/10.1002/ajh.25628
Keywords
Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Blast Crisis/blood/diagnosis/genetics/*mortality; Bone Marrow/pathology; Cell Count; Chromosome Aberrations; Europe/epidemiology; Female; Follow-Up Studies; Hemoglobins/analysis; Humans; Kaplan-Meier Estimate; Leukemia, Myeloid, Accelerated Phase/blood/diagnosis/genetics/*mortality; Male; Middle Aged; Neoplasm Staging/methods; Neoplastic Stem Cells; Prognosis; Proportional Hazards Models; Registries; Young Adult
Liang, L. A.; Zeissig, S. R.; Schauberger, G.; et al. (2022) Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study. BMC Womens Health. https://www.doi.org/10.1186/s12905-022-01851-6
Title
Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study
Publication date
2022
Abstract
BACKGROUND: A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study. METHODS: Data from the MARZY prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance. RESULTS: At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having >/= 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening. CONCLUSIONS: Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness.
DOI
https://www.doi.org/10.1186/s12905-022-01851-6
Keywords
*Atypical Squamous Cells of the Cervix; *Cervical Intraepithelial Neoplasia/diagnosis; Child; Cohort Studies; Colposcopy; Early Detection of Cancer/methods; Female; Humans; Middle Aged; Papillomaviridae; *Papillomavirus Infections/diagnosis; Pregnancy; Prospective Studies; *Uterine Cervical Neoplasms; Vaginal Smears; Abnormal screening result; Cervical cancer screening; HPV status; HPV testing; Non-attendance; Screening follow-up
Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study
Publication date
2022
Abstract
BACKGROUND: A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study. METHODS: Data from the MARZY prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance. RESULTS: At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having >/= 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening. CONCLUSIONS: Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness.
DOI
https://www.doi.org/10.1186/s12905-022-01851-6
Keywords
*Atypical Squamous Cells of the Cervix; *Cervical Intraepithelial Neoplasia/diagnosis; Child; Cohort Studies; Colposcopy; Early Detection of Cancer/methods; Female; Humans; Middle Aged; Papillomaviridae; *Papillomavirus Infections/diagnosis; Pregnancy; Prospective Studies; *Uterine Cervical Neoplasms; Vaginal Smears; Abnormal screening result; Cervical cancer screening; HPV status; HPV testing; Non-attendance; Screening follow-up
Lindberg-Scharf, P.; Steinger, B.; Koller, M.; et al. (2021) Long-term improvement of quality of life in patients with breast cancer: supporting patient-physician communication by an electronic tool for inpatient and outpatient care. Support Care Cancer. https://www.doi.org/10.1007/s00520-021-06270-1
Title
Long-term improvement of quality of life in patients with breast cancer: supporting patient-physician communication by an electronic tool for inpatient and outpatient care
Publication date
2021
Abstract
PURPOSE: The effectiveness of a pathway with quality of life (QoL) diagnosis and therapy has been already demonstrated in an earlier randomized trial (RCT) in patients with breast cancer. We refined the pathway by developing and evaluating an electronic tool for QoL assessment in routine inpatient and outpatient care. METHODS: In a single-arm study, patients with breast cancer with surgical treatment in two German hospitals were enrolled. QoL (EORTC QLQ-C30, QLQ-BR23) was measured with an electronic tool after surgery and during aftercare in outpatient medical practices (3, 6, 9, 12, 18, and 24 months) so that results (QoL-profile) were available immediately. Feedback by patients and physicians was analyzed to evaluate feasibility and impact on patient-physician communication. RESULTS: Between May 2016 and July 2018, 56 patients were enrolled. Physicians evaluated the QoL pathway as feasible. Patients whose physician regularly discussed QoL-profiles with them reported significantly more often that their specific needs were cared for (p < .001) and that their physician had found the right treatment strategy for these needs (p < .001) compared with patients whose doctor never/rarely discussed QoL-profiles. The latter significantly more often had no benefit from QoL assessments (p < .001). CONCLUSION: The QoL pathway with electronic QoL assessments is feasible for inpatient and outpatient care. QoL results should be discussed directly with the patient. CLINICAL TRIAL INFORMATION: NCT04334096, date of registration 06.04.2020.
DOI
https://www.doi.org/10.1007/s00520-021-06270-1
Keywords
Ambulatory Care; *Breast Neoplasms/therapy; Communication; Electronics; Female; Humans; Inpatients; *Physicians; Quality of Life; Breast cancer; Complex intervention; Electronic assessment; Patient-physician communication; Patient-reported outcomes
Long-term improvement of quality of life in patients with breast cancer: supporting patient-physician communication by an electronic tool for inpatient and outpatient care
Publication date
2021
Abstract
PURPOSE: The effectiveness of a pathway with quality of life (QoL) diagnosis and therapy has been already demonstrated in an earlier randomized trial (RCT) in patients with breast cancer. We refined the pathway by developing and evaluating an electronic tool for QoL assessment in routine inpatient and outpatient care. METHODS: In a single-arm study, patients with breast cancer with surgical treatment in two German hospitals were enrolled. QoL (EORTC QLQ-C30, QLQ-BR23) was measured with an electronic tool after surgery and during aftercare in outpatient medical practices (3, 6, 9, 12, 18, and 24 months) so that results (QoL-profile) were available immediately. Feedback by patients and physicians was analyzed to evaluate feasibility and impact on patient-physician communication. RESULTS: Between May 2016 and July 2018, 56 patients were enrolled. Physicians evaluated the QoL pathway as feasible. Patients whose physician regularly discussed QoL-profiles with them reported significantly more often that their specific needs were cared for (p < .001) and that their physician had found the right treatment strategy for these needs (p < .001) compared with patients whose doctor never/rarely discussed QoL-profiles. The latter significantly more often had no benefit from QoL assessments (p < .001). CONCLUSION: The QoL pathway with electronic QoL assessments is feasible for inpatient and outpatient care. QoL results should be discussed directly with the patient. CLINICAL TRIAL INFORMATION: NCT04334096, date of registration 06.04.2020.
DOI
https://www.doi.org/10.1007/s00520-021-06270-1
Keywords
Ambulatory Care; *Breast Neoplasms/therapy; Communication; Electronics; Female; Humans; Inpatients; *Physicians; Quality of Life; Breast cancer; Complex intervention; Electronic assessment; Patient-physician communication; Patient-reported outcomes
Liu, Z.; Thong, M. S. Y.; Doege, D.; et al. (2023) Benefit finding, posttraumatic growth and health-related quality of life in long-term cancer survivors: a prospective population-based study. Acta Oncol. https://www.doi.org/10.1080/0284186X.2023.2245560
Title
Benefit finding, posttraumatic growth and health-related quality of life in long-term cancer survivors: a prospective population-based study
Publication date
2023
Abstract
BACKGROUND: We explored the relationship between benefit finding (BF)/posttraumatic growth (PTG) at baseline and health-related quality of life (HRQOL) at baseline and follow-up in long-term cancer survivors (LTCS; >/=5-year post-diagnosis). MATERIALS AND METHODS: HRQOL was assessed in LTCS in 2009-2011 (5- to 16-year post-diagnosis, baseline) and re-assessed in 2018/2019 (14- to 24-year post-diagnosis, follow-up). BF and PTG were measured at baseline; mean scores were dichotomized into 'none-to-low' (<3) and 'moderate-to-high' (> =3). Linear regression models and linear mixed regression models were employed to assess the association of BF/PTG with HRQOL. RESULTS: Of the 6057 baseline participants, 4373 were alive in 2019, of whom 2704 completed the follow-up questionnaire. Cross-sectionally, LTCS with none-to-low BF reported better HRQOL at baseline and at follow-up than LTCS with higher BF. Longitudinally, no difference was found between none-to-low and moderate-to-high BF on the HRQOL change from baseline to follow-up. HRQOL differences between the PTG groups were not statistically significant cross-sectionally and longitudinally, except those participants with moderate-to-high PTG reported higher role functioning and global health status/QOL. CONCLUSIONS: Cross-sectionally, BF was significantly negatively related to subscales of HRQOL, while PTG was positively correlated to role functioning and global health status/QOL. The results add further evidence that BF and PTG are two different positive psychological concepts.
DOI
https://www.doi.org/10.1080/0284186X.2023.2245560
Keywords
Humans; *Cancer Survivors/psychology; *Posttraumatic Growth, Psychological; Quality of Life/psychology; Adaptation, Psychological; Prospective Studies; *Stress Disorders, Post-Traumatic; *Neoplasms/psychology; Benefit finding; cancer survivors; health-related quality of life; posttraumatic growth
Benefit finding, posttraumatic growth and health-related quality of life in long-term cancer survivors: a prospective population-based study
Publication date
2023
Abstract
BACKGROUND: We explored the relationship between benefit finding (BF)/posttraumatic growth (PTG) at baseline and health-related quality of life (HRQOL) at baseline and follow-up in long-term cancer survivors (LTCS; >/=5-year post-diagnosis). MATERIALS AND METHODS: HRQOL was assessed in LTCS in 2009-2011 (5- to 16-year post-diagnosis, baseline) and re-assessed in 2018/2019 (14- to 24-year post-diagnosis, follow-up). BF and PTG were measured at baseline; mean scores were dichotomized into 'none-to-low' (<3) and 'moderate-to-high' (> =3). Linear regression models and linear mixed regression models were employed to assess the association of BF/PTG with HRQOL. RESULTS: Of the 6057 baseline participants, 4373 were alive in 2019, of whom 2704 completed the follow-up questionnaire. Cross-sectionally, LTCS with none-to-low BF reported better HRQOL at baseline and at follow-up than LTCS with higher BF. Longitudinally, no difference was found between none-to-low and moderate-to-high BF on the HRQOL change from baseline to follow-up. HRQOL differences between the PTG groups were not statistically significant cross-sectionally and longitudinally, except those participants with moderate-to-high PTG reported higher role functioning and global health status/QOL. CONCLUSIONS: Cross-sectionally, BF was significantly negatively related to subscales of HRQOL, while PTG was positively correlated to role functioning and global health status/QOL. The results add further evidence that BF and PTG are two different positive psychological concepts.
DOI
https://www.doi.org/10.1080/0284186X.2023.2245560
Keywords
Humans; *Cancer Survivors/psychology; *Posttraumatic Growth, Psychological; Quality of Life/psychology; Adaptation, Psychological; Prospective Studies; *Stress Disorders, Post-Traumatic; *Neoplasms/psychology; Benefit finding; cancer survivors; health-related quality of life; posttraumatic growth
Lykoudis, P. M.; Partelli, S.; Muffatti, F.; et al. (2019) Treatment challenges in and outside a specialist network setting: Pancreatic neuroendocrine tumours. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2017.08.019
Title
Treatment challenges in and outside a specialist network setting: Pancreatic neuroendocrine tumours
Publication date
2019
Abstract
Pancreatic Neuroendocrine Neoplasms comprise a group of rare tumours with special biology, an often indolent behaviour and particular diagnostic and therapeutic requirements. The specialized biochemical tests and radiological investigations, the complexity of surgical options and the variety of medical treatments that require individual tailoring, mandate a multidisciplinary approach that can be optimally achieved through an organized network. The present study describes currents concepts in the management of these tumours as well as an insight into the challenges of delivering the pathway in and outside a Network.
DOI
https://www.doi.org/10.1016/j.ejso.2017.08.019
Keywords
Delivery of Health Care/*organization & administration; Humans; Neuroendocrine Tumors/*diagnosis/*therapy; Pancreatic Neoplasms/*diagnosis/*therapy; Patient Care Team; Precision Medicine; Rare Diseases/therapy; Survival Rate; *Liver metastases; *Neuroendocrine tumours; *Pancreas; *Rare cancers
Treatment challenges in and outside a specialist network setting: Pancreatic neuroendocrine tumours
Publication date
2019
Abstract
Pancreatic Neuroendocrine Neoplasms comprise a group of rare tumours with special biology, an often indolent behaviour and particular diagnostic and therapeutic requirements. The specialized biochemical tests and radiological investigations, the complexity of surgical options and the variety of medical treatments that require individual tailoring, mandate a multidisciplinary approach that can be optimally achieved through an organized network. The present study describes currents concepts in the management of these tumours as well as an insight into the challenges of delivering the pathway in and outside a Network.
DOI
https://www.doi.org/10.1016/j.ejso.2017.08.019
Keywords
Delivery of Health Care/*organization & administration; Humans; Neuroendocrine Tumors/*diagnosis/*therapy; Pancreatic Neoplasms/*diagnosis/*therapy; Patient Care Team; Precision Medicine; Rare Diseases/therapy; Survival Rate; *Liver metastases; *Neuroendocrine tumours; *Pancreas; *Rare cancers
Markowiak, T.; Dakkak, B.; Loch, E.; et al. (2021) Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival. J Cardiothorac Surg. https://www.doi.org/10.1186/s13019-021-01460-8
Title
Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival
Publication date
2021
Abstract
BACKGROUND: Surgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent. METHODS: In this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively. RESULTS: A total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9-14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1-75.9), and there was no significant difference with regard to the surgical method used (p = 0.34). CONCLUSIONS: VATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.
DOI
https://www.doi.org/10.1186/s13019-021-01460-8
Keywords
Aged; Female; Humans; Lung/surgery; Lung Neoplasms/mortality/secondary/*surgery; Male; *Metastasectomy/adverse effects/mortality; Middle Aged; Pneumonectomy/methods/*mortality; Retrospective Studies; *Thoracic Surgery, Video-Assisted/mortality; *Thoracotomy/mortality; Lung metastases; Metastectomy; Prognosis; Pulmonary metastases; Video-assisted thoracoscopic surgery
Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival
Publication date
2021
Abstract
BACKGROUND: Surgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent. METHODS: In this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively. RESULTS: A total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9-14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1-75.9), and there was no significant difference with regard to the surgical method used (p = 0.34). CONCLUSIONS: VATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.
DOI
https://www.doi.org/10.1186/s13019-021-01460-8
Keywords
Aged; Female; Humans; Lung/surgery; Lung Neoplasms/mortality/secondary/*surgery; Male; *Metastasectomy/adverse effects/mortality; Middle Aged; Pneumonectomy/methods/*mortality; Retrospective Studies; *Thoracic Surgery, Video-Assisted/mortality; *Thoracotomy/mortality; Lung metastases; Metastectomy; Prognosis; Pulmonary metastases; Video-assisted thoracoscopic surgery
Meyer, S.; Buser, L.; Haferkamp, S.; et al. (2023) Identification of high-risk patients with a seven-biomarker prognostic signature for adjuvant treatment trial recruitment in American Joint Committee on Cancer v8 stage I-IIA cutaneous melanoma. Eur J Cancer. https://www.doi.org/10.1016/j.ejca.2023.01.002
Title
Identification of high-risk patients with a seven-biomarker prognostic signature for adjuvant treatment trial recruitment in American Joint Committee on Cancer v8 stage I-IIA cutaneous melanoma
Publication date
2023
Abstract
PURPOSE: Many patients with resected American Joint Committee on Cancer (AJCC) early-stage cutaneous melanoma nonetheless die of melanoma; additional risk stratification approaches are needed. PATIENTS AND METHODS: Using prospectively-collected whole-tissue sections, we assessed in consecutive stage I-IIA patients (N = 439), a previously-validated, immunohistochemistry-based, 7-biomarker signature to prognosticate disease-free survival (DFS), melanoma-specific survival (MSS; primary end-point) and overall survival (OS), independent of AJCC classification. RESULTS: Seven-marker signature testing designated 25.1% of patients (110/439) as high-risk (stage IA, 13.3% [43/323], IB, 53.2% [42/79], and IIA, 67.6% [25/37]). A Kaplan-Meier analysis demonstrated high-risk patients to have significantly worse DFS, MSS and OS versus low-risk counterparts (P < 0.001). In multivariable Cox regression modelling also including key clinicopathological/demographic factors, 7-marker signature data independently prognosticated the studied end-points. Models with the 7-marker signature risk category plus clinicopathological/demographic covariates substantially outperformed models with clinicopathological/demographic variables alone in predicting all studied outcomes (areas under the receiver operator characteristic curve 74.1% versus 68.4% for DFS, 81.5% versus 71.2% for MSS, 80.9% versus 73.0% for OS; absolute differences 5.7%, 10.3% and 7.9%, respectively, favouring 7-marker signature risk category-containing models). CONCLUSION: In patients with AJCC early-stage disease, the 7-marker signature reliably prognosticates melanoma-related outcomes, independent of AJCC classification, and provides a valuable complement to clinicopathological/demographic factors.
DOI
https://www.doi.org/10.1016/j.ejca.2023.01.002
Keywords
Humans; United States; *Melanoma/pathology; *Skin Neoplasms/pathology; Prognosis; Neoplasm Staging; Biomarkers; Data collection; Disease-free survival (DFS); Malignant melanoma; Prognostic factor; Prospective studies; Risk assessment; Survival; Tumour staging
Identification of high-risk patients with a seven-biomarker prognostic signature for adjuvant treatment trial recruitment in American Joint Committee on Cancer v8 stage I-IIA cutaneous melanoma
Publication date
2023
Abstract
PURPOSE: Many patients with resected American Joint Committee on Cancer (AJCC) early-stage cutaneous melanoma nonetheless die of melanoma; additional risk stratification approaches are needed. PATIENTS AND METHODS: Using prospectively-collected whole-tissue sections, we assessed in consecutive stage I-IIA patients (N = 439), a previously-validated, immunohistochemistry-based, 7-biomarker signature to prognosticate disease-free survival (DFS), melanoma-specific survival (MSS; primary end-point) and overall survival (OS), independent of AJCC classification. RESULTS: Seven-marker signature testing designated 25.1% of patients (110/439) as high-risk (stage IA, 13.3% [43/323], IB, 53.2% [42/79], and IIA, 67.6% [25/37]). A Kaplan-Meier analysis demonstrated high-risk patients to have significantly worse DFS, MSS and OS versus low-risk counterparts (P < 0.001). In multivariable Cox regression modelling also including key clinicopathological/demographic factors, 7-marker signature data independently prognosticated the studied end-points. Models with the 7-marker signature risk category plus clinicopathological/demographic covariates substantially outperformed models with clinicopathological/demographic variables alone in predicting all studied outcomes (areas under the receiver operator characteristic curve 74.1% versus 68.4% for DFS, 81.5% versus 71.2% for MSS, 80.9% versus 73.0% for OS; absolute differences 5.7%, 10.3% and 7.9%, respectively, favouring 7-marker signature risk category-containing models). CONCLUSION: In patients with AJCC early-stage disease, the 7-marker signature reliably prognosticates melanoma-related outcomes, independent of AJCC classification, and provides a valuable complement to clinicopathological/demographic factors.
DOI
https://www.doi.org/10.1016/j.ejca.2023.01.002
Keywords
Humans; United States; *Melanoma/pathology; *Skin Neoplasms/pathology; Prognosis; Neoplasm Staging; Biomarkers; Data collection; Disease-free survival (DFS); Malignant melanoma; Prognostic factor; Prospective studies; Risk assessment; Survival; Tumour staging
Michl, M.; Taverna, F.; Kumbrink, J.; et al. (2021) Biomarker alterations associated with distinct patterns of metastatic spread in colorectal cancer. Virchows Arch. https://www.doi.org/10.1007/s00428-020-02983-6
Title
Biomarker alterations associated with distinct patterns of metastatic spread in colorectal cancer
Publication date
2021
Abstract
Metastatic spread is the most important life-threatening feature of colorectal cancer and is supposed to be mainly driven by alterations in different carcinogenic pathways. The present study compared mutation and expression profiles of distinctive biomarkers in colorectal cancer patients with different clinical metastatic patterns. As for a case-control study, patients were matched according to T category, grading and primary tumour site. Overall, 246 patients with either exclusive lung metastasis (N = 82), exclusive liver metastasis (N = 82) or non-metastatic colorectal cancer (N = 82) were identified. Paraffin-embedded specimens were examined for mutations in the RAS and RAF genes and for the expression of beta-catenin and CD133. Clinical endpoints were presence or absence of distant metastasis, formation of metastasis in lungs versus the liver and survival. MAPK pathway mutations in either the KRAS, NRAS or BRAF gene were associated with the development of lung metastasis (63.4%) compared to the control group (47.6%; p = 0.04). MAPK pathway alterations plus high beta-catenin expression were associated with metastasis to the lungs but not to the liver (28.0% vs. 13.4%; p = 0.02). High CD133 expression correlated with the development of liver metastasis compared to the control group (30.5% vs. 14.6%; p = 0.02). This data indicates that different patterns of distant spread are associated with specific biomarker alterations and may represent different molecular subtypes of colorectal cancer. However, underlying mechanisms of metastasis formation in different anatomic sites remains unclear. Since knowledge of the anticipated site of distant spread would substantially impact clinical management, further research is needed to identify solid biomarkers for different metastatic patterns.
DOI
https://www.doi.org/10.1007/s00428-020-02983-6
Keywords
AC133 Antigen/metabolism; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor/*genetics/*metabolism; Case-Control Studies; Colorectal Neoplasms/genetics/metabolism/mortality/*pathology; Female; Follow-Up Studies; GTP Phosphohydrolases/genetics; *Gene Expression Regulation, Neoplastic; Humans; Immunohistochemistry; Liver Neoplasms/genetics/metabolism/mortality/*secondary; Lung Neoplasms/genetics/metabolism/mortality/*secondary; Male; Matched-Pair Analysis; Membrane Proteins/genetics; Middle Aged; Mutation; Neoplasm Grading; Neoplasm Staging; Prognosis; Proto-Oncogene Proteins B-raf/genetics; Proto-Oncogene Proteins p21(ras)/genetics; Retrospective Studies; Survival Analysis; beta Catenin/metabolism; Biomarker; Cd133; Lung metastasis; MAPK pathway mutations; Metastatic colorectal cancer; beta-catenin
Biomarker alterations associated with distinct patterns of metastatic spread in colorectal cancer
Publication date
2021
Abstract
Metastatic spread is the most important life-threatening feature of colorectal cancer and is supposed to be mainly driven by alterations in different carcinogenic pathways. The present study compared mutation and expression profiles of distinctive biomarkers in colorectal cancer patients with different clinical metastatic patterns. As for a case-control study, patients were matched according to T category, grading and primary tumour site. Overall, 246 patients with either exclusive lung metastasis (N = 82), exclusive liver metastasis (N = 82) or non-metastatic colorectal cancer (N = 82) were identified. Paraffin-embedded specimens were examined for mutations in the RAS and RAF genes and for the expression of beta-catenin and CD133. Clinical endpoints were presence or absence of distant metastasis, formation of metastasis in lungs versus the liver and survival. MAPK pathway mutations in either the KRAS, NRAS or BRAF gene were associated with the development of lung metastasis (63.4%) compared to the control group (47.6%; p = 0.04). MAPK pathway alterations plus high beta-catenin expression were associated with metastasis to the lungs but not to the liver (28.0% vs. 13.4%; p = 0.02). High CD133 expression correlated with the development of liver metastasis compared to the control group (30.5% vs. 14.6%; p = 0.02). This data indicates that different patterns of distant spread are associated with specific biomarker alterations and may represent different molecular subtypes of colorectal cancer. However, underlying mechanisms of metastasis formation in different anatomic sites remains unclear. Since knowledge of the anticipated site of distant spread would substantially impact clinical management, further research is needed to identify solid biomarkers for different metastatic patterns.
DOI
https://www.doi.org/10.1007/s00428-020-02983-6
Keywords
AC133 Antigen/metabolism; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor/*genetics/*metabolism; Case-Control Studies; Colorectal Neoplasms/genetics/metabolism/mortality/*pathology; Female; Follow-Up Studies; GTP Phosphohydrolases/genetics; *Gene Expression Regulation, Neoplastic; Humans; Immunohistochemistry; Liver Neoplasms/genetics/metabolism/mortality/*secondary; Lung Neoplasms/genetics/metabolism/mortality/*secondary; Male; Matched-Pair Analysis; Membrane Proteins/genetics; Middle Aged; Mutation; Neoplasm Grading; Neoplasm Staging; Prognosis; Proto-Oncogene Proteins B-raf/genetics; Proto-Oncogene Proteins p21(ras)/genetics; Retrospective Studies; Survival Analysis; beta Catenin/metabolism; Biomarker; Cd133; Lung metastasis; MAPK pathway mutations; Metastatic colorectal cancer; beta-catenin
Nennecke, A.; Barnes, B.; Brenner, H.; et al. (2013) [Data quality or differences in oncological care? - standards of reporting for cancer survival analyses based on registry data]. Gesundheitswesen. https://www.doi.org/10.1055/s-0032-1311622
Title
[Data quality or differences in oncological care? - standards of reporting for cancer survival analyses based on registry data]
Publication date
2013
Abstract
BACKGROUND: The results of population-based cancer survival analyses are essential criteria with regard to the evaluation of oncological care. Their use and their interpretation as such require knowledge and transparency with regard to the data basis in order to avoid inadequate conclusions. METHOD: The working group 'survival analysis' of the Association of Population-Based Cancer Registries in Germany (GEKID) has identified factors within cancer registration and data evaluation which may distort population-based cancer survival analyses to a relevant degree. Recommendations in terms of standards of reporting were developed by mutual consent following empirical studies and discussions within GEKID. RESULTS: We provide a list of 17 indicators to be taken into account and to be presented within the scope of population-based survival analyses. CONCLUSIONS: Referring to the "standards of reporting concerning population-based cancer survival analyses" introduced by GEKID there is a proposal on data transparency on hand, which might contribute substantially to the assessability of outcome quality in oncological care.
DOI
https://www.doi.org/10.1055/s-0032-1311622
Keywords
Data Interpretation, Statistical; Germany/epidemiology; Guideline Adherence/*statistics & numerical data; Humans; *Mandatory Reporting; Neoplasms/*mortality/*therapy; *Practice Guidelines as Topic; Prevalence; Registries/*standards/statistics & numerical data; *Survival Analysis; Survival Rate; Treatment Outcome
[Data quality or differences in oncological care? - standards of reporting for cancer survival analyses based on registry data]
Publication date
2013
Abstract
BACKGROUND: The results of population-based cancer survival analyses are essential criteria with regard to the evaluation of oncological care. Their use and their interpretation as such require knowledge and transparency with regard to the data basis in order to avoid inadequate conclusions. METHOD: The working group 'survival analysis' of the Association of Population-Based Cancer Registries in Germany (GEKID) has identified factors within cancer registration and data evaluation which may distort population-based cancer survival analyses to a relevant degree. Recommendations in terms of standards of reporting were developed by mutual consent following empirical studies and discussions within GEKID. RESULTS: We provide a list of 17 indicators to be taken into account and to be presented within the scope of population-based survival analyses. CONCLUSIONS: Referring to the "standards of reporting concerning population-based cancer survival analyses" introduced by GEKID there is a proposal on data transparency on hand, which might contribute substantially to the assessability of outcome quality in oncological care.
DOI
https://www.doi.org/10.1055/s-0032-1311622
Keywords
Data Interpretation, Statistical; Germany/epidemiology; Guideline Adherence/*statistics & numerical data; Humans; *Mandatory Reporting; Neoplasms/*mortality/*therapy; *Practice Guidelines as Topic; Prevalence; Registries/*standards/statistics & numerical data; *Survival Analysis; Survival Rate; Treatment Outcome
Nennecke, A.; Brenner, H.; Eberle, A.; et al. (2010) [Cancer survival analysis in Germany--heading towards representative and comparable findings]. Gesundheitswesen. https://www.doi.org/10.1055/s-0029-1242772
Title
[Cancer survival analysis in Germany--heading towards representative and comparable findings]
Publication date
2010
Abstract
Cancer is an important issue within the German health care system with an estimated annual number of 435 000 incident cases and almost 210 000 deaths. Data of population-based cancer registries enable us to identify improvements of survival in oncological patients due to progress in therapeutic care and secondary prevention, as well as to investigate regional and international differences of this outcome. Comparing cancer survival rates, however, requires considering the impact of both methodical approaches and data quality. Potential factors of influence like algorithms, reference population, completeness of case ascertainment and quality of follow-up are discussed. For the first time harmonized proceedings are recommended in order to achieve comparability of population-based cancer survival rates in Germany.
DOI
https://www.doi.org/10.1055/s-0029-1242772
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Cause of Death; Cross-Cultural Comparison; Data Collection/statistics & numerical data; Female; Humans; Incidence; Male; Mathematical Computing; Middle Aged; National Health Programs/statistics & numerical data; Neoplasms/*mortality; Registries; Software; Survival Analysis; Young Adult
[Cancer survival analysis in Germany--heading towards representative and comparable findings]
Publication date
2010
Abstract
Cancer is an important issue within the German health care system with an estimated annual number of 435 000 incident cases and almost 210 000 deaths. Data of population-based cancer registries enable us to identify improvements of survival in oncological patients due to progress in therapeutic care and secondary prevention, as well as to investigate regional and international differences of this outcome. Comparing cancer survival rates, however, requires considering the impact of both methodical approaches and data quality. Potential factors of influence like algorithms, reference population, completeness of case ascertainment and quality of follow-up are discussed. For the first time harmonized proceedings are recommended in order to achieve comparability of population-based cancer survival rates in Germany.
DOI
https://www.doi.org/10.1055/s-0029-1242772
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Cause of Death; Cross-Cultural Comparison; Data Collection/statistics & numerical data; Female; Humans; Incidence; Male; Mathematical Computing; Middle Aged; National Health Programs/statistics & numerical data; Neoplasms/*mortality; Registries; Software; Survival Analysis; Young Adult
Nennecke, A.; Geiss, K.; Hentschel, S.; et al. (2014) Survival of cancer patients in urban and rural areas of Germany--a comparison. Cancer Epidemiol. https://www.doi.org/10.1016/j.canep.2014.02.011
Title
Survival of cancer patients in urban and rural areas of Germany--a comparison
Publication date
2014
Abstract
BACKGROUND: Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancer patients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people. MATERIAL AND METHODS: Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance. RESULTS: The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancer patients and male malignant melanoma patients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older. CONCLUSION: With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.
DOI
https://www.doi.org/10.1016/j.canep.2014.02.011
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; Female; Germany/epidemiology; Humans; Male; Middle Aged; Neoplasms/epidemiology/*mortality; Registries; Rural Population/statistics & numerical data; Survival Analysis; Urban Population/statistics & numerical data; Young Adult; Cancer registry; Cancer survival; Germany; Regional variation
Survival of cancer patients in urban and rural areas of Germany--a comparison
Publication date
2014
Abstract
BACKGROUND: Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancer patients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people. MATERIAL AND METHODS: Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance. RESULTS: The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancer patients and male malignant melanoma patients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older. CONCLUSION: With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.
DOI
https://www.doi.org/10.1016/j.canep.2014.02.011
Keywords
Adolescent; Adult; Aged; Aged, 80 and over; Female; Germany/epidemiology; Humans; Male; Middle Aged; Neoplasms/epidemiology/*mortality; Registries; Rural Population/statistics & numerical data; Survival Analysis; Urban Population/statistics & numerical data; Young Adult; Cancer registry; Cancer survival; Germany; Regional variation
Nicolai, N.; Biasoni, D.; Catanzaro, M. A.; et al. (2019) Testicular germ-cell tumours and penile squamous cell carcinoma: Appropriate management makes the difference. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2018.02.006
Title
Testicular germ-cell tumours and penile squamous cell carcinoma: Appropriate management makes the difference
Publication date
2019
Abstract
Germ-cell tumours (GCT) of the testis and penile squamous cell carcinoma (PeSCC) are a rare and a very rare uro-genital cancers, respectively. Both tumours are well defined entities in terms of management, where specific recommendations - in the form of continuously up-to-dated guide lines-are provided. Impact of these tumour is relevant. Testicular GCT affects young, healthy men at the beginning of their adult life. PeSCC affects older men, but a proportion of these patients are young and the personal consequences of the disease may be devastating. Deviation from recommended management may be a reason of a significant prognostic worsening, as proper treatment favourably impacts on these tumours, dramatically on GCT and significantly on PeSCC. RARECAREnet data may permit to analyse how survivals may vary according to geographical areas, histology and age, leading to assume that non-homogeneous health-care resources may impact the cure and definitive outcomes. In support of this hypothesis, some epidemiologic datasets and clinical findings would indicate that survival may improve when appropriate treatments are delivered, linked to a different accessibility to the best health institutions, as a consequence of geographical, cultural and economic barriers. Finally, strong clues based on epidemiological and clinical data support the hypothesis that treatment delivered at reference centres or under the aegis of a qualified multi-institutional network is associated with a better prognosis of patients with these malignancies. The ERN EURACAN represents the best current European effort to answer this clinical need.
DOI
https://www.doi.org/10.1016/j.ejso.2018.02.006
Keywords
Cancer Care Facilities; Carcinoma, Squamous Cell/*diagnosis/secondary/*therapy; Delivery of Health Care/*organization & administration; Europe; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal/diagnosis/secondary/*therapy; Penile Neoplasms/diagnosis/pathology/*therapy; Rare Diseases/diagnosis/pathology/therapy; Referral and Consultation; Survival Rate; Testicular Neoplasms/diagnosis/pathology/*therapy; *Carcinoma; *Community network; *Europe; *Germ cell and embryonal; *Neoplasms; *Penis neoplasms; *Rare diseases; *Squamous cell; *Survival; *Tertiary care centres; *Testicular neoplasms
Testicular germ-cell tumours and penile squamous cell carcinoma: Appropriate management makes the difference
Publication date
2019
Abstract
Germ-cell tumours (GCT) of the testis and penile squamous cell carcinoma (PeSCC) are a rare and a very rare uro-genital cancers, respectively. Both tumours are well defined entities in terms of management, where specific recommendations - in the form of continuously up-to-dated guide lines-are provided. Impact of these tumour is relevant. Testicular GCT affects young, healthy men at the beginning of their adult life. PeSCC affects older men, but a proportion of these patients are young and the personal consequences of the disease may be devastating. Deviation from recommended management may be a reason of a significant prognostic worsening, as proper treatment favourably impacts on these tumours, dramatically on GCT and significantly on PeSCC. RARECAREnet data may permit to analyse how survivals may vary according to geographical areas, histology and age, leading to assume that non-homogeneous health-care resources may impact the cure and definitive outcomes. In support of this hypothesis, some epidemiologic datasets and clinical findings would indicate that survival may improve when appropriate treatments are delivered, linked to a different accessibility to the best health institutions, as a consequence of geographical, cultural and economic barriers. Finally, strong clues based on epidemiological and clinical data support the hypothesis that treatment delivered at reference centres or under the aegis of a qualified multi-institutional network is associated with a better prognosis of patients with these malignancies. The ERN EURACAN represents the best current European effort to answer this clinical need.
DOI
https://www.doi.org/10.1016/j.ejso.2018.02.006
Keywords
Cancer Care Facilities; Carcinoma, Squamous Cell/*diagnosis/secondary/*therapy; Delivery of Health Care/*organization & administration; Europe; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal/diagnosis/secondary/*therapy; Penile Neoplasms/diagnosis/pathology/*therapy; Rare Diseases/diagnosis/pathology/therapy; Referral and Consultation; Survival Rate; Testicular Neoplasms/diagnosis/pathology/*therapy; *Carcinoma; *Community network; *Europe; *Germ cell and embryonal; *Neoplasms; *Penis neoplasms; *Rare diseases; *Squamous cell; *Survival; *Tertiary care centres; *Testicular neoplasms
Orlandi, E.; Alfieri, S.; Simon, C.; et al. (2019) Treatment challenges in and outside a network setting: Head and neck cancers. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2018.02.007
Title
Treatment challenges in and outside a network setting: Head and neck cancers
Publication date
2019
Abstract
Head and neck cancer (HNC) is a rare disease that can affect different sites and is characterized by variable incidence and 5-year survival rates across Europe. Multiple factors need to be considered when choosing the most appropriate treatment for HNC patients, such as age, comorbidities, social issues, and especially whether to prefer surgery or radiation-based protocols. Given the complexity of this scenario, the creation of a highly specialized multidisciplinary team is recommended to guarantee the best oncological outcome and prevent or adequately treat any adverse effect. Data from literature suggest that the multidisciplinary team-based approach is beneficial for HNC patients and lead to improved survival rates. This result is likely due to improved diagnostic and staging accuracy, a more efficacious therapeutic approach and enhanced communication across disciplines. Despite the benefit of MTD, it must be noted that this approach requires considerable time, effort and financial resources and is usually more frequent in highly organized and high-volume centers. Literature data on clinical research suggest that patients treated in high-accrual centers report better treatment outcomes compared to patients treated in low-volume centers, where a lower radiotherapy-compliance and worst overall survival have been reported. There is general agreement that treatment of rare cancers such as HNC should be concentrated in high volume, specialized and multidisciplinary centers. In order to achieve this goal, the creation of international collaboration network is fundamental. The European Reference Networks for example aim to create an international virtual advisory board, whose objectives are the exchange of expertise, training, clinical collaboration and the reduction of disparities and enhancement of rationalize migration across Europe. The purpose of our work is to review all aspects and challenges in and outside this network setting planned for the management of HNC patients.
DOI
https://www.doi.org/10.1016/j.ejso.2018.02.007
Keywords
Delivery of Health Care/*organization & administration; Europe; Head and Neck Neoplasms/epidemiology/*therapy; Humans; Patient Care Team; Rare Diseases/epidemiology/*therapy; Referral and Consultation; *European reference networks joint action of rare cancers; *Head and neck cancer; *Multidisciplinary team; *Rare disease
Treatment challenges in and outside a network setting: Head and neck cancers
Publication date
2019
Abstract
Head and neck cancer (HNC) is a rare disease that can affect different sites and is characterized by variable incidence and 5-year survival rates across Europe. Multiple factors need to be considered when choosing the most appropriate treatment for HNC patients, such as age, comorbidities, social issues, and especially whether to prefer surgery or radiation-based protocols. Given the complexity of this scenario, the creation of a highly specialized multidisciplinary team is recommended to guarantee the best oncological outcome and prevent or adequately treat any adverse effect. Data from literature suggest that the multidisciplinary team-based approach is beneficial for HNC patients and lead to improved survival rates. This result is likely due to improved diagnostic and staging accuracy, a more efficacious therapeutic approach and enhanced communication across disciplines. Despite the benefit of MTD, it must be noted that this approach requires considerable time, effort and financial resources and is usually more frequent in highly organized and high-volume centers. Literature data on clinical research suggest that patients treated in high-accrual centers report better treatment outcomes compared to patients treated in low-volume centers, where a lower radiotherapy-compliance and worst overall survival have been reported. There is general agreement that treatment of rare cancers such as HNC should be concentrated in high volume, specialized and multidisciplinary centers. In order to achieve this goal, the creation of international collaboration network is fundamental. The European Reference Networks for example aim to create an international virtual advisory board, whose objectives are the exchange of expertise, training, clinical collaboration and the reduction of disparities and enhancement of rationalize migration across Europe. The purpose of our work is to review all aspects and challenges in and outside this network setting planned for the management of HNC patients.
DOI
https://www.doi.org/10.1016/j.ejso.2018.02.007
Keywords
Delivery of Health Care/*organization & administration; Europe; Head and Neck Neoplasms/epidemiology/*therapy; Humans; Patient Care Team; Rare Diseases/epidemiology/*therapy; Referral and Consultation; *European reference networks joint action of rare cancers; *Head and neck cancer; *Multidisciplinary team; *Rare disease
Papathemelis, T.; Knobloch, S.; Gerken, M.; et al. (2019) Impact of nodal status and treatment strategy on overall survival in advanced stage cervical cancer. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-019-02890-7
Title
Impact of nodal status and treatment strategy on overall survival in advanced stage cervical cancer
Publication date
2019
Abstract
PURPOSE: The lack of prognostic data impedes implementation of optimal therapy for cervical cancer. For instance, recommended therapy for FIGO IIB cervical cancer is radical hysterectomy or radiochemotherapy. To enlighten different therapeutic approaches, we investigated the benefit of individual therapies or combination thereof in patients with or without infested lymph nodes. METHODS: The German Tumor Centre Regensburg registered 389 patients with FIGO IIB, IIIA, IIIB, and IVA cervical cancer between 2002 and 2015. We estimated hazard ratios (HR) for overall survival against different therapies using univariable and multivariable cox regression. After risk adjustment with respect to clinicopathological parameters, we performed model selection using conditional stepwise reverse selection. RESULTS: We demonstrated the need for thorough assessment of the nodal status to obtain reliable data for treatment strategy. Our analysis showed significant differences for overall survival in FIGO IIB depending on therapy and nodal status. Outcome was inferior with radiochemotherapy without surgery for patients with N0 compared to surgery and radiochemotherapy combined (HR 3.012; 95% CI 1.075-8.441; p = 0.036); however, for N1, radiochemotherapy without surgery resulted in comparable outcome (HR 0.808; 95% CI 0.189-3.403; p = 0.765), whereas surgery alone yielded in poor outcome (HR 2.889; 95% CI 1.356-6.156; p = 0.006). Regardless of the nodal status, chemotherapy was superior in advanced stage cervical cancer FIGO III to IVA. CONCLUSIONS: Our study suggests that in terms of oncological outcome FIGO IIB cervical cancer patients benefit from a combination of surgery and radiochemotherapy. However, in the presence of lymph node infestation, surgery does not add substantial benefit to the patient.
DOI
https://www.doi.org/10.1007/s00432-019-02890-7
Keywords
Adult; Aged; Aged, 80 and over; Combined Modality Therapy/methods; Comorbidity; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes/*pathology; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Retrospective Studies; Uterine Cervical Neoplasms/*mortality/*pathology/therapy; Young Adult; Cervical cancer; Lymphadenectomy; Nodal status; Outcome; Overall survival; Therapy
Impact of nodal status and treatment strategy on overall survival in advanced stage cervical cancer
Publication date
2019
Abstract
PURPOSE: The lack of prognostic data impedes implementation of optimal therapy for cervical cancer. For instance, recommended therapy for FIGO IIB cervical cancer is radical hysterectomy or radiochemotherapy. To enlighten different therapeutic approaches, we investigated the benefit of individual therapies or combination thereof in patients with or without infested lymph nodes. METHODS: The German Tumor Centre Regensburg registered 389 patients with FIGO IIB, IIIA, IIIB, and IVA cervical cancer between 2002 and 2015. We estimated hazard ratios (HR) for overall survival against different therapies using univariable and multivariable cox regression. After risk adjustment with respect to clinicopathological parameters, we performed model selection using conditional stepwise reverse selection. RESULTS: We demonstrated the need for thorough assessment of the nodal status to obtain reliable data for treatment strategy. Our analysis showed significant differences for overall survival in FIGO IIB depending on therapy and nodal status. Outcome was inferior with radiochemotherapy without surgery for patients with N0 compared to surgery and radiochemotherapy combined (HR 3.012; 95% CI 1.075-8.441; p = 0.036); however, for N1, radiochemotherapy without surgery resulted in comparable outcome (HR 0.808; 95% CI 0.189-3.403; p = 0.765), whereas surgery alone yielded in poor outcome (HR 2.889; 95% CI 1.356-6.156; p = 0.006). Regardless of the nodal status, chemotherapy was superior in advanced stage cervical cancer FIGO III to IVA. CONCLUSIONS: Our study suggests that in terms of oncological outcome FIGO IIB cervical cancer patients benefit from a combination of surgery and radiochemotherapy. However, in the presence of lymph node infestation, surgery does not add substantial benefit to the patient.
DOI
https://www.doi.org/10.1007/s00432-019-02890-7
Keywords
Adult; Aged; Aged, 80 and over; Combined Modality Therapy/methods; Comorbidity; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes/*pathology; Lymphatic Metastasis; Middle Aged; Neoplasm Staging; Retrospective Studies; Uterine Cervical Neoplasms/*mortality/*pathology/therapy; Young Adult; Cervical cancer; Lymphadenectomy; Nodal status; Outcome; Overall survival; Therapy
Papathemelis, T.; Oppermann, H.; Grafl, S.; et al. (2020) Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-019-03122-8
Title
Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure
Publication date
2020
Abstract
OBJECTIVE: The primary therapy for intermediate- and high-risk endometrial cancer includes pelvic and paraaortic lymph node evaluation. Laparoscopic surgery is an increasingly popular intervention due to decreased risk and better short-term morbidity; however, a recent study casts doubt on the benefit of this approach in terms of oncological safety. In this cancer registry study, we sought to evaluate the benefit of laparoscopy versus laparotomy and retrospectively compared overall survival, recurrence rates, and recurrence-free survival among patients with intermediate- and high-risk endometrial cancer who underwent either laparoscopic or open surgery. METHODS: This observational study included 419 patients who have been treated from 2011 to 2017. We employed Kaplan-Meier method, and univariable and multivariable Cox-regression to compare overall survival, recurrence rates, and recurrence-free survival in 110 patients, who underwent laparoscopic, with 309 patients, who underwent open surgery. To address the confounding bias in this retrospective study, we also performed a propensity score matching (PSM) analysis including 357 patients (laparoscopy: n = 107; open surgery: n = 250). RESULTS: We found a benefit for laparoscopic over open surgery in patients with intermediate- and high-risk endometrial cancer for overall survival in both univariable (p = 0.002; PSM: p = 0.016) and multivariable analyses (p = 0.019; PSM: p = 0.007). In contrast, there was no statistically significant difference between both patient groups regarding the cumulative recurrence rates. A univariable analysis identified a significant benefit for laparoscopy regarding recurrence-free survival (p = 0.003; PSM: p = 0.029) but a multivariable analysis failed to confirm this finding (p = 0.108; PSM: p = 0.118). CONCLUSIONS: Our study provides evidence that laparoscopic systematic lymphadenectomy does not present a lower oncological efficacy than open surgery in the treatment of patients with endometrial cancer.
DOI
https://www.doi.org/10.1007/s00432-019-03122-8
Keywords
Aged; Cohort Studies; Disease-Free Survival; Endometrial Neoplasms/pathology/*surgery; Female; Humans; Kaplan-Meier Estimate; Laparoscopy/methods/statistics & numerical data; Lymph Node Excision/*methods/statistics & numerical data; Lymph Nodes/pathology/*surgery; Middle Aged; Neoplasm Staging; Propensity Score; Proportional Hazards Models; Retrospective Studies; Treatment Outcome; Cancer registry study; Endometrial cancer; Laparoscopy; Laparotomy; Observational study; Overall survival; Pelvic and paraaortic lymphadenectomy
Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure
Publication date
2020
Abstract
OBJECTIVE: The primary therapy for intermediate- and high-risk endometrial cancer includes pelvic and paraaortic lymph node evaluation. Laparoscopic surgery is an increasingly popular intervention due to decreased risk and better short-term morbidity; however, a recent study casts doubt on the benefit of this approach in terms of oncological safety. In this cancer registry study, we sought to evaluate the benefit of laparoscopy versus laparotomy and retrospectively compared overall survival, recurrence rates, and recurrence-free survival among patients with intermediate- and high-risk endometrial cancer who underwent either laparoscopic or open surgery. METHODS: This observational study included 419 patients who have been treated from 2011 to 2017. We employed Kaplan-Meier method, and univariable and multivariable Cox-regression to compare overall survival, recurrence rates, and recurrence-free survival in 110 patients, who underwent laparoscopic, with 309 patients, who underwent open surgery. To address the confounding bias in this retrospective study, we also performed a propensity score matching (PSM) analysis including 357 patients (laparoscopy: n = 107; open surgery: n = 250). RESULTS: We found a benefit for laparoscopic over open surgery in patients with intermediate- and high-risk endometrial cancer for overall survival in both univariable (p = 0.002; PSM: p = 0.016) and multivariable analyses (p = 0.019; PSM: p = 0.007). In contrast, there was no statistically significant difference between both patient groups regarding the cumulative recurrence rates. A univariable analysis identified a significant benefit for laparoscopy regarding recurrence-free survival (p = 0.003; PSM: p = 0.029) but a multivariable analysis failed to confirm this finding (p = 0.108; PSM: p = 0.118). CONCLUSIONS: Our study provides evidence that laparoscopic systematic lymphadenectomy does not present a lower oncological efficacy than open surgery in the treatment of patients with endometrial cancer.
DOI
https://www.doi.org/10.1007/s00432-019-03122-8
Keywords
Aged; Cohort Studies; Disease-Free Survival; Endometrial Neoplasms/pathology/*surgery; Female; Humans; Kaplan-Meier Estimate; Laparoscopy/methods/statistics & numerical data; Lymph Node Excision/*methods/statistics & numerical data; Lymph Nodes/pathology/*surgery; Middle Aged; Neoplasm Staging; Propensity Score; Proportional Hazards Models; Retrospective Studies; Treatment Outcome; Cancer registry study; Endometrial cancer; Laparoscopy; Laparotomy; Observational study; Overall survival; Pelvic and paraaortic lymphadenectomy
Pasquali, S.; Bonvalot, S.; Tzanis, D.; et al. (2019) Treatment challenges in and outside a network setting: Soft tissue sarcomas. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2017.09.015
Title
Treatment challenges in and outside a network setting: Soft tissue sarcomas
Publication date
2019
Abstract
Patients with soft tissue sarcoma (STS) experienced better outcomes when treated according to existing clinical practice guidelines either at reference institution or dedicated treatment networks. Despite increasing evidence supporting referral to sarcoma specialised units, up to half of patients are not managed according to guidelines, particularly those in the early stage of their disease requiring surgery. Also, criteria to certify expertise of institutions, such as the treatment volume, are debated and health authorities have only recently started identification of these centres and creation of treatment networks in Europe as well as in several countries. This process have important implications for both patient outcomes and innovation of existing treatment strategies through clinical research, making improvement of clinical pathways a priority for health care authorities. This article will discuss issues with management of patients with STS, such as pathological diagnosis and adherence to guidelines, and the definition of referral centres and networks will be illustrated along with existing experiences and population-based data.
DOI
https://www.doi.org/10.1016/j.ejso.2017.09.015
Keywords
*Cancer Care Facilities; Delivery of Health Care/organization & administration; Europe; Humans; Practice Guidelines as Topic; Rare Diseases/diagnosis/pathology/therapy; Referral and Consultation; *Registries; Sarcoma/diagnosis/*pathology/*therapy; *Guidelines; *Network; *Referral centre; *Sarcoma; *Treatment
Treatment challenges in and outside a network setting: Soft tissue sarcomas
Publication date
2019
Abstract
Patients with soft tissue sarcoma (STS) experienced better outcomes when treated according to existing clinical practice guidelines either at reference institution or dedicated treatment networks. Despite increasing evidence supporting referral to sarcoma specialised units, up to half of patients are not managed according to guidelines, particularly those in the early stage of their disease requiring surgery. Also, criteria to certify expertise of institutions, such as the treatment volume, are debated and health authorities have only recently started identification of these centres and creation of treatment networks in Europe as well as in several countries. This process have important implications for both patient outcomes and innovation of existing treatment strategies through clinical research, making improvement of clinical pathways a priority for health care authorities. This article will discuss issues with management of patients with STS, such as pathological diagnosis and adherence to guidelines, and the definition of referral centres and networks will be illustrated along with existing experiences and population-based data.
DOI
https://www.doi.org/10.1016/j.ejso.2017.09.015
Keywords
*Cancer Care Facilities; Delivery of Health Care/organization & administration; Europe; Humans; Practice Guidelines as Topic; Rare Diseases/diagnosis/pathology/therapy; Referral and Consultation; *Registries; Sarcoma/diagnosis/*pathology/*therapy; *Guidelines; *Network; *Referral centre; *Sarcoma; *Treatment
Petrova, E.; Wellner, J.; Nording, A. K.; et al. (2021) Survival Outcome and Prognostic Factors for Pancreatic Acinar Cell Carcinoma: Retrospective Analysis from the German Cancer Registry Group. Cancers (Basel). https://www.doi.org/10.3390/cancers13236121
Title
Survival Outcome and Prognostic Factors for Pancreatic Acinar Cell Carcinoma: Retrospective Analysis from the German Cancer Registry Group
Publication date
2021
Abstract
BACKGROUND: Pancreatic acinar cell carcinoma (PACC) is a distinct type of pancreatic cancer with low prevalence. We aimed to analyze prognostic factors and survival outcome for PACC in comparison to pancreatic ductal adenocarcinoma (PDAC), based on data from the German Cancer Registry Group. METHODS: Patients with PACC and PDAC were extracted from pooled data of the German clinical cancer registries (years 2000 to 2019). The distribution of demographic parameters, tumor stage and therapy modes were compared between PACC and PDAC. The Kaplan-Meier method and Cox regression analysis were used to delineate prognostic factors for PACC. Propensity score matching was used to compare survival between PACC and PDAC. RESULTS: There were 233 (0.44%) patients with PACC out of 52,518 patients with pancreatic malignancy. Compared to PDAC, patients with PACC were younger (median age 66 versus 70, respectively, p < 0.001) and the percentage of males was higher (66.1% versus 53.3%, respectively, p < 0.001). More patients were resected with PACC than with PDAC (56.2% versus 38.9%, respectively, p < 0.001). The estimated overall median survival in PACC was 22 months (95% confidence interval 15 to 27), compared to 12 months (95% confidence interval 10 to 13) in the matched PDAC cohort (p < 0.001). Surgical resection was the strongest positive prognostic factor for PACC after adjusting for sex, age, and distant metastases (hazard ratio 0.34, 95% confidence interval 0.22 to 0.51, p < 0.001). There was no survival benefit for adjuvant therapy in PACC. CONCLUSIONS: PACC has overall better prognosis than PDAC. Surgical resection is the best therapeutic strategy for PACC and should be advocated even in advanced tumor stages.
DOI
https://www.doi.org/10.3390/cancers13236121
Keywords
German Cancer Registry Group; pancreatic acinar cell carcinoma; pancreatic cancer
Survival Outcome and Prognostic Factors for Pancreatic Acinar Cell Carcinoma: Retrospective Analysis from the German Cancer Registry Group
Publication date
2021
Abstract
BACKGROUND: Pancreatic acinar cell carcinoma (PACC) is a distinct type of pancreatic cancer with low prevalence. We aimed to analyze prognostic factors and survival outcome for PACC in comparison to pancreatic ductal adenocarcinoma (PDAC), based on data from the German Cancer Registry Group. METHODS: Patients with PACC and PDAC were extracted from pooled data of the German clinical cancer registries (years 2000 to 2019). The distribution of demographic parameters, tumor stage and therapy modes were compared between PACC and PDAC. The Kaplan-Meier method and Cox regression analysis were used to delineate prognostic factors for PACC. Propensity score matching was used to compare survival between PACC and PDAC. RESULTS: There were 233 (0.44%) patients with PACC out of 52,518 patients with pancreatic malignancy. Compared to PDAC, patients with PACC were younger (median age 66 versus 70, respectively, p < 0.001) and the percentage of males was higher (66.1% versus 53.3%, respectively, p < 0.001). More patients were resected with PACC than with PDAC (56.2% versus 38.9%, respectively, p < 0.001). The estimated overall median survival in PACC was 22 months (95% confidence interval 15 to 27), compared to 12 months (95% confidence interval 10 to 13) in the matched PDAC cohort (p < 0.001). Surgical resection was the strongest positive prognostic factor for PACC after adjusting for sex, age, and distant metastases (hazard ratio 0.34, 95% confidence interval 0.22 to 0.51, p < 0.001). There was no survival benefit for adjuvant therapy in PACC. CONCLUSIONS: PACC has overall better prognosis than PDAC. Surgical resection is the best therapeutic strategy for PACC and should be advocated even in advanced tumor stages.
DOI
https://www.doi.org/10.3390/cancers13236121
Keywords
German Cancer Registry Group; pancreatic acinar cell carcinoma; pancreatic cancer
Petruch, N.; Servin Rojas, M.; Lillemoe, K. D.; et al. (2023) The impact of surgical-oncologic textbook outcome in patients with stage I to III pancreatic ductal adenocarcinoma: A cross-validation study of two national registries. Surgery. https://www.doi.org/10.1016/j.surg.2023.11.004
Title
The impact of surgical-oncologic textbook outcome in patients with stage I to III pancreatic ductal adenocarcinoma: A cross-validation study of two national registries
Publication date
2023
Abstract
BACKGROUND: Using national registries, we aimed to evaluate oncologic textbook outcomes in pancreatic ductal adenocarcinoma patients. METHODS: Patients with stage I to III pancreatic ductal adenocarcinoma and surgical resection from 2010 to 2020 in the US and Germany were identified using the National Cancer Database and National Cancer Registries data. The surgical-oncologic textbook outcome was defined as complete oncologic resection with no residual tumor and >/=12 harvested lymph nodes. The composite endpoint was defined as surgical-oncologic textbook outcome and receipt of perioperative systemic and/or radiation therapy. RESULTS: In total, 33,498 patients from the National Cancer Database and 14,589 patients from the National Cancer Registries were included. In the National Cancer Database, 28,931 (86%) patients had complete oncologic resection with no residual tumor, and 11,595 (79%) in the National Cancer Registries. 8,723 (26%) patients in the National Cancer Database and 556 (4%) in the National Cancer Registries had <12 lymph nodes harvested. The National Cancer Database shows 26,135 (78%) underwent perioperative therapy and 8,333 (57%) in the National Cancer Registries. Surgical-oncologic textbook outcome was achieved in 21,198 (63%) patients in the National Cancer Database and in 11,234 (77%) patients from the National Cancer Registries. 16,967 (50%) patients in the National Cancer Database and 7,878 (54%) patients in the National Cancer Registries had composite textbook outcome. Median overall survival in patients with composite textbook outcomes was 32 months in the National Cancer Database and 27 months in the National Cancer Registries (P < .001). In contrast, those with non-textbook outcomes had a median overall survival of 23 months in the National Cancer Database and 20 months in the National Cancer Registries (P < .001). CONCLUSION: Surgical-oncologic textbook outcomes were achieved in > 50% of stage I to III pancreatic ductal adenocarcinoma for both the National Cancer Database and the National Cancer Registries. Failure to achieve textbook outcomes was associated with impaired survival across both registries.
DOI
https://www.doi.org/10.1016/j.surg.2023.11.004
The impact of surgical-oncologic textbook outcome in patients with stage I to III pancreatic ductal adenocarcinoma: A cross-validation study of two national registries
Publication date
2023
Abstract
BACKGROUND: Using national registries, we aimed to evaluate oncologic textbook outcomes in pancreatic ductal adenocarcinoma patients. METHODS: Patients with stage I to III pancreatic ductal adenocarcinoma and surgical resection from 2010 to 2020 in the US and Germany were identified using the National Cancer Database and National Cancer Registries data. The surgical-oncologic textbook outcome was defined as complete oncologic resection with no residual tumor and >/=12 harvested lymph nodes. The composite endpoint was defined as surgical-oncologic textbook outcome and receipt of perioperative systemic and/or radiation therapy. RESULTS: In total, 33,498 patients from the National Cancer Database and 14,589 patients from the National Cancer Registries were included. In the National Cancer Database, 28,931 (86%) patients had complete oncologic resection with no residual tumor, and 11,595 (79%) in the National Cancer Registries. 8,723 (26%) patients in the National Cancer Database and 556 (4%) in the National Cancer Registries had <12 lymph nodes harvested. The National Cancer Database shows 26,135 (78%) underwent perioperative therapy and 8,333 (57%) in the National Cancer Registries. Surgical-oncologic textbook outcome was achieved in 21,198 (63%) patients in the National Cancer Database and in 11,234 (77%) patients from the National Cancer Registries. 16,967 (50%) patients in the National Cancer Database and 7,878 (54%) patients in the National Cancer Registries had composite textbook outcome. Median overall survival in patients with composite textbook outcomes was 32 months in the National Cancer Database and 27 months in the National Cancer Registries (P < .001). In contrast, those with non-textbook outcomes had a median overall survival of 23 months in the National Cancer Database and 20 months in the National Cancer Registries (P < .001). CONCLUSION: Surgical-oncologic textbook outcomes were achieved in > 50% of stage I to III pancreatic ductal adenocarcinoma for both the National Cancer Database and the National Cancer Registries. Failure to achieve textbook outcomes was associated with impaired survival across both registries.
DOI
https://www.doi.org/10.1016/j.surg.2023.11.004
Pokora, R. M.; Büttner, M.; Schulz, A.; et al. (2022) Determinants of mammography screening participation-a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS). PLoS One. https://www.doi.org/10.1371/journal.pone.0275525
Title
Determinants of mammography screening participation-a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS)
Publication date
2022
Abstract
PURPOSE: We investigated the association between social inequality and participation in a mammography screening program (MSP). Since the German government offers mammography screening free of charge, any effect of social inequality on participation should be due to educational status and not due to the financial burden. METHODS: The 'Gutenberg Health Study' is a cohort study in the Rhine-Main-region, Germany. A health check-up was performed, and questions about medical history, health behavior, including secondary prevention such as use of mammography, and social status are included. Two indicators of social inequality (equivalence income and educational status), an interaction term of these two, and different covariables were used to explore an association in different logistic regression models. RESULTS: A total of 4,681 women meeting the inclusion criteria were included. Only 6.2% never participated in the MSP. A higher income was associated with higher chances of ever participating in a mammography screening (odds ratios (OR): 1.67 per euro1000; 95%CI:1.26-2.25, model 3, adjusted for age, education and an interaction term of income and education). Compared to women with a low educational status, the odds ratios for ever participating in the MSP was lower for the intermediate educational status group (OR = 0.64, 95%CI:0.45-0.91) and for the high educational status group (0.53, 95%CI:0.37-0.76). Results persisted also after controlling for relevant confounders. CONCLUSIONS: Despite the absence of financial barriers for participation in the MSP, socioeconomic inequalities still influence participation. It would be interesting to examine whether the educational effect is due to an informed decision.
DOI
https://www.doi.org/10.1371/journal.pone.0275525
Keywords
*Breast Neoplasms/diagnostic imaging; Cohort Studies; Cross-Sectional Studies; Early Detection of Cancer; Female; Humans; *Mammography; Mass Screening; Socioeconomic Factors
Determinants of mammography screening participation-a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS)
Publication date
2022
Abstract
PURPOSE: We investigated the association between social inequality and participation in a mammography screening program (MSP). Since the German government offers mammography screening free of charge, any effect of social inequality on participation should be due to educational status and not due to the financial burden. METHODS: The 'Gutenberg Health Study' is a cohort study in the Rhine-Main-region, Germany. A health check-up was performed, and questions about medical history, health behavior, including secondary prevention such as use of mammography, and social status are included. Two indicators of social inequality (equivalence income and educational status), an interaction term of these two, and different covariables were used to explore an association in different logistic regression models. RESULTS: A total of 4,681 women meeting the inclusion criteria were included. Only 6.2% never participated in the MSP. A higher income was associated with higher chances of ever participating in a mammography screening (odds ratios (OR): 1.67 per euro1000; 95%CI:1.26-2.25, model 3, adjusted for age, education and an interaction term of income and education). Compared to women with a low educational status, the odds ratios for ever participating in the MSP was lower for the intermediate educational status group (OR = 0.64, 95%CI:0.45-0.91) and for the high educational status group (0.53, 95%CI:0.37-0.76). Results persisted also after controlling for relevant confounders. CONCLUSIONS: Despite the absence of financial barriers for participation in the MSP, socioeconomic inequalities still influence participation. It would be interesting to examine whether the educational effect is due to an informed decision.
DOI
https://www.doi.org/10.1371/journal.pone.0275525
Keywords
*Breast Neoplasms/diagnostic imaging; Cohort Studies; Cross-Sectional Studies; Early Detection of Cancer; Female; Humans; *Mammography; Mass Screening; Socioeconomic Factors
Pölcher, M.; Rottmann, M.; Brugger, S.; et al. (2019) Lymph node dissection in endometrial cancer and clinical outcome: A population-based study in 5546 patients. Gynecol Oncol. https://www.doi.org/10.1016/j.ygyno.2019.04.002
Title
Lymph node dissection in endometrial cancer and clinical outcome: A population-based study in 5546 patients
Publication date
2019
Abstract
BACKGROUND: According to current treatment guidelines, comprehensive surgical staging procedures in endometrial cancer confined to the uterus depend on uterine risk factors: a systematic lymph node dissection (LND) is recommended in high risk patients and should be omitted in low risk patients. Its role in intermediate and high intermediate risk patients is inconclusive. The aim of this analysis was to review the implementation of this risk-adopted strategy. MATERIALS AND METHODS: Data were provided by the population-based Munich Cancer Registry. Patients with endometrial cancer diagnosed between 1998 and 2016 were included. RESULTS: Of 5446 eligible patients, 58.5%, 30.1% and 11.4% belonged to the low risk, intermediate/high-intermediate and high risk group, respectively. Lymph node dissection was performed in 20.2%, 53.0% and 63.7% within these groups. Lymph node involvement was diagnosed in 1.7%, 9.6% and 19.3%, respectively. Within these risk groups, there was no significant difference in the time to local recurrence, lymph node recurrence or distant metastases between patients with and without LND. After adjusting for age and comorbidity-status, no significant difference in overall survival was found. CONCLUSIONS: The application of a risk-adopted management of LND in early endometrial cancer in real-life is associated with a high rate of surgical under- and overtreatment. Corresponding survival data do not show a significant benefit of a systematic lymph node dissection. In order to improve the management and outcome of early endometrial cancer in the future, prospective trials, new surgical concepts and prognostic markers will be primary and necessary.
DOI
https://www.doi.org/10.1016/j.ygyno.2019.04.002
Keywords
Aged; Aged, 80 and over; Endometrial Neoplasms/mortality/*pathology/*surgery; Female; Germany/epidemiology; Humans; Lymph Node Excision/statistics & numerical data; Lymph Nodes/*pathology/*surgery; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local/pathology; Registries; Risk; Treatment Outcome; *Comorbidity; *Endometrial cancer; *Lymph node dissection; *Sentinel lymph node; *Surgery; *Survival
Lymph node dissection in endometrial cancer and clinical outcome: A population-based study in 5546 patients
Publication date
2019
Abstract
BACKGROUND: According to current treatment guidelines, comprehensive surgical staging procedures in endometrial cancer confined to the uterus depend on uterine risk factors: a systematic lymph node dissection (LND) is recommended in high risk patients and should be omitted in low risk patients. Its role in intermediate and high intermediate risk patients is inconclusive. The aim of this analysis was to review the implementation of this risk-adopted strategy. MATERIALS AND METHODS: Data were provided by the population-based Munich Cancer Registry. Patients with endometrial cancer diagnosed between 1998 and 2016 were included. RESULTS: Of 5446 eligible patients, 58.5%, 30.1% and 11.4% belonged to the low risk, intermediate/high-intermediate and high risk group, respectively. Lymph node dissection was performed in 20.2%, 53.0% and 63.7% within these groups. Lymph node involvement was diagnosed in 1.7%, 9.6% and 19.3%, respectively. Within these risk groups, there was no significant difference in the time to local recurrence, lymph node recurrence or distant metastases between patients with and without LND. After adjusting for age and comorbidity-status, no significant difference in overall survival was found. CONCLUSIONS: The application of a risk-adopted management of LND in early endometrial cancer in real-life is associated with a high rate of surgical under- and overtreatment. Corresponding survival data do not show a significant benefit of a systematic lymph node dissection. In order to improve the management and outcome of early endometrial cancer in the future, prospective trials, new surgical concepts and prognostic markers will be primary and necessary.
DOI
https://www.doi.org/10.1016/j.ygyno.2019.04.002
Keywords
Aged; Aged, 80 and over; Endometrial Neoplasms/mortality/*pathology/*surgery; Female; Germany/epidemiology; Humans; Lymph Node Excision/statistics & numerical data; Lymph Nodes/*pathology/*surgery; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local/pathology; Registries; Risk; Treatment Outcome; *Comorbidity; *Endometrial cancer; *Lymph node dissection; *Sentinel lymph node; *Surgery; *Survival
Prantl, L.; Gerken, M.; Zeman, F.; et al. (2020) Incidence of Anaplastic Large Cell Lymphoma and Breast-Implant-Associated Lymphoma-An Analysis of a Certified Tumor Registry over 17 Years. J Clin Med. https://www.doi.org/10.3390/jcm9051247
Title
Incidence of Anaplastic Large Cell Lymphoma and Breast-Implant-Associated Lymphoma-An Analysis of a Certified Tumor Registry over 17 Years
Publication date
2020
Abstract
BACKGROUND: Breast-implant-associated anaplastic large cell lymphoma (BI-ALCL) and primary breast ALCL are rare extranodal manifestations of non-Hodgkin lymphoma. The rarity of both diseases, along with unreleased sales data on breast implants and constant updates of classification systems impede the calculation of an exact incidence. METHODS: The database of the Tumor Center Regensburg in Bavaria was searched for patients with CD30-positive and ALK-negative anaplastic large cell lymphoma between 2002 and 2018. These lymphomas were identified by the ICD-O-3 morphology code "97023" and were cross-checked by searching the diagnosis by name the and ICD-10 code C84.7. Furthermore, we tried to calculate the incidence rates and corresponding 95% confidence intervals, standardized to 1,000,000 implant years of breast-implant-associated anaplastic large cell lymphoma and primary breast anaplastic large cell lymphoma. RESULTS: Twelve ALK-negative and CD30-positive anaplastic large cell lymphomas were identified out of 170,405 malignancies. No case was found within the breast tissue and none of the patients had a previous history of breast implant placement. In five cases, lymph node involvement in close proximity to the breast was observed. CONCLUSION: We found a low incidence of anaplastic large cell lymphoma and no association to breast implants in these patients. A review of the current literature revealed inconsistent use of classification systems for anaplastic large cell lymphomas and potential overestimation of cases.
DOI
https://www.doi.org/10.3390/jcm9051247
Keywords
ALK-negative; CD-30 positive; anaplastic large cell lymphoma; breast implants; incidence
Incidence of Anaplastic Large Cell Lymphoma and Breast-Implant-Associated Lymphoma-An Analysis of a Certified Tumor Registry over 17 Years
Publication date
2020
Abstract
BACKGROUND: Breast-implant-associated anaplastic large cell lymphoma (BI-ALCL) and primary breast ALCL are rare extranodal manifestations of non-Hodgkin lymphoma. The rarity of both diseases, along with unreleased sales data on breast implants and constant updates of classification systems impede the calculation of an exact incidence. METHODS: The database of the Tumor Center Regensburg in Bavaria was searched for patients with CD30-positive and ALK-negative anaplastic large cell lymphoma between 2002 and 2018. These lymphomas were identified by the ICD-O-3 morphology code "97023" and were cross-checked by searching the diagnosis by name the and ICD-10 code C84.7. Furthermore, we tried to calculate the incidence rates and corresponding 95% confidence intervals, standardized to 1,000,000 implant years of breast-implant-associated anaplastic large cell lymphoma and primary breast anaplastic large cell lymphoma. RESULTS: Twelve ALK-negative and CD30-positive anaplastic large cell lymphomas were identified out of 170,405 malignancies. No case was found within the breast tissue and none of the patients had a previous history of breast implant placement. In five cases, lymph node involvement in close proximity to the breast was observed. CONCLUSION: We found a low incidence of anaplastic large cell lymphoma and no association to breast implants in these patients. A review of the current literature revealed inconsistent use of classification systems for anaplastic large cell lymphomas and potential overestimation of cases.
DOI
https://www.doi.org/10.3390/jcm9051247
Keywords
ALK-negative; CD-30 positive; anaplastic large cell lymphoma; breast implants; incidence
Radespiel-Tröger, M.; Batzler, W. U.; Holleczek, B.; et al. (2014) [Rising incidence of papillary thyroid carcinoma in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. https://www.doi.org/10.1007/s00103-013-1884-1
Title
[Rising incidence of papillary thyroid carcinoma in Germany]
Publication date
2014
Abstract
BACKGROUND: The incidence of thyroid cancer (TC), a rare malignancy, has strongly risen in recent decades. Possible causes of this rise include increasing diagnostic activity, nuclear tests after World War II, and the Chernobyl disaster. AIM: This article presents the time trends of TC incidence between 2003 and 2008 in Germany according to histological tumor type and sex, and provides a description of TC incidence according to districts (Kreise) and sex in Germany. METHODS: Data on persons newly diagnosed with thyroid cancer (ICD-10 code, C73) between 2003 and 2008 were obtained from the Center of Cancer Registry Data at the Robert Koch Institute. Official population and mortality data were used. Age-specific and age-standardized incidence rates (ASIR) were calculated according to sex and tumor histology. RESULTS: Between 2003 and 2008, the ASIR of TC rose from 2.7 to 3.4 (men) and from 6.5 to 8.9 (women) per 100,000 per year. This rise can be almost completely attributed to the rising incidence of papillary TC. The steepest rise in frequency was observed in TNM-T1 tumors. A positive north-south gradient of TC incidence was found. DISCUSSION: The cause of the marked rise of TC incidence in recent decades is unknown. The positive north-south gradient of the TC incidence may possibly be attributed in part to long-standing differences of iodine intake between different German regions. CONCLUSION: An epidemiological study of the possible causes of the rising TC incidence and of the regional differences of TC incidence in Germany is recommended.
DOI
https://www.doi.org/10.1007/s00103-013-1884-1
Keywords
Adult; Age Distribution; Aged; Aged, 80 and over; Carcinoma/*mortality; Carcinoma, Papillary; Female; Germany/epidemiology; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; *Registries; Risk Factors; Sex Distribution; Spatio-Temporal Analysis; Survival Rate; Thyroid Cancer, Papillary; Thyroid Neoplasms/*mortality
[Rising incidence of papillary thyroid carcinoma in Germany]
Publication date
2014
Abstract
BACKGROUND: The incidence of thyroid cancer (TC), a rare malignancy, has strongly risen in recent decades. Possible causes of this rise include increasing diagnostic activity, nuclear tests after World War II, and the Chernobyl disaster. AIM: This article presents the time trends of TC incidence between 2003 and 2008 in Germany according to histological tumor type and sex, and provides a description of TC incidence according to districts (Kreise) and sex in Germany. METHODS: Data on persons newly diagnosed with thyroid cancer (ICD-10 code, C73) between 2003 and 2008 were obtained from the Center of Cancer Registry Data at the Robert Koch Institute. Official population and mortality data were used. Age-specific and age-standardized incidence rates (ASIR) were calculated according to sex and tumor histology. RESULTS: Between 2003 and 2008, the ASIR of TC rose from 2.7 to 3.4 (men) and from 6.5 to 8.9 (women) per 100,000 per year. This rise can be almost completely attributed to the rising incidence of papillary TC. The steepest rise in frequency was observed in TNM-T1 tumors. A positive north-south gradient of TC incidence was found. DISCUSSION: The cause of the marked rise of TC incidence in recent decades is unknown. The positive north-south gradient of the TC incidence may possibly be attributed in part to long-standing differences of iodine intake between different German regions. CONCLUSION: An epidemiological study of the possible causes of the rising TC incidence and of the regional differences of TC incidence in Germany is recommended.
DOI
https://www.doi.org/10.1007/s00103-013-1884-1
Keywords
Adult; Age Distribution; Aged; Aged, 80 and over; Carcinoma/*mortality; Carcinoma, Papillary; Female; Germany/epidemiology; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; *Registries; Risk Factors; Sex Distribution; Spatio-Temporal Analysis; Survival Rate; Thyroid Cancer, Papillary; Thyroid Neoplasms/*mortality
Radespiel-Tröger, M.; Geiss, K.; Gartig-Daugs, A.; et al. (2008) Registration completeness and tumour-node-metastases category distribution in prostatic and testicular cancer in Bavaria. Eur J Cancer Prev. https://www.doi.org/10.1097/CEJ.0b013e3282f0c03d
Title
Registration completeness and tumour-node-metastases category distribution in prostatic and testicular cancer in Bavaria
Publication date
2008
Abstract
Tumour-node-metastases (TNM) category distribution can be used as a short-term surrogate measure for survival probability to evaluate the impact of interventions for improved prevention and early detection of cancer. We aimed to demonstrate whether or not an association between registration completeness and TNM category distribution exists and whether accurate estimates of the TNM category distribution are possible before complete registration. With respect to the diagnosis year 2002, the number of registered cases of prostatic and testicular cancer at the Bavarian cancer registry was determined every 6 months between 2003 and 2006 together with the respective TNM category distributions and the completeness of registration. For the diagnosis year 2002, 6135 and 480 cases of newly developed prostatic and testicular cancer, respectively, were reported to the registry. After 2003, the proportion of prostatic cancer cases labelled 'T1' fluctuated by only 1%. A stable TNM category distribution was seen with a minimum registration completeness of 65-70%. No relevant association between registration completeness and TNM category distribution could be demonstrated for prostatic and testicular cancer. Therefore, in prostatic and testicular cancer, the TNM category distribution can be used for short-term evaluation of quality assurance projects and in health services research.
DOI
https://www.doi.org/10.1097/CEJ.0b013e3282f0c03d
Keywords
Cohort Studies; Follow-Up Studies; Germany/epidemiology; Humans; Lymph Nodes/pathology; Lymphatic Metastasis; Male; Population; Prostatic Neoplasms/*classification/epidemiology/mortality/*pathology; Quality Control; *Registries/standards; Testicular Neoplasms/*classification/epidemiology/mortality/*pathology; Time Factors; Tumor Burden
Registration completeness and tumour-node-metastases category distribution in prostatic and testicular cancer in Bavaria
Publication date
2008
Abstract
Tumour-node-metastases (TNM) category distribution can be used as a short-term surrogate measure for survival probability to evaluate the impact of interventions for improved prevention and early detection of cancer. We aimed to demonstrate whether or not an association between registration completeness and TNM category distribution exists and whether accurate estimates of the TNM category distribution are possible before complete registration. With respect to the diagnosis year 2002, the number of registered cases of prostatic and testicular cancer at the Bavarian cancer registry was determined every 6 months between 2003 and 2006 together with the respective TNM category distributions and the completeness of registration. For the diagnosis year 2002, 6135 and 480 cases of newly developed prostatic and testicular cancer, respectively, were reported to the registry. After 2003, the proportion of prostatic cancer cases labelled 'T1' fluctuated by only 1%. A stable TNM category distribution was seen with a minimum registration completeness of 65-70%. No relevant association between registration completeness and TNM category distribution could be demonstrated for prostatic and testicular cancer. Therefore, in prostatic and testicular cancer, the TNM category distribution can be used for short-term evaluation of quality assurance projects and in health services research.
DOI
https://www.doi.org/10.1097/CEJ.0b013e3282f0c03d
Keywords
Cohort Studies; Follow-Up Studies; Germany/epidemiology; Humans; Lymph Nodes/pathology; Lymphatic Metastasis; Male; Population; Prostatic Neoplasms/*classification/epidemiology/mortality/*pathology; Quality Control; *Registries/standards; Testicular Neoplasms/*classification/epidemiology/mortality/*pathology; Time Factors; Tumor Burden
Radespiel-Tröger, M.; Meyer, M.. (2013) Association between drinking water uranium content and cancer risk in Bavaria, Germany. Int Arch Occup Environ Health. https://www.doi.org/10.1007/s00420-012-0806-0
Title
Association between drinking water uranium content and cancer risk in Bavaria, Germany
Publication date
2013
Abstract
OBJECTIVE: To evaluate the possible association between uranium (U) content in public drinking water on the one hand and the risk of cancer of the colorectum, lung, female breast, prostate, kidney, and urinary bladder, total cancer, and leukemia on the other hand in Bavaria, an ecologic study on the level of municipalities was performed. METHODS: Cancer incidence data for the years 2002-2008 were obtained from the population-based cancer registry Bavaria according to sex. Current U content data of public drinking water on the level of municipalities were obtained from a publicly available source. The possible association between drinking water U content and cancer risk adjusted for average socio-economic status was evaluated using Poisson regression. RESULTS: Drinking water U content was below 20 mug/L in 458 out of 461 included municipalities. We found a significantly increased risk of leukemia in men in the intermediate (U level, 1.00-4.99 mug/L; relative risk [RR], 1.14) and in the highest U exposure category (U level, >/=5 mug/L; RR, 1.28). Moreover, in women, a significantly elevated risk was identified with respect to kidney cancer in the highest exposure category (RR, 1.16) and with respect to lung cancer in the intermediate exposure category (RR, 1.12). CONCLUSION: The slightly increased risk of leukemia in men, kidney cancer in women, and lung cancer in women may require further investigation. If an increased cancer risk is confirmed, preventive measures (e.g., introduction of U filters in public water systems) may be considered.
DOI
https://www.doi.org/10.1007/s00420-012-0806-0
Keywords
Aged; Drinking Water/*chemistry; Female; Germany/epidemiology; Humans; Incidence; Kidney Neoplasms/epidemiology; Leukemia/epidemiology; Lung Neoplasms/epidemiology; Male; Middle Aged; Neoplasms/*epidemiology; *Registries; Sex Factors; Uranium/*analysis/toxicity; Urban Population/*statistics & numerical data; Water Supply
Association between drinking water uranium content and cancer risk in Bavaria, Germany
Publication date
2013
Abstract
OBJECTIVE: To evaluate the possible association between uranium (U) content in public drinking water on the one hand and the risk of cancer of the colorectum, lung, female breast, prostate, kidney, and urinary bladder, total cancer, and leukemia on the other hand in Bavaria, an ecologic study on the level of municipalities was performed. METHODS: Cancer incidence data for the years 2002-2008 were obtained from the population-based cancer registry Bavaria according to sex. Current U content data of public drinking water on the level of municipalities were obtained from a publicly available source. The possible association between drinking water U content and cancer risk adjusted for average socio-economic status was evaluated using Poisson regression. RESULTS: Drinking water U content was below 20 mug/L in 458 out of 461 included municipalities. We found a significantly increased risk of leukemia in men in the intermediate (U level, 1.00-4.99 mug/L; relative risk [RR], 1.14) and in the highest U exposure category (U level, >/=5 mug/L; RR, 1.28). Moreover, in women, a significantly elevated risk was identified with respect to kidney cancer in the highest exposure category (RR, 1.16) and with respect to lung cancer in the intermediate exposure category (RR, 1.12). CONCLUSION: The slightly increased risk of leukemia in men, kidney cancer in women, and lung cancer in women may require further investigation. If an increased cancer risk is confirmed, preventive measures (e.g., introduction of U filters in public water systems) may be considered.
DOI
https://www.doi.org/10.1007/s00420-012-0806-0
Keywords
Aged; Drinking Water/*chemistry; Female; Germany/epidemiology; Humans; Incidence; Kidney Neoplasms/epidemiology; Leukemia/epidemiology; Lung Neoplasms/epidemiology; Male; Middle Aged; Neoplasms/*epidemiology; *Registries; Sex Factors; Uranium/*analysis/toxicity; Urban Population/*statistics & numerical data; Water Supply
Radespiel-Tröger, M.; Meyer, M.; Fenner, M.. (2012) Geographic differences and time trends of intraoral cancer incidence and mortality in Bavaria, Germany. J Craniomaxillofac Surg. https://www.doi.org/10.1016/j.jcms.2012.01.004
Title
Geographic differences and time trends of intraoral cancer incidence and mortality in Bavaria, Germany
Publication date
2012
Abstract
OBJECTIVE: To examine possible geographic differences and time trends of intraoral cancer (IOC) incidence and mortality in Bavaria between 2002 and 2008. METHODS: Incidence data for IOC (ICD-10 codes, C01-C06) were obtained from the population-based cancer registry Bavaria. Age-specific and age-standardised IOC incidence and mortality rates in Bavaria and its regions were calculated separately by sex and year of diagnosis. RESULTS: We found an excess incidence of 34% and 25% among men and women in Upper Franconia compared to Bavaria. Incidence and mortality related to IOC in Bavaria are comparable to those found in other European cancer registries. IOC mortality appears to decrease over time in both sexes, whereas IOC incidence appears to decrease only in men. CONCLUSIONS: The observed geographic differences with respect to IOC incidence and mortality in Bavaria may possibly be explained in part by socioeconomic differences.
DOI
https://www.doi.org/10.1016/j.jcms.2012.01.004
Keywords
Adult; Age Factors; Aged; Aged, 80 and over; Female; Germany/epidemiology; Gingival Neoplasms/epidemiology; Humans; Incidence; Male; Middle Aged; Mouth Floor/pathology; Mouth Neoplasms/*epidemiology/mortality; Neoplasm Grading/statistics & numerical data; Neoplasm Staging/statistics & numerical data; Palatal Neoplasms/epidemiology; Population Surveillance; Registries; Sex Factors; Tongue Neoplasms/epidemiology
Geographic differences and time trends of intraoral cancer incidence and mortality in Bavaria, Germany
Publication date
2012
Abstract
OBJECTIVE: To examine possible geographic differences and time trends of intraoral cancer (IOC) incidence and mortality in Bavaria between 2002 and 2008. METHODS: Incidence data for IOC (ICD-10 codes, C01-C06) were obtained from the population-based cancer registry Bavaria. Age-specific and age-standardised IOC incidence and mortality rates in Bavaria and its regions were calculated separately by sex and year of diagnosis. RESULTS: We found an excess incidence of 34% and 25% among men and women in Upper Franconia compared to Bavaria. Incidence and mortality related to IOC in Bavaria are comparable to those found in other European cancer registries. IOC mortality appears to decrease over time in both sexes, whereas IOC incidence appears to decrease only in men. CONCLUSIONS: The observed geographic differences with respect to IOC incidence and mortality in Bavaria may possibly be explained in part by socioeconomic differences.
DOI
https://www.doi.org/10.1016/j.jcms.2012.01.004
Keywords
Adult; Age Factors; Aged; Aged, 80 and over; Female; Germany/epidemiology; Gingival Neoplasms/epidemiology; Humans; Incidence; Male; Middle Aged; Mouth Floor/pathology; Mouth Neoplasms/*epidemiology/mortality; Neoplasm Grading/statistics & numerical data; Neoplasm Staging/statistics & numerical data; Palatal Neoplasms/epidemiology; Population Surveillance; Registries; Sex Factors; Tongue Neoplasms/epidemiology
Radespiel-Tröger, M.; Meyer, M.; Pfahlberg, A.; et al. (2009) Outdoor work and skin cancer incidence: a registry-based study in Bavaria. Int Arch Occup Environ Health. https://www.doi.org/10.1007/s00420-008-0342-0
Title
Outdoor work and skin cancer incidence: a registry-based study in Bavaria
Publication date
2009
Abstract
OBJECTIVE: To analyse the association between occupational ultraviolet (UV) light exposure and skin cancer (basal cell carcinoma, BCC; squamous cell carcinoma, SCC; cutaneous malignant melanoma, CMM) based on data from the Bavarian population-based cancer registry. METHODS: The population-based cancer registry of Bavaria (Germany) provided data on incident cases of BCC, SCC, and CMM, respectively, during the period 2001 until 2005. Eleven Bavarian districts with complete skin cancer registration were included in this analysis based on 2,156,336 person years. Cases were assigned to "indoor", "mixed indoor/outdoor", and "outdoor" exposure categories according to their job title. We computed age-specific and age-adjusted incidence rates of BCC (n = 1,641), SCC (n = 499), and CMM (n = 454) by work type, and the relative risk (RR) of skin cancer occurrence for "outdoor" and "mixed indoor/outdoor" workers, respectively, compared to "indoor" workers. RESULTS: The risk of BCC was substantially elevated in male (RR, 2.9; 95% CI, 2.2-3.9) and female (RR, 2.7; 95% CI, 1.8-4.1) outdoor workers compared to male and female indoor workers, respectively. We also found an elevated risk of similar magnitude for SCC in male (RR, 2.5; 95% CI, 1.4-4.7) and female (RR, 3.6; 95% CI, 1.6-8.1) outdoor workers compared to male and female indoor workers, respectively. CMM risk was not significantly associated with outdoor work. CONCLUSION: Our study confirms previous reports on the increased risk of BCC and SCC in outdoor workers compared to indoor workers.
DOI
https://www.doi.org/10.1007/s00420-008-0342-0
Keywords
Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell/epidemiology/etiology; Carcinoma, Squamous Cell/epidemiology/etiology; Female; Germany/epidemiology; Humans; Incidence; Male; Melanoma/epidemiology/etiology; Middle Aged; Neoplasms, Radiation-Induced/*epidemiology; Occupational Diseases/epidemiology/*etiology; *Occupational Exposure; Occupations; *Registries; Risk Factors; Skin Neoplasms/epidemiology/*etiology; Ultraviolet Rays/*adverse effects; Young Adult
Outdoor work and skin cancer incidence: a registry-based study in Bavaria
Publication date
2009
Abstract
OBJECTIVE: To analyse the association between occupational ultraviolet (UV) light exposure and skin cancer (basal cell carcinoma, BCC; squamous cell carcinoma, SCC; cutaneous malignant melanoma, CMM) based on data from the Bavarian population-based cancer registry. METHODS: The population-based cancer registry of Bavaria (Germany) provided data on incident cases of BCC, SCC, and CMM, respectively, during the period 2001 until 2005. Eleven Bavarian districts with complete skin cancer registration were included in this analysis based on 2,156,336 person years. Cases were assigned to "indoor", "mixed indoor/outdoor", and "outdoor" exposure categories according to their job title. We computed age-specific and age-adjusted incidence rates of BCC (n = 1,641), SCC (n = 499), and CMM (n = 454) by work type, and the relative risk (RR) of skin cancer occurrence for "outdoor" and "mixed indoor/outdoor" workers, respectively, compared to "indoor" workers. RESULTS: The risk of BCC was substantially elevated in male (RR, 2.9; 95% CI, 2.2-3.9) and female (RR, 2.7; 95% CI, 1.8-4.1) outdoor workers compared to male and female indoor workers, respectively. We also found an elevated risk of similar magnitude for SCC in male (RR, 2.5; 95% CI, 1.4-4.7) and female (RR, 3.6; 95% CI, 1.6-8.1) outdoor workers compared to male and female indoor workers, respectively. CMM risk was not significantly associated with outdoor work. CONCLUSION: Our study confirms previous reports on the increased risk of BCC and SCC in outdoor workers compared to indoor workers.
DOI
https://www.doi.org/10.1007/s00420-008-0342-0
Keywords
Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell/epidemiology/etiology; Carcinoma, Squamous Cell/epidemiology/etiology; Female; Germany/epidemiology; Humans; Incidence; Male; Melanoma/epidemiology/etiology; Middle Aged; Neoplasms, Radiation-Induced/*epidemiology; Occupational Diseases/epidemiology/*etiology; *Occupational Exposure; Occupations; *Registries; Risk Factors; Skin Neoplasms/epidemiology/*etiology; Ultraviolet Rays/*adverse effects; Young Adult
Radespiel-Tröger, M.; Müller-Nordhorn, J.; Zeissig, S. R.. (2023) Epidemiologie gastrointestinaler Stromatumoren in Bayern 2003–2019: Zunahme der Inzidenz und verbessertes Überleben. Die Onkologie. https://www.doi.org/10.1007/s00761-022-01277-7
Title
Epidemiologie gastrointestinaler Stromatumoren in Bayern 2003–2019: Zunahme der Inzidenz und verbessertes Überleben
Publication date
2023
Abstract
Hintergrund: Gastrointestinale Stromatumoren (GIST) sind die häufigsten Weichgewebesarkome im Magen-Darm-Trakt. Die unterschiedlichen Angaben zur Inzidenz sowie eine seit Jahren international beobachtete Zunahme in der Literatur beruhen vermutlich überwiegend auf einer spezifischeren Diagnostik, aber auch auf Änderungen in der Kodierung und damit der Erfassung dieser Tumoren in Krebsregistern. Ziel der Arbeit: Dieser Artikel gibt eine Übersicht über die Inzidenz, tadienverteilung und das Überleben bei GIST in Bayern (2003–2019). Material und Methoden: Dieser Auswertung liegen Daten des Bayerischen Krebsregisters zu GIST (Lokalisation nach ICD-O-3: C15–C21, Histologie nach ICD-O-3: 8931/3 bzw. 8936/3) zugrunde. Inzidenzraten werden sowohl roh als auch direkt altersstandardisiert pro 100.000 Männer bzw. Frauen pro Jahr angegeben. Das relative Überleben wird aus den alters- und geschlechtsspezifischen deutschen Sterbetafeln des Statistischen Bundesamts mithilfe der Ederer-II-Methode geschätzt. Ergebnisse: Die altersstandardisierte Inzidenz lag bei 1,7 (Männer) bzw. 1,1 (Frauen) pro 100.000 für das Diagnosejahr 2019 und ist in den Jahren seit 2003 etwa um das Dreifache gestiegen. Am häufigsten wurden GIST im UICC-Stadium I gemeldet (Männer: 22 %, Frauen: 17%). Die relative 5-Jahres-Überlebensrate bei Personen mit GIST hat sich zwischen den Zeitperioden 2003–2008 bzw. 2014–2019 von 73% auf 85%(Männer) bzw. von 83%auf 93%(Frauen) verbessert. Schlussfolgerung: Beim Vergleich der Ergebnisse mit internationalen und deutschlandweiten Auswertungen zu GIST zeigte sich, dass mit dem Bayerischen Krebsregister nationale und internationale Ergebnisse zur Epidemiologie von GIST repliziert werden konnten.
DOI
https://www.doi.org/10.1007/s00761-022-01277-7
Epidemiologie gastrointestinaler Stromatumoren in Bayern 2003–2019: Zunahme der Inzidenz und verbessertes Überleben
Publication date
2023
Abstract
Hintergrund: Gastrointestinale Stromatumoren (GIST) sind die häufigsten Weichgewebesarkome im Magen-Darm-Trakt. Die unterschiedlichen Angaben zur Inzidenz sowie eine seit Jahren international beobachtete Zunahme in der Literatur beruhen vermutlich überwiegend auf einer spezifischeren Diagnostik, aber auch auf Änderungen in der Kodierung und damit der Erfassung dieser Tumoren in Krebsregistern. Ziel der Arbeit: Dieser Artikel gibt eine Übersicht über die Inzidenz, tadienverteilung und das Überleben bei GIST in Bayern (2003–2019). Material und Methoden: Dieser Auswertung liegen Daten des Bayerischen Krebsregisters zu GIST (Lokalisation nach ICD-O-3: C15–C21, Histologie nach ICD-O-3: 8931/3 bzw. 8936/3) zugrunde. Inzidenzraten werden sowohl roh als auch direkt altersstandardisiert pro 100.000 Männer bzw. Frauen pro Jahr angegeben. Das relative Überleben wird aus den alters- und geschlechtsspezifischen deutschen Sterbetafeln des Statistischen Bundesamts mithilfe der Ederer-II-Methode geschätzt. Ergebnisse: Die altersstandardisierte Inzidenz lag bei 1,7 (Männer) bzw. 1,1 (Frauen) pro 100.000 für das Diagnosejahr 2019 und ist in den Jahren seit 2003 etwa um das Dreifache gestiegen. Am häufigsten wurden GIST im UICC-Stadium I gemeldet (Männer: 22 %, Frauen: 17%). Die relative 5-Jahres-Überlebensrate bei Personen mit GIST hat sich zwischen den Zeitperioden 2003–2008 bzw. 2014–2019 von 73% auf 85%(Männer) bzw. von 83%auf 93%(Frauen) verbessert. Schlussfolgerung: Beim Vergleich der Ergebnisse mit internationalen und deutschlandweiten Auswertungen zu GIST zeigte sich, dass mit dem Bayerischen Krebsregister nationale und internationale Ergebnisse zur Epidemiologie von GIST repliziert werden konnten.
DOI
https://www.doi.org/10.1007/s00761-022-01277-7
Radespiel-Tröger, Martin; Voigtländer, Sven; Meyer, Martin; et al. (2019) Assoziation zwischen Häufigkeit der Sonographie und Prävalenz bösartiger Neubildungen der Schilddrüse bei Versicherten der AOK in Bayern. Der Onkologe. https://www.doi.org/10.1007/s00761-019-0608-z
Title
Assoziation zwischen Häufigkeit der Sonographie und Prävalenz bösartiger Neubildungen der Schilddrüse bei Versicherten der AOK in Bayern
Publication date
2019
Abstract
Bayern weist von allen deutschen Bundesländern die höchste Inzidenz des Schilddrüsenkarzinoms (SDK) auf. Das SDK ist derzeit der häufigste endokrine Tumor und für ca. 2 % aller invasiven Malignome in Bayern verantwortlich. Aufgrund des in den letzten 15 Jahren beobachteten SDK-Inzidenzanstiegs bei gleichzeitig abfallender SDK-Mortalität besteht der Verdacht auf Überdiagnostik mittels Schilddrüsen(SD)-Sonographie.
DOI
https://www.doi.org/10.1007/s00761-019-0608-z
Assoziation zwischen Häufigkeit der Sonographie und Prävalenz bösartiger Neubildungen der Schilddrüse bei Versicherten der AOK in Bayern
Publication date
2019
Abstract
Bayern weist von allen deutschen Bundesländern die höchste Inzidenz des Schilddrüsenkarzinoms (SDK) auf. Das SDK ist derzeit der häufigste endokrine Tumor und für ca. 2 % aller invasiven Malignome in Bayern verantwortlich. Aufgrund des in den letzten 15 Jahren beobachteten SDK-Inzidenzanstiegs bei gleichzeitig abfallender SDK-Mortalität besteht der Verdacht auf Überdiagnostik mittels Schilddrüsen(SD)-Sonographie.
DOI
https://www.doi.org/10.1007/s00761-019-0608-z
Ray-Coquard, I.; Trama, A.; Seckl, M. J.; et al. (2019) Rare ovarian tumours: Epidemiology, treatment challenges in and outside a network setting. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2017.09.025
Title
Rare ovarian tumours: Epidemiology, treatment challenges in and outside a network setting
Publication date
2019
Abstract
PURPOSE OF THE REVIEW: More than 50% of all gynaecological cancers can be classified as rare tumours (defined as an annual incidence of <6 per 100,000) and such tumours represent an important challenge for clinicians. RECENT FINDINGS: Rare cancers account for more than one fifth of all new cancer diagnoses, more than any of the single common cancers alone. Reviewing the RARECAREnet database, some of the tumours occur infrequently, whilst others because of their natural history have a high prevalence, and therefore appear to be more common, although their incidence is also rare. Harmonization of medical practice, guidelines and novel trials are needed to identify rare tumours and facilitate the development of new treatments. Ovarian tumours are the focus of this review, but we comment on other rare gynaecological tumours, as the diagnosis and treatment challenges faced are similar. FUTURE: This requires European collaboration, international partnerships, harmonization of treatment and collaboration to overcome the regulatory barriers to conduct international trials. Whilst randomized trials can be done in many tumour types, there are some for which conducting even single arm studies may be challenging. For these tumours alternative study designs, robust collection of data through national registries and audits could lead to improvements in the treatment of rare tumours. In addition, concentring the care of patients with rare tumours into a limited number of centres will help to build expertise, facilitate trials and improve outcomes.
DOI
https://www.doi.org/10.1016/j.ejso.2017.09.025
Keywords
Clinical Trials as Topic; Delivery of Health Care/*organization & administration; Europe; Female; Humans; Incidence; *International Cooperation; Ovarian Neoplasms/*epidemiology/*therapy; Prevalence; *Quality of Health Care; Rare Diseases/*epidemiology/*therapy; Survival Rate; *Gynecologic cancer; *Rare cancer
Rare ovarian tumours: Epidemiology, treatment challenges in and outside a network setting
Publication date
2019
Abstract
PURPOSE OF THE REVIEW: More than 50% of all gynaecological cancers can be classified as rare tumours (defined as an annual incidence of <6 per 100,000) and such tumours represent an important challenge for clinicians. RECENT FINDINGS: Rare cancers account for more than one fifth of all new cancer diagnoses, more than any of the single common cancers alone. Reviewing the RARECAREnet database, some of the tumours occur infrequently, whilst others because of their natural history have a high prevalence, and therefore appear to be more common, although their incidence is also rare. Harmonization of medical practice, guidelines and novel trials are needed to identify rare tumours and facilitate the development of new treatments. Ovarian tumours are the focus of this review, but we comment on other rare gynaecological tumours, as the diagnosis and treatment challenges faced are similar. FUTURE: This requires European collaboration, international partnerships, harmonization of treatment and collaboration to overcome the regulatory barriers to conduct international trials. Whilst randomized trials can be done in many tumour types, there are some for which conducting even single arm studies may be challenging. For these tumours alternative study designs, robust collection of data through national registries and audits could lead to improvements in the treatment of rare tumours. In addition, concentring the care of patients with rare tumours into a limited number of centres will help to build expertise, facilitate trials and improve outcomes.
DOI
https://www.doi.org/10.1016/j.ejso.2017.09.025
Keywords
Clinical Trials as Topic; Delivery of Health Care/*organization & administration; Europe; Female; Humans; Incidence; *International Cooperation; Ovarian Neoplasms/*epidemiology/*therapy; Prevalence; *Quality of Health Care; Rare Diseases/*epidemiology/*therapy; Survival Rate; *Gynecologic cancer; *Rare cancer
Roessler, M.; Schmitt, J.; Bobeth, C.; et al. (2022) Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study. BMC Cancer. https://www.doi.org/10.1186/s12885-022-09731-w
Title
Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study
Publication date
2022
Abstract
BACKGROUND: Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. METHODS: We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009-2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan-Meier estimator and Cox regression with shared frailty. RESULTS: The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85-0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. CONCLUSION: This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT04334239 ).
DOI
https://www.doi.org/10.1186/s12885-022-09731-w
Keywords
*Certification; Cohort Studies; Germany/epidemiology; Hospitals; Humans; *Pancreatic Neoplasms/therapy; Survival Analysis; Certified cancer center; Cohort study; Cox regression; Pancreatic cancer; Survival
Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study
Publication date
2022
Abstract
BACKGROUND: Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. METHODS: We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009-2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan-Meier estimator and Cox regression with shared frailty. RESULTS: The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85-0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. CONCLUSION: This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT04334239 ).
DOI
https://www.doi.org/10.1186/s12885-022-09731-w
Keywords
*Certification; Cohort Studies; Germany/epidemiology; Hospitals; Humans; *Pancreatic Neoplasms/therapy; Survival Analysis; Certified cancer center; Cohort study; Cox regression; Pancreatic cancer; Survival
Röhrmoser, K.; Ignatov, A.; Gerken, M.; et al. (2022) Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-022-03954-x
Title
Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration
Publication date
2022
Abstract
BACKGROUND: To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking. METHODS: This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan-Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates. RESULTS: After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6-4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1-3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1-4.4). CONCLUSION: Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients.
DOI
https://www.doi.org/10.1007/s00432-022-03954-x
Keywords
Follow-up; Recurrence; Risk factors; Survival; Vulvar cancer
Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration
Publication date
2022
Abstract
BACKGROUND: To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking. METHODS: This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan-Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates. RESULTS: After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6-4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1-3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1-4.4). CONCLUSION: Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients.
DOI
https://www.doi.org/10.1007/s00432-022-03954-x
Keywords
Follow-up; Recurrence; Risk factors; Survival; Vulvar cancer
Röhrmoser, K.; Ignatov, A.; Gerken, M.; et al. (2023) Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-022-03954-x
Title
Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration
Publication date
2023
Abstract
BACKGROUND: To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking. METHODS: This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan-Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates. RESULTS: After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6-4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1-3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1-4.4). CONCLUSION: Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients.
DOI
https://www.doi.org/10.1007/s00432-022-03954-x
Keywords
Female; Humans; Aged; Aged, 80 and over; Retrospective Studies; Follow-Up Studies; *Vulvar Neoplasms/therapy; Neoplasm Recurrence, Local/epidemiology; Risk Factors; Follow-up; Recurrence; Survival; Vulvar cancer
Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration
Publication date
2023
Abstract
BACKGROUND: To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking. METHODS: This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan-Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates. RESULTS: After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6-4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1-3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1-4.4). CONCLUSION: Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients.
DOI
https://www.doi.org/10.1007/s00432-022-03954-x
Keywords
Female; Humans; Aged; Aged, 80 and over; Retrospective Studies; Follow-Up Studies; *Vulvar Neoplasms/therapy; Neoplasm Recurrence, Local/epidemiology; Risk Factors; Follow-up; Recurrence; Survival; Vulvar cancer
Rottmann, M.; Burges, A.; Mahner, S.; et al. (2017) Cancer of the ovary, fallopian tube, and peritoneum: a population-based comparison of the prognostic factors and outcomes. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-017-2422-6
Title
Cancer of the ovary, fallopian tube, and peritoneum: a population-based comparison of the prognostic factors and outcomes
Publication date
2017
Abstract
PURPOSE: The objective was to compare the prognostic factors and outcomes among primary ovarian cancer (OC), fallopian tube cancer (FC), and peritoneal cancer (PC) patients in a population-based setting. METHODS: We analysed 5399 OC, 327 FC, and 416 PC patients diagnosed between 1998 and 2014 in the catchment area of the Munich Cancer Registry (meanwhile 4.8 million inhabitants). Tumour site differences were examined by comparing prognostic factors, treatments, the time to progression, and survival. The effect of the tumour site was additionally analysed by a Cox regression model. RESULTS: The median age at diagnosis, histology, and FIGO stage significantly differed among the tumour sites (p < 0.001); PC patients were older, more often diagnosed with a serous subtype, and in FIGO stage III or IV. The time to progression and survival significantly differed among the tumour sites. When stratified by FIGO stage, the differences in time to progression disappeared, and the differences in survival considerably weakened. The differences in the multivariate survival analysis showed an almost identical outcome in PC patients (HR 1.07 [0.91-1.25]) and an improved survival of FC patients (HR 0.63 [0.49-0.81]) compared to that of OC patients. CONCLUSION: The comparison of OC, FC, and PC patients in this large-scale population-based study showed differences in the prognostic factors. These differences primarily account for the inferior outcome of PC patients, and for the improved survival of FC compared to OC patients.
DOI
https://www.doi.org/10.1007/s00432-017-2422-6
Keywords
Adult; Aged; Aged, 80 and over; Fallopian Tube Neoplasms/*mortality/pathology; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Ovarian Neoplasms/*mortality/pathology; Peritoneal Neoplasms/*mortality/pathology; Prognosis; Proportional Hazards Models; *Treatment Outcome; Cancer registry; Fallopian tube cancer; Ovarian cancer; Peritoneal cancer; Prognostic factors; Survival
Cancer of the ovary, fallopian tube, and peritoneum: a population-based comparison of the prognostic factors and outcomes
Publication date
2017
Abstract
PURPOSE: The objective was to compare the prognostic factors and outcomes among primary ovarian cancer (OC), fallopian tube cancer (FC), and peritoneal cancer (PC) patients in a population-based setting. METHODS: We analysed 5399 OC, 327 FC, and 416 PC patients diagnosed between 1998 and 2014 in the catchment area of the Munich Cancer Registry (meanwhile 4.8 million inhabitants). Tumour site differences were examined by comparing prognostic factors, treatments, the time to progression, and survival. The effect of the tumour site was additionally analysed by a Cox regression model. RESULTS: The median age at diagnosis, histology, and FIGO stage significantly differed among the tumour sites (p < 0.001); PC patients were older, more often diagnosed with a serous subtype, and in FIGO stage III or IV. The time to progression and survival significantly differed among the tumour sites. When stratified by FIGO stage, the differences in time to progression disappeared, and the differences in survival considerably weakened. The differences in the multivariate survival analysis showed an almost identical outcome in PC patients (HR 1.07 [0.91-1.25]) and an improved survival of FC patients (HR 0.63 [0.49-0.81]) compared to that of OC patients. CONCLUSION: The comparison of OC, FC, and PC patients in this large-scale population-based study showed differences in the prognostic factors. These differences primarily account for the inferior outcome of PC patients, and for the improved survival of FC compared to OC patients.
DOI
https://www.doi.org/10.1007/s00432-017-2422-6
Keywords
Adult; Aged; Aged, 80 and over; Fallopian Tube Neoplasms/*mortality/pathology; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Ovarian Neoplasms/*mortality/pathology; Peritoneal Neoplasms/*mortality/pathology; Prognosis; Proportional Hazards Models; *Treatment Outcome; Cancer registry; Fallopian tube cancer; Ovarian cancer; Peritoneal cancer; Prognostic factors; Survival
Scharl, S.; Becher, C.; Gerken, M.; et al. (2021) Is there a benefit for adjuvant radio(chemo)therapy in early cervical cancer? Results from a population-based study. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-021-05989-w
Title
Is there a benefit for adjuvant radio(chemo)therapy in early cervical cancer? Results from a population-based study
Publication date
2021
Abstract
PURPOSE: Due to insufficient and conflicting prospective evidence, the recommendations on when to apply adjuvant radiochemotherapy in early-stage cervical cancer vary between international guidelines. In this population-based study, we evaluated the outcome of patients with early-stage cervical cancer based on risk factors and the adjuvant therapy they received. METHODS: The effect of primary therapy (surgery and radiochemotherapy RCT, surgery and radiotherapy RT, and surgery alone) on overall survival (OS) and recurrence-free survival (RFS) was evaluated in the complete cohort of 442 patients and in subgroups according to risk profile and nodal status. RESULTS: In low-risk patients, there was no difference in OS (p = 0.276) depending on whether patients received adjuvant therapy or not. Concerning RFS, patients with RT (including one patient with RCT) exhibited a significantly worse outcome compared to the group with surgery alone (p = 0.015). In intermediate-risk patients, the administration of adjuvant RT significantly benefited RFS when compared to surgery only in multivariate analysis (p = 0.031). Concerning OS, no significant influence for adjuvant treatment could be seen (p = 0.354). Though trends towards better OS and RFS could be observed in patients of the high-risk group-both in RCT and RT groups compared to surgery alone-the effects did not prove to be significant. CONCLUSION: Our study reaffirms the evidence against the use of adjuvant radio(chemo)therapy in low-risk early-stage cervical cancer. In intermediate-, and less pronounced in high-risk patients, however, it seems to be beneficial. The role of adjuvant radio(chemo)therapy in early cervical cancer should be further investigated in prospective randomized trials.
DOI
https://www.doi.org/10.1007/s00404-021-05989-w
Keywords
Adult; Aged; Aged, 80 and over; Antineoplastic Agents/*therapeutic use; Chemotherapy, Adjuvant; Combined Modality Therapy/*methods; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Neoplasm Staging; Radiotherapy Dosage; Radiotherapy, Adjuvant; Survival Rate; Treatment Outcome; Uterine Cervical Neoplasms/*drug therapy/mortality/pathology/*radiotherapy; *Adjuvant therapy; *Cervical cancer; *Radio(chemo)therapy; *Risk groups
Is there a benefit for adjuvant radio(chemo)therapy in early cervical cancer? Results from a population-based study
Publication date
2021
Abstract
PURPOSE: Due to insufficient and conflicting prospective evidence, the recommendations on when to apply adjuvant radiochemotherapy in early-stage cervical cancer vary between international guidelines. In this population-based study, we evaluated the outcome of patients with early-stage cervical cancer based on risk factors and the adjuvant therapy they received. METHODS: The effect of primary therapy (surgery and radiochemotherapy RCT, surgery and radiotherapy RT, and surgery alone) on overall survival (OS) and recurrence-free survival (RFS) was evaluated in the complete cohort of 442 patients and in subgroups according to risk profile and nodal status. RESULTS: In low-risk patients, there was no difference in OS (p = 0.276) depending on whether patients received adjuvant therapy or not. Concerning RFS, patients with RT (including one patient with RCT) exhibited a significantly worse outcome compared to the group with surgery alone (p = 0.015). In intermediate-risk patients, the administration of adjuvant RT significantly benefited RFS when compared to surgery only in multivariate analysis (p = 0.031). Concerning OS, no significant influence for adjuvant treatment could be seen (p = 0.354). Though trends towards better OS and RFS could be observed in patients of the high-risk group-both in RCT and RT groups compared to surgery alone-the effects did not prove to be significant. CONCLUSION: Our study reaffirms the evidence against the use of adjuvant radio(chemo)therapy in low-risk early-stage cervical cancer. In intermediate-, and less pronounced in high-risk patients, however, it seems to be beneficial. The role of adjuvant radio(chemo)therapy in early cervical cancer should be further investigated in prospective randomized trials.
DOI
https://www.doi.org/10.1007/s00404-021-05989-w
Keywords
Adult; Aged; Aged, 80 and over; Antineoplastic Agents/*therapeutic use; Chemotherapy, Adjuvant; Combined Modality Therapy/*methods; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Neoplasm Staging; Radiotherapy Dosage; Radiotherapy, Adjuvant; Survival Rate; Treatment Outcome; Uterine Cervical Neoplasms/*drug therapy/mortality/pathology/*radiotherapy; *Adjuvant therapy; *Cervical cancer; *Radio(chemo)therapy; *Risk groups
Scharl, S.; Gerken, M.; Sprötge, T.; et al. (2021) Comparison of survival outcomes and effects of therapy between subtypes of high-grade endometrial cancer - a population-based study. Acta Oncol. https://www.doi.org/10.1080/0284186X.2021.1914347
Title
Comparison of survival outcomes and effects of therapy between subtypes of high-grade endometrial cancer - a population-based study
Publication date
2021
Abstract
BACKGROUND: Similarities in outcome between grade 3 endometrioid cancer and non-endometrioid histologies have been reported by a number of studies. Other reports, however, stated a significantly better prognosis for G3 endometrioid compared to type II histology. In this population-based study, we compared the outcome and treatment approaches of high-grade endometrial cancer patients with FIGO stages I-III depending on their histology. MATERIAL AND METHODS: 284 high-grade endometrial cancer patients diagnosed between 1998 and 2015 were retrospectively analyzed. Overall survival (OS), recurrence-free survival (RFS), and recurrence rates were compared depending on histology. RESULTS: Type I G3 patients had a statistically significant OS advantage over women suffering from type II carcinoma (HR 1.527, 95%-CI 1.024-2.276; p = 0.038) and carcinosarcoma (HR 2.106, 95%-CI 1.270-3.493; p = 0.004) in univariable and multivariable Cox-regression analysis. RFS in Type I G3 was significantly superior compared to patients with carcinosarcoma (HR 1.719, 95%-CI 1.018-2.901; p = 0.043) and not significantly superior to type II patients (HR 1.368, 95%-CI 0.920-2.036; p = 0.122). Cumulative recurrence rates were significantly higher in carcinosarcoma compared to type I G3 (HR 2.217, 95%-CI 1.096-4.485; p = 0.027) in univariable analysis, but not after risk adjustment (HR of 1.472, 95%-CI 0.654-3.311; p = 0.350). CONCLUSION: The prognosis of patients with type I G3 endometrial cancer patients seems to be significantly superior to patients with type II cancer and particularly carcinosarcoma. Systematic LND seemed to be beneficial in all of the three subtypes. The benefit of adjuvant treatment methods may differ between histologies.
DOI
https://www.doi.org/10.1080/0284186X.2021.1914347
Keywords
*Carcinoma, Endometrioid/pathology; *Endometrial Neoplasms/pathology/therapy; Female; Humans; Neoplasm Recurrence, Local/epidemiology/pathology; Neoplasm Staging; Retrospective Studies; Endometrial cancer; carcinosarcoma; high grade; type II
Comparison of survival outcomes and effects of therapy between subtypes of high-grade endometrial cancer - a population-based study
Publication date
2021
Abstract
BACKGROUND: Similarities in outcome between grade 3 endometrioid cancer and non-endometrioid histologies have been reported by a number of studies. Other reports, however, stated a significantly better prognosis for G3 endometrioid compared to type II histology. In this population-based study, we compared the outcome and treatment approaches of high-grade endometrial cancer patients with FIGO stages I-III depending on their histology. MATERIAL AND METHODS: 284 high-grade endometrial cancer patients diagnosed between 1998 and 2015 were retrospectively analyzed. Overall survival (OS), recurrence-free survival (RFS), and recurrence rates were compared depending on histology. RESULTS: Type I G3 patients had a statistically significant OS advantage over women suffering from type II carcinoma (HR 1.527, 95%-CI 1.024-2.276; p = 0.038) and carcinosarcoma (HR 2.106, 95%-CI 1.270-3.493; p = 0.004) in univariable and multivariable Cox-regression analysis. RFS in Type I G3 was significantly superior compared to patients with carcinosarcoma (HR 1.719, 95%-CI 1.018-2.901; p = 0.043) and not significantly superior to type II patients (HR 1.368, 95%-CI 0.920-2.036; p = 0.122). Cumulative recurrence rates were significantly higher in carcinosarcoma compared to type I G3 (HR 2.217, 95%-CI 1.096-4.485; p = 0.027) in univariable analysis, but not after risk adjustment (HR of 1.472, 95%-CI 0.654-3.311; p = 0.350). CONCLUSION: The prognosis of patients with type I G3 endometrial cancer patients seems to be significantly superior to patients with type II cancer and particularly carcinosarcoma. Systematic LND seemed to be beneficial in all of the three subtypes. The benefit of adjuvant treatment methods may differ between histologies.
DOI
https://www.doi.org/10.1080/0284186X.2021.1914347
Keywords
*Carcinoma, Endometrioid/pathology; *Endometrial Neoplasms/pathology/therapy; Female; Humans; Neoplasm Recurrence, Local/epidemiology/pathology; Neoplasm Staging; Retrospective Studies; Endometrial cancer; carcinosarcoma; high grade; type II
Scharl, S.; Sprötge, T.; Gerken, M.; et al. (2021) Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-021-06140-5
Title
Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study
Publication date
2021
Abstract
PURPOSE: Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient's preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age. METHODS: The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology. RESULTS: Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (p = 0.015) or higher age (p < 0.01). Guideline adherence was not affected by comorbidities (p = 0.563), but was significantly reduced with higher age (p < 0.01). In a multivariable model, higher age (p < 0.01), obesity (p = 0.011), higher FIGO Stage (p < 0.01) and histologic subtype (p < 0.01) significantly decreased OS. Surgery (p < 0.001), chemotherapy (p < 0.01) and systematic LNE (p = 0.011) were associated with higher OS. CONCLUSION: Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.
DOI
https://www.doi.org/10.1007/s00404-021-06140-5
Keywords
Comorbidities; Endometrial cancer; Guideline adherence; Overall survival
Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study
Publication date
2021
Abstract
PURPOSE: Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient's preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age. METHODS: The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology. RESULTS: Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (p = 0.015) or higher age (p < 0.01). Guideline adherence was not affected by comorbidities (p = 0.563), but was significantly reduced with higher age (p < 0.01). In a multivariable model, higher age (p < 0.01), obesity (p = 0.011), higher FIGO Stage (p < 0.01) and histologic subtype (p < 0.01) significantly decreased OS. Surgery (p < 0.001), chemotherapy (p < 0.01) and systematic LNE (p = 0.011) were associated with higher OS. CONCLUSION: Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.
DOI
https://www.doi.org/10.1007/s00404-021-06140-5
Keywords
Comorbidities; Endometrial cancer; Guideline adherence; Overall survival
Scharl, S.; Sprötge, T.; Gerken, M.; et al. (2022) Guideline concordant therapy improves survival in high-grade endometrial cancer patients. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-022-04318-1
Title
Guideline concordant therapy improves survival in high-grade endometrial cancer patients
Publication date
2022
Abstract
PURPOSE: Data from randomized controlled trials in high-grade endometrial cancer are scarce due to its low prevalence. Therefore, guideline recommendations in this cancer subtype rely on relatively few randomized trials and data from retrospective studies. The aim of this study was to evaluate the benefits from guideline-concordant therapy in high-grade endometrial cancer in a real-world patient group. METHODS: The effect of treatment according to German S3 guidelines and the former S2k guideline on overall survival (OS) and recurrence-free survival (RFS) was evaluated in a cohort of 293 high-grade endometrial cancer patients. RESULTS: Treatment concordant with the S3 guideline significantly improved OS (HR 0.623, CI 0.420-0.923, p = 0.018) and RFS (HR 0.578, CI 0.387-0.863, p = 0.007). Treatment concordant with the S2k guideline did not result in a significantly higher OS (HR 0.783, CI 0.465-1.316, p = 0.335) or RFS (HR 0.741, CI 0.347-1.740, p = 0.242). CONCLUSION: Therapy according to the German S3 guideline improved OS and RFS in univariate as well as multivariate analysis in this cohort of high-grade endometrial cancer patients.
DOI
https://www.doi.org/10.1007/s00432-022-04318-1
Keywords
Endometrial cancer; Guideline concordant therapy; High grade; S3 guideline
Guideline concordant therapy improves survival in high-grade endometrial cancer patients
Publication date
2022
Abstract
PURPOSE: Data from randomized controlled trials in high-grade endometrial cancer are scarce due to its low prevalence. Therefore, guideline recommendations in this cancer subtype rely on relatively few randomized trials and data from retrospective studies. The aim of this study was to evaluate the benefits from guideline-concordant therapy in high-grade endometrial cancer in a real-world patient group. METHODS: The effect of treatment according to German S3 guidelines and the former S2k guideline on overall survival (OS) and recurrence-free survival (RFS) was evaluated in a cohort of 293 high-grade endometrial cancer patients. RESULTS: Treatment concordant with the S3 guideline significantly improved OS (HR 0.623, CI 0.420-0.923, p = 0.018) and RFS (HR 0.578, CI 0.387-0.863, p = 0.007). Treatment concordant with the S2k guideline did not result in a significantly higher OS (HR 0.783, CI 0.465-1.316, p = 0.335) or RFS (HR 0.741, CI 0.347-1.740, p = 0.242). CONCLUSION: Therapy according to the German S3 guideline improved OS and RFS in univariate as well as multivariate analysis in this cohort of high-grade endometrial cancer patients.
DOI
https://www.doi.org/10.1007/s00432-022-04318-1
Keywords
Endometrial cancer; Guideline concordant therapy; High grade; S3 guideline
Scharl, S.; Sprötge, T.; Gerken, M.; et al. (2023) Guideline concordant therapy improves survival in high-grade endometrial cancer patients. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-022-04318-1
Title
Guideline concordant therapy improves survival in high-grade endometrial cancer patients
Publication date
2023
Abstract
PURPOSE: Data from randomized controlled trials in high-grade endometrial cancer are scarce due to its low prevalence. Therefore, guideline recommendations in this cancer subtype rely on relatively few randomized trials and data from retrospective studies. The aim of this study was to evaluate the benefits from guideline-concordant therapy in high-grade endometrial cancer in a real-world patient group. METHODS: The effect of treatment according to German S3 guidelines and the former S2k guideline on overall survival (OS) and recurrence-free survival (RFS) was evaluated in a cohort of 293 high-grade endometrial cancer patients. RESULTS: Treatment concordant with the S3 guideline significantly improved OS (HR 0.623, CI 0.420-0.923, p = 0.018) and RFS (HR 0.578, CI 0.387-0.863, p = 0.007). Treatment concordant with the S2k guideline did not result in a significantly higher OS (HR 0.783, CI 0.465-1.316, p = 0.335) or RFS (HR 0.741, CI 0.347-1.740, p = 0.242). CONCLUSION: Therapy according to the German S3 guideline improved OS and RFS in univariate as well as multivariate analysis in this cohort of high-grade endometrial cancer patients.
DOI
https://www.doi.org/10.1007/s00432-022-04318-1
Keywords
Humans; Female; Retrospective Studies; *Endometrial Neoplasms/drug therapy; Radiotherapy, Adjuvant; Neoplasm Staging; Endometrial cancer; Guideline concordant therapy; High grade; S3 guideline
Guideline concordant therapy improves survival in high-grade endometrial cancer patients
Publication date
2023
Abstract
PURPOSE: Data from randomized controlled trials in high-grade endometrial cancer are scarce due to its low prevalence. Therefore, guideline recommendations in this cancer subtype rely on relatively few randomized trials and data from retrospective studies. The aim of this study was to evaluate the benefits from guideline-concordant therapy in high-grade endometrial cancer in a real-world patient group. METHODS: The effect of treatment according to German S3 guidelines and the former S2k guideline on overall survival (OS) and recurrence-free survival (RFS) was evaluated in a cohort of 293 high-grade endometrial cancer patients. RESULTS: Treatment concordant with the S3 guideline significantly improved OS (HR 0.623, CI 0.420-0.923, p = 0.018) and RFS (HR 0.578, CI 0.387-0.863, p = 0.007). Treatment concordant with the S2k guideline did not result in a significantly higher OS (HR 0.783, CI 0.465-1.316, p = 0.335) or RFS (HR 0.741, CI 0.347-1.740, p = 0.242). CONCLUSION: Therapy according to the German S3 guideline improved OS and RFS in univariate as well as multivariate analysis in this cohort of high-grade endometrial cancer patients.
DOI
https://www.doi.org/10.1007/s00432-022-04318-1
Keywords
Humans; Female; Retrospective Studies; *Endometrial Neoplasms/drug therapy; Radiotherapy, Adjuvant; Neoplasm Staging; Endometrial cancer; Guideline concordant therapy; High grade; S3 guideline
Schmitt, J.; Klinkhammer-Schalke, M.; Bierbaum, V.; et al. (2023) Initial Cancer Treatment in Certified Versus Non-Certified Hospitals. Dtsch Arztebl Int. https://www.doi.org/10.3238/arztebl.m2023.0169
Title
Initial Cancer Treatment in Certified Versus Non-Certified Hospitals
Publication date
2023
Abstract
BACKGROUND: According to the National Cancer Plan in Germany, all cancer patients should receive high-quality care in accordance with evidence-based treatment guidelines. Certification programs were established for this purpose but have not yet been comprehensively evaluated. METHODS: In the WiZen project, which was supported by the Innovation Fund (supported project number 01VSF17020), controlled cohort studies were performed to investigate whether initial treatment in hospitals with or without a certificate from the German Cancer Society was associated with a difference in overall survival (primary endpoint) in patients with cancer of the colon, rectum, lung, pancreas, breast, cervix, prostate, endometrium, and ovary, head and neck cancer, and neuro-oncological tumors. The studies were based on nationwide data from adult insurees of the AOK statutory health insurance carrier for the years 2009-2017. RESULTS: The majority of patients with all entities except breast cancer received their initial treatment in non-certified hospitals. Initial treatment in a certified hospital was found to be beneficial in terms of overall survival for all cancer entities, even after extensive adjustment for patient- and hospital-related confounders. The hazard ratio (HR) ranged from 0.97 (95% CI: [0.94; 1.00]) for lung cancer to 0.77 [0.74; 0.81] for breast cancer, corresponding to an absolute risk reduction (ARR) for overall survival of 0.62 months for lung cancer to 4.61 months for cervical cancer. CONCLUSION: The WiZen study shows for the entities studied that initial cancer treatment in a certified center is associated with lower mortality. Despite the recommendations of the National Cancer Plan, however, more than 40% of all cancer patients still receive their initial treatment in a non-certified hospital. The preferential provision of initial care in certified hospitals would be likely to improve overall survival. Although the study design does not permit any conclusion with regard to causality, the findings seem robust considering that a control group was used, confounders were taken into account, and the study population was of large size.
DOI
https://www.doi.org/10.3238/arztebl.m2023.0169
Keywords
Male; Adult; Female; Humans; Hospitals; *Head and Neck Neoplasms; *Breast Neoplasms/therapy; Germany/epidemiology; *Lung Neoplasms; Certification
Initial Cancer Treatment in Certified Versus Non-Certified Hospitals
Publication date
2023
Abstract
BACKGROUND: According to the National Cancer Plan in Germany, all cancer patients should receive high-quality care in accordance with evidence-based treatment guidelines. Certification programs were established for this purpose but have not yet been comprehensively evaluated. METHODS: In the WiZen project, which was supported by the Innovation Fund (supported project number 01VSF17020), controlled cohort studies were performed to investigate whether initial treatment in hospitals with or without a certificate from the German Cancer Society was associated with a difference in overall survival (primary endpoint) in patients with cancer of the colon, rectum, lung, pancreas, breast, cervix, prostate, endometrium, and ovary, head and neck cancer, and neuro-oncological tumors. The studies were based on nationwide data from adult insurees of the AOK statutory health insurance carrier for the years 2009-2017. RESULTS: The majority of patients with all entities except breast cancer received their initial treatment in non-certified hospitals. Initial treatment in a certified hospital was found to be beneficial in terms of overall survival for all cancer entities, even after extensive adjustment for patient- and hospital-related confounders. The hazard ratio (HR) ranged from 0.97 (95% CI: [0.94; 1.00]) for lung cancer to 0.77 [0.74; 0.81] for breast cancer, corresponding to an absolute risk reduction (ARR) for overall survival of 0.62 months for lung cancer to 4.61 months for cervical cancer. CONCLUSION: The WiZen study shows for the entities studied that initial cancer treatment in a certified center is associated with lower mortality. Despite the recommendations of the National Cancer Plan, however, more than 40% of all cancer patients still receive their initial treatment in a non-certified hospital. The preferential provision of initial care in certified hospitals would be likely to improve overall survival. Although the study design does not permit any conclusion with regard to causality, the findings seem robust considering that a control group was used, confounders were taken into account, and the study population was of large size.
DOI
https://www.doi.org/10.3238/arztebl.m2023.0169
Keywords
Male; Adult; Female; Humans; Hospitals; *Head and Neck Neoplasms; *Breast Neoplasms/therapy; Germany/epidemiology; *Lung Neoplasms; Certification
Schmoeckel, E.; Hofmann, S.; Fromberger, D.; et al. (2019) Comprehensive analysis of PD-L1 expression, HER2 amplification, ALK/EML4 fusion, and mismatch repair deficiency as putative predictive and prognostic factors in ovarian carcinoma. Virchows Arch. https://www.doi.org/10.1007/s00428-019-02528-6
Title
Comprehensive analysis of PD-L1 expression, HER2 amplification, ALK/EML4 fusion, and mismatch repair deficiency as putative predictive and prognostic factors in ovarian carcinoma
Publication date
2019
Abstract
Most ovarian carcinomas (OC) are characterized by poor prognosis, particularly the most frequent type high-grade serous carcinoma. Besides PARP inhibitors, target-based therapeutic strategies are not well established. We asked the question which other therapeutic targets could be of potential value and, therefore, analyzed a large cohort of OC for several predictive factors. Two hundred eighty-eight (288) cases of OC including the major histological types were analyzed by immunohistochemistry for PD-L1HER2, ALK, and the mismatch repair (MMR) proteins MLH1, PMS2, MSH2, and MSH6. HER2 amplification and ALK/EML4 fusion were assessed by fluorescence in situ hybridization. The most frequent finding was PD-L1 expression >/= 1% in 19.5% of the cases, which correlated with a significantly better overall survival in multivariate analysis (p < 0.001). HER2 amplification was detected in 11 cases (4%), all high-grade serous carcinomas. Amplification of HER2 did not correlate with patients' survival. ALK/EML4 fusion was found in two cases (0.74%): one high-grade serous and one endometrioid carcinoma. MMR deficiency was only present in one case of stage IV high-grade serous carcinoma. Subsets of high-grade serous carcinomas show PD-L1 expression and HER2 amplification, respectively, and, therefore, could qualify for immune checkpoint inhibitor therapy or anti HER2 therapy. PD-L1 is also of prognostic impact. ALK/EML4 fusion is very rare in OC and not a putative therapeutic target.
DOI
https://www.doi.org/10.1007/s00428-019-02528-6
Keywords
Anaplastic Lymphoma Kinase/metabolism; B7-H1 Antigen/*metabolism; Biomarkers, Tumor/metabolism; Carcinoma, Endometrioid/diagnosis/*pathology; Cell Cycle Proteins/metabolism; DNA Mismatch Repair/genetics; Endometrial Neoplasms/*pathology; Female; Humans; Immunohistochemistry/methods; Microtubule-Associated Proteins/metabolism; Ovarian Neoplasms/diagnosis/*pathology; Prognosis; Receptor, ErbB-2/*metabolism; Serine Endopeptidases/metabolism; Alk/eml4; Her2; Microsatellite instability; Mismatch repair deficiency; Ovarian carcinoma; Pd-l1
Comprehensive analysis of PD-L1 expression, HER2 amplification, ALK/EML4 fusion, and mismatch repair deficiency as putative predictive and prognostic factors in ovarian carcinoma
Publication date
2019
Abstract
Most ovarian carcinomas (OC) are characterized by poor prognosis, particularly the most frequent type high-grade serous carcinoma. Besides PARP inhibitors, target-based therapeutic strategies are not well established. We asked the question which other therapeutic targets could be of potential value and, therefore, analyzed a large cohort of OC for several predictive factors. Two hundred eighty-eight (288) cases of OC including the major histological types were analyzed by immunohistochemistry for PD-L1HER2, ALK, and the mismatch repair (MMR) proteins MLH1, PMS2, MSH2, and MSH6. HER2 amplification and ALK/EML4 fusion were assessed by fluorescence in situ hybridization. The most frequent finding was PD-L1 expression >/= 1% in 19.5% of the cases, which correlated with a significantly better overall survival in multivariate analysis (p < 0.001). HER2 amplification was detected in 11 cases (4%), all high-grade serous carcinomas. Amplification of HER2 did not correlate with patients' survival. ALK/EML4 fusion was found in two cases (0.74%): one high-grade serous and one endometrioid carcinoma. MMR deficiency was only present in one case of stage IV high-grade serous carcinoma. Subsets of high-grade serous carcinomas show PD-L1 expression and HER2 amplification, respectively, and, therefore, could qualify for immune checkpoint inhibitor therapy or anti HER2 therapy. PD-L1 is also of prognostic impact. ALK/EML4 fusion is very rare in OC and not a putative therapeutic target.
DOI
https://www.doi.org/10.1007/s00428-019-02528-6
Keywords
Anaplastic Lymphoma Kinase/metabolism; B7-H1 Antigen/*metabolism; Biomarkers, Tumor/metabolism; Carcinoma, Endometrioid/diagnosis/*pathology; Cell Cycle Proteins/metabolism; DNA Mismatch Repair/genetics; Endometrial Neoplasms/*pathology; Female; Humans; Immunohistochemistry/methods; Microtubule-Associated Proteins/metabolism; Ovarian Neoplasms/diagnosis/*pathology; Prognosis; Receptor, ErbB-2/*metabolism; Serine Endopeptidases/metabolism; Alk/eml4; Her2; Microsatellite instability; Mismatch repair deficiency; Ovarian carcinoma; Pd-l1
Schmoeckel, E.; Odai-Afotey, A. A.; Schleissheimer, M.; et al. (2017) LEF1 is preferentially expressed in the tubal-peritoneal junctions and is a reliable marker of tubal intraepithelial lesions. Mod Pathol. https://www.doi.org/10.1038/modpathol.2017.53
Title
LEF1 is preferentially expressed in the tubal-peritoneal junctions and is a reliable marker of tubal intraepithelial lesions
Publication date
2017
Abstract
Recently it has been reported that serous tubal intraepithelial carcinoma (STIC), the likely precursor of ovarian/extra-uterine high-grade serous carcinoma, are frequently located in the vicinity of tubal-peritoneal junctions, consistent with the cancer-prone features of many epithelial transitional regions. To test if p53 (aka TP53)-signatures and secretory cell outgrowths (SCOUTs) also localize to tubal-peritoneal junctions, we examined these lesions in the fallopian tubes of patients undergoing salpingo-oophorectomy for sporadic high-grade serous carcinomas or as a prophylactic procedure for carriers of familial BRCA1 or 2 mutations. STICs were located closest to the tubal-peritoneal junctions with an average distance of 1.31 mm, while SCOUTs were not detected in the fimbriated end of the fallopian tube. As many epithelial transitional regions contain stem cells, we also determined the expression of stem cell markers in the normal fallopian tube, tubal intraepithelial lesions and high-grade serous carcinomas. Of those, LEF1 was consistently expressed in the tubal-peritoneal junctions and all lesions, independent of p53 status. All SCOUTs demonstrated strong nuclear expression of beta-catenin consistent with the LEF1 participation in the canonical WNT pathway. However, beta-catenin was preferentially located in the cytoplasm of cells comprising STICs and p53 signatures, suggesting WNT-independent function of LEF1 in those lesions. Both frequency of LEF1 expression and beta-catenin nuclear expression correlated with the worst 5-year patient survival, supporting important role of both proteins in high-grade serous carcinoma. Taken together, our findings suggest the existence of stem cell niche within the tubal-peritoneal junctions. Furthermore, they support the notion that the pathogenesis of SCOUTs is distinct from that of STICs and p53 signatures. The location and discrete patterns of LEF1 and beta-catenin expression may serve as highly sensitive and reliable ancillary markers for the detection and differential diagnosis of tubal intraepithelial lesions.
DOI
https://www.doi.org/10.1038/modpathol.2017.53
Keywords
Adult; Aged; Aged, 80 and over; BRCA1 Protein/genetics; BRCA2 Protein/genetics; Biomarkers, Tumor/*analysis; Carcinoma in Situ/*chemistry/genetics/pathology/surgery; Case-Control Studies; Fallopian Tube Neoplasms/*chemistry/genetics/pathology/surgery; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymphoid Enhancer-Binding Factor 1/*analysis; Middle Aged; Mutation; Neoplasm Grading; Neoplastic Stem Cells/*chemistry/pathology; Predictive Value of Tests; Proportional Hazards Models; Reproducibility of Results; Salpingo-oophorectomy; Stem Cell Niche; Time Factors; Treatment Outcome; Tumor Microenvironment; Tumor Suppressor Protein p53/analysis; beta Catenin/analysis
LEF1 is preferentially expressed in the tubal-peritoneal junctions and is a reliable marker of tubal intraepithelial lesions
Publication date
2017
Abstract
Recently it has been reported that serous tubal intraepithelial carcinoma (STIC), the likely precursor of ovarian/extra-uterine high-grade serous carcinoma, are frequently located in the vicinity of tubal-peritoneal junctions, consistent with the cancer-prone features of many epithelial transitional regions. To test if p53 (aka TP53)-signatures and secretory cell outgrowths (SCOUTs) also localize to tubal-peritoneal junctions, we examined these lesions in the fallopian tubes of patients undergoing salpingo-oophorectomy for sporadic high-grade serous carcinomas or as a prophylactic procedure for carriers of familial BRCA1 or 2 mutations. STICs were located closest to the tubal-peritoneal junctions with an average distance of 1.31 mm, while SCOUTs were not detected in the fimbriated end of the fallopian tube. As many epithelial transitional regions contain stem cells, we also determined the expression of stem cell markers in the normal fallopian tube, tubal intraepithelial lesions and high-grade serous carcinomas. Of those, LEF1 was consistently expressed in the tubal-peritoneal junctions and all lesions, independent of p53 status. All SCOUTs demonstrated strong nuclear expression of beta-catenin consistent with the LEF1 participation in the canonical WNT pathway. However, beta-catenin was preferentially located in the cytoplasm of cells comprising STICs and p53 signatures, suggesting WNT-independent function of LEF1 in those lesions. Both frequency of LEF1 expression and beta-catenin nuclear expression correlated with the worst 5-year patient survival, supporting important role of both proteins in high-grade serous carcinoma. Taken together, our findings suggest the existence of stem cell niche within the tubal-peritoneal junctions. Furthermore, they support the notion that the pathogenesis of SCOUTs is distinct from that of STICs and p53 signatures. The location and discrete patterns of LEF1 and beta-catenin expression may serve as highly sensitive and reliable ancillary markers for the detection and differential diagnosis of tubal intraepithelial lesions.
DOI
https://www.doi.org/10.1038/modpathol.2017.53
Keywords
Adult; Aged; Aged, 80 and over; BRCA1 Protein/genetics; BRCA2 Protein/genetics; Biomarkers, Tumor/*analysis; Carcinoma in Situ/*chemistry/genetics/pathology/surgery; Case-Control Studies; Fallopian Tube Neoplasms/*chemistry/genetics/pathology/surgery; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymphoid Enhancer-Binding Factor 1/*analysis; Middle Aged; Mutation; Neoplasm Grading; Neoplastic Stem Cells/*chemistry/pathology; Predictive Value of Tests; Proportional Hazards Models; Reproducibility of Results; Salpingo-oophorectomy; Stem Cell Niche; Time Factors; Treatment Outcome; Tumor Microenvironment; Tumor Suppressor Protein p53/analysis; beta Catenin/analysis
Schmuck, R.; Gerken, M.; Teegen, E. M.; et al. (2020) Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients. Langenbecks Arch Surg. https://www.doi.org/10.1007/s00423-019-01850-6
Title
Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients
Publication date
2020
Abstract
INTRODUCTION: Colorectal carcinomas represent the third most common cause of cancer-related deaths in Germany. Although the incidence is significantly higher in men compared with women and gender is a well-established crucial factor for outcome in other diseases, detailed gender comparisons for colon cancer are lacking. METHODS: This retrospective population-based cohort study included all patients diagnosed with colon cancer in Germany between 2000 and 2016 who were included in the common dataset of colorectal cancer patients from the quality conference of the German Cancer Society. We compared clinical, histopathological, and therapeutic characteristics as well as overall and recurrence-free survival. RESULTS: A total of 185,967 patients were included in the study, of which 85,685 were female (46.1%) and 100,282 were male (53.9%). The proportion of women diagnosed with colon cancer decreased from 2000 to 2016 (f: 26.6 to 40.1%; m: 24.9 to 41.9%; p < 0.001), and the proportion of very old patients was especially high in women (f: 27.3%; m: 15.6%; p < 0.001). The localization in women was more right-sided (f: 45.0%, m: 36.7%; p < 0.001), and women had a higher tumor grading and a higher UICC stage (especially stage III nodal-positive) at diagnosis of primary colon cancer (UICC III: f: 22.7%, m: 21.0%; p < 0.001). We could detect a significantly better overall (hazard ratio: 0.853, lower 95%: 0.841, upper 95%: 0.864; p < 0.001) and recurrence-free survival (hazard ratio: 0.857, lower 95%: 0.845, upper 95%: 0.868; p < 0.001) in women compared with men, even though women received chemotherapy less frequently compared with men (f: 26.1%, m: 28.1%; p < 0.001). CONCLUSION: We could detect several variables that differed significantly between men and women regarding clinical, histopathological, therapeutic, and outcome factors. We believe that it is crucial to consider gender as a key factor in the diagnosis and treatment of colon cancer. Sex-specific diagnostic tools could lead to an earlier diagnosis of colon cancer in women, and ways to increase the rate of chemotherapy in women should be evaluated. Furthermore, we recommend stratifying randomized trials by gender.
DOI
https://www.doi.org/10.1007/s00423-019-01850-6
Keywords
Colonic Neoplasms/diagnosis/*epidemiology/pathology/therapy; Female; Germany/epidemiology; Humans; Male; Outcome Assessment, Health Care; Retrospective Studies; Risk Factors; Sex Factors; Colon cancer; Gender; Sex differences
Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients
Publication date
2020
Abstract
INTRODUCTION: Colorectal carcinomas represent the third most common cause of cancer-related deaths in Germany. Although the incidence is significantly higher in men compared with women and gender is a well-established crucial factor for outcome in other diseases, detailed gender comparisons for colon cancer are lacking. METHODS: This retrospective population-based cohort study included all patients diagnosed with colon cancer in Germany between 2000 and 2016 who were included in the common dataset of colorectal cancer patients from the quality conference of the German Cancer Society. We compared clinical, histopathological, and therapeutic characteristics as well as overall and recurrence-free survival. RESULTS: A total of 185,967 patients were included in the study, of which 85,685 were female (46.1%) and 100,282 were male (53.9%). The proportion of women diagnosed with colon cancer decreased from 2000 to 2016 (f: 26.6 to 40.1%; m: 24.9 to 41.9%; p < 0.001), and the proportion of very old patients was especially high in women (f: 27.3%; m: 15.6%; p < 0.001). The localization in women was more right-sided (f: 45.0%, m: 36.7%; p < 0.001), and women had a higher tumor grading and a higher UICC stage (especially stage III nodal-positive) at diagnosis of primary colon cancer (UICC III: f: 22.7%, m: 21.0%; p < 0.001). We could detect a significantly better overall (hazard ratio: 0.853, lower 95%: 0.841, upper 95%: 0.864; p < 0.001) and recurrence-free survival (hazard ratio: 0.857, lower 95%: 0.845, upper 95%: 0.868; p < 0.001) in women compared with men, even though women received chemotherapy less frequently compared with men (f: 26.1%, m: 28.1%; p < 0.001). CONCLUSION: We could detect several variables that differed significantly between men and women regarding clinical, histopathological, therapeutic, and outcome factors. We believe that it is crucial to consider gender as a key factor in the diagnosis and treatment of colon cancer. Sex-specific diagnostic tools could lead to an earlier diagnosis of colon cancer in women, and ways to increase the rate of chemotherapy in women should be evaluated. Furthermore, we recommend stratifying randomized trials by gender.
DOI
https://www.doi.org/10.1007/s00423-019-01850-6
Keywords
Colonic Neoplasms/diagnosis/*epidemiology/pathology/therapy; Female; Germany/epidemiology; Humans; Male; Outcome Assessment, Health Care; Retrospective Studies; Risk Factors; Sex Factors; Colon cancer; Gender; Sex differences
Schnitzbauer, V.; Gerken, M.; Benz, S.; et al. (2020) Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort. Surg Endosc. https://www.doi.org/10.1007/s00464-019-06861-4
Title
Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort
Publication date
2020
Abstract
BACKGROUND: Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. METHODS: The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan-Meier plots and multivariable Cox regression conducted separately for UICC stages I-III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable survival analysis. RESULTS: Of 16,378 patients, 4540 (27.7%) underwent laparoscopic surgery, a trend which increased during the observation period. Patients undergoing laparoscopy attained better results for 90-day mortality (odds ratio, OR 0.658, 95% confidence interval, CI 0.526-0.822). The 5-year OS rate in the laparoscopic group was 82.6%, vs. 76.6% in the open surgery group, with a hazard ratio (HR) of 0.819 in multivariable Cox regression (95% CI 0.747-0.899, p < 0.001). The laparoscopic group showed a better 5-year RFS, with 81.8 vs. 74.3% and HR 0.770 (95% CI 0.705-0.842, p < 0.001). The 5-year relative survival rates were also in favor of laparoscopy, with 93.1 vs. 88.4% (p = 0.012). CONCLUSION: Laparoscopic surgery for rectal cancer can be performed safely and, according to this study, is associated with an oncological outcome superior to that of the open procedure. Therefore, in the absence of individual contraindications, it should be considered as a standard approach.
DOI
https://www.doi.org/10.1007/s00464-019-06861-4
Keywords
Adult; Aged; Datasets as Topic; Female; Germany; Humans; *Laparoscopy; Male; Middle Aged; Proctectomy/*methods; Propensity Score; Rectal Neoplasms/mortality/*surgery; Rectum/surgery; Regression Analysis; Retrospective Studies; Survival Analysis; Survival Rate; Treatment Outcome; *Health services research; *Long-term survival; *Minimal invasive surgery; *Rectal cancer; *Retrospective analysis; *Short-term survival
Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort
Publication date
2020
Abstract
BACKGROUND: Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. METHODS: The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan-Meier plots and multivariable Cox regression conducted separately for UICC stages I-III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable survival analysis. RESULTS: Of 16,378 patients, 4540 (27.7%) underwent laparoscopic surgery, a trend which increased during the observation period. Patients undergoing laparoscopy attained better results for 90-day mortality (odds ratio, OR 0.658, 95% confidence interval, CI 0.526-0.822). The 5-year OS rate in the laparoscopic group was 82.6%, vs. 76.6% in the open surgery group, with a hazard ratio (HR) of 0.819 in multivariable Cox regression (95% CI 0.747-0.899, p < 0.001). The laparoscopic group showed a better 5-year RFS, with 81.8 vs. 74.3% and HR 0.770 (95% CI 0.705-0.842, p < 0.001). The 5-year relative survival rates were also in favor of laparoscopy, with 93.1 vs. 88.4% (p = 0.012). CONCLUSION: Laparoscopic surgery for rectal cancer can be performed safely and, according to this study, is associated with an oncological outcome superior to that of the open procedure. Therefore, in the absence of individual contraindications, it should be considered as a standard approach.
DOI
https://www.doi.org/10.1007/s00464-019-06861-4
Keywords
Adult; Aged; Datasets as Topic; Female; Germany; Humans; *Laparoscopy; Male; Middle Aged; Proctectomy/*methods; Propensity Score; Rectal Neoplasms/mortality/*surgery; Rectum/surgery; Regression Analysis; Retrospective Studies; Survival Analysis; Survival Rate; Treatment Outcome; *Health services research; *Long-term survival; *Minimal invasive surgery; *Rectal cancer; *Retrospective analysis; *Short-term survival
Scholz-Kreisel, P.; Becker, C.; Kaiser, M.; et al. (2023) Subsequent primary neoplasms after childhood cancer therapy - design and description of the German nested case-control study STATT-SCAR. Cancer Causes Control. https://www.doi.org/10.1007/s10552-023-01760-5
Title
Subsequent primary neoplasms after childhood cancer therapy - design and description of the German nested case-control study STATT-SCAR
Publication date
2023
Abstract
BACKGROUND: Subsequent primary neoplasms (SPN) are among the most severe late effects and the second most frequent cause of death in childhood cancer patients. In this paper we introduce method and properties of the STATT-SCAR study (Second Tumor After Tumor Therapy, Second Cancer After Radiotherapy), which is a joint nested matched case-control study to evaluate the impact of chemotherapy (STATT) as well as radiotherapy (SCAR) on the risk of developing a SPN. METHODS: Based on the cohort of the German childhood cancer registry (GCCR), we selected patients diagnosed with a first neoplasm before age 15 or younger between 1980 and 2014. We selected those with a SPN at least half a year after the first neoplasm, and matched up to four controls to each case. Therapy data were acquired from various sources, including clinical study centers and treating hospitals. To analyze the impact of radiotherapy, organ doses were estimated by using reconstructed treatment plans. The effect of chemotherapy was analyzed using substance groups summarized after isotoxic dose conversion. RESULTS: 1244 cases with a SPN were identified and matched with 4976 controls. Treatment data were acquired for 83% of all match groups (one case and at least one control). Based on preliminary analyses, 98% of all patients received chemotherapy and 54% of all patients were treated with radiotherapy. CONCLUSIONS: Based on our data, detailed analyses of dose response relationships and treatment element combinations are possible, leading to a deeper insight into SPN risks after cancer treatments. TRIAL REGISTRATION: The study is registered at the German clinical trial register (DRKS) under number DRKS00017847 [45].
DOI
https://www.doi.org/10.1007/s10552-023-01760-5
Keywords
Chemotherapy; Childhood cancer; Nested case control study; Radiotherapy; Subsequent primary neoplasm
Subsequent primary neoplasms after childhood cancer therapy - design and description of the German nested case-control study STATT-SCAR
Publication date
2023
Abstract
BACKGROUND: Subsequent primary neoplasms (SPN) are among the most severe late effects and the second most frequent cause of death in childhood cancer patients. In this paper we introduce method and properties of the STATT-SCAR study (Second Tumor After Tumor Therapy, Second Cancer After Radiotherapy), which is a joint nested matched case-control study to evaluate the impact of chemotherapy (STATT) as well as radiotherapy (SCAR) on the risk of developing a SPN. METHODS: Based on the cohort of the German childhood cancer registry (GCCR), we selected patients diagnosed with a first neoplasm before age 15 or younger between 1980 and 2014. We selected those with a SPN at least half a year after the first neoplasm, and matched up to four controls to each case. Therapy data were acquired from various sources, including clinical study centers and treating hospitals. To analyze the impact of radiotherapy, organ doses were estimated by using reconstructed treatment plans. The effect of chemotherapy was analyzed using substance groups summarized after isotoxic dose conversion. RESULTS: 1244 cases with a SPN were identified and matched with 4976 controls. Treatment data were acquired for 83% of all match groups (one case and at least one control). Based on preliminary analyses, 98% of all patients received chemotherapy and 54% of all patients were treated with radiotherapy. CONCLUSIONS: Based on our data, detailed analyses of dose response relationships and treatment element combinations are possible, leading to a deeper insight into SPN risks after cancer treatments. TRIAL REGISTRATION: The study is registered at the German clinical trial register (DRKS) under number DRKS00017847 [45].
DOI
https://www.doi.org/10.1007/s10552-023-01760-5
Keywords
Chemotherapy; Childhood cancer; Nested case control study; Radiotherapy; Subsequent primary neoplasm
Schrodi, S.; Braisch, U.; Schenkirsch, G.; et al. (2013) [Changes in therapy for breast cancer patients as a result of mammography screening. An analysis of Bavarian cancer registry data from 2000 to 2008]. Gesundheitswesen. https://www.doi.org/10.1055/s-0032-1331732
Title
[Changes in therapy for breast cancer patients as a result of mammography screening. An analysis of Bavarian cancer registry data from 2000 to 2008]
Publication date
2013
Abstract
PURPOSE: A quality controlled mammography screening programme was initiated at the end of 2003 in Bavaria, a region with 12.5 million inhabitants, and transferred over to the national screening programme at the end of 2006. The purpose of this study was to evaluate immediate population-based consequences of mammography screening on breast cancer therapy. METHODS: Data from 75 475 breast cancer cases, diagnosed between 2000 and 2008 and registered in one of the 6 Bavarian clinical cancer registries were analysed. 51.4% of these patients were between 50 and 69 years of age and therefore the target population for screening. Trends of prognostic factors and standard therapies were calculated for 3 age groups (/=70 years) by means of annual percentages as well as 95%-confidence intervals for the percent difference between 2000 and 2008 (year of diagnosis). For interpretation of therapy trends, logistic regression models were calculated. RESULTS: Therapy trends showed that the increasingly favourable stage distribution may have resulted in the reduction of more radical surgical methods such as mastectomy (2000: 32.6%; 2008: 19.6%) or axillary dissection (89.0% vs. 37.0%), especially for women aged 50-69. An increase of radiation therapies (59.7% vs. 66.6%) can be explained to some extent by the increase in breast conserving surgeries. The shift to more favourable prognostic factors led, in accordance with the guidelines, to an increase of the proportion of singular endocrine therapies (28.5% vs. 40.7%), a decrease of chemotherapies (20.4% vs. 13.1%) and therefore to more gentle systemic therapies overall. These trends strengthened in the years following the introduction of screening, with a simultaneous rise of screening participants in the target population. CONCLUSION: The introduction of mammography screening in Bavaria has already shown the expected trend towards more favourable prognostic factors. Among other things, this could be a reason for the increasing use of more gentle therapies. Whether the screening in Bavaria leads to a mortality reduction, has to be analysed on the basis of an initial comparison of participation status followed by the trends in mortality thereafter.
DOI
https://www.doi.org/10.1055/s-0032-1331732
Keywords
Adult; Aged; Breast Neoplasms/*diagnostic imaging/epidemiology/*therapy; Combined Modality Therapy/statistics & numerical data; Drug Therapy/statistics & numerical data; Early Detection of Cancer/*statistics & numerical data; Female; Germany/epidemiology; Humans; Mammography/*statistics & numerical data; Mastectomy, Segmental/statistics & numerical data; Middle Aged; Practice Patterns, Physicians'/*statistics & numerical data/*trends; Prevalence; *Registries; Risk Factors; Young Adult
[Changes in therapy for breast cancer patients as a result of mammography screening. An analysis of Bavarian cancer registry data from 2000 to 2008]
Publication date
2013
Abstract
PURPOSE: A quality controlled mammography screening programme was initiated at the end of 2003 in Bavaria, a region with 12.5 million inhabitants, and transferred over to the national screening programme at the end of 2006. The purpose of this study was to evaluate immediate population-based consequences of mammography screening on breast cancer therapy. METHODS: Data from 75 475 breast cancer cases, diagnosed between 2000 and 2008 and registered in one of the 6 Bavarian clinical cancer registries were analysed. 51.4% of these patients were between 50 and 69 years of age and therefore the target population for screening. Trends of prognostic factors and standard therapies were calculated for 3 age groups (/=70 years) by means of annual percentages as well as 95%-confidence intervals for the percent difference between 2000 and 2008 (year of diagnosis). For interpretation of therapy trends, logistic regression models were calculated. RESULTS: Therapy trends showed that the increasingly favourable stage distribution may have resulted in the reduction of more radical surgical methods such as mastectomy (2000: 32.6%; 2008: 19.6%) or axillary dissection (89.0% vs. 37.0%), especially for women aged 50-69. An increase of radiation therapies (59.7% vs. 66.6%) can be explained to some extent by the increase in breast conserving surgeries. The shift to more favourable prognostic factors led, in accordance with the guidelines, to an increase of the proportion of singular endocrine therapies (28.5% vs. 40.7%), a decrease of chemotherapies (20.4% vs. 13.1%) and therefore to more gentle systemic therapies overall. These trends strengthened in the years following the introduction of screening, with a simultaneous rise of screening participants in the target population. CONCLUSION: The introduction of mammography screening in Bavaria has already shown the expected trend towards more favourable prognostic factors. Among other things, this could be a reason for the increasing use of more gentle therapies. Whether the screening in Bavaria leads to a mortality reduction, has to be analysed on the basis of an initial comparison of participation status followed by the trends in mortality thereafter.
DOI
https://www.doi.org/10.1055/s-0032-1331732
Keywords
Adult; Aged; Breast Neoplasms/*diagnostic imaging/epidemiology/*therapy; Combined Modality Therapy/statistics & numerical data; Drug Therapy/statistics & numerical data; Early Detection of Cancer/*statistics & numerical data; Female; Germany/epidemiology; Humans; Mammography/*statistics & numerical data; Mastectomy, Segmental/statistics & numerical data; Middle Aged; Practice Patterns, Physicians'/*statistics & numerical data/*trends; Prevalence; *Registries; Risk Factors; Young Adult
Schrodi, S.; Braun, M.; Andrulat, A.; et al. (2021) Outcome of breast cancer patients with low hormone receptor positivity: analysis of a 15-year population-based cohort. Ann Oncol. https://www.doi.org/10.1016/j.annonc.2021.08.1988
Title
Outcome of breast cancer patients with low hormone receptor positivity: analysis of a 15-year population-based cohort
Publication date
2021
Abstract
BACKGROUND: Guideline recommendations for the treatment of breast cancer with low hormone receptor (HR) expression (1%-9%) are ambiguous and several studies showed more similarities with HR-negative tumors than with HR strongly positive tumors (>/=10%). We used a population-based 15-year cohort to compare patient characteristics and outcome of HR low positive tumors with HR-negative and HR strongly positive tumors, respectively. PATIENTS AND METHODS: A total of 38 560 women diagnosed with early invasive breast cancer between 2004 and 2018 within the scope of the Munich Cancer Registry with 4.9 million inhabitants were included. Descriptive analyses of prognostic factors, treatment, and outcome analyses using the Kaplan-Meier method; cumulative incidence in consideration of competing risks; and multivariate analyses (Cox regression and Fine-Gray model) were conducted. Endpoints were time to local recurrence (TTLR), time to lymph node recurrence (TTLNR), time to metastasis (TTM), overall survival (OS), and relative survival (RS). RESULTS: A total of 861 patients (2%) had HR low positive, 4862 (13%) HR-negative, and 32 837 (85%) HR strongly positive tumors. Within the HER2-negative cohort (n = 33 366), survival of HR low positive tumors was significantly worse than that of HR strongly positive tumors [OS hazard ratio 0.66 (95% confidence interval 0.55-0.78)], whereas between HR low positive and HR-negative tumors no significant survival difference could be detected [OS hazard ratio 0.93 (95% confidence interval 0.78-1.11)]. TTLR, TTLNR, and TTM showed similar results. By contrast, within the HER2-positive cohort (n = 5194), no statistically significant differences between the three HR groups could be detected in multivariate analyses. CONCLUSION: Current definitions for HR positivity and its clinical relevance should be reconsidered. Patients with HR low positive/HER2-negative tumors could be regarded and treated similar to patients with triple-negative tumors.
DOI
https://www.doi.org/10.1016/j.annonc.2021.08.1988
Keywords
breast cancer; cancer registry; health services research; hormone receptor; systemic therapy; Lilly, MSD, Novartis, Pierre Fabre, Pfizer, Roche, Sandoz/Hexal, Seagen outsides; the submitted work. SM has attended advisory boards, provided research support,; and received honoraria and travel expenses from AbbVie, AstraZeneca, Clovis,; Eisai, GlaxoSmithKline, Medac, MSD, Novartis, Olympus, PharmaMar, Pfizer, Roche,; Sensor Kinesis, Teva, Tesaro. MK declares the following COIs: Renumeration:; Springer Press, Biermann Press, Celgene, Astra Zeneca, Myriad Genetics, TEVA, Eli; Lilly. Consultant/advisory role: Myriad Genetics, Bavarian KVB, DKMS Life, BLAEK,; TEVA, Exeltis. Equity owner: Therawis Diagnostic GmbH, AIM GmbH. Funding:; Sphingotec, Deutsche Krebshilfe, DFG, Senator Roesner Foundation, Dr. Pommer-Jung; Foundation, Waltraut Bergmann Foundation, Bavarian State Ministry of Economy. WW; has attended advisory boards and served as speaker for Roche, MSD, BMS,; AstraZeneca, Pfizer, Merck, Lilly, Boehringer, Novartis, Takeda, Bayer, Amgen,; Astellas, Eisai, Illumina, Siemens, Agilent, ADC, GSK and Molecular Health. WW; receives research funding from Roche, MSD, BMS and AstraZeneca. All other authors; have declared no conflicts of interest. Ethical approval For the evaluation,; anonymized patient data was used, therefore this retrospective study does not; require ethics approval.
Outcome of breast cancer patients with low hormone receptor positivity: analysis of a 15-year population-based cohort
Publication date
2021
Abstract
BACKGROUND: Guideline recommendations for the treatment of breast cancer with low hormone receptor (HR) expression (1%-9%) are ambiguous and several studies showed more similarities with HR-negative tumors than with HR strongly positive tumors (>/=10%). We used a population-based 15-year cohort to compare patient characteristics and outcome of HR low positive tumors with HR-negative and HR strongly positive tumors, respectively. PATIENTS AND METHODS: A total of 38 560 women diagnosed with early invasive breast cancer between 2004 and 2018 within the scope of the Munich Cancer Registry with 4.9 million inhabitants were included. Descriptive analyses of prognostic factors, treatment, and outcome analyses using the Kaplan-Meier method; cumulative incidence in consideration of competing risks; and multivariate analyses (Cox regression and Fine-Gray model) were conducted. Endpoints were time to local recurrence (TTLR), time to lymph node recurrence (TTLNR), time to metastasis (TTM), overall survival (OS), and relative survival (RS). RESULTS: A total of 861 patients (2%) had HR low positive, 4862 (13%) HR-negative, and 32 837 (85%) HR strongly positive tumors. Within the HER2-negative cohort (n = 33 366), survival of HR low positive tumors was significantly worse than that of HR strongly positive tumors [OS hazard ratio 0.66 (95% confidence interval 0.55-0.78)], whereas between HR low positive and HR-negative tumors no significant survival difference could be detected [OS hazard ratio 0.93 (95% confidence interval 0.78-1.11)]. TTLR, TTLNR, and TTM showed similar results. By contrast, within the HER2-positive cohort (n = 5194), no statistically significant differences between the three HR groups could be detected in multivariate analyses. CONCLUSION: Current definitions for HR positivity and its clinical relevance should be reconsidered. Patients with HR low positive/HER2-negative tumors could be regarded and treated similar to patients with triple-negative tumors.
DOI
https://www.doi.org/10.1016/j.annonc.2021.08.1988
Keywords
breast cancer; cancer registry; health services research; hormone receptor; systemic therapy; Lilly, MSD, Novartis, Pierre Fabre, Pfizer, Roche, Sandoz/Hexal, Seagen outsides; the submitted work. SM has attended advisory boards, provided research support,; and received honoraria and travel expenses from AbbVie, AstraZeneca, Clovis,; Eisai, GlaxoSmithKline, Medac, MSD, Novartis, Olympus, PharmaMar, Pfizer, Roche,; Sensor Kinesis, Teva, Tesaro. MK declares the following COIs: Renumeration:; Springer Press, Biermann Press, Celgene, Astra Zeneca, Myriad Genetics, TEVA, Eli; Lilly. Consultant/advisory role: Myriad Genetics, Bavarian KVB, DKMS Life, BLAEK,; TEVA, Exeltis. Equity owner: Therawis Diagnostic GmbH, AIM GmbH. Funding:; Sphingotec, Deutsche Krebshilfe, DFG, Senator Roesner Foundation, Dr. Pommer-Jung; Foundation, Waltraut Bergmann Foundation, Bavarian State Ministry of Economy. WW; has attended advisory boards and served as speaker for Roche, MSD, BMS,; AstraZeneca, Pfizer, Merck, Lilly, Boehringer, Novartis, Takeda, Bayer, Amgen,; Astellas, Eisai, Illumina, Siemens, Agilent, ADC, GSK and Molecular Health. WW; receives research funding from Roche, MSD, BMS and AstraZeneca. All other authors; have declared no conflicts of interest. Ethical approval For the evaluation,; anonymized patient data was used, therefore this retrospective study does not; require ethics approval.
Schultze, M.; Müller-Nordhorn, J.; Holmberg, C.. (2020) Discussing the effects of prostate cancer beyond biographical disruption and new normalcy: the experiences of men with prostate cancer in Germany. Sociol Health Illn. https://www.doi.org/10.1111/1467-9566.13113
Title
Discussing the effects of prostate cancer beyond biographical disruption and new normalcy: the experiences of men with prostate cancer in Germany
Publication date
2020
Abstract
The concept of biographical disruption has been used to explain the experience of a cancer diagnosis. Studies on cancer experience increasingly suggest that people diagnosed in older age may not have such disruptive experiences. Prostate cancer is diagnosed more often in older men and is often considered a disease of old age; furthermore, the signs of illness in prostate cancer and the signs of ageing might become convoluted. With this in mind, this paper aims to explore how 42 men with prostate cancer who participated in an interview study respond to and make sense of bodily changes. The sample was selected using a maximum variation strategy in order to describe a range of possible experiences with prostate cancer. Analysis was conducted thematically. The men's narratives tell of the constant process of dealing with ageing-related and/or cancer-related changes to both their bodies and their social interactions, and their struggle to disentangle the related effects of ageing and/or cancer on their bodies. We describe how men "muddle through" problems of urinary leakage, potency and loss of libido. We then identify how men attributed changes as part of ageing and/or cancer to (better) manage the experiences of loss.
DOI
https://www.doi.org/10.1111/1467-9566.13113
Keywords
Adaptation, Psychological; Aged; Aging; Germany; Humans; Male; Narration; *Prostatic Neoplasms; *ageing; *biographical disruption; *coping strategies; *interviewing (qualitative); *prostate cancer
Discussing the effects of prostate cancer beyond biographical disruption and new normalcy: the experiences of men with prostate cancer in Germany
Publication date
2020
Abstract
The concept of biographical disruption has been used to explain the experience of a cancer diagnosis. Studies on cancer experience increasingly suggest that people diagnosed in older age may not have such disruptive experiences. Prostate cancer is diagnosed more often in older men and is often considered a disease of old age; furthermore, the signs of illness in prostate cancer and the signs of ageing might become convoluted. With this in mind, this paper aims to explore how 42 men with prostate cancer who participated in an interview study respond to and make sense of bodily changes. The sample was selected using a maximum variation strategy in order to describe a range of possible experiences with prostate cancer. Analysis was conducted thematically. The men's narratives tell of the constant process of dealing with ageing-related and/or cancer-related changes to both their bodies and their social interactions, and their struggle to disentangle the related effects of ageing and/or cancer on their bodies. We describe how men "muddle through" problems of urinary leakage, potency and loss of libido. We then identify how men attributed changes as part of ageing and/or cancer to (better) manage the experiences of loss.
DOI
https://www.doi.org/10.1111/1467-9566.13113
Keywords
Adaptation, Psychological; Aged; Aging; Germany; Humans; Male; Narration; *Prostatic Neoplasms; *ageing; *biographical disruption; *coping strategies; *interviewing (qualitative); *prostate cancer
Schumann, L.; Eisemann, N.; Augustin, J.; et al. (2023) Association of early-stage incidence and mortality in malignant melanoma - a population-based ecological study. J Dtsch Dermatol Ges. https://www.doi.org/10.1111/ddg.15218
Title
Association of early-stage incidence and mortality in malignant melanoma - a population-based ecological study
Publication date
2023
Abstract
BACKGROUND: Germany-wide skin cancer screening was introduced in 2008 to reduce skin cancer mortality and morbidity. However, the effectiveness of the program is still unclear. We explore the relationship between early-stage melanoma incidence and melanoma mortality in subsequent years, using early-stage melanoma incidence as surrogate for screening participation and early detection. PATIENTS AND METHODS: Data on melanoma incidence for 2005-2016 and melanoma mortality for 2005-2018 were obtained for 244 German counties. We investigated the correlation between several measures of incidence and mortality with correlation analyses and linear regressions. RESULTS: Melanoma incidence of early stages (in situ and T1) rose by 69% between pre-screening (2005-2007) and screening period (2008-2010). In contrast, there was no temporal trend in mortality over time. Correlation coefficients between incidence and mortality variables ranged between -0.14 and 0.10 (not significant). Linear regression indicated that mortality 6 years after screening introduction decreases with increasing change in early-stage incidence (b = -0.0029, 95% confidence interval [-0.0066, 0.0007]). CONCLUSIONS: The estimated population-based effects of skin cancer screening on melanoma mortality were minimal and not significant. A potential effectiveness cannot be demonstrated.
DOI
https://www.doi.org/10.1111/ddg.15218
Keywords
early detection; effectiveness; screening; skin cancer
Association of early-stage incidence and mortality in malignant melanoma - a population-based ecological study
Publication date
2023
Abstract
BACKGROUND: Germany-wide skin cancer screening was introduced in 2008 to reduce skin cancer mortality and morbidity. However, the effectiveness of the program is still unclear. We explore the relationship between early-stage melanoma incidence and melanoma mortality in subsequent years, using early-stage melanoma incidence as surrogate for screening participation and early detection. PATIENTS AND METHODS: Data on melanoma incidence for 2005-2016 and melanoma mortality for 2005-2018 were obtained for 244 German counties. We investigated the correlation between several measures of incidence and mortality with correlation analyses and linear regressions. RESULTS: Melanoma incidence of early stages (in situ and T1) rose by 69% between pre-screening (2005-2007) and screening period (2008-2010). In contrast, there was no temporal trend in mortality over time. Correlation coefficients between incidence and mortality variables ranged between -0.14 and 0.10 (not significant). Linear regression indicated that mortality 6 years after screening introduction decreases with increasing change in early-stage incidence (b = -0.0029, 95% confidence interval [-0.0066, 0.0007]). CONCLUSIONS: The estimated population-based effects of skin cancer screening on melanoma mortality were minimal and not significant. A potential effectiveness cannot be demonstrated.
DOI
https://www.doi.org/10.1111/ddg.15218
Keywords
early detection; effectiveness; screening; skin cancer
Spanier, G.; Böttcher, J.; Gerken, M.; et al. (2020) Prognostic value of perioperative red blood cell transfusion and anemia on survival and recurrence in oral squamous cell carcinoma. Oral Oncol. https://www.doi.org/10.1016/j.oraloncology.2020.104773
Title
Prognostic value of perioperative red blood cell transfusion and anemia on survival and recurrence in oral squamous cell carcinoma
Publication date
2020
Abstract
OBJECTIVE: To evaluate the prognostic effect of allogenic red blood cell transfusion (RBT) and preoperative anemia in patients with oral squamous cell carcinoma (OSCC) undergoing primary tumor resection. METHODS: We retrospectively analyzed a cohort of 621 patients, diagnosed with OSCC receiving tumor resection in curative intention. Preoperative anemia and perioperative RBT were evaluated according to WHO definition. Overall survival (OAS) as well as recurrence-free survival (RFS) was evaluated in transfused and non-transfused as well as in anemic and non-anemic patients. In addition, outcome parameters were calculated for distinct amounts of perioperatively administered RBTs. Data analysis was performed by uni- and multivariate statistics. Mean follow-up time was 7.3 years. RESULTS: Preoperative anemia was diagnosed in 29% of OSCC patients. Anemic patients displayed a significantly decreased five-year OAS (44%) in comparison to non-anemic equivalents (69%). 70% of non-transfused OSCC patients were alive after five years, whereas in case of RBT five-year OAS was 41%. These findings were substantiated by subgroup analysis in patients without preoperative anemia. For anemic patients however, no deleterious effect on survival in case of perioperative RBT was seen. Increasing numbers of received RBTs were shown to worsen outcome of OSCC patients in a dose-dependent manner. CONCLUSION: Preoperative anemia and RBT are significantly associated with impaired long-term outcome of patients suffering from OSCC. Future studies are needed to evaluate differentiated effects of RBTs in anemic and non-anemic OSCC patients and accordingly providing individual transfusion strategies to ameliorate outcome of patients suffering from OSCC.
DOI
https://www.doi.org/10.1016/j.oraloncology.2020.104773
Keywords
*Anemia; *Oral cancer; *Oral squamous cell carcinoma; *Survival; *Trim; *Transfusion; *Transfusion-related immunomodulation; of interest.
Prognostic value of perioperative red blood cell transfusion and anemia on survival and recurrence in oral squamous cell carcinoma
Publication date
2020
Abstract
OBJECTIVE: To evaluate the prognostic effect of allogenic red blood cell transfusion (RBT) and preoperative anemia in patients with oral squamous cell carcinoma (OSCC) undergoing primary tumor resection. METHODS: We retrospectively analyzed a cohort of 621 patients, diagnosed with OSCC receiving tumor resection in curative intention. Preoperative anemia and perioperative RBT were evaluated according to WHO definition. Overall survival (OAS) as well as recurrence-free survival (RFS) was evaluated in transfused and non-transfused as well as in anemic and non-anemic patients. In addition, outcome parameters were calculated for distinct amounts of perioperatively administered RBTs. Data analysis was performed by uni- and multivariate statistics. Mean follow-up time was 7.3 years. RESULTS: Preoperative anemia was diagnosed in 29% of OSCC patients. Anemic patients displayed a significantly decreased five-year OAS (44%) in comparison to non-anemic equivalents (69%). 70% of non-transfused OSCC patients were alive after five years, whereas in case of RBT five-year OAS was 41%. These findings were substantiated by subgroup analysis in patients without preoperative anemia. For anemic patients however, no deleterious effect on survival in case of perioperative RBT was seen. Increasing numbers of received RBTs were shown to worsen outcome of OSCC patients in a dose-dependent manner. CONCLUSION: Preoperative anemia and RBT are significantly associated with impaired long-term outcome of patients suffering from OSCC. Future studies are needed to evaluate differentiated effects of RBTs in anemic and non-anemic OSCC patients and accordingly providing individual transfusion strategies to ameliorate outcome of patients suffering from OSCC.
DOI
https://www.doi.org/10.1016/j.oraloncology.2020.104773
Keywords
*Anemia; *Oral cancer; *Oral squamous cell carcinoma; *Survival; *Trim; *Transfusion; *Transfusion-related immunomodulation; of interest.
Spanier, G.; Ugele, I.; Nieberle, F.; et al. (2021) The predictive power of CD3(+) T cell infiltration of oral squamous cell tumors is limited to non-diabetic patients. Cancer Lett. https://www.doi.org/10.1016/j.canlet.2020.11.029
Title
The predictive power of CD3(+) T cell infiltration of oral squamous cell tumors is limited to non-diabetic patients
Publication date
2021
Abstract
Diabetes mellitus type II (DM) and immune cell infiltration determine patient outcome in many tumor entities. Here we studied a possible link between the metabolic and immune cell status of OSCC patients. Glucose transporter (GLUT) 1 mRNA expression was elevated in all tumor samples, whereas other glycolytic markers such as lactate dehydrogenase (LDH) A or monocarboxylate transporter (MCT) 1 were increased in tumor samples from patients with diabetes and these patients had a significantly worse prognosis compared to non-diabetic patients. Analyses of immune cell infiltration in tumors from diabetic and non-diabetic patients revealed an increased leukocyte (CD45(+)) infiltration compared to normal mucosa only in non-diabetic patients. In line, the amount of CD3(+) T cells per mm(2) tumor tissue, was elevated in patients without diabetes and crucial for patient outcome in OSCC patients without diabetes, as compared to healthy mucosa using fluorescence immunohistochemistry in tissue microarrays of 229 patients. Our results demonstrate that diabetes is a prognostic factor for OSCC patients and associates with decreased leukocyte and CD3(+) infiltration indicating that metabolic differences between diabetic and non-diabetic patients may alter tumor-infiltrating T cells and thereby determine patient outcome.
DOI
https://www.doi.org/10.1016/j.canlet.2020.11.029
Keywords
Adult; CD3 Complex/metabolism; Diabetes Mellitus, Type 2/*epidemiology/immunology/metabolism; Glucose Transporter Type 1/metabolism; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymphocytes, Tumor-Infiltrating/*immunology/metabolism; Male; Middle Aged; Monocarboxylic Acid Transporters/metabolism; Mouth Mucosa/immunology/pathology/surgery; Mouth Neoplasms/immunology/metabolism/*mortality/surgery; Predictive Value of Tests; Prognosis; Risk Assessment/methods/statistics & numerical data; Risk Factors; Squamous Cell Carcinoma of Head and Neck/immunology/metabolism/*mortality/surgery; Symporters/metabolism; T-Lymphocytes/*immunology/metabolism; Warburg Effect, Oncologic; Diabetes mellitus; Metabolism; Oscc; Til
The predictive power of CD3(+) T cell infiltration of oral squamous cell tumors is limited to non-diabetic patients
Publication date
2021
Abstract
Diabetes mellitus type II (DM) and immune cell infiltration determine patient outcome in many tumor entities. Here we studied a possible link between the metabolic and immune cell status of OSCC patients. Glucose transporter (GLUT) 1 mRNA expression was elevated in all tumor samples, whereas other glycolytic markers such as lactate dehydrogenase (LDH) A or monocarboxylate transporter (MCT) 1 were increased in tumor samples from patients with diabetes and these patients had a significantly worse prognosis compared to non-diabetic patients. Analyses of immune cell infiltration in tumors from diabetic and non-diabetic patients revealed an increased leukocyte (CD45(+)) infiltration compared to normal mucosa only in non-diabetic patients. In line, the amount of CD3(+) T cells per mm(2) tumor tissue, was elevated in patients without diabetes and crucial for patient outcome in OSCC patients without diabetes, as compared to healthy mucosa using fluorescence immunohistochemistry in tissue microarrays of 229 patients. Our results demonstrate that diabetes is a prognostic factor for OSCC patients and associates with decreased leukocyte and CD3(+) infiltration indicating that metabolic differences between diabetic and non-diabetic patients may alter tumor-infiltrating T cells and thereby determine patient outcome.
DOI
https://www.doi.org/10.1016/j.canlet.2020.11.029
Keywords
Adult; CD3 Complex/metabolism; Diabetes Mellitus, Type 2/*epidemiology/immunology/metabolism; Glucose Transporter Type 1/metabolism; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymphocytes, Tumor-Infiltrating/*immunology/metabolism; Male; Middle Aged; Monocarboxylic Acid Transporters/metabolism; Mouth Mucosa/immunology/pathology/surgery; Mouth Neoplasms/immunology/metabolism/*mortality/surgery; Predictive Value of Tests; Prognosis; Risk Assessment/methods/statistics & numerical data; Risk Factors; Squamous Cell Carcinoma of Head and Neck/immunology/metabolism/*mortality/surgery; Symporters/metabolism; T-Lymphocytes/*immunology/metabolism; Warburg Effect, Oncologic; Diabetes mellitus; Metabolism; Oscc; Til
Spoerl, S.; Erber, R.; Gerken, M.; et al. (2023) A20 as a Potential New Tool in Predicting Recurrence and Patient's Survival in Oral Squamous Cell Carcinoma. Cancers (Basel). https://www.doi.org/10.3390/cancers15030675
Title
A20 as a Potential New Tool in Predicting Recurrence and Patient's Survival in Oral Squamous Cell Carcinoma
Publication date
2023
Abstract
A20, known as a potent inhibitor of NF-kappaB signaling, has been characterized in numerous clinical as well as preclinical studies. Recently, especially in various malignant diseases, the prognostic and therapeutic relevance of A20 was investigated. In oral squamous cell carcinoma (OSCC) however, the characterization of A20 is uncharted territory. We analyzed a tissue microarray (TMA) of 229 surgically-treated OSCC patients (2003-2013). Immunohistochemical (IHC) stainings were performed for A20 and CD3; additionally, standard haematoxylin-eosin staining was applied. IHC findings were correlated with a comprehensive dataset, comprising clinical and pathohistological information. A20 expression was analyzed in tumor cells as well as in tumor infiltrating lymphocytes (TILs) and correlated with the overall survival (OS) and recurrence-free survival (RFS) using uni- and multivariable Cox regression. The median follow-up time was 10.9 years and the A20 expression was significantly decreased in CD3+ TILs compared to mucosa-infiltrating lymphocytes (MILs). In the Kaplan-Meier analyses, higher A20 expression in TILs was correlated with better OS (p = 0.017) and RFS (p = 0.020). In the multivariable survival analysis, A20 overexpression correlated with improved OS (HR: 0.582; 95% CI 0.388-0.873, p = 0.009) and RFS (HR 0.605; 95% CI 0.411-0.889, p = 0.011). Our results indicate a novel prognostic role for A20 in OSCC. Due to its elevated expression in TILs, further research is highly desirable, which therefore could offer new therapeutic opportunities for patients suffering from OSCC.
DOI
https://www.doi.org/10.3390/cancers15030675
Keywords
A20; Oscc; Tnfaip3; oral squamous cell carcinoma; tissue microarray
A20 as a Potential New Tool in Predicting Recurrence and Patient's Survival in Oral Squamous Cell Carcinoma
Publication date
2023
Abstract
A20, known as a potent inhibitor of NF-kappaB signaling, has been characterized in numerous clinical as well as preclinical studies. Recently, especially in various malignant diseases, the prognostic and therapeutic relevance of A20 was investigated. In oral squamous cell carcinoma (OSCC) however, the characterization of A20 is uncharted territory. We analyzed a tissue microarray (TMA) of 229 surgically-treated OSCC patients (2003-2013). Immunohistochemical (IHC) stainings were performed for A20 and CD3; additionally, standard haematoxylin-eosin staining was applied. IHC findings were correlated with a comprehensive dataset, comprising clinical and pathohistological information. A20 expression was analyzed in tumor cells as well as in tumor infiltrating lymphocytes (TILs) and correlated with the overall survival (OS) and recurrence-free survival (RFS) using uni- and multivariable Cox regression. The median follow-up time was 10.9 years and the A20 expression was significantly decreased in CD3+ TILs compared to mucosa-infiltrating lymphocytes (MILs). In the Kaplan-Meier analyses, higher A20 expression in TILs was correlated with better OS (p = 0.017) and RFS (p = 0.020). In the multivariable survival analysis, A20 overexpression correlated with improved OS (HR: 0.582; 95% CI 0.388-0.873, p = 0.009) and RFS (HR 0.605; 95% CI 0.411-0.889, p = 0.011). Our results indicate a novel prognostic role for A20 in OSCC. Due to its elevated expression in TILs, further research is highly desirable, which therefore could offer new therapeutic opportunities for patients suffering from OSCC.
DOI
https://www.doi.org/10.3390/cancers15030675
Keywords
A20; Oscc; Tnfaip3; oral squamous cell carcinoma; tissue microarray
Spoerl, S.; Gerken, M.; Chamilos, C.; et al. (2022) Clinical significance of panendoscopy in initial staging of oral squamous cell carcinoma and detection of synchronous second malignancies of the upper aerodigestive tract - Insights from a retrospective population-based cohort study. J Craniomaxillofac Surg. https://www.doi.org/10.1016/j.jcms.2022.04.001
Title
Clinical significance of panendoscopy in initial staging of oral squamous cell carcinoma and detection of synchronous second malignancies of the upper aerodigestive tract - Insights from a retrospective population-based cohort study
Publication date
2022
Abstract
The aim of this study was to examine the prevalence of synchronous upper aerodigestive tract (UAT) tumors within oral squamous cell carcinoma (OSCC) patients, and to specify distinct risk groups who benefit from panendoscopy. Definite clinical and pathohistological characteristics, as well as overall and recurrence-free survival (OAS and RFS, respectively) of OSCC patients with and without synchronous second UAT tumors, carcinomas in situ, or higher-grade dysplasia/metaplasia, were evaluated based on a retrospective population-based cohort study, including alignment with cancer registry data. Out of 727 included OSCC patients, 465 cases (64.0%) received panendoscopy. Among these, 18 UAT tumors were detected, all of which were linked to patients with a positive history of nicotine abuse. Every synchronous UAT tumor was revealed by panendoscopy, which, analyzed as an independent staging procedure, was accompanied by a low complication rate (1.7%). When illuminating the impact of a second UAT tumor in OSCC patients, survival analysis revealed reduced 5-year OAS (63.9% vs 43.5%, p = 0.010) and RFS (57.1% vs 32.4%, p = 0.016) for patients with a second oncology diagnosis of the UAT. Within the limitations of the study, it seems that panendoscopy should be performed in the majority of patients suffering from OSCC, because most of them have a history of smoking and drinking, which correlates with an increased risk of developing synchronous UAT tumors.
DOI
https://www.doi.org/10.1016/j.jcms.2022.04.001
Keywords
*Carcinoma, Squamous Cell/pathology; Cohort Studies; *Head and Neck Neoplasms/epidemiology/pathology; Humans; *Mouth Neoplasms/pathology; Neoplasm Staging; *Neoplasms, Multiple Primary/diagnosis/epidemiology/pathology; *Neoplasms, Second Primary/epidemiology/pathology; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck/pathology; Oral cancer; Oral squamous cell carcinoma; Panendoscopy; Risk factor; Staging; Synchronous second carcinoma; Upper aerodigestive tract
Clinical significance of panendoscopy in initial staging of oral squamous cell carcinoma and detection of synchronous second malignancies of the upper aerodigestive tract - Insights from a retrospective population-based cohort study
Publication date
2022
Abstract
The aim of this study was to examine the prevalence of synchronous upper aerodigestive tract (UAT) tumors within oral squamous cell carcinoma (OSCC) patients, and to specify distinct risk groups who benefit from panendoscopy. Definite clinical and pathohistological characteristics, as well as overall and recurrence-free survival (OAS and RFS, respectively) of OSCC patients with and without synchronous second UAT tumors, carcinomas in situ, or higher-grade dysplasia/metaplasia, were evaluated based on a retrospective population-based cohort study, including alignment with cancer registry data. Out of 727 included OSCC patients, 465 cases (64.0%) received panendoscopy. Among these, 18 UAT tumors were detected, all of which were linked to patients with a positive history of nicotine abuse. Every synchronous UAT tumor was revealed by panendoscopy, which, analyzed as an independent staging procedure, was accompanied by a low complication rate (1.7%). When illuminating the impact of a second UAT tumor in OSCC patients, survival analysis revealed reduced 5-year OAS (63.9% vs 43.5%, p = 0.010) and RFS (57.1% vs 32.4%, p = 0.016) for patients with a second oncology diagnosis of the UAT. Within the limitations of the study, it seems that panendoscopy should be performed in the majority of patients suffering from OSCC, because most of them have a history of smoking and drinking, which correlates with an increased risk of developing synchronous UAT tumors.
DOI
https://www.doi.org/10.1016/j.jcms.2022.04.001
Keywords
*Carcinoma, Squamous Cell/pathology; Cohort Studies; *Head and Neck Neoplasms/epidemiology/pathology; Humans; *Mouth Neoplasms/pathology; Neoplasm Staging; *Neoplasms, Multiple Primary/diagnosis/epidemiology/pathology; *Neoplasms, Second Primary/epidemiology/pathology; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck/pathology; Oral cancer; Oral squamous cell carcinoma; Panendoscopy; Risk factor; Staging; Synchronous second carcinoma; Upper aerodigestive tract
Spoerl, S.; Gerken, M.; Fischer, R.; et al. (2020) Lymphatic and vascular invasion in oral squamous cell carcinoma: Implications for recurrence and survival in a population-based cohort study. Oral Oncol. https://www.doi.org/10.1016/j.oraloncology.2020.105009
Title
Lymphatic and vascular invasion in oral squamous cell carcinoma: Implications for recurrence and survival in a population-based cohort study
Publication date
2020
Abstract
OBJECTIVE: Numerous studies analyzed lymphovascular invasion (LVI) in various malignant diseases, however, little is known about the role of lymphatic invasion (LI) as well as vascular invasion (VI) in oral squamous cell carcinoma (OSCC). The aim of this study is to illuminate the role of LI and VI in a population-based cohort study. METHODS: We retrospectively analyzed 745 primarily resected OSCC patients in Eastern Bavaria for histopathologically verified LI and VI. Overall survival (OS) and recurrence-free survival (RFS) were calculated, whereas analysis was performed by uni- and multivariate statistics. Mean follow-up time was 7.4 years. RESULTS: LI was found in 115 patients (15.4%), VI was diagnosed in 23 cases (3.1%). LI correlated significantly with distinct anatomical sites (p = 0.004), increasing pT-classification (p < 0.001), lymph node involvement (p < 0.001), higher grading (p < 0.001), advanced UICC-stages (p < 0.001) and adjuvant therapies (p < 0.001). Similar results were found for VI. Survival analysis resulted in a significantly decreased five-year OS and RFS in patients with diagnosed LI (OS: 41.1%, RFS: 38.3%) in contrast to LI-negative cases (OS: 66.8%, RFS: 59.7.7%, p < 0.001). Analogous outcomes were seen for patients with VI. Additionally, LI was identified as a predictive parameter, indicating individual patients' response to adjuvant therapies. CONCLUSION: This population-based cohort study underlines the unfavorable aspect of LI and VI on outcome in OSCC. Including LI and VI in existing staging systems could help to stratify patients' risk for adverse outcome and consecutively determine adjuvant treatment in malignant disease.
DOI
https://www.doi.org/10.1016/j.oraloncology.2020.105009
Keywords
Adult; Aged; Aged, 80 and over; Analysis of Variance; Blood Vessels/*pathology; Chemoradiotherapy, Adjuvant; Cohort Studies; Disease-Free Survival; Female; Follow-Up Studies; Germany; Humans; Lymph Nodes/pathology; Lymphatic Vessels/*pathology; Male; Middle Aged; Mouth Neoplasms/mortality/*pathology/surgery/therapy; Neoplasm Invasiveness/pathology; *Neoplasm Recurrence, Local/mortality; Radiotherapy, Adjuvant; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck/mortality/*pathology/surgery/therapy; Survival Analysis; *Adjuvant therapy; *Blood vessel invasion; *Lymphatic vessel invasion; *Lymphovascular invasion; *Oral squamous cell carcinoma; *Survival
Lymphatic and vascular invasion in oral squamous cell carcinoma: Implications for recurrence and survival in a population-based cohort study
Publication date
2020
Abstract
OBJECTIVE: Numerous studies analyzed lymphovascular invasion (LVI) in various malignant diseases, however, little is known about the role of lymphatic invasion (LI) as well as vascular invasion (VI) in oral squamous cell carcinoma (OSCC). The aim of this study is to illuminate the role of LI and VI in a population-based cohort study. METHODS: We retrospectively analyzed 745 primarily resected OSCC patients in Eastern Bavaria for histopathologically verified LI and VI. Overall survival (OS) and recurrence-free survival (RFS) were calculated, whereas analysis was performed by uni- and multivariate statistics. Mean follow-up time was 7.4 years. RESULTS: LI was found in 115 patients (15.4%), VI was diagnosed in 23 cases (3.1%). LI correlated significantly with distinct anatomical sites (p = 0.004), increasing pT-classification (p < 0.001), lymph node involvement (p < 0.001), higher grading (p < 0.001), advanced UICC-stages (p < 0.001) and adjuvant therapies (p < 0.001). Similar results were found for VI. Survival analysis resulted in a significantly decreased five-year OS and RFS in patients with diagnosed LI (OS: 41.1%, RFS: 38.3%) in contrast to LI-negative cases (OS: 66.8%, RFS: 59.7.7%, p < 0.001). Analogous outcomes were seen for patients with VI. Additionally, LI was identified as a predictive parameter, indicating individual patients' response to adjuvant therapies. CONCLUSION: This population-based cohort study underlines the unfavorable aspect of LI and VI on outcome in OSCC. Including LI and VI in existing staging systems could help to stratify patients' risk for adverse outcome and consecutively determine adjuvant treatment in malignant disease.
DOI
https://www.doi.org/10.1016/j.oraloncology.2020.105009
Keywords
Adult; Aged; Aged, 80 and over; Analysis of Variance; Blood Vessels/*pathology; Chemoradiotherapy, Adjuvant; Cohort Studies; Disease-Free Survival; Female; Follow-Up Studies; Germany; Humans; Lymph Nodes/pathology; Lymphatic Vessels/*pathology; Male; Middle Aged; Mouth Neoplasms/mortality/*pathology/surgery/therapy; Neoplasm Invasiveness/pathology; *Neoplasm Recurrence, Local/mortality; Radiotherapy, Adjuvant; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck/mortality/*pathology/surgery/therapy; Survival Analysis; *Adjuvant therapy; *Blood vessel invasion; *Lymphatic vessel invasion; *Lymphovascular invasion; *Oral squamous cell carcinoma; *Survival
Spoerl, S.; Gerken, M.; Fischer, R.; et al. (2023) Statin Use Ameliorates Survival in Oral Squamous Cell Carcinoma-Data from a Population-Based Cohort Study Applying Propensity Score Matching. Biomedicines. https://www.doi.org/10.3390/biomedicines11020369
Title
Statin Use Ameliorates Survival in Oral Squamous Cell Carcinoma-Data from a Population-Based Cohort Study Applying Propensity Score Matching
Publication date
2023
Abstract
The anti-cancer properties of statins have attracted much attention recently, but little is known about the prognostic role of statins in oral squamous cell carcinoma (OSCC). In a retrospective approach, we analyzed a population-based cohort of 602 OSCC patients with primary curative tumor resection to negative margins and concomitant neck dissection between 2005-2017. Long-term medication with statins was correlated with overall survival (OAS) as well as recurrence-free survival (RFS) using uni- and multivariable Cox regression. Additionally, propensity score matching was applied to adjust for confounders. Statin use was present in 96 patients (15.9%) at a median age of 65.7 years. Statin treatment correlated with ameliorated survival in multivariable Cox regression in the complete cohort (OAS: HR 0.664; 95% CI 0.467-0.945, p = 0.023; RFS: HR 0.662; 95% CI 0.476-0.920, p = 0.014) as well as matched-pair cohort of OSCC patients (OAS: HR 0.691; 95% CI 0.479-0.997, p = 0.048; RFS: HR 0.694; 95% CI 0.493-0.976, p = 0.036) when compared to patients not taking statins at time of diagnosis. These findings were even more pronounced by sub-group analysis in the matched-pair cohort (age < 70 years). These data indicate that statin use might ameliorate the oncological outcome in primarily resected OSCC patients, but prospective clinical trials are highly recommended.
DOI
https://www.doi.org/10.3390/biomedicines11020369
Keywords
Cvd; Hnscc; Oscc; Psm; cardiovascular disease; hydroxymethylglutaryl CoA reductase inhibitor; oral squamous cell carcinoma; propensity score matching; statin; survival
Statin Use Ameliorates Survival in Oral Squamous Cell Carcinoma-Data from a Population-Based Cohort Study Applying Propensity Score Matching
Publication date
2023
Abstract
The anti-cancer properties of statins have attracted much attention recently, but little is known about the prognostic role of statins in oral squamous cell carcinoma (OSCC). In a retrospective approach, we analyzed a population-based cohort of 602 OSCC patients with primary curative tumor resection to negative margins and concomitant neck dissection between 2005-2017. Long-term medication with statins was correlated with overall survival (OAS) as well as recurrence-free survival (RFS) using uni- and multivariable Cox regression. Additionally, propensity score matching was applied to adjust for confounders. Statin use was present in 96 patients (15.9%) at a median age of 65.7 years. Statin treatment correlated with ameliorated survival in multivariable Cox regression in the complete cohort (OAS: HR 0.664; 95% CI 0.467-0.945, p = 0.023; RFS: HR 0.662; 95% CI 0.476-0.920, p = 0.014) as well as matched-pair cohort of OSCC patients (OAS: HR 0.691; 95% CI 0.479-0.997, p = 0.048; RFS: HR 0.694; 95% CI 0.493-0.976, p = 0.036) when compared to patients not taking statins at time of diagnosis. These findings were even more pronounced by sub-group analysis in the matched-pair cohort (age < 70 years). These data indicate that statin use might ameliorate the oncological outcome in primarily resected OSCC patients, but prospective clinical trials are highly recommended.
DOI
https://www.doi.org/10.3390/biomedicines11020369
Keywords
Cvd; Hnscc; Oscc; Psm; cardiovascular disease; hydroxymethylglutaryl CoA reductase inhibitor; oral squamous cell carcinoma; propensity score matching; statin; survival
Spoerl, S.; Gerken, M.; Mamilos, A.; et al. (2020) Lymph node ratio as a predictor for outcome in oral squamous cell carcinoma: a multicenter population-based cohort study. Clin Oral Investig. https://www.doi.org/10.1007/s00784-020-03471-6
Title
Lymph node ratio as a predictor for outcome in oral squamous cell carcinoma: a multicenter population-based cohort study
Publication date
2020
Abstract
OBJECTIVES: Recently, multiple studies addressed the importance of lymph node ratio (LNR) in specifying patients' risk of disease recurrence in various malignancies. The present study examines the prognostic significance of LNR in predicting outcome of oral squamous cell carcinoma (OSCC) patients after surgical treatment with curative intent. METHODS: Here, we describe a retrospective population-based cohort with 717 patients previously diagnosed with OSCC. Histopathologically verified lymph node metastasis was diagnosed in 290 patients. Among these patients, we evaluated the impact of LNR on overall survival (OAS) and recurrence-free survival (RFS) in uni- as well as multivariate analysis. RESULTS: A median cutoff (0.055) in LNR was found to significantly predict outcome in OSCC patients. Five-year OAS was 54.1% in patients with a low LNR, whereas a high LNR was associated with a 5-year OAS of 33.3% (p < 0.001). Similar results were detected for RFS with a 5-year survival rate of 49.8% (LNR low) and 30.3% (LNR high) (p = 0.002). Results were confirmed in multivariate Cox regression which substantiated the importance of LNR in predicting survival in OSCC patients. CONCLUSIONS: LNR was shown to be an independent prognostic factor for outcome of OSCC in a population-based cohort in uni- as well as multivariate analysis. Hereby, a LNR >/= 0.055 predicted a shorter OAS and RFS in our cohort. CLINICAL RELEVANCE: Besides established histopathological factors, LNR can be used as a reliable predictor of outcome in OSCC and might therefore be further applied in evaluating adjuvant treatment after resection in curative intention.
DOI
https://www.doi.org/10.1007/s00784-020-03471-6
Keywords
Lymph node density; Lymph node ratio; Oral squamous cell carcinoma; Recurrence; Survival
Lymph node ratio as a predictor for outcome in oral squamous cell carcinoma: a multicenter population-based cohort study
Publication date
2020
Abstract
OBJECTIVES: Recently, multiple studies addressed the importance of lymph node ratio (LNR) in specifying patients' risk of disease recurrence in various malignancies. The present study examines the prognostic significance of LNR in predicting outcome of oral squamous cell carcinoma (OSCC) patients after surgical treatment with curative intent. METHODS: Here, we describe a retrospective population-based cohort with 717 patients previously diagnosed with OSCC. Histopathologically verified lymph node metastasis was diagnosed in 290 patients. Among these patients, we evaluated the impact of LNR on overall survival (OAS) and recurrence-free survival (RFS) in uni- as well as multivariate analysis. RESULTS: A median cutoff (0.055) in LNR was found to significantly predict outcome in OSCC patients. Five-year OAS was 54.1% in patients with a low LNR, whereas a high LNR was associated with a 5-year OAS of 33.3% (p < 0.001). Similar results were detected for RFS with a 5-year survival rate of 49.8% (LNR low) and 30.3% (LNR high) (p = 0.002). Results were confirmed in multivariate Cox regression which substantiated the importance of LNR in predicting survival in OSCC patients. CONCLUSIONS: LNR was shown to be an independent prognostic factor for outcome of OSCC in a population-based cohort in uni- as well as multivariate analysis. Hereby, a LNR >/= 0.055 predicted a shorter OAS and RFS in our cohort. CLINICAL RELEVANCE: Besides established histopathological factors, LNR can be used as a reliable predictor of outcome in OSCC and might therefore be further applied in evaluating adjuvant treatment after resection in curative intention.
DOI
https://www.doi.org/10.1007/s00784-020-03471-6
Keywords
Lymph node density; Lymph node ratio; Oral squamous cell carcinoma; Recurrence; Survival
Spoerl, S.; Spanier, G.; Reiter, E.; et al. (2021) Head and neck melanoma: outcome and predictors in a population-based cohort study. Head Face Med. https://www.doi.org/10.1186/s13005-021-00295-x
Title
Head and neck melanoma: outcome and predictors in a population-based cohort study
Publication date
2021
Abstract
BACKGROUND: To evaluate predictive clinico-pathological characteristics on outcome in head and neck melanoma (HNM) in a population-based study with particular emphasis on the prognostic effect of sentinel lymph node biopsy (SLNB), Charlson comorbidity index (CCI) and distinct tumor localisations. METHODS: Here we primarily describe a retrospective multicenter population-based cohort study with 402 patients having undergone resection with curative intent of HNM between 2010 and 2017. SLNB was used in the diagnosis of 79 HNM patients. Outcome was analyzed, focusing on SLNB, CCI as well as tumor localisation. Overall survival (OAS) und recurrence free survival (RFS) was examined by uni- and multivariate analysis. RESULTS: Histopathologically verified lymph node metastasis according to SLNB was associated with impaired RFS in HNM patients (p = 0.004). Especially in higher tumor stages, the sole implementation of SLNB improved survival significantly in the present cohort (p = 0.042). With most of the HNM being located in the face, melanoma of the scalp and neck could be linked to deteriorated patient's outcome in uni- as well as multivariate analysis (p = 0.021, p = 0.004). CONCLUSIONS: SLNB is a useful tool in predicting development of distant metastasis after HNM resection with curative intent. Especially in higher tumor stages, performing a SLNB ameliorated survival of HNM patients. Additionally, CCI as well as a distinct tumor localisations in HNM were identified as important risk factors in our population-based cohort study.
DOI
https://www.doi.org/10.1186/s13005-021-00295-x
Keywords
Cohort Studies; *Head and Neck Neoplasms/epidemiology/surgery; Humans; *Melanoma/epidemiology/surgery; Retrospective Studies; Sentinel Lymph Node Biopsy; Cci; Comorbidities; Head and neck; Melanoma; Recurrence; Slnb; Sentinel lymph node; Survival
Head and neck melanoma: outcome and predictors in a population-based cohort study
Publication date
2021
Abstract
BACKGROUND: To evaluate predictive clinico-pathological characteristics on outcome in head and neck melanoma (HNM) in a population-based study with particular emphasis on the prognostic effect of sentinel lymph node biopsy (SLNB), Charlson comorbidity index (CCI) and distinct tumor localisations. METHODS: Here we primarily describe a retrospective multicenter population-based cohort study with 402 patients having undergone resection with curative intent of HNM between 2010 and 2017. SLNB was used in the diagnosis of 79 HNM patients. Outcome was analyzed, focusing on SLNB, CCI as well as tumor localisation. Overall survival (OAS) und recurrence free survival (RFS) was examined by uni- and multivariate analysis. RESULTS: Histopathologically verified lymph node metastasis according to SLNB was associated with impaired RFS in HNM patients (p = 0.004). Especially in higher tumor stages, the sole implementation of SLNB improved survival significantly in the present cohort (p = 0.042). With most of the HNM being located in the face, melanoma of the scalp and neck could be linked to deteriorated patient's outcome in uni- as well as multivariate analysis (p = 0.021, p = 0.004). CONCLUSIONS: SLNB is a useful tool in predicting development of distant metastasis after HNM resection with curative intent. Especially in higher tumor stages, performing a SLNB ameliorated survival of HNM patients. Additionally, CCI as well as a distinct tumor localisations in HNM were identified as important risk factors in our population-based cohort study.
DOI
https://www.doi.org/10.1186/s13005-021-00295-x
Keywords
Cohort Studies; *Head and Neck Neoplasms/epidemiology/surgery; Humans; *Melanoma/epidemiology/surgery; Retrospective Studies; Sentinel Lymph Node Biopsy; Cci; Comorbidities; Head and neck; Melanoma; Recurrence; Slnb; Sentinel lymph node; Survival
Spoerl, S.; Spoerl, S.; Reil, S.; et al. (2022) Prognostic Value of Perineural Invasion on Survival and Recurrence in Oral Squamous Cell Carcinoma. Diagnostics (Basel). https://www.doi.org/10.3390/diagnostics12051062
Title
Prognostic Value of Perineural Invasion on Survival and Recurrence in Oral Squamous Cell Carcinoma
Publication date
2022
Abstract
A diagnosis of perineural invasion (PNI) is widely accepted as an unfavorable prognostic factor in various solid malignancies. Although PNI has been described as a high-risk parameter in oral squamous cell carcinoma (OSCC), its role in the current staging manuals of the American Joint Committee on Cancer (AJCC) is rather subordinate. We analysed the prognostic value of PNI on survival and recurrence in a large, multicenter OSCC cohort and a population-based approach. A total of 493 OSCC patients with primary tumor resection to negative margins and concomitant neck dissection between 2010 and 2017 were enrolled. PNI was evaluated in relation to overall survival (OAS) and recurrence-free survival (RFS) using uni- and multi-variable Cox regression. The median follow-up time was 5.0 years and PNI was diagnosed in 48 patients (9.7%). A pathohistological verification of PNI correlated significantly with a deteriorated OAS in uni- (HR 2.312; 95% CI 2.312-3.493, p = 0.001) and multivariable Cox regression (HR 1.820; 95% CI 1.164-2.847, p = 0.009). Additionally, a diagnosis of PNI correlated with increased cumulative, as well as distant, metastasis 5-year-recurrence rates (p = 0.027 and p = 0.011, respectively). The application of adjuvant radiotherapy (RT) or radiochemotherapy (RCT) in patients with PNI did not alter OAS or RFS in survival analysis when compared to patients without PNI. The results underline the adverse impact of PNI on the survival and recurrence of surgically treated OSCC patients. Based on our findings, we highly recommend an emphasis on PNI in the TNM staging concept.
DOI
https://www.doi.org/10.3390/diagnostics12051062
Keywords
Pni; oral cancer; oral squamous cell carcinoma; perineural invasion; recurrence; survival
Prognostic Value of Perineural Invasion on Survival and Recurrence in Oral Squamous Cell Carcinoma
Publication date
2022
Abstract
A diagnosis of perineural invasion (PNI) is widely accepted as an unfavorable prognostic factor in various solid malignancies. Although PNI has been described as a high-risk parameter in oral squamous cell carcinoma (OSCC), its role in the current staging manuals of the American Joint Committee on Cancer (AJCC) is rather subordinate. We analysed the prognostic value of PNI on survival and recurrence in a large, multicenter OSCC cohort and a population-based approach. A total of 493 OSCC patients with primary tumor resection to negative margins and concomitant neck dissection between 2010 and 2017 were enrolled. PNI was evaluated in relation to overall survival (OAS) and recurrence-free survival (RFS) using uni- and multi-variable Cox regression. The median follow-up time was 5.0 years and PNI was diagnosed in 48 patients (9.7%). A pathohistological verification of PNI correlated significantly with a deteriorated OAS in uni- (HR 2.312; 95% CI 2.312-3.493, p = 0.001) and multivariable Cox regression (HR 1.820; 95% CI 1.164-2.847, p = 0.009). Additionally, a diagnosis of PNI correlated with increased cumulative, as well as distant, metastasis 5-year-recurrence rates (p = 0.027 and p = 0.011, respectively). The application of adjuvant radiotherapy (RT) or radiochemotherapy (RCT) in patients with PNI did not alter OAS or RFS in survival analysis when compared to patients without PNI. The results underline the adverse impact of PNI on the survival and recurrence of surgically treated OSCC patients. Based on our findings, we highly recommend an emphasis on PNI in the TNM staging concept.
DOI
https://www.doi.org/10.3390/diagnostics12051062
Keywords
Pni; oral cancer; oral squamous cell carcinoma; perineural invasion; recurrence; survival
Stangl, S.; Haas, K.; Eichner, F. A.; et al. (2020) Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease-the "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry. Pilot Feasibility Stud. https://www.doi.org/10.1186/s40814-019-0541-3
Title
Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease-the "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry
Publication date
2020
Abstract
Background: Patients with metastatic breast cancer (MBC) are treated with a palliative approach with focus on controlling for disease symptoms and maintaining high quality of life. Information on individual needs of patients and their relatives as well as on treatment patterns in clinical routine care for this specific patient group are lacking or are not routinely documented in established Cancer Registries. Thus, we developed a registry concept specifically adapted for these incurable patients comprising primary and secondary data as well as mobile-health (m-health) data. Methods: The concept for patient-centered "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry was developed and piloted exemplarily in the region of Main-Franconia, a mainly rural region in Germany comprising about 1.3 M inhabitants. The registry concept includes data on diagnosis, therapy, progression, patient-reported outcome measures (PROMs), and needs of family members from several sources of information including routine data from established Cancer Registries in different federal states, treating physicians in hospital as well as in outpatient settings, patients with metastatic breast cancer and their family members. Linkage with routine cancer registry data was performed to collect secondary data on diagnosis, therapy, and progression. Paper and online-based questionnaires were used to assess PROMs. A dedicated mobile application software (APP) was developed to monitor needs, progression, and therapy change of individual patients. Patient's acceptance and feasibility of data collection in clinical routine was assessed within a proof-of-concept study. Results: The concept for the BRE-4-MED registry was developed and piloted between September 2017 and May 2018. In total n = 31 patients were included in the pilot study, n = 22 patients were followed up after 1 month. Record linkage with the Cancer Registries of Bavaria and Baden-Wurttemberg demonstrated to be feasible. The voluntary APP/online questionnaire was used by n = 7 participants. The feasibility of the registry concept in clinical routine was positively evaluated by the participating hospitals. Conclusion: The concept of the BRE-4-MED registry provides evidence that combinatorial evaluation of PROMs, needs of family members, and raising clinical parameters from primary and secondary data sources as well as m-health applications are feasible and accepted in an incurable cancer collective.
DOI
https://www.doi.org/10.1186/s40814-019-0541-3
Keywords
Health care service research; Metastatic breast cancer; Patient-centered registry; Patient's needs; m-Health; no disclosures. Felizitas Eichner reports no disclosures. Anna Grau reports no; disclosures. Udo Selig reports no disclosures. Timo Ludwig reports no; disclosures. Tanja Fehm reports no disclosures. Tanja Stuber reports no; disclosure Asarnusch Rashid reports no disclosures. Alexander Kerscher reports no; disclosures. Ralf Bargou reports no disclosures. Silke Hermann reports no; disclosures. Volker Arndt reports no disclosures. Martin Meyer reports no; disclosures. Manfred Wildner reports no disclosures. Hermann Faller reports no; disclosures. Michael G. Schrauder reports no disclosures. Michael Weigel reports; no disclosures. Ulrich Schlembach reports no disclosures. Peter U. Heuschmann; reports research grants from German Ministry of Research and Education, German; Research Foundation, European Union, Charite-Universitatsmedizin Berlin, Berlin; Chamber of Physicians, German Parkinson Society, University Hospital Wurzburg,; Robert Koch Institute, German Heart Foundation, University Gottingen (within; FIND-AF randomized, supported by an unrestricted research grant to the University; Gottingen from Boehringer-Ingelheim), University Hospital Heidelberg (within; RASUNOA-prime, supported by an unrestricted research grant to the University; Hospital Heidelberg from Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo),; grants from Charite-Universitatsmedizin Berlin (within Mondafis, supported by an; unrestricted research grant to the Charite from Bayer), outside the submitted; work. Achim Wockel reports grant from German Ministry of Research and Education,; received honoraria for consultancy and presentation from Amgen, Novartis, Eisai,; Celgene, Pfizer, Tesaro, Aurikamed, TEVA, Lilly, and Roche within the last 5; years.
Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease-the "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry
Publication date
2020
Abstract
Background: Patients with metastatic breast cancer (MBC) are treated with a palliative approach with focus on controlling for disease symptoms and maintaining high quality of life. Information on individual needs of patients and their relatives as well as on treatment patterns in clinical routine care for this specific patient group are lacking or are not routinely documented in established Cancer Registries. Thus, we developed a registry concept specifically adapted for these incurable patients comprising primary and secondary data as well as mobile-health (m-health) data. Methods: The concept for patient-centered "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry was developed and piloted exemplarily in the region of Main-Franconia, a mainly rural region in Germany comprising about 1.3 M inhabitants. The registry concept includes data on diagnosis, therapy, progression, patient-reported outcome measures (PROMs), and needs of family members from several sources of information including routine data from established Cancer Registries in different federal states, treating physicians in hospital as well as in outpatient settings, patients with metastatic breast cancer and their family members. Linkage with routine cancer registry data was performed to collect secondary data on diagnosis, therapy, and progression. Paper and online-based questionnaires were used to assess PROMs. A dedicated mobile application software (APP) was developed to monitor needs, progression, and therapy change of individual patients. Patient's acceptance and feasibility of data collection in clinical routine was assessed within a proof-of-concept study. Results: The concept for the BRE-4-MED registry was developed and piloted between September 2017 and May 2018. In total n = 31 patients were included in the pilot study, n = 22 patients were followed up after 1 month. Record linkage with the Cancer Registries of Bavaria and Baden-Wurttemberg demonstrated to be feasible. The voluntary APP/online questionnaire was used by n = 7 participants. The feasibility of the registry concept in clinical routine was positively evaluated by the participating hospitals. Conclusion: The concept of the BRE-4-MED registry provides evidence that combinatorial evaluation of PROMs, needs of family members, and raising clinical parameters from primary and secondary data sources as well as m-health applications are feasible and accepted in an incurable cancer collective.
DOI
https://www.doi.org/10.1186/s40814-019-0541-3
Keywords
Health care service research; Metastatic breast cancer; Patient-centered registry; Patient's needs; m-Health; no disclosures. Felizitas Eichner reports no disclosures. Anna Grau reports no; disclosures. Udo Selig reports no disclosures. Timo Ludwig reports no; disclosures. Tanja Fehm reports no disclosures. Tanja Stuber reports no; disclosure Asarnusch Rashid reports no disclosures. Alexander Kerscher reports no; disclosures. Ralf Bargou reports no disclosures. Silke Hermann reports no; disclosures. Volker Arndt reports no disclosures. Martin Meyer reports no; disclosures. Manfred Wildner reports no disclosures. Hermann Faller reports no; disclosures. Michael G. Schrauder reports no disclosures. Michael Weigel reports; no disclosures. Ulrich Schlembach reports no disclosures. Peter U. Heuschmann; reports research grants from German Ministry of Research and Education, German; Research Foundation, European Union, Charite-Universitatsmedizin Berlin, Berlin; Chamber of Physicians, German Parkinson Society, University Hospital Wurzburg,; Robert Koch Institute, German Heart Foundation, University Gottingen (within; FIND-AF randomized, supported by an unrestricted research grant to the University; Gottingen from Boehringer-Ingelheim), University Hospital Heidelberg (within; RASUNOA-prime, supported by an unrestricted research grant to the University; Hospital Heidelberg from Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo),; grants from Charite-Universitatsmedizin Berlin (within Mondafis, supported by an; unrestricted research grant to the Charite from Bayer), outside the submitted; work. Achim Wockel reports grant from German Ministry of Research and Education,; received honoraria for consultancy and presentation from Amgen, Novartis, Eisai,; Celgene, Pfizer, Tesaro, Aurikamed, TEVA, Lilly, and Roche within the last 5; years.
Stangl, S.; Rauch, S.; Rauh, J.; et al. (2021) Disparities in accessibility to evidence-based breast cancer care facilities by rural and urban areas in Bavaria, Germany. Cancer. https://www.doi.org/10.1002/cncr.33493
Title
Disparities in accessibility to evidence-based breast cancer care facilities by rural and urban areas in Bavaria, Germany
Publication date
2021
Abstract
BACKGROUND: Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. METHODS: Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof-of-concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population-based Cancer Registry of Bavaria were linked at the district level. RESULTS: Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho-oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. CONCLUSIONS: Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high-quality health care to all inhabitants, regardless of residence.
DOI
https://www.doi.org/10.1002/cncr.33493
Keywords
accessibility; breast cancer; evidence-based medicine; geographic information science; health care service research
Disparities in accessibility to evidence-based breast cancer care facilities by rural and urban areas in Bavaria, Germany
Publication date
2021
Abstract
BACKGROUND: Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. METHODS: Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof-of-concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population-based Cancer Registry of Bavaria were linked at the district level. RESULTS: Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho-oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. CONCLUSIONS: Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high-quality health care to all inhabitants, regardless of residence.
DOI
https://www.doi.org/10.1002/cncr.33493
Keywords
accessibility; breast cancer; evidence-based medicine; geographic information science; health care service research
Staykov, D.; Radespiel-Tröger, M.; Meyer, M.; et al. (2009) Birth month and risk of glioma in adults: a registry-based study in Bavaria. Chronobiol Int. https://www.doi.org/10.1080/07420520902761778
Title
Birth month and risk of glioma in adults: a registry-based study in Bavaria
Publication date
2009
Abstract
The aim of the present study was to evaluate the possible seasonality of birth in adult patients suffering from glioma. For this purpose, data from the database of the population-based cancer registry of Bavaria (Germany) were retrieved. For the period 2002-2005, we identified a total of 2174 patients born between 1931 and 1986 diagnosed with malignant glioma. Statistical analyses failed to document a significant annual periodicity of glioma risk in either men or women with respect to birth month in the observed cohort. Thus, we found no association between month of birth and the risk of glioma. In contrast, an analysis of the official birth rate data of Bavaria revealed marked annual variation in birth rates up until 1965, which decreased markedly in prominence in the years thereafter. Our findings confirm the results of a recent similar study conducted in The Netherlands. Therefore, we support the hypothesis of possible etiological factors of glioma acting in adulthood rather than in the perinatal period.
DOI
https://www.doi.org/10.1080/07420520902761778
Keywords
Adolescent; Adult; Birth Rate; Child; Female; Germany/epidemiology; *Glioma/epidemiology/etiology; Humans; Male; *Parturition; Periodicity; *Registries; Risk Factors; *Seasons
Birth month and risk of glioma in adults: a registry-based study in Bavaria
Publication date
2009
Abstract
The aim of the present study was to evaluate the possible seasonality of birth in adult patients suffering from glioma. For this purpose, data from the database of the population-based cancer registry of Bavaria (Germany) were retrieved. For the period 2002-2005, we identified a total of 2174 patients born between 1931 and 1986 diagnosed with malignant glioma. Statistical analyses failed to document a significant annual periodicity of glioma risk in either men or women with respect to birth month in the observed cohort. Thus, we found no association between month of birth and the risk of glioma. In contrast, an analysis of the official birth rate data of Bavaria revealed marked annual variation in birth rates up until 1965, which decreased markedly in prominence in the years thereafter. Our findings confirm the results of a recent similar study conducted in The Netherlands. Therefore, we support the hypothesis of possible etiological factors of glioma acting in adulthood rather than in the perinatal period.
DOI
https://www.doi.org/10.1080/07420520902761778
Keywords
Adolescent; Adult; Birth Rate; Child; Female; Germany/epidemiology; *Glioma/epidemiology/etiology; Humans; Male; *Parturition; Periodicity; *Registries; Risk Factors; *Seasons
Stürzl, R.; Gerken, M.; Bruns, C.; et al. (2022) [Surgical treatment of adenocarcinoma of the esophagogastric junction type II : Comparison between transhiatal extended gastrectomy and thoracoabdominal esophagectomy]. Chirurgie (Heidelb). https://www.doi.org/10.1007/s00104-022-01703-x
Title
[Surgical treatment of adenocarcinoma of the esophagogastric junction type II : Comparison between transhiatal extended gastrectomy and thoracoabdominal esophagectomy]
Publication date
2022
Abstract
BACKGROUND: The incidence of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased. However, the best surgical treatment for AEG type II is still the subject of current research. The goal of this retrospective cohort study is to compare survival and recurrence rates in patients, who underwent either thoracoabdominal esophagectomy (TAE) or transhiatal extended gastrectomy (TEG). MATERIAL AND METHODS: The study is based on a cohort of 272 patients diagnosed with AEG type II between 2002 and 2020, recorded by a population-based clinical cancer registry. Of the included patients 63 underwent TAE and 209 TEG. In order to compare overall survival, recurrence rates, and recurrence free survival, we applied the Kaplan-Meier method, univariable and multivariable Cox regression. RESULTS: Our analysis showed no statistically significant difference concerning overall survival (p = 0.333). However a tendency towards higher survival rates after TAE for the period from 2016-2020 (p = 0,058) is possible. In contrast a significant difference concerning higher cumulative recurrence rates after TAE was found after Kaplan-Meier analysis (p = 0.049). This trend was not observed for the time after 2016 (p = 0.993), in which over 50% of TAE were performed. No differences were found regarding recurrence-free survival (p = 0.772). CONCLUSION: Our findings in a rather small cohort are concordant with most studies showing no differences or a trend towards better survival after TAE. Other studies found no significant difference regarding recurrence-free survival as well. In conclusion, no significant differences were found between TEG and TAE in surgical treatment of AEG type II.
DOI
https://www.doi.org/10.1007/s00104-022-01703-x
Keywords
Humans; Esophagectomy/methods; Retrospective Studies; *Stomach Neoplasms/surgery; Esophagogastric Junction/surgery; Gastrectomy/methods; *Adenocarcinoma/surgery; AEG type II; Cardia; Siewert classification; Thoracoabdominal esophagectomy; Transhiatal extended gastrectomy
[Surgical treatment of adenocarcinoma of the esophagogastric junction type II : Comparison between transhiatal extended gastrectomy and thoracoabdominal esophagectomy]
Publication date
2022
Abstract
BACKGROUND: The incidence of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased. However, the best surgical treatment for AEG type II is still the subject of current research. The goal of this retrospective cohort study is to compare survival and recurrence rates in patients, who underwent either thoracoabdominal esophagectomy (TAE) or transhiatal extended gastrectomy (TEG). MATERIAL AND METHODS: The study is based on a cohort of 272 patients diagnosed with AEG type II between 2002 and 2020, recorded by a population-based clinical cancer registry. Of the included patients 63 underwent TAE and 209 TEG. In order to compare overall survival, recurrence rates, and recurrence free survival, we applied the Kaplan-Meier method, univariable and multivariable Cox regression. RESULTS: Our analysis showed no statistically significant difference concerning overall survival (p = 0.333). However a tendency towards higher survival rates after TAE for the period from 2016-2020 (p = 0,058) is possible. In contrast a significant difference concerning higher cumulative recurrence rates after TAE was found after Kaplan-Meier analysis (p = 0.049). This trend was not observed for the time after 2016 (p = 0.993), in which over 50% of TAE were performed. No differences were found regarding recurrence-free survival (p = 0.772). CONCLUSION: Our findings in a rather small cohort are concordant with most studies showing no differences or a trend towards better survival after TAE. Other studies found no significant difference regarding recurrence-free survival as well. In conclusion, no significant differences were found between TEG and TAE in surgical treatment of AEG type II.
DOI
https://www.doi.org/10.1007/s00104-022-01703-x
Keywords
Humans; Esophagectomy/methods; Retrospective Studies; *Stomach Neoplasms/surgery; Esophagogastric Junction/surgery; Gastrectomy/methods; *Adenocarcinoma/surgery; AEG type II; Cardia; Siewert classification; Thoracoabdominal esophagectomy; Transhiatal extended gastrectomy
Taubenhansl, C.; Ortmann, O.; Gerken, M.; et al. (2020) Guideline-concordant chemotherapy in patients with hormone receptor-positive and node-positive, early breast cancer leads to better overall and metastases-free survival with limited benefit in elderly patients. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-019-05387-3
Title
Guideline-concordant chemotherapy in patients with hormone receptor-positive and node-positive, early breast cancer leads to better overall and metastases-free survival with limited benefit in elderly patients
Publication date
2020
Abstract
PURPOSE: The German guideline for breast cancer recommends using chemotherapy (CHT) in patients with hormone receptor-positive and node-positive, invasive breast cancer. The aim of this study was to analyse the effects of CHT in this patient group on overall survival (OS) and distant metastases-free survival (DMFS), especially considering the 70-year threshold. METHODS: 1772 patients from the clinical cancer registry Regensburg (Germany) with hormone receptor-positive and node-positive, invasive breast cancer diagnosed between 2003 and 2013 were analysed in a retrospective cohort study. OS and DMFS were evaluated by means of Kaplan-Meier and multivariable Cox-regression method. Results were further examined according to age at diagnosis. RESULTS: The comparison of 1544 patients with CHT to 228 patients without CHT showed a significant benefit for CHT regarding 5-year OS (91.3% vs. 76.8%) and 5-year DMFS (86.7% vs. 74.4%, both p < 0.001). Likewise, better OS and DMFS were seen in patients aged < 70 years using CHT compared to patients without CHT of the same age. Patients aged >/= 70 years with CHT had a minimal benefit regarding 5-year OS compared to patients without CHT, but no advantage considering DMFS. All results were confirmed in multivariable analyses except for patients being >/= 70 years of age. CONCLUSION: Patients with hormone receptor-positive and node-positive, invasive breast cancer benefit from chemotherapy with regard to a significantly better overall and distant metastases-free survival, although chemotherapy use in patients aged >/= 70 years results in a smaller benefit considering OS and no benefit considering DMFS.
DOI
https://www.doi.org/10.1007/s00404-019-05387-3
Keywords
Aged; Breast Neoplasms/*drug therapy/mortality; Chemotherapy, Adjuvant/*methods; Disease-Free Survival; Female; Humans; Middle Aged; *Breast cancer; *Chemotherapy; *Distant metastases-free survival; *Elderly patients; *Hormone and node positive; *Overall survival
Guideline-concordant chemotherapy in patients with hormone receptor-positive and node-positive, early breast cancer leads to better overall and metastases-free survival with limited benefit in elderly patients
Publication date
2020
Abstract
PURPOSE: The German guideline for breast cancer recommends using chemotherapy (CHT) in patients with hormone receptor-positive and node-positive, invasive breast cancer. The aim of this study was to analyse the effects of CHT in this patient group on overall survival (OS) and distant metastases-free survival (DMFS), especially considering the 70-year threshold. METHODS: 1772 patients from the clinical cancer registry Regensburg (Germany) with hormone receptor-positive and node-positive, invasive breast cancer diagnosed between 2003 and 2013 were analysed in a retrospective cohort study. OS and DMFS were evaluated by means of Kaplan-Meier and multivariable Cox-regression method. Results were further examined according to age at diagnosis. RESULTS: The comparison of 1544 patients with CHT to 228 patients without CHT showed a significant benefit for CHT regarding 5-year OS (91.3% vs. 76.8%) and 5-year DMFS (86.7% vs. 74.4%, both p < 0.001). Likewise, better OS and DMFS were seen in patients aged < 70 years using CHT compared to patients without CHT of the same age. Patients aged >/= 70 years with CHT had a minimal benefit regarding 5-year OS compared to patients without CHT, but no advantage considering DMFS. All results were confirmed in multivariable analyses except for patients being >/= 70 years of age. CONCLUSION: Patients with hormone receptor-positive and node-positive, invasive breast cancer benefit from chemotherapy with regard to a significantly better overall and distant metastases-free survival, although chemotherapy use in patients aged >/= 70 years results in a smaller benefit considering OS and no benefit considering DMFS.
DOI
https://www.doi.org/10.1007/s00404-019-05387-3
Keywords
Aged; Breast Neoplasms/*drug therapy/mortality; Chemotherapy, Adjuvant/*methods; Disease-Free Survival; Female; Humans; Middle Aged; *Breast cancer; *Chemotherapy; *Distant metastases-free survival; *Elderly patients; *Hormone and node positive; *Overall survival
Teufel, A.; Gerken, M.; Fürst, A.; et al. (2020) Benefit of adjuvant chemotherapy in high-risk colon cancer: A 17-year population-based analysis of 6131 patients with Union for International Cancer Control stage II T4N0M0 colon cancer. Eur J Cancer. https://www.doi.org/10.1016/j.ejca.2020.06.036
Title
Benefit of adjuvant chemotherapy in high-risk colon cancer: A 17-year population-based analysis of 6131 patients with Union for International Cancer Control stage II T4N0M0 colon cancer
Publication date
2020
Abstract
BACKGROUND: The benefit of adjuvant chemotherapy in Union for International Cancer Control (UICC) stage III colon cancer has been demonstrated in numerous studies. While adjuvant chemotherapy is generally not recommended in stage II patients, its role in high-risk UICC stage II disease (e.g. T4 tumours) remains controversial. METHODS: The present population-based multicenter cohort study investigated the influence of adjuvant chemotherapy on survival and recurrence rates in high-risk UICC stage II T4N0M0 tumours. Based on an anonymised nationwide ADT data set from 31 clinical cancer registries, we identified a total of 6651 patients with a T4 tumour of the colon, of whom 6131 were eligible for survival analysis. A matched-pair analysis based on propensity scores (PSM) was performed with a subset of 3986 patients. RESULTS: Multivariable analyses demonstrated a significant benefit of adjuvant chemotherapy for overall survival (OS) (hazard ratio [HR]: 0.711, 95% confidence interval [CI]: 0.643-0.785, p < 0.001), cumulative recurrence rate (HR: 0.780, 95% CI: 0.681-0.893, p < 0.001), and recurrence-free survival (HR: 0.715, 95% CI: 0.652-0.785, p < 0.001) further confirmed by the matched-pair cohort. CONCLUSION: This large and representative study demonstrated a significant advantage of adjuvant chemotherapy for patients with T4 UICC stage II colon cancer in terms of OS, recurrence rate, and relapse-free survival. Based on these results, adjuvant chemotherapy should be recommended for these patients.
DOI
https://www.doi.org/10.1016/j.ejca.2020.06.036
Keywords
Adjuvant; Chemotherapy; Colon cancer; Registry; Risk factor; Survival
Benefit of adjuvant chemotherapy in high-risk colon cancer: A 17-year population-based analysis of 6131 patients with Union for International Cancer Control stage II T4N0M0 colon cancer
Publication date
2020
Abstract
BACKGROUND: The benefit of adjuvant chemotherapy in Union for International Cancer Control (UICC) stage III colon cancer has been demonstrated in numerous studies. While adjuvant chemotherapy is generally not recommended in stage II patients, its role in high-risk UICC stage II disease (e.g. T4 tumours) remains controversial. METHODS: The present population-based multicenter cohort study investigated the influence of adjuvant chemotherapy on survival and recurrence rates in high-risk UICC stage II T4N0M0 tumours. Based on an anonymised nationwide ADT data set from 31 clinical cancer registries, we identified a total of 6651 patients with a T4 tumour of the colon, of whom 6131 were eligible for survival analysis. A matched-pair analysis based on propensity scores (PSM) was performed with a subset of 3986 patients. RESULTS: Multivariable analyses demonstrated a significant benefit of adjuvant chemotherapy for overall survival (OS) (hazard ratio [HR]: 0.711, 95% confidence interval [CI]: 0.643-0.785, p < 0.001), cumulative recurrence rate (HR: 0.780, 95% CI: 0.681-0.893, p < 0.001), and recurrence-free survival (HR: 0.715, 95% CI: 0.652-0.785, p < 0.001) further confirmed by the matched-pair cohort. CONCLUSION: This large and representative study demonstrated a significant advantage of adjuvant chemotherapy for patients with T4 UICC stage II colon cancer in terms of OS, recurrence rate, and relapse-free survival. Based on these results, adjuvant chemotherapy should be recommended for these patients.
DOI
https://www.doi.org/10.1016/j.ejca.2020.06.036
Keywords
Adjuvant; Chemotherapy; Colon cancer; Registry; Risk factor; Survival
Teufel, A.; Li, M.; Gerken, M.; et al. (2022) Second Cancer After Additive Chemotherapy in Patients With Colon Cancer. Clin Colorectal Cancer. https://www.doi.org/10.1016/j.clcc.2022.07.002
Title
Second Cancer After Additive Chemotherapy in Patients With Colon Cancer
Publication date
2022
Abstract
BACKGROUND: Additive chemotherapeutic treatment of UICC-stage -III / IV colon cancer with fluorouracil, leucovorin and oxaliplatin is widely accepted as current standard of treatment after R0-resection. However, as patients survival is increasing, long-term side effects of chemotherapeutic agents such as second cancer development are becoming increasingly important. PATIENTS: We therefore investigated a total of 2 856 Patients with UICC-stage III / IV colon cancer, 223 of whom (7.8%) had developed a subsequent second cancer. RESULTS: Median follow-up was 73.2 months (range 209.9 months, 95%-CI 69.8-76.9). Most frequent second cancers were prostate cancer (18.4%), colon cancer (16.1%), breast cancers (8.1%), lung cancer (8.1%), rectal cancer (4.9%) and uterine cancer (4.9%). However, in comparison to non-treated patients this did not represent a significantly increased risk for subsequent second cancer in patients after treatment with additive chemotherapy. Of interest, our data suggest a significantly decreased second cancer rate in patients treated with FOLFOX compared to FUFOL for additive treatment. CONCLUSIONS: Second cancer development was not increased after additive chemotherapy for colon cancer, which is a novel aspect in the ongoing discussions on reduction of adjuvant treatment to 3 months or treatment of lymph node negative patients. Novelty and Impact Statement To our knowledge, this is the first population-based study analyzing second cancer development after additive chemotherapy in patients with UICC III-IV colon cancer. The results have an important impact on the surveillance and long-term follow-up of cancer patients.
DOI
https://www.doi.org/10.1016/j.clcc.2022.07.002
Keywords
5-fu; Adjuvant chemotherapy; Adverse event; Cancer registry; oxaliplatin
Second Cancer After Additive Chemotherapy in Patients With Colon Cancer
Publication date
2022
Abstract
BACKGROUND: Additive chemotherapeutic treatment of UICC-stage -III / IV colon cancer with fluorouracil, leucovorin and oxaliplatin is widely accepted as current standard of treatment after R0-resection. However, as patients survival is increasing, long-term side effects of chemotherapeutic agents such as second cancer development are becoming increasingly important. PATIENTS: We therefore investigated a total of 2 856 Patients with UICC-stage III / IV colon cancer, 223 of whom (7.8%) had developed a subsequent second cancer. RESULTS: Median follow-up was 73.2 months (range 209.9 months, 95%-CI 69.8-76.9). Most frequent second cancers were prostate cancer (18.4%), colon cancer (16.1%), breast cancers (8.1%), lung cancer (8.1%), rectal cancer (4.9%) and uterine cancer (4.9%). However, in comparison to non-treated patients this did not represent a significantly increased risk for subsequent second cancer in patients after treatment with additive chemotherapy. Of interest, our data suggest a significantly decreased second cancer rate in patients treated with FOLFOX compared to FUFOL for additive treatment. CONCLUSIONS: Second cancer development was not increased after additive chemotherapy for colon cancer, which is a novel aspect in the ongoing discussions on reduction of adjuvant treatment to 3 months or treatment of lymph node negative patients. Novelty and Impact Statement To our knowledge, this is the first population-based study analyzing second cancer development after additive chemotherapy in patients with UICC III-IV colon cancer. The results have an important impact on the surveillance and long-term follow-up of cancer patients.
DOI
https://www.doi.org/10.1016/j.clcc.2022.07.002
Keywords
5-fu; Adjuvant chemotherapy; Adverse event; Cancer registry; oxaliplatin
Teufel, A.; Meindl-Beinker, N. M.; Hösel, P.; et al. (2022) Characteristics and outcome of patients with small bowel adenocarcinoma (SBA). J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-022-04344-z
Title
Characteristics and outcome of patients with small bowel adenocarcinoma (SBA)
Publication date
2022
Abstract
BACKGROUND: Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS: To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS: We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION: SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
DOI
https://www.doi.org/10.1007/s00432-022-04344-z
Keywords
Adenocarcinoma; Chemothherapy; Register; Small bowel; Survival; Tumo center
Characteristics and outcome of patients with small bowel adenocarcinoma (SBA)
Publication date
2022
Abstract
BACKGROUND: Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS: To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS: We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION: SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
DOI
https://www.doi.org/10.1007/s00432-022-04344-z
Keywords
Adenocarcinoma; Chemothherapy; Register; Small bowel; Survival; Tumo center
Teufel, A.; Meindl-Beinker, N. M.; Hösel, P.; et al. (2023) Characteristics and outcome of patients with small bowel adenocarcinoma (SBA). J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-022-04344-z
Title
Characteristics and outcome of patients with small bowel adenocarcinoma (SBA)
Publication date
2023
Abstract
BACKGROUND: Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS: To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS: We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION: SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
DOI
https://www.doi.org/10.1007/s00432-022-04344-z
Keywords
Humans; *Intestinal Neoplasms/epidemiology/therapy; Intestine, Small/pathology; *Ileal Neoplasms/pathology/therapy; *Duodenal Neoplasms/epidemiology/therapy; *Jejunal Neoplasms/pathology/therapy; *Adenocarcinoma/epidemiology/therapy/diagnosis; *Colonic Neoplasms/pathology; Adenocarcinoma; Chemothherapy; Register; Small bowel; Survival; Tumo center
Characteristics and outcome of patients with small bowel adenocarcinoma (SBA)
Publication date
2023
Abstract
BACKGROUND: Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS: To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS: We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION: SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
DOI
https://www.doi.org/10.1007/s00432-022-04344-z
Keywords
Humans; *Intestinal Neoplasms/epidemiology/therapy; Intestine, Small/pathology; *Ileal Neoplasms/pathology/therapy; *Duodenal Neoplasms/epidemiology/therapy; *Jejunal Neoplasms/pathology/therapy; *Adenocarcinoma/epidemiology/therapy/diagnosis; *Colonic Neoplasms/pathology; Adenocarcinoma; Chemothherapy; Register; Small bowel; Survival; Tumo center
Thong, M. S. Y.; Doege, D.; Weisser, L.; et al. (2022) Health and life insurance-related problems in very long-term cancer survivors in Germany: a population-based study. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-021-03825-x
Title
Health and life insurance-related problems in very long-term cancer survivors in Germany: a population-based study
Publication date
2022
Abstract
PURPOSE: Limited research suggests that cancer survivors have problems with insurance. Our study aimed to gain insight into the proportion of very long-term (14-24 years post-diagnosis) survivors of breast, colorectal, and prostate cancers who had problems with health (HI) and life (LI) insurance. METHODS: We used data from CAESAR (CAncEr Survivorship-A multi-Regional population-based study). Participants completed questions on change in insurance providers since cancer diagnosis, problems with requesting (additional) HI or LI, and how potential problems were resolved. We conducted logistic regression to determine factors associated with change in statutory HI. RESULTS: Of the 2714 respondents, 174 (6%) reported having changed HI providers. Most switched between different statutory HI providers (86%), 9% from statutory to private, and 5% from private to statutory. Respondents who changed statutory HI providers were more likely to be prostate cancer survivors (OR 2.79, 95% CI 1.01-7.68) while being >/= 65 years at time of diagnosis (OR 0.58, 95% CI 0.35-0.96) and having >/= 2 comorbid conditions (OR 0.61, 95% CI 0.40-0.92) were associated with reduced odds for change. Problems in changing HI were minimal and were resolved with additional contribution. Of the 310 respondents who tried to get LI, 25 respondents reported having difficulties, of whom the majority had their request rejected. CONCLUSION: Most cancer survivors did not change their HI nor tried to buy LI after cancer diagnosis. Problems with changing statutory HI were generally resolved with additional contribution while the main problem encountered when buying LI was rejection of request.
DOI
https://www.doi.org/10.1007/s00432-021-03825-x
Keywords
Aged; Breast Neoplasms/therapy; Cancer Survivors/*statistics & numerical data; Colorectal Neoplasms/therapy; Female; Germany; Humans; *Insurance Selection Bias; Insurance, Health/*statistics & numerical data; Insurance, Life/*statistics & numerical data; Male; Middle Aged; Prostatic Neoplasms/therapy; Surveys and Questionnaires; Cancer survivors; Financial toxicity; Insurance problems; Population-based
Health and life insurance-related problems in very long-term cancer survivors in Germany: a population-based study
Publication date
2022
Abstract
PURPOSE: Limited research suggests that cancer survivors have problems with insurance. Our study aimed to gain insight into the proportion of very long-term (14-24 years post-diagnosis) survivors of breast, colorectal, and prostate cancers who had problems with health (HI) and life (LI) insurance. METHODS: We used data from CAESAR (CAncEr Survivorship-A multi-Regional population-based study). Participants completed questions on change in insurance providers since cancer diagnosis, problems with requesting (additional) HI or LI, and how potential problems were resolved. We conducted logistic regression to determine factors associated with change in statutory HI. RESULTS: Of the 2714 respondents, 174 (6%) reported having changed HI providers. Most switched between different statutory HI providers (86%), 9% from statutory to private, and 5% from private to statutory. Respondents who changed statutory HI providers were more likely to be prostate cancer survivors (OR 2.79, 95% CI 1.01-7.68) while being >/= 65 years at time of diagnosis (OR 0.58, 95% CI 0.35-0.96) and having >/= 2 comorbid conditions (OR 0.61, 95% CI 0.40-0.92) were associated with reduced odds for change. Problems in changing HI were minimal and were resolved with additional contribution. Of the 310 respondents who tried to get LI, 25 respondents reported having difficulties, of whom the majority had their request rejected. CONCLUSION: Most cancer survivors did not change their HI nor tried to buy LI after cancer diagnosis. Problems with changing statutory HI were generally resolved with additional contribution while the main problem encountered when buying LI was rejection of request.
DOI
https://www.doi.org/10.1007/s00432-021-03825-x
Keywords
Aged; Breast Neoplasms/therapy; Cancer Survivors/*statistics & numerical data; Colorectal Neoplasms/therapy; Female; Germany; Humans; *Insurance Selection Bias; Insurance, Health/*statistics & numerical data; Insurance, Life/*statistics & numerical data; Male; Middle Aged; Prostatic Neoplasms/therapy; Surveys and Questionnaires; Cancer survivors; Financial toxicity; Insurance problems; Population-based
Thong, M. S. Y.; Doege, D.; Weisser, L.; et al. (2023) Persisting Deficits in Health-Related Quality of Life of Colorectal Cancer Survivors 14-24 Years Post-Diagnosis: A Population-Based Study. Curr Oncol. https://www.doi.org/10.3390/curroncol30030257
Title
Persisting Deficits in Health-Related Quality of Life of Colorectal Cancer Survivors 14-24 Years Post-Diagnosis: A Population-Based Study
Publication date
2023
Abstract
(1) Background: The health-related quality of life (HRQOL) of colorectal cancer (CRC) survivors >10 years post-diagnosis is understudied. We aimed to compare the HRQOL of CRC survivors 14-24 years post-diagnosis to that of age- and sex-matched non-cancer controls, stratified by demographic and clinical factors. (2) Methods: We used data from 506 long-term CRC survivors and 1489 controls recruited from German population-based multi-regional studies. HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Core-30 (EORTC QLQ-C30) questionnaire. We estimated differences in the HRQOL of CRC survivors and controls with multiple regression, adjusted for age at survey, sex, and education, where appropriate. (3) Results: CRC survivors reported poorer social functioning but better health status/QOL than controls. CRC survivors, in general, had higher levels of symptom burden, and in particular diarrhea and constipation, regardless of demographic or clinical factors. In stratified analyses, HRQOL differed by age, sex, cancer type, and having a permanent stoma. (4) Conclusions: Although CRC survivors may have a comparable health status/QOL to controls 14-24 years after diagnosis, they still live with persistent bowel dysfunction that can negatively impact aspects of functioning. Healthcare providers should provide timely and adapted follow-up care to ameliorate potential long-term suffering.
DOI
https://www.doi.org/10.3390/curroncol30030257
Keywords
Humans; Quality of Life; *Cancer Survivors; Survivors; Surveys and Questionnaires; *Colorectal Neoplasms; colorectal cancer; health-related quality of life; long-term survivors; non-cancer controls; population-based
Persisting Deficits in Health-Related Quality of Life of Colorectal Cancer Survivors 14-24 Years Post-Diagnosis: A Population-Based Study
Publication date
2023
Abstract
(1) Background: The health-related quality of life (HRQOL) of colorectal cancer (CRC) survivors >10 years post-diagnosis is understudied. We aimed to compare the HRQOL of CRC survivors 14-24 years post-diagnosis to that of age- and sex-matched non-cancer controls, stratified by demographic and clinical factors. (2) Methods: We used data from 506 long-term CRC survivors and 1489 controls recruited from German population-based multi-regional studies. HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Core-30 (EORTC QLQ-C30) questionnaire. We estimated differences in the HRQOL of CRC survivors and controls with multiple regression, adjusted for age at survey, sex, and education, where appropriate. (3) Results: CRC survivors reported poorer social functioning but better health status/QOL than controls. CRC survivors, in general, had higher levels of symptom burden, and in particular diarrhea and constipation, regardless of demographic or clinical factors. In stratified analyses, HRQOL differed by age, sex, cancer type, and having a permanent stoma. (4) Conclusions: Although CRC survivors may have a comparable health status/QOL to controls 14-24 years after diagnosis, they still live with persistent bowel dysfunction that can negatively impact aspects of functioning. Healthcare providers should provide timely and adapted follow-up care to ameliorate potential long-term suffering.
DOI
https://www.doi.org/10.3390/curroncol30030257
Keywords
Humans; Quality of Life; *Cancer Survivors; Survivors; Surveys and Questionnaires; *Colorectal Neoplasms; colorectal cancer; health-related quality of life; long-term survivors; non-cancer controls; population-based
Thurmaier, J.; Heinemann, V.; Engel, J.; et al. (2021) Patients with colorectal cancer and brain metastasis: The relevance of extracranial metastatic patterns predicting time intervals to first occurrence of intracranial metastasis and survival. Int J Cancer. https://www.doi.org/10.1002/ijc.33364
Title
Patients with colorectal cancer and brain metastasis: The relevance of extracranial metastatic patterns predicting time intervals to first occurrence of intracranial metastasis and survival
Publication date
2021
Abstract
The aim of the study was to investigate the predictive impact of extracranial metastatic patterns on course of disease and survival in patients with colorectal cancer (CRC) and brain metastasis (BM). A total of 228 patients (134 male [59%], 94 female [41%]) with histologically proven CRC and BM were classified into different groups according to extracranial metastatic patterns. Time intervals to metastatic events and survival times from initial CRC diagnosis, extracranial and intracranial metastasis were analyzed. Extracranial organs mostly affected were liver (102 of 228 [44.7%]) and lung (96 of 228 [42.1%]). Liver and lung metastases were detected in 31 patients (13.6%). Calculated over the entire course of disease, patients with lung metastasis showed longer overall survival (OS) than patients with liver metastasis or patients without lung metastasis (43.9 vs 34.6 [P = .002] vs 35.0 months [P = .002]). From the date of initial CRC diagnosis, lung metastasis occurred later in CRC history than liver metastasis (24.3 vs 7.5 months). Once lung metastasis was diagnosed, BM occurred faster than in patients with liver metastasis (15.8 vs 26.0 months; Delta 10.2 months). Accordingly, OS from the diagnosis of liver metastasis was longer than from lung metastasis (27.1 vs 19.6 months [P = .08]). Once BM was present, patients with lung metastasis lived longer than patients with liver metastasis (3.8 vs 1.1 months [P = .028]). Shortest survival times in all survival categories analyzed revealed patients with concurrent liver and lung metastasis. Patients with CRC and BM form a heterogeneous cohort where extracranial metastasis to liver or lungs predicts survival.
DOI
https://www.doi.org/10.1002/ijc.33364
Keywords
Brain Neoplasms/diagnosis/*secondary; Cohort Studies; Colorectal Neoplasms/*pathology/therapy; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms/diagnosis/*secondary; Lung Neoplasms/diagnosis/*secondary; Male; Outcome Assessment, Health Care/methods/statistics & numerical data; Prognosis; Time Factors; *brain metastasis; *extracranial metastatic patterns; *metastatic colorectal cancer
Patients with colorectal cancer and brain metastasis: The relevance of extracranial metastatic patterns predicting time intervals to first occurrence of intracranial metastasis and survival
Publication date
2021
Abstract
The aim of the study was to investigate the predictive impact of extracranial metastatic patterns on course of disease and survival in patients with colorectal cancer (CRC) and brain metastasis (BM). A total of 228 patients (134 male [59%], 94 female [41%]) with histologically proven CRC and BM were classified into different groups according to extracranial metastatic patterns. Time intervals to metastatic events and survival times from initial CRC diagnosis, extracranial and intracranial metastasis were analyzed. Extracranial organs mostly affected were liver (102 of 228 [44.7%]) and lung (96 of 228 [42.1%]). Liver and lung metastases were detected in 31 patients (13.6%). Calculated over the entire course of disease, patients with lung metastasis showed longer overall survival (OS) than patients with liver metastasis or patients without lung metastasis (43.9 vs 34.6 [P = .002] vs 35.0 months [P = .002]). From the date of initial CRC diagnosis, lung metastasis occurred later in CRC history than liver metastasis (24.3 vs 7.5 months). Once lung metastasis was diagnosed, BM occurred faster than in patients with liver metastasis (15.8 vs 26.0 months; Delta 10.2 months). Accordingly, OS from the diagnosis of liver metastasis was longer than from lung metastasis (27.1 vs 19.6 months [P = .08]). Once BM was present, patients with lung metastasis lived longer than patients with liver metastasis (3.8 vs 1.1 months [P = .028]). Shortest survival times in all survival categories analyzed revealed patients with concurrent liver and lung metastasis. Patients with CRC and BM form a heterogeneous cohort where extracranial metastasis to liver or lungs predicts survival.
DOI
https://www.doi.org/10.1002/ijc.33364
Keywords
Brain Neoplasms/diagnosis/*secondary; Cohort Studies; Colorectal Neoplasms/*pathology/therapy; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms/diagnosis/*secondary; Lung Neoplasms/diagnosis/*secondary; Male; Outcome Assessment, Health Care/methods/statistics & numerical data; Prognosis; Time Factors; *brain metastasis; *extracranial metastatic patterns; *metastatic colorectal cancer
Trillsch, F.; Mahner, S.; Czogalla, B.; et al. (2021) Primary platinum resistance and its prognostic impact in patients with recurrent ovarian cancer: an analysis of three prospective trials from the NOGGO study group. J Gynecol Oncol. https://www.doi.org/10.3802/jgo.2021.32.e37
Title
Primary platinum resistance and its prognostic impact in patients with recurrent ovarian cancer: an analysis of three prospective trials from the NOGGO study group
Publication date
2021
Abstract
OBJECTIVE: Patients with platinum-resistant ovarian cancer (PROC) have a high need for reliable prognostic markers. Since significance of primary platinum resistance (PPR) versus secondary platinum resistance (SPR) was identified for patients receiving anti-angiogenic therapy, it has not been confirmed for chemotherapy only. METHODS: PROC patients from 3 prospective trials of the NOGGO study group (TOWER, NOGGO-Treosulfan, and TRIAS) were included in this meta-analysis. Exploratory Cox and logistic regression analyses were performed to correlate progression-free survival (PFS) and overall survival (OS) with the timing when platinum resistance developed. RESULTS: Of 477 patients, 264 (55.3%) were classified as PPR, compared to 213 (44.7%) with SPR. For patients receiving chemotherapy only, SPR was associated with a significantly longer median PFS of 3.9 compared to 3.1 months for PPR (hazard ratio [HR]=0.78; p=0.015). SPR versus PPR was confirmed to be an independent prognostic factor for better PFS in multivariate analysis (HR=0.74; p=0.029). Benefit from adding sorafenib to chemotherapy was mainly seen in PPR (HR=0.40; p<0.001) compared to SPR patients (HR=0.83; p=0.465). CONCLUSIONS: Prognostic significance of SPR versus PPR could be elucidated for patients receiving chemotherapy only. In contrast to bevacizumab, the multi-kinase inhibitor sorafenib exhibits profound therapeutic efficacy in PPR patients indicating potential to overcome this negative prognostic impact.
DOI
https://www.doi.org/10.3802/jgo.2021.32.e37
Keywords
Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Drug Resistance, Neoplasm; Female; Humans; Neoplasm Recurrence, Local/drug therapy; *Ovarian Neoplasms/drug therapy; Prognosis; Prospective Studies; *Anti-angiogenic Treatment; *Mono-chemotherapy; *Primary Platinum Resistance; *Prognostic Factor; *Recurrent Ovarian Cancer; *Sorafenib; PharmaMar, Roche, and Tesaro/GSK. Sven Mahner: grants and personal fees from; AstraZeneca, Clovis, Medac, Novartis, Olympus Europe, PharmaMar, Pfizer, Roche,; Sensor Kinesis, Tesaro/GSK, and TEVA. Pauline Wimberger: grants and personal fees; from AstraZeneca, Amgen, Clovis, Medac, MSD, Pfizer, PharmaMar, Roche,; Tesaro/GSK, Novartis, Eisai, Celgene and TEVA. Jalid Sehouli: grants and personal; fees from Astra Zeneca, Bayer, Eisai, Clovis, Olympus, Johnsons and Johnson,; PharmaMar, Pfizer, TEVA, Tesaro/GSK, MSD, Lilly, Roche and Merck. All remaining; authors have declared no conflicts of interest.
Primary platinum resistance and its prognostic impact in patients with recurrent ovarian cancer: an analysis of three prospective trials from the NOGGO study group
Publication date
2021
Abstract
OBJECTIVE: Patients with platinum-resistant ovarian cancer (PROC) have a high need for reliable prognostic markers. Since significance of primary platinum resistance (PPR) versus secondary platinum resistance (SPR) was identified for patients receiving anti-angiogenic therapy, it has not been confirmed for chemotherapy only. METHODS: PROC patients from 3 prospective trials of the NOGGO study group (TOWER, NOGGO-Treosulfan, and TRIAS) were included in this meta-analysis. Exploratory Cox and logistic regression analyses were performed to correlate progression-free survival (PFS) and overall survival (OS) with the timing when platinum resistance developed. RESULTS: Of 477 patients, 264 (55.3%) were classified as PPR, compared to 213 (44.7%) with SPR. For patients receiving chemotherapy only, SPR was associated with a significantly longer median PFS of 3.9 compared to 3.1 months for PPR (hazard ratio [HR]=0.78; p=0.015). SPR versus PPR was confirmed to be an independent prognostic factor for better PFS in multivariate analysis (HR=0.74; p=0.029). Benefit from adding sorafenib to chemotherapy was mainly seen in PPR (HR=0.40; p<0.001) compared to SPR patients (HR=0.83; p=0.465). CONCLUSIONS: Prognostic significance of SPR versus PPR could be elucidated for patients receiving chemotherapy only. In contrast to bevacizumab, the multi-kinase inhibitor sorafenib exhibits profound therapeutic efficacy in PPR patients indicating potential to overcome this negative prognostic impact.
DOI
https://www.doi.org/10.3802/jgo.2021.32.e37
Keywords
Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Drug Resistance, Neoplasm; Female; Humans; Neoplasm Recurrence, Local/drug therapy; *Ovarian Neoplasms/drug therapy; Prognosis; Prospective Studies; *Anti-angiogenic Treatment; *Mono-chemotherapy; *Primary Platinum Resistance; *Prognostic Factor; *Recurrent Ovarian Cancer; *Sorafenib; PharmaMar, Roche, and Tesaro/GSK. Sven Mahner: grants and personal fees from; AstraZeneca, Clovis, Medac, Novartis, Olympus Europe, PharmaMar, Pfizer, Roche,; Sensor Kinesis, Tesaro/GSK, and TEVA. Pauline Wimberger: grants and personal fees; from AstraZeneca, Amgen, Clovis, Medac, MSD, Pfizer, PharmaMar, Roche,; Tesaro/GSK, Novartis, Eisai, Celgene and TEVA. Jalid Sehouli: grants and personal; fees from Astra Zeneca, Bayer, Eisai, Clovis, Olympus, Johnsons and Johnson,; PharmaMar, Pfizer, TEVA, Tesaro/GSK, MSD, Lilly, Roche and Merck. All remaining; authors have declared no conflicts of interest.
Twardella, D.; Geiss, K.; Radespiel-Tröger, M.; et al. (2018) [Trends in incidence of lung cancer according to histological subtype among men and women in Germany : Analysis of cancer registry data with the application of multiple imputation techniques]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. https://www.doi.org/10.1007/s00103-017-2659-x
Title
[Trends in incidence of lung cancer according to histological subtype among men and women in Germany : Analysis of cancer registry data with the application of multiple imputation techniques]
Publication date
2018
Abstract
BACKGROUND: Lung cancer can be described by histological subtype, of which small cell, squamous cell and adenocarcinoma are the most common. International data show that adenocarcinoma is becoming the dominant histological subtype of lung cancer although the relative risk due to smoking has been found to be smaller than that for other histological subtypes. OBJECTIVE: The aim of the analysis was to describe the time trends in incidence of lung cancer among women and men in Germany according to histological subtype. MATERIALS AND METHODS: All lung cancer cases (ICD-10 C33-C34) newly diagnosed between 2003 and 2012 and collected by the epidemiologic cancer registries of the German federal states with average completeness of registration of at least 90% were considered and grouped into histologic subtypes. If data on tumor histology were not microscopically verified or unspecific, multiple imputation techniques were applied to estimate the histologic subtype. RESULTS: Among women age-standardized lung cancer rates increased considerably between 2003 and 2012 (annual percent change APC = 2.7%), mostly driven by a rising adenocarcinoma incidence (APC = 4.7%). Among men overall lung cancer rates decreased during the same time (APC = -1.7%). Still, a slight increase in adenocarcinoma incidence was also observed in men (APC = 1.0%). CONCLUSION: The rising incidence of adenocarcinoma of the lung is alarming. The cancer registry data do not allow risk factor analysis. In the international discussion, the introduction of filter cigarettes as well as the changing composition of cigarettes has been hypothesized as being responsible. Further epidemiologic studies are strongly needed.
DOI
https://www.doi.org/10.1007/s00103-017-2659-x
Keywords
Adenocarcinoma/epidemiology/pathology; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Carcinoma, Large Cell/epidemiology/pathology; Carcinoma, Small Cell/epidemiology/pathology; Carcinoma, Squamous Cell/epidemiology/pathology; Child; Child, Preschool; Data Interpretation, Statistical; Female; Germany; Humans; Incidence; Infant; Lung Neoplasms/*epidemiology/pathology; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Registries/*statistics & numerical data; Sex Factors; Smoking/adverse effects/epidemiology; Young Adult; Adenocarcinoma; Cancer registry; Filter cigarettes; Lung cancer; Multiple imputation
[Trends in incidence of lung cancer according to histological subtype among men and women in Germany : Analysis of cancer registry data with the application of multiple imputation techniques]
Publication date
2018
Abstract
BACKGROUND: Lung cancer can be described by histological subtype, of which small cell, squamous cell and adenocarcinoma are the most common. International data show that adenocarcinoma is becoming the dominant histological subtype of lung cancer although the relative risk due to smoking has been found to be smaller than that for other histological subtypes. OBJECTIVE: The aim of the analysis was to describe the time trends in incidence of lung cancer among women and men in Germany according to histological subtype. MATERIALS AND METHODS: All lung cancer cases (ICD-10 C33-C34) newly diagnosed between 2003 and 2012 and collected by the epidemiologic cancer registries of the German federal states with average completeness of registration of at least 90% were considered and grouped into histologic subtypes. If data on tumor histology were not microscopically verified or unspecific, multiple imputation techniques were applied to estimate the histologic subtype. RESULTS: Among women age-standardized lung cancer rates increased considerably between 2003 and 2012 (annual percent change APC = 2.7%), mostly driven by a rising adenocarcinoma incidence (APC = 4.7%). Among men overall lung cancer rates decreased during the same time (APC = -1.7%). Still, a slight increase in adenocarcinoma incidence was also observed in men (APC = 1.0%). CONCLUSION: The rising incidence of adenocarcinoma of the lung is alarming. The cancer registry data do not allow risk factor analysis. In the international discussion, the introduction of filter cigarettes as well as the changing composition of cigarettes has been hypothesized as being responsible. Further epidemiologic studies are strongly needed.
DOI
https://www.doi.org/10.1007/s00103-017-2659-x
Keywords
Adenocarcinoma/epidemiology/pathology; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Carcinoma, Large Cell/epidemiology/pathology; Carcinoma, Small Cell/epidemiology/pathology; Carcinoma, Squamous Cell/epidemiology/pathology; Child; Child, Preschool; Data Interpretation, Statistical; Female; Germany; Humans; Incidence; Infant; Lung Neoplasms/*epidemiology/pathology; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Registries/*statistics & numerical data; Sex Factors; Smoking/adverse effects/epidemiology; Young Adult; Adenocarcinoma; Cancer registry; Filter cigarettes; Lung cancer; Multiple imputation
Villegas, S. L.; Nekljudova, V.; Pfarr, N.; et al. (2021) Therapy response and prognosis of patients with early breast cancer with low positivity for hormone receptors - An analysis of 2765 patients from neoadjuvant clinical trials. Eur J Cancer. https://www.doi.org/10.1016/j.ejca.2021.02.020
Title
Therapy response and prognosis of patients with early breast cancer with low positivity for hormone receptors - An analysis of 2765 patients from neoadjuvant clinical trials
Publication date
2021
Abstract
AIM: To evaluate HER2-negative breast cancer (BC) with a low hormone receptor (HR) expression, with regard to pathological complete response (pCR) and survival, in comparison to triple-negative BC (TNBC) and strong HR-positive BC. METHODS: We compared negative [oestrogen (ER) and progesterone receptor (PR) <1%], low-positive (ER and/or PR 1-9%) and strong-positive (ER or PR 10-100%) HR-expression in neoadjuvant clinical trial cohorts (n = 2765) of BC patients. End-points were disease-free survival (DFS), distant-disease free survival (DDFS) and overall survival (OS). We performed RNA sequencing on available tumour tissue samples from patients with low-HR expression (n = 38). RESULTS: Ninety-four (3.4%) patients had low HR-positive tumours, 1769 (64.0%) had strong HR-positive tumours, and 902 (32.6%) had TNBC. There were no significant differences in pCR rates between women with low HR-positive tumours (27.7%) and women with TNBC (35.5%). DFS and DDFS were also not different [for DFS, hazard ratio 1.26, 95%-CI (confidence interval) : 0.87-1.83, log-rank test p = 0.951; for DDFS, hazard ratio 1.17, 95%-CI: 0.78-1.76, log-rank test p = 0.774]. Patients with strong HR-positive tumours had a significantly lower pCR rate (pCR 9.4%; odds ratio 0.38, 95%-CI: 0.23-0.63), but better DFS (hazard ratio 0.48, 95%-CI: 0.33-0.70) and DDFS (hazard ratio 0.49, 95%-CI: 0.33-0.74) than patients with low HR-positive tumours. Molecular subtyping (RNA sequencing) of low HR-positive tumours classified these predominantly into a basal subtype (86.8%). CONCLUSION: Low HR-positive, HER2-negative tumours have a similar clinical behaviour to TNBC showing high pCR rates and poor survival and also a basal-like gene expression signature. Patients with low HR-positive tumours should be regarded as candidates for therapy strategies targeting TNBC.
DOI
https://www.doi.org/10.1016/j.ejca.2021.02.020
Keywords
Adult; Aged; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use; Biomarkers, Tumor/*genetics; Chemotherapy, Adjuvant/*mortality; Female; Follow-Up Studies; Gene Expression Profiling; Humans; Middle Aged; Neoadjuvant Therapy/*mortality; Prognosis; Receptor, ErbB-2/metabolism; Receptors, Estrogen/metabolism; Receptors, Progesterone/metabolism; Remission Induction; Survival Rate; Triple Negative Breast Neoplasms/drug therapy/genetics/*mortality/pathology; *Breast cancer; *Breast neoplasms; *Cancer biomarkers; *ER-negative PR-negative HER2-negative breast cancer; *Hormone-dependent neoplasms; *Mammary cancer; *Neoadjuvant therapy; *Oestrogen receptors; *Progesterone receptors; *Triple-negative breast cancer; interests/personal relationships which may be considered as potential competing; interests: AS reports grants from Celgene, grants from Roche, grants from AbbVie,; grants from Molecular Partner, personal fees from Roche, personal fees from; AstraZeneca, personal fees from Celgene, personal fees from Roche, personal fees; from Roche, personal fees from Celgene, personal fees from Pfizer, personal fees; from AstraZeneca, personal fees from Novartis, personal fees from MSD, personal; fees from Tesaro, personal fees from Lilly, personal fees from Pfizer, other from; Roche, outside the submitted work. CD reports grant support from the European; Commission (Responsify and Oncobiome project) as well as from the German Cancer; Aid (Deutsche Krebshilfe, TransLuminal-B and Integrate-TN project) during the; conduct of the study; ownership interest in Sividon Diagnostics outside the; submitted work; and honoraria from Pfizer, Merck, Sharp & Dohme, Amgen, Myriad,; Teva, Celgene, Roche, and AstraZeneca outside the submitted work. CH reports; personal fees from Novartis, personal fees from Celgene, personal fees from; Lilly, personal fees from Astra Zeneca, personal fees from Amgen, outside the; submitted work. CJ reports personal fees from Roche, personal fees from Celegen,; personal fees from Amgen, outside the submitted work. FM reports personal fees; from Roche, personal fees from AstraZeneca, personal fees from Pfizer, personal; fees from Tesaro, personal fees from Novartis, personal fees from Amgen, personal; fees from PharmaMar, personal fees from GenomicHealth, personal fees from; CureVac, personal fees from EISAI, personal fees from Clovis, personal fees from; Celgene, outside the submitted work. HT reports personal fees and non-financial; support from Roche, personal fees and non-financial support from Pfizer, personal; fees and non-financial support from Novartis, personal fees and non-financial; support from AstraZeneca, outside the submitted work. JH reports grants and; personal fees from Novartis, personal fees from Lilly, personal fees from Abbvie,; personal fees from Pfizer, personal fees from Roche, personal fees from MSD,; personal fees from Astra Zeneca, grants and personal fees from Celgene, outside; the submitted work. KEW reports personal fees and other from Myriad, outside the; submitted work. MK reports grants from Deutsche Krebshilfe (German Cancer Aid),; grants from DFG/BMBF, grants from Senator Roesner Foundation, grants from Dr.; Pommer-Jung Foundation, personal fees from Springer Press, personal fees from; Biermann Press, personal fees from Celgene, personal fees from Astra Zeneca,; personal fees from Myriad Genetics, personal fees from TEVA, personal fees from; Bavarian KVB, personal fees from DKMS Life, personal fees from BLAK, other from; Therawis Diagnostics GmbH, other from Busenfreundin GmbH, outside the submitted; work. MU reports personal fees and non-financial support from Abbvie, personal; fees and non-financial support from Amgen GmbH, personal fees and non-financial; support from Astra Zeneca, personal fees from BMS, personal fees and; non-financial support from Celgene GmbH, personal fees and non-financial support; from Daiji Sankyo, personal fees and non-financial support from Eisai GmbH,; personal fees from Lilly Deutschland, personal fees and non-financial support; from Lilly Int., personal fees and non-financial support from MSD Merck, personal; fees and non-financial support from Mundipharma, personal fees and non-financial; support from Myriad Genetics, personal fees and non-financial support from; Odonate, personal fees and non-financial support from Pfizer GmbH, personal fees; from PUMA Biotechnology, personal fees and non-financial support from Roche; Pharma AG, personal fees and non-financial support from Sanofi Aventis; Deutschland GmbH, personal fees and non-financial support from TEVA; Pharmaceuticals Ind Ltd, personal fees and non-financial support from Novartis,; personal fees from Pierre Fabre, outside the submitted work. MVM reports personal; fees from Amgen, personal fees from AstraZeneca, personal fees from Genomic; Health, non-financial support from Novartis, non-financial support from Lilly,; outside the submitted work. NP reports personal fees from Roche, personal fees; from Novartis, outside the submitted work. PAF reports grants from Novartis,; grants from BioNTech, personal fees from Novartis, personal fees from Roche,; personal fees from Pfizer, personal fees from Celgene, personal fees from; Daiichi-Sankyo, personal fees from TEVA, personal fees from Astra Zeneca,; personal fees from Merck Sharp & Dohme, personal fees from Myelo Therapeutics,; personal fees from Macrogenics, personal fees from Eisai, personal fees from; Puma, grants from Cepheid, personal fees from Lilly, during the conduct of the; study. SL reports grants and other from Abbvie, grants and other from Amgen,; grants and other from AstraZeneca, grants and other from Celgene, grants and; other from Novartis, grants and other from Pfizer, grants and other from Roche,; other from Seattle Genetics, other from Prime/Medscape, personal fees from; Chugai, grants from Teva, grants from Vifor, grants and other from; Daiichi-Sankyo, other from Lilly, other from Samsung, other from Eirgenix,; outside the submitted work; In addition, Dr. Loibl has a patent EP14153692.0; pending. WDS reports personal fees from AstraZeneca, outside the submitted work.; WW reports personal fees from Roche, MSD, BMS, AstraZeneca, Pfizer, Merck, Lilly,; Boehringer, Novartis, Takeda, Amgen, Astellas and grants from Roche, MSD, BMS,; Bruker outside the submitted work. All other authors declare no competing; interests.
Therapy response and prognosis of patients with early breast cancer with low positivity for hormone receptors - An analysis of 2765 patients from neoadjuvant clinical trials
Publication date
2021
Abstract
AIM: To evaluate HER2-negative breast cancer (BC) with a low hormone receptor (HR) expression, with regard to pathological complete response (pCR) and survival, in comparison to triple-negative BC (TNBC) and strong HR-positive BC. METHODS: We compared negative [oestrogen (ER) and progesterone receptor (PR) <1%], low-positive (ER and/or PR 1-9%) and strong-positive (ER or PR 10-100%) HR-expression in neoadjuvant clinical trial cohorts (n = 2765) of BC patients. End-points were disease-free survival (DFS), distant-disease free survival (DDFS) and overall survival (OS). We performed RNA sequencing on available tumour tissue samples from patients with low-HR expression (n = 38). RESULTS: Ninety-four (3.4%) patients had low HR-positive tumours, 1769 (64.0%) had strong HR-positive tumours, and 902 (32.6%) had TNBC. There were no significant differences in pCR rates between women with low HR-positive tumours (27.7%) and women with TNBC (35.5%). DFS and DDFS were also not different [for DFS, hazard ratio 1.26, 95%-CI (confidence interval) : 0.87-1.83, log-rank test p = 0.951; for DDFS, hazard ratio 1.17, 95%-CI: 0.78-1.76, log-rank test p = 0.774]. Patients with strong HR-positive tumours had a significantly lower pCR rate (pCR 9.4%; odds ratio 0.38, 95%-CI: 0.23-0.63), but better DFS (hazard ratio 0.48, 95%-CI: 0.33-0.70) and DDFS (hazard ratio 0.49, 95%-CI: 0.33-0.74) than patients with low HR-positive tumours. Molecular subtyping (RNA sequencing) of low HR-positive tumours classified these predominantly into a basal subtype (86.8%). CONCLUSION: Low HR-positive, HER2-negative tumours have a similar clinical behaviour to TNBC showing high pCR rates and poor survival and also a basal-like gene expression signature. Patients with low HR-positive tumours should be regarded as candidates for therapy strategies targeting TNBC.
DOI
https://www.doi.org/10.1016/j.ejca.2021.02.020
Keywords
Adult; Aged; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use; Biomarkers, Tumor/*genetics; Chemotherapy, Adjuvant/*mortality; Female; Follow-Up Studies; Gene Expression Profiling; Humans; Middle Aged; Neoadjuvant Therapy/*mortality; Prognosis; Receptor, ErbB-2/metabolism; Receptors, Estrogen/metabolism; Receptors, Progesterone/metabolism; Remission Induction; Survival Rate; Triple Negative Breast Neoplasms/drug therapy/genetics/*mortality/pathology; *Breast cancer; *Breast neoplasms; *Cancer biomarkers; *ER-negative PR-negative HER2-negative breast cancer; *Hormone-dependent neoplasms; *Mammary cancer; *Neoadjuvant therapy; *Oestrogen receptors; *Progesterone receptors; *Triple-negative breast cancer; interests/personal relationships which may be considered as potential competing; interests: AS reports grants from Celgene, grants from Roche, grants from AbbVie,; grants from Molecular Partner, personal fees from Roche, personal fees from; AstraZeneca, personal fees from Celgene, personal fees from Roche, personal fees; from Roche, personal fees from Celgene, personal fees from Pfizer, personal fees; from AstraZeneca, personal fees from Novartis, personal fees from MSD, personal; fees from Tesaro, personal fees from Lilly, personal fees from Pfizer, other from; Roche, outside the submitted work. CD reports grant support from the European; Commission (Responsify and Oncobiome project) as well as from the German Cancer; Aid (Deutsche Krebshilfe, TransLuminal-B and Integrate-TN project) during the; conduct of the study; ownership interest in Sividon Diagnostics outside the; submitted work; and honoraria from Pfizer, Merck, Sharp & Dohme, Amgen, Myriad,; Teva, Celgene, Roche, and AstraZeneca outside the submitted work. CH reports; personal fees from Novartis, personal fees from Celgene, personal fees from; Lilly, personal fees from Astra Zeneca, personal fees from Amgen, outside the; submitted work. CJ reports personal fees from Roche, personal fees from Celegen,; personal fees from Amgen, outside the submitted work. FM reports personal fees; from Roche, personal fees from AstraZeneca, personal fees from Pfizer, personal; fees from Tesaro, personal fees from Novartis, personal fees from Amgen, personal; fees from PharmaMar, personal fees from GenomicHealth, personal fees from; CureVac, personal fees from EISAI, personal fees from Clovis, personal fees from; Celgene, outside the submitted work. HT reports personal fees and non-financial; support from Roche, personal fees and non-financial support from Pfizer, personal; fees and non-financial support from Novartis, personal fees and non-financial; support from AstraZeneca, outside the submitted work. JH reports grants and; personal fees from Novartis, personal fees from Lilly, personal fees from Abbvie,; personal fees from Pfizer, personal fees from Roche, personal fees from MSD,; personal fees from Astra Zeneca, grants and personal fees from Celgene, outside; the submitted work. KEW reports personal fees and other from Myriad, outside the; submitted work. MK reports grants from Deutsche Krebshilfe (German Cancer Aid),; grants from DFG/BMBF, grants from Senator Roesner Foundation, grants from Dr.; Pommer-Jung Foundation, personal fees from Springer Press, personal fees from; Biermann Press, personal fees from Celgene, personal fees from Astra Zeneca,; personal fees from Myriad Genetics, personal fees from TEVA, personal fees from; Bavarian KVB, personal fees from DKMS Life, personal fees from BLAK, other from; Therawis Diagnostics GmbH, other from Busenfreundin GmbH, outside the submitted; work. MU reports personal fees and non-financial support from Abbvie, personal; fees and non-financial support from Amgen GmbH, personal fees and non-financial; support from Astra Zeneca, personal fees from BMS, personal fees and; non-financial support from Celgene GmbH, personal fees and non-financial support; from Daiji Sankyo, personal fees and non-financial support from Eisai GmbH,; personal fees from Lilly Deutschland, personal fees and non-financial support; from Lilly Int., personal fees and non-financial support from MSD Merck, personal; fees and non-financial support from Mundipharma, personal fees and non-financial; support from Myriad Genetics, personal fees and non-financial support from; Odonate, personal fees and non-financial support from Pfizer GmbH, personal fees; from PUMA Biotechnology, personal fees and non-financial support from Roche; Pharma AG, personal fees and non-financial support from Sanofi Aventis; Deutschland GmbH, personal fees and non-financial support from TEVA; Pharmaceuticals Ind Ltd, personal fees and non-financial support from Novartis,; personal fees from Pierre Fabre, outside the submitted work. MVM reports personal; fees from Amgen, personal fees from AstraZeneca, personal fees from Genomic; Health, non-financial support from Novartis, non-financial support from Lilly,; outside the submitted work. NP reports personal fees from Roche, personal fees; from Novartis, outside the submitted work. PAF reports grants from Novartis,; grants from BioNTech, personal fees from Novartis, personal fees from Roche,; personal fees from Pfizer, personal fees from Celgene, personal fees from; Daiichi-Sankyo, personal fees from TEVA, personal fees from Astra Zeneca,; personal fees from Merck Sharp & Dohme, personal fees from Myelo Therapeutics,; personal fees from Macrogenics, personal fees from Eisai, personal fees from; Puma, grants from Cepheid, personal fees from Lilly, during the conduct of the; study. SL reports grants and other from Abbvie, grants and other from Amgen,; grants and other from AstraZeneca, grants and other from Celgene, grants and; other from Novartis, grants and other from Pfizer, grants and other from Roche,; other from Seattle Genetics, other from Prime/Medscape, personal fees from; Chugai, grants from Teva, grants from Vifor, grants and other from; Daiichi-Sankyo, other from Lilly, other from Samsung, other from Eirgenix,; outside the submitted work; In addition, Dr. Loibl has a patent EP14153692.0; pending. WDS reports personal fees from AstraZeneca, outside the submitted work.; WW reports personal fees from Roche, MSD, BMS, AstraZeneca, Pfizer, Merck, Lilly,; Boehringer, Novartis, Takeda, Amgen, Astellas and grants from Roche, MSD, BMS,; Bruker outside the submitted work. All other authors declare no competing; interests.
Voigtländer, S.; Hakimhashemi, A.; Grundmann, N.; et al. (2022) Comparison of trends in early-onset colorectal cancer in North America and Europe. Lancet Gastroenterol Hepatol. https://www.doi.org/10.1016/S2468-1253(22)00094-2
Title
Comparison of trends in early-onset colorectal cancer in North America and Europe
Publication date
2022
DOI
https://www.doi.org/10.1016/S2468-1253(22)00094-2
Keywords
*Colorectal Neoplasms/diagnosis/epidemiology; Europe/epidemiology; Humans; North America/epidemiology
Comparison of trends in early-onset colorectal cancer in North America and Europe
Publication date
2022
DOI
https://www.doi.org/10.1016/S2468-1253(22)00094-2
Keywords
*Colorectal Neoplasms/diagnosis/epidemiology; Europe/epidemiology; Humans; North America/epidemiology
Voigtländer, S.; Hakimhashemi, A.; Grundmann, N.; et al. (2023) Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany. J Cancer Res Clin Oncol. https://www.doi.org/10.1007/s00432-023-04707-0
Title
Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany
Publication date
2023
Abstract
PURPOSE: The aim of our study was to explore the impact of the COVID-19 pandemic on reported cancer cases in Bavaria, Germany, by comparing pre-pandemic (March 2019 to February 2020) and pandemic period (March 2020 to February 2021). METHODS: Data on incident cases were retrieved from the Bavarian Cancer Registry (until 22nd April 2022). We included patients with malignant and in situ neoplasms reported by pathology departments with consistent reporting. We calculated the number of incident cases during the COVID-19 pandemic and the pre-pandemic period with 95% confidence intervals (CI) with Bonferroni correction (alpha = 0.0018) based on a Poisson approach. We stratified for malignancy (malignant, in situ), tumor site, and month of year. RESULTS: Data was available for 30 out of 58 pathology departments (51.7%) from Bavaria. Incident malignant neoplasms dropped from 42,857 cases in the pre-pandemic period to 39,980 cases in the pandemic period (- 6.7%; 95% CI - 8.7%, - 4.7%). Reductions were higher for colon, rectum, skin/melanoma as well as liver (> 10.0% reduction) and less for breast cancer (4.9% reduction). No case reductions were observed for pancreas, esophagus, ovary, and cervix. Percent changes were largest for April 2020 (- 20.9%; 95% CI - 24.7%, - 16.8%) and January 2021 (- 25.2%; 95% CI - 28.8%, - 21.5%) compared to the previous year. Declines tended to be larger for in situ compared to malignant neoplasms. CONCLUSION: Detection and diagnosis of cancer were substantially reduced during the COVID-19 pandemic. Potential effects, e.g. a stage shift of tumors or an increase of cancer mortality, need to be monitored.
DOI
https://www.doi.org/10.1007/s00432-023-04707-0
Keywords
Benign neoplasms; Covid-19; Cancer; Cancer registry; Incidence; Pandemics
Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany
Publication date
2023
Abstract
PURPOSE: The aim of our study was to explore the impact of the COVID-19 pandemic on reported cancer cases in Bavaria, Germany, by comparing pre-pandemic (March 2019 to February 2020) and pandemic period (March 2020 to February 2021). METHODS: Data on incident cases were retrieved from the Bavarian Cancer Registry (until 22nd April 2022). We included patients with malignant and in situ neoplasms reported by pathology departments with consistent reporting. We calculated the number of incident cases during the COVID-19 pandemic and the pre-pandemic period with 95% confidence intervals (CI) with Bonferroni correction (alpha = 0.0018) based on a Poisson approach. We stratified for malignancy (malignant, in situ), tumor site, and month of year. RESULTS: Data was available for 30 out of 58 pathology departments (51.7%) from Bavaria. Incident malignant neoplasms dropped from 42,857 cases in the pre-pandemic period to 39,980 cases in the pandemic period (- 6.7%; 95% CI - 8.7%, - 4.7%). Reductions were higher for colon, rectum, skin/melanoma as well as liver (> 10.0% reduction) and less for breast cancer (4.9% reduction). No case reductions were observed for pancreas, esophagus, ovary, and cervix. Percent changes were largest for April 2020 (- 20.9%; 95% CI - 24.7%, - 16.8%) and January 2021 (- 25.2%; 95% CI - 28.8%, - 21.5%) compared to the previous year. Declines tended to be larger for in situ compared to malignant neoplasms. CONCLUSION: Detection and diagnosis of cancer were substantially reduced during the COVID-19 pandemic. Potential effects, e.g. a stage shift of tumors or an increase of cancer mortality, need to be monitored.
DOI
https://www.doi.org/10.1007/s00432-023-04707-0
Keywords
Benign neoplasms; Covid-19; Cancer; Cancer registry; Incidence; Pandemics
Voigtländer, S.; Hakimhashemi, A.; Grundmann, N.; et al. (2022) Trends of colorectal cancer incidence according to age, anatomic site, and histological subgroup in Bavaria: A registry-based study. Front Oncol. https://www.doi.org/10.3389/fonc.2022.904546
Title
Trends of colorectal cancer incidence according to age, anatomic site, and histological subgroup in Bavaria: A registry-based study
Publication date
2022
Abstract
BACKGROUND: Recent studies reported an increase in colorectal cancer incidence for adults below 50 years. There is a lack of studies distinguishing between histological subgroups, especially from Europe. METHODS: Using data from the Bavarian Cancer Registry, we analyzed incidence trends in colorectal cancer by age (20-29, 30-39, 40-49, and 50 years and above), anatomic site (colon without appendix, appendix, and rectum), and histological subgroup (adenocarcinoma and neuroendocrine neoplasm) from 2005 to 2019. We calculated 3-year average annual age-standardized incidence rates (ASIR) per 100,000 persons for the beginning (2005-2007) and the end (2017-2019) of the study period and estimated average annual percentage change. RESULTS: Data from 137,469 persons diagnosed with colorectal cancer were included. From 139,420 cases in total, 109,825 (78.8%) were adenocarcinomas (ACs), 2,800 (2.0%) were neuroendocrine neoplasms (NENs), and 26,795 (19.2%) had other histologies. This analysis showed a significant increase in the 3-year average annual ASIR of colorectal NENs in all age groups between 2005-2007 and 2017-2019 with the highest increase in the age groups 30-39 years (0.47 to 1.53 cases per 100,000 persons; +226%; p < 0.05) and 20-29 years (0.52 to 1.38 cases per 100,000 persons; +165%; p < 0.05). The increase was driven by appendiceal and rectal NENs but not by colonic NENs. The 3-year average annual ASIR of colorectal ACs did not change significantly for the age groups below 50 years. For those aged 50 years and above, the 3-year average annual ASIR of colorectal ACs decreased significantly (132.55 to 105.95 cases per 100,000 persons; -20%; p < 0.05]). The proportion of NENs increased across all age groups, especially in the younger age groups. CONCLUSION: Future studies that analyze trends in early-onset colorectal cancer need to distinguish between anatomic sites as well as histological subgroups and may, thus, provide useful information regarding the organization of colorectal cancer screening, which primarily helps to detect adenomas and adenocarcinomas."
DOI
https://www.doi.org/10.3389/fonc.2022.904546
Keywords
adenocarcinoma; appendiceal malignancies; colorectal cancer; epidemiology; histology; incidence; neuroendocrine neoplasm
Trends of colorectal cancer incidence according to age, anatomic site, and histological subgroup in Bavaria: A registry-based study
Publication date
2022
Abstract
BACKGROUND: Recent studies reported an increase in colorectal cancer incidence for adults below 50 years. There is a lack of studies distinguishing between histological subgroups, especially from Europe. METHODS: Using data from the Bavarian Cancer Registry, we analyzed incidence trends in colorectal cancer by age (20-29, 30-39, 40-49, and 50 years and above), anatomic site (colon without appendix, appendix, and rectum), and histological subgroup (adenocarcinoma and neuroendocrine neoplasm) from 2005 to 2019. We calculated 3-year average annual age-standardized incidence rates (ASIR) per 100,000 persons for the beginning (2005-2007) and the end (2017-2019) of the study period and estimated average annual percentage change. RESULTS: Data from 137,469 persons diagnosed with colorectal cancer were included. From 139,420 cases in total, 109,825 (78.8%) were adenocarcinomas (ACs), 2,800 (2.0%) were neuroendocrine neoplasms (NENs), and 26,795 (19.2%) had other histologies. This analysis showed a significant increase in the 3-year average annual ASIR of colorectal NENs in all age groups between 2005-2007 and 2017-2019 with the highest increase in the age groups 30-39 years (0.47 to 1.53 cases per 100,000 persons; +226%; p < 0.05) and 20-29 years (0.52 to 1.38 cases per 100,000 persons; +165%; p < 0.05). The increase was driven by appendiceal and rectal NENs but not by colonic NENs. The 3-year average annual ASIR of colorectal ACs did not change significantly for the age groups below 50 years. For those aged 50 years and above, the 3-year average annual ASIR of colorectal ACs decreased significantly (132.55 to 105.95 cases per 100,000 persons; -20%; p < 0.05]). The proportion of NENs increased across all age groups, especially in the younger age groups. CONCLUSION: Future studies that analyze trends in early-onset colorectal cancer need to distinguish between anatomic sites as well as histological subgroups and may, thus, provide useful information regarding the organization of colorectal cancer screening, which primarily helps to detect adenomas and adenocarcinomas."
DOI
https://www.doi.org/10.3389/fonc.2022.904546
Keywords
adenocarcinoma; appendiceal malignancies; colorectal cancer; epidemiology; histology; incidence; neuroendocrine neoplasm
Voigtländer, S.; Hakimhashemi, A.; Inwald, E. C.; et al. (2021) The Impact of the COVID-19 Pandemic on Cancer Incidence and Treatment by Cancer Stage in Bavaria, Germany. Dtsch Arztebl Int. https://www.doi.org/10.3238/arztebl.m2021.0329
Title
The Impact of the COVID-19 Pandemic on Cancer Incidence and Treatment by Cancer Stage in Bavaria, Germany
Publication date
2021
DOI
https://www.doi.org/10.3238/arztebl.m2021.0329
Keywords
*covid-19; Germany/epidemiology; Humans; Incidence; *Neoplasms/epidemiology/therapy; Pandemics/prevention & control; SARS-CoV-2
The Impact of the COVID-19 Pandemic on Cancer Incidence and Treatment by Cancer Stage in Bavaria, Germany
Publication date
2021
DOI
https://www.doi.org/10.3238/arztebl.m2021.0329
Keywords
*covid-19; Germany/epidemiology; Humans; Incidence; *Neoplasms/epidemiology/therapy; Pandemics/prevention & control; SARS-CoV-2
Völkel, V.; Draeger, T.; Schnitzbauer, V.; et al. (2019) Surgical treatment of rectal cancer patients aged 80 years and older-a German nationwide analysis comparing short- and long-term survival after laparoscopic and open tumor resection. Eur J Surg Oncol. https://www.doi.org/10.1016/j.ejso.2019.05.005
Title
Surgical treatment of rectal cancer patients aged 80 years and older-a German nationwide analysis comparing short- and long-term survival after laparoscopic and open tumor resection
Publication date
2019
Abstract
BACKGROUND: Minimally invasive removal of rectal tumors has proven to be a safe alternative to the open approach. Despite increased use of laparoscopy, its eligibility for older adults requires further exploration. This study compares perioperative mortality and 5-year overall, disease-free, and relative survival after laparoscopic and open surgery in rectal cancer patients aged >/=80 years. MATERIALS AND METHODS: Data derive from 30 German regional cancer registries and cover approximately one quarter of the entire German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were applied; a sensitivity analysis assessed bias by exclusion. RESULTS: 1532 patients were included, of whom 17.1% underwent laparoscopic procedures. 30 days after surgery, 2.7% of the laparoscopy patients had died compared to 7.0% in the open surgery group. The multivariable analysis confirmed that minimally invasive procedures are followed by a lower 30-day postoperative mortality risk (odds ratio, OR, 0.352; 95% confidence interval, CI, 0.161-0.771; p=0.009). With a 5-year disease-free survival rate of 52.0 vs. 47.6% (p=0.557), only an nonsignificant long-term advantage of the minimally invasive approach was observed. CONCLUSION: Given the results of this study, older rectal cancer patients are likely to benefit from the laparoscopic approach in the short term, and there are also no disadvantages in terms of long-term survival. Therefore, laparoscopy should be considered a standard procedure for older adults as well.
DOI
https://www.doi.org/10.1016/j.ejso.2019.05.005
Keywords
Aged, 80 and over; Female; Germany/epidemiology; Humans; Kaplan-Meier Estimate; Laparoscopy/*methods; Male; Neoplasm Grading; Neoplasm Staging; Rectal Neoplasms/*mortality/pathology/*surgery; Registries; Bowel cancer; Cohort studies; Elderly patients; Health services research; Minimally invasive surgery
Surgical treatment of rectal cancer patients aged 80 years and older-a German nationwide analysis comparing short- and long-term survival after laparoscopic and open tumor resection
Publication date
2019
Abstract
BACKGROUND: Minimally invasive removal of rectal tumors has proven to be a safe alternative to the open approach. Despite increased use of laparoscopy, its eligibility for older adults requires further exploration. This study compares perioperative mortality and 5-year overall, disease-free, and relative survival after laparoscopic and open surgery in rectal cancer patients aged >/=80 years. MATERIALS AND METHODS: Data derive from 30 German regional cancer registries and cover approximately one quarter of the entire German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were applied; a sensitivity analysis assessed bias by exclusion. RESULTS: 1532 patients were included, of whom 17.1% underwent laparoscopic procedures. 30 days after surgery, 2.7% of the laparoscopy patients had died compared to 7.0% in the open surgery group. The multivariable analysis confirmed that minimally invasive procedures are followed by a lower 30-day postoperative mortality risk (odds ratio, OR, 0.352; 95% confidence interval, CI, 0.161-0.771; p=0.009). With a 5-year disease-free survival rate of 52.0 vs. 47.6% (p=0.557), only an nonsignificant long-term advantage of the minimally invasive approach was observed. CONCLUSION: Given the results of this study, older rectal cancer patients are likely to benefit from the laparoscopic approach in the short term, and there are also no disadvantages in terms of long-term survival. Therefore, laparoscopy should be considered a standard procedure for older adults as well.
DOI
https://www.doi.org/10.1016/j.ejso.2019.05.005
Keywords
Aged, 80 and over; Female; Germany/epidemiology; Humans; Kaplan-Meier Estimate; Laparoscopy/*methods; Male; Neoplasm Grading; Neoplasm Staging; Rectal Neoplasms/*mortality/pathology/*surgery; Registries; Bowel cancer; Cohort studies; Elderly patients; Health services research; Minimally invasive surgery
Völkel, V.; Gerken, M.; Kleihues-van Tol, K.; et al. (2023) Treatment of Colorectal Cancer in Certified Centers: Results of a Large German Registry Study Focusing on Long-Term Survival. Cancers (Basel). https://www.doi.org/10.3390/cancers15184568
Title
Treatment of Colorectal Cancer in Certified Centers: Results of a Large German Registry Study Focusing on Long-Term Survival
Publication date
2023
Abstract
(1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan-Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I-III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers.
DOI
https://www.doi.org/10.3390/cancers15184568
Keywords
German Cancer Society; WiZen; certified cancer center; cohort study; colon cancer; evidence-based medicine; quality of cancer care; rectal cancer; registries; survival
Treatment of Colorectal Cancer in Certified Centers: Results of a Large German Registry Study Focusing on Long-Term Survival
Publication date
2023
Abstract
(1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan-Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I-III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers.
DOI
https://www.doi.org/10.3390/cancers15184568
Keywords
German Cancer Society; WiZen; certified cancer center; cohort study; colon cancer; evidence-based medicine; quality of cancer care; rectal cancer; registries; survival
Völkel, V.; Klinkhammer-Schalke, M.; Fürst, A.. (2021) Falling Mortality Thanks to Improved Treatment for Colorectal Cancer. Dtsch Arztebl Int. https://www.doi.org/10.3238/arztebl.m2021.0259
Title
Falling Mortality Thanks to Improved Treatment for Colorectal Cancer
Publication date
2021
DOI
https://www.doi.org/10.3238/arztebl.m2021.0259
Keywords
*Accidental Falls; *Colorectal Neoplasms/therapy; Humans; Risk Factors
Falling Mortality Thanks to Improved Treatment for Colorectal Cancer
Publication date
2021
DOI
https://www.doi.org/10.3238/arztebl.m2021.0259
Keywords
*Accidental Falls; *Colorectal Neoplasms/therapy; Humans; Risk Factors
Völkel, V.; Schatz, S.; Draeger, T.; et al. (2022) Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany. Surg Endosc. https://www.doi.org/10.1007/s00464-021-08384-3
Title
Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany
Publication date
2022
Abstract
BACKGROUND: Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center. PATIENTS AND METHODS: Data were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan-Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis. RESULTS: During the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien-Dindo 3-4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%. CONCLUSION: TaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.
DOI
https://www.doi.org/10.1007/s00464-021-08384-3
Keywords
Humans; *Laparoscopy/adverse effects/methods; Postoperative Complications/epidemiology/etiology/surgery; *Proctectomy/adverse effects; *Rectal Neoplasms; Rectum/surgery; *Transanal Endoscopic Surgery/methods; Treatment Outcome; Clinical implementation; Low rectal carcinoma; Minimal-invasive surgery; NOTES-natural orifice transluminal endoscopic surgery; TaTME
Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany
Publication date
2022
Abstract
BACKGROUND: Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center. PATIENTS AND METHODS: Data were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan-Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis. RESULTS: During the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien-Dindo 3-4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%. CONCLUSION: TaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.
DOI
https://www.doi.org/10.1007/s00464-021-08384-3
Keywords
Humans; *Laparoscopy/adverse effects/methods; Postoperative Complications/epidemiology/etiology/surgery; *Proctectomy/adverse effects; *Rectal Neoplasms; Rectum/surgery; *Transanal Endoscopic Surgery/methods; Treatment Outcome; Clinical implementation; Low rectal carcinoma; Minimal-invasive surgery; NOTES-natural orifice transluminal endoscopic surgery; TaTME
Völkel, V.; Steinger, B.; Koller, M.; et al. (2023) Colorectal cancer survivors' long-term recollections of their illness and therapy up to seven years after enrolment into a randomised controlled clinical trial. BMC Cancer. https://www.doi.org/10.1186/s12885-023-10604-z
Title
Colorectal cancer survivors' long-term recollections of their illness and therapy up to seven years after enrolment into a randomised controlled clinical trial
Publication date
2023
Abstract
BACKGROUND: As a consequence of effective treatment procedures, the number of long-term survivors of colorectal cancer is ever increasing. Adopting the method of a previous study on breast cancer patients, the goal of the present research was to investigate colorectal cancer patients' recollections of their illness and treatment experiences up to seven years after they have been enrolled in a randomised controlled clinical trial on the direct improvement of quality of life (RCT DIQOL). METHODS: Colorectal cancer survivors in Bavaria, Germany were mailed a questionnaire on average 78.3 months after the start of their therapy and enrolment into RCT DIQOL. The questionnaire enquired about their worst experience during the colorectal cancer episode, positive aspects of the illness, and any advice they would give to newly diagnosed patients. Patient responses were categorised by two independent raters and cross-checked by a third independent rater. Frequencies of these categories were then quantitatively analysed using descriptive statistics. RESULTS: Of 146 remaining survivors initially enrolled in RCT DIQOL, 96 (66%) returned the questionnaire. The majority (33%) of statements regarding the worst experience was referring to "psychological distress", followed by "indigestion and discomfort during defecation" (17%), and "cancer diagnosis" (16%). Among survivors with history of a stoma, the majority (36%) regarded "stoma" as their worst experience. With 45%, "change in life priorities" has been the most frequent positive category before "support by physicians/ nurses" (25%). 43% of the survivors deemed "fighting spirit" as most important advice to overcome the disease. CONCLUSION: Even after many years, colorectal cancer survivors clearly remember experiences from the time of their illness. Echoing the results of the previous breast cancer survivors' study, "psychological distress", "change in life priorities" and "fighting spirit" emerged as prominent concepts. In addition, some aspects like the impact of a stoma are of specific importance for colorectal cancer survivors. These findings can be used to inform programmes to improve patient- and quality of life centred aftercare of tumour patients. CLINICAL TRIAL INFORMATION: NCT04930016, date of registration 18.06.2021.
DOI
https://www.doi.org/10.1186/s12885-023-10604-z
Keywords
Humans; Female; *Cancer Survivors/psychology; Quality of Life/psychology; *Colorectal Neoplasms/pathology; Survivors/psychology; *Breast Neoplasms/therapy/psychology; Colorectal cancer; Long-term survival; Patient-centred care; Patient-reported outcomes; Quality of life
Colorectal cancer survivors' long-term recollections of their illness and therapy up to seven years after enrolment into a randomised controlled clinical trial
Publication date
2023
Abstract
BACKGROUND: As a consequence of effective treatment procedures, the number of long-term survivors of colorectal cancer is ever increasing. Adopting the method of a previous study on breast cancer patients, the goal of the present research was to investigate colorectal cancer patients' recollections of their illness and treatment experiences up to seven years after they have been enrolled in a randomised controlled clinical trial on the direct improvement of quality of life (RCT DIQOL). METHODS: Colorectal cancer survivors in Bavaria, Germany were mailed a questionnaire on average 78.3 months after the start of their therapy and enrolment into RCT DIQOL. The questionnaire enquired about their worst experience during the colorectal cancer episode, positive aspects of the illness, and any advice they would give to newly diagnosed patients. Patient responses were categorised by two independent raters and cross-checked by a third independent rater. Frequencies of these categories were then quantitatively analysed using descriptive statistics. RESULTS: Of 146 remaining survivors initially enrolled in RCT DIQOL, 96 (66%) returned the questionnaire. The majority (33%) of statements regarding the worst experience was referring to "psychological distress", followed by "indigestion and discomfort during defecation" (17%), and "cancer diagnosis" (16%). Among survivors with history of a stoma, the majority (36%) regarded "stoma" as their worst experience. With 45%, "change in life priorities" has been the most frequent positive category before "support by physicians/ nurses" (25%). 43% of the survivors deemed "fighting spirit" as most important advice to overcome the disease. CONCLUSION: Even after many years, colorectal cancer survivors clearly remember experiences from the time of their illness. Echoing the results of the previous breast cancer survivors' study, "psychological distress", "change in life priorities" and "fighting spirit" emerged as prominent concepts. In addition, some aspects like the impact of a stoma are of specific importance for colorectal cancer survivors. These findings can be used to inform programmes to improve patient- and quality of life centred aftercare of tumour patients. CLINICAL TRIAL INFORMATION: NCT04930016, date of registration 18.06.2021.
DOI
https://www.doi.org/10.1186/s12885-023-10604-z
Keywords
Humans; Female; *Cancer Survivors/psychology; Quality of Life/psychology; *Colorectal Neoplasms/pathology; Survivors/psychology; *Breast Neoplasms/therapy/psychology; Colorectal cancer; Long-term survival; Patient-centred care; Patient-reported outcomes; Quality of life
Weiss, M.; Sim, D. A.; Herold, T.; et al. (2018) Compliance and Adherence of Patients with Diabetic Macular Edema to Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Daily Practice. Retina. https://www.doi.org/10.1097/IAE.0000000000001892
Title
Compliance and Adherence of Patients with Diabetic Macular Edema to Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Daily Practice
Publication date
2018
Abstract
PURPOSE: We assessed differences in compliance and adherence (lateness of patients, visual acuity, reasons for abstaining) between patients with diabetic macular edema (DME) and patients with age-related macular degeneration (AMD), both under anti-vascular endothelial growth factor therapy. METHODS: We included 136 patients with DME (36% women, 65 years, 22 visits, 13.9 injections, and 29.9 months of follow-up) and 109 patients with AMD (59% women, 76 years, 20 visits, 14.7 injections, and 22.3 months of follow-up) (minimum follow-up of 12 months and at least 5 injections). We assessed missed appointments (lateness >14 days) and therapy break-offs (lateness >100 days). All delayed patients were called and interviewed for abstaining reasons. RESULTS: Forty-six percent of patients with DME and 22% of patients with AMD had at least one break-off. Thirty-five percent of patients with DME and 50% of patients with AMD were always on schedule. In patients with DME, there was significant correlation (P = 0.017) between the number of break-offs and change of visual acuity. In 60% DME and 38% AMD of break-off cases, visual acuity was worse than the before break-off. The most common reason for abstaining was comorbidities (33% AMD and 20% DME). CONCLUSION: There are significant differences between patients with AMD and DME regarding compliance and adherence, which also affects outcome. Strategies to tie patients with DME to costly intravitreal therapy need to be developed to improve outcomes and efficacy.
DOI
https://www.doi.org/10.1097/IAE.0000000000001892
Keywords
Aged; Angiogenesis Inhibitors/administration & dosage; Bevacizumab/*administration & dosage; Diabetic Retinopathy/complications/diagnosis/*drug therapy; Female; Follow-Up Studies; Humans; Intravitreal Injections; Macula Lutea/*pathology; Macular Degeneration/diagnosis/drug therapy; Macular Edema/diagnosis/*drug therapy/etiology; Male; *Medication Adherence; Office Visits/statistics & numerical data; Patient Compliance; Ranibizumab/*administration & dosage; Receptors, Vascular Endothelial Growth Factor/*administration & dosage; Recombinant Fusion Proteins/*administration & dosage; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Visual Acuity
Compliance and Adherence of Patients with Diabetic Macular Edema to Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Daily Practice
Publication date
2018
Abstract
PURPOSE: We assessed differences in compliance and adherence (lateness of patients, visual acuity, reasons for abstaining) between patients with diabetic macular edema (DME) and patients with age-related macular degeneration (AMD), both under anti-vascular endothelial growth factor therapy. METHODS: We included 136 patients with DME (36% women, 65 years, 22 visits, 13.9 injections, and 29.9 months of follow-up) and 109 patients with AMD (59% women, 76 years, 20 visits, 14.7 injections, and 22.3 months of follow-up) (minimum follow-up of 12 months and at least 5 injections). We assessed missed appointments (lateness >14 days) and therapy break-offs (lateness >100 days). All delayed patients were called and interviewed for abstaining reasons. RESULTS: Forty-six percent of patients with DME and 22% of patients with AMD had at least one break-off. Thirty-five percent of patients with DME and 50% of patients with AMD were always on schedule. In patients with DME, there was significant correlation (P = 0.017) between the number of break-offs and change of visual acuity. In 60% DME and 38% AMD of break-off cases, visual acuity was worse than the before break-off. The most common reason for abstaining was comorbidities (33% AMD and 20% DME). CONCLUSION: There are significant differences between patients with AMD and DME regarding compliance and adherence, which also affects outcome. Strategies to tie patients with DME to costly intravitreal therapy need to be developed to improve outcomes and efficacy.
DOI
https://www.doi.org/10.1097/IAE.0000000000001892
Keywords
Aged; Angiogenesis Inhibitors/administration & dosage; Bevacizumab/*administration & dosage; Diabetic Retinopathy/complications/diagnosis/*drug therapy; Female; Follow-Up Studies; Humans; Intravitreal Injections; Macula Lutea/*pathology; Macular Degeneration/diagnosis/drug therapy; Macular Edema/diagnosis/*drug therapy/etiology; Male; *Medication Adherence; Office Visits/statistics & numerical data; Patient Compliance; Ranibizumab/*administration & dosage; Receptors, Vascular Endothelial Growth Factor/*administration & dosage; Recombinant Fusion Proteins/*administration & dosage; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Vascular Endothelial Growth Factor A/antagonists & inhibitors; Visual Acuity
Willvonseder, B.; Stögbauer, F.; Steiger, K.; et al. (2021) The immunologic tumor microenvironment in endometrioid endometrial cancer in the morphomolecular context: mutual correlations and prognostic impact depending on molecular alterations. Cancer Immunol Immunother. https://www.doi.org/10.1007/s00262-020-02813-3
Title
The immunologic tumor microenvironment in endometrioid endometrial cancer in the morphomolecular context: mutual correlations and prognostic impact depending on molecular alterations
Publication date
2021
Abstract
OBJECTIVE: POLE-mutant, microsatellite-instable (MSI), p53-mutant and non-specific molecular profile (NSMP) are TCGA-defined molecular subgroups of endometrial cancer (EC). Hypothesizing that morphology and tumor immunology might differ depending on molecular background concerning composition and prognostic impact, we aimed to comprehensively interconnect morphologic, immunologic and molecular data. METHODS: TCGA-defined molecular groups were determined by immunohistochemistry and sequencing in n = 142 endometrioid EC. WHO-defined histopathological grading was performed. The immunologic microenvironment (iTME) was characterised by the quantification of intraepithelial and stromal populations of tumor-infiltrating lymphocytes (TIL: overall T-cells; T-Killer cells; regulatory T-cells (Treg)). Immunologic parameters were correlated with WHO-grading, TCGA-subgroups and prognosis. RESULTS: High density TIL were significantly more frequent in high-grade (G3) compared to low-grade (G1/2) EC in the whole cohort and in the subgroup of POLE-wildtype-/microsatellite-stable-EC. MSI was associated with high-level TIL-infiltration when taking into account the type of mismatch repair defect (MLH1/PMS2; MSH2/MSH6). Prognostic impact of biomarkers depended on molecular subgroups: In p53-mutant EC, Treg were independently prognostic, in NSMP, the unique independently prognostic biomarker was WHO-grading. CONCLUSIONS: EC morphology and immunology differ depending on genetics. Our study delineated two molecularly distinct subgroups of immunogenic EC characterized by high-density TIL-infiltration: MSI EC and high-grade POLE-wildtype/microsatellite-stable-EC. Prognostic impact of TIL-populations relied on TCGA-subgroups indicating specific roles for TIL depending on molecular background. In NSMP, histopathological grading was the only prognostic biomarker demonstrating the relevance of WHO-grading in an era of molecular subtyping.
DOI
https://www.doi.org/10.1007/s00262-020-02813-3
Keywords
Adult; Aged; Aged, 80 and over; Biomarkers, Tumor/*genetics; Carcinoma, Endometrioid/genetics/immunology/*pathology; Endometrial Neoplasms/genetics/immunology/*pathology; Female; Follow-Up Studies; Humans; Lymphocytes, Tumor-Infiltrating/*immunology; *Microsatellite Instability; Middle Aged; *Mutation; Prognosis; Retrospective Studies; Survival Rate; Tumor Microenvironment/*immunology; Endometrioid endometrial cancer; Immunologic microenvironment; Molecular subgroups; Prognostic impact
The immunologic tumor microenvironment in endometrioid endometrial cancer in the morphomolecular context: mutual correlations and prognostic impact depending on molecular alterations
Publication date
2021
Abstract
OBJECTIVE: POLE-mutant, microsatellite-instable (MSI), p53-mutant and non-specific molecular profile (NSMP) are TCGA-defined molecular subgroups of endometrial cancer (EC). Hypothesizing that morphology and tumor immunology might differ depending on molecular background concerning composition and prognostic impact, we aimed to comprehensively interconnect morphologic, immunologic and molecular data. METHODS: TCGA-defined molecular groups were determined by immunohistochemistry and sequencing in n = 142 endometrioid EC. WHO-defined histopathological grading was performed. The immunologic microenvironment (iTME) was characterised by the quantification of intraepithelial and stromal populations of tumor-infiltrating lymphocytes (TIL: overall T-cells; T-Killer cells; regulatory T-cells (Treg)). Immunologic parameters were correlated with WHO-grading, TCGA-subgroups and prognosis. RESULTS: High density TIL were significantly more frequent in high-grade (G3) compared to low-grade (G1/2) EC in the whole cohort and in the subgroup of POLE-wildtype-/microsatellite-stable-EC. MSI was associated with high-level TIL-infiltration when taking into account the type of mismatch repair defect (MLH1/PMS2; MSH2/MSH6). Prognostic impact of biomarkers depended on molecular subgroups: In p53-mutant EC, Treg were independently prognostic, in NSMP, the unique independently prognostic biomarker was WHO-grading. CONCLUSIONS: EC morphology and immunology differ depending on genetics. Our study delineated two molecularly distinct subgroups of immunogenic EC characterized by high-density TIL-infiltration: MSI EC and high-grade POLE-wildtype/microsatellite-stable-EC. Prognostic impact of TIL-populations relied on TCGA-subgroups indicating specific roles for TIL depending on molecular background. In NSMP, histopathological grading was the only prognostic biomarker demonstrating the relevance of WHO-grading in an era of molecular subtyping.
DOI
https://www.doi.org/10.1007/s00262-020-02813-3
Keywords
Adult; Aged; Aged, 80 and over; Biomarkers, Tumor/*genetics; Carcinoma, Endometrioid/genetics/immunology/*pathology; Endometrial Neoplasms/genetics/immunology/*pathology; Female; Follow-Up Studies; Humans; Lymphocytes, Tumor-Infiltrating/*immunology; *Microsatellite Instability; Middle Aged; *Mutation; Prognosis; Retrospective Studies; Survival Rate; Tumor Microenvironment/*immunology; Endometrioid endometrial cancer; Immunologic microenvironment; Molecular subgroups; Prognostic impact
Wimmer, T.; Ortmann, O.; Gerken, M.; et al. (2019) Adherence to guidelines and benefit of adjuvant radiotherapy in patients with invasive breast cancer: results from a large population-based cohort study of a cancer registry. Arch Gynecol Obstet. https://www.doi.org/10.1007/s00404-018-5030-z
Title
Adherence to guidelines and benefit of adjuvant radiotherapy in patients with invasive breast cancer: results from a large population-based cohort study of a cancer registry
Publication date
2019
Abstract
PURPOSE: According to German S3 guidelines, radiotherapy (RT) is indicated in patients with invasive breast cancer after breast-conserving therapy (BCT). The aim of this analysis was to assess adherence to guidelines, long-term survival, recurrence rates, and recurrence-free survival after adjuvant RT in patients with BCT in daily clinical practice. METHODS: This retrospective cohort study comprised data from the population-based clinical cancer registry of the Tumor Centre Regensburg (Bavaria, Germany). 6370 patients with non-metastatic invasive breast cancer and UICC tumor stages I, II, and III who were treated in certified breast cancer centers by BCT and diagnosed between 2003 and 2013 were included in the study. RESULTS: 6184 (97.1%) breast cancer patients received guideline concordant RT and showed a 3-year overall survival (OAS) of 96.8% in contrast to 90.9% in patients without RT (5-year OAS of 93.1% vs. 79.0%, p < 0.001). In multivariable Cox regression models, better overall survival was confirmed for the RT group (HR 0.64, 95% CI 0.46-0.88, p = 0.007). The 5-year local recurrence-free survival rate (RFS) in the irradiated patients was 92.1% vs. 62.0% in the comparison group (p < 0.001). The 10-year RFS was 80.5% vs. 36.0% (p < 0.001). This difference persisted after adjusting in multivariable analysis (HR 0.20, 95% CI 0.16-0.26, p < 0.001). CONCLUSIONS: This population-based analysis showed that the implementation of German guidelines in clinical routine was successful and guideline concordant adjuvant radiotherapy after BCT leads to better overall and recurrence-free survival and lower local recurrence rates.
DOI
https://www.doi.org/10.1007/s00404-018-5030-z
Keywords
Adult; Aged; Breast Neoplasms/mortality/*radiotherapy/surgery; Female; *Guideline Adherence; Humans; Mastectomy, Segmental; Middle Aged; Radiotherapy, Adjuvant; Registries; Retrospective Studies; *Breast cancer; *Cancer registry; *Overall survival; *Radiotherapy; *Recurrence-free survival
Adherence to guidelines and benefit of adjuvant radiotherapy in patients with invasive breast cancer: results from a large population-based cohort study of a cancer registry
Publication date
2019
Abstract
PURPOSE: According to German S3 guidelines, radiotherapy (RT) is indicated in patients with invasive breast cancer after breast-conserving therapy (BCT). The aim of this analysis was to assess adherence to guidelines, long-term survival, recurrence rates, and recurrence-free survival after adjuvant RT in patients with BCT in daily clinical practice. METHODS: This retrospective cohort study comprised data from the population-based clinical cancer registry of the Tumor Centre Regensburg (Bavaria, Germany). 6370 patients with non-metastatic invasive breast cancer and UICC tumor stages I, II, and III who were treated in certified breast cancer centers by BCT and diagnosed between 2003 and 2013 were included in the study. RESULTS: 6184 (97.1%) breast cancer patients received guideline concordant RT and showed a 3-year overall survival (OAS) of 96.8% in contrast to 90.9% in patients without RT (5-year OAS of 93.1% vs. 79.0%, p < 0.001). In multivariable Cox regression models, better overall survival was confirmed for the RT group (HR 0.64, 95% CI 0.46-0.88, p = 0.007). The 5-year local recurrence-free survival rate (RFS) in the irradiated patients was 92.1% vs. 62.0% in the comparison group (p < 0.001). The 10-year RFS was 80.5% vs. 36.0% (p < 0.001). This difference persisted after adjusting in multivariable analysis (HR 0.20, 95% CI 0.16-0.26, p < 0.001). CONCLUSIONS: This population-based analysis showed that the implementation of German guidelines in clinical routine was successful and guideline concordant adjuvant radiotherapy after BCT leads to better overall and recurrence-free survival and lower local recurrence rates.
DOI
https://www.doi.org/10.1007/s00404-018-5030-z
Keywords
Adult; Aged; Breast Neoplasms/mortality/*radiotherapy/surgery; Female; *Guideline Adherence; Humans; Mastectomy, Segmental; Middle Aged; Radiotherapy, Adjuvant; Registries; Retrospective Studies; *Breast cancer; *Cancer registry; *Overall survival; *Radiotherapy; *Recurrence-free survival
Windschüttl, S.; Pukrop, T.; Herrmann, A.; et al. (2021) [Development of a screening workflow to identify patient needs in an interdisciplinary oncological day clinic]. Z Evid Fortbild Qual Gesundhwes. https://www.doi.org/10.1016/j.zefq.2021.04.004
Title
[Development of a screening workflow to identify patient needs in an interdisciplinary oncological day clinic]
Publication date
2021
Abstract
INTRODUCTION: The diagnosis of cancer leads to high levels of emotional distress in many patients. Quality of life is an important therapeutic goal in this context. A quality-of-life guide was implemented in the oncological day clinic (ICT) at the University Hospital of Regensburg (UKR) in order to individually support outpatients, help them with their questions and needs and improve their quality of life. METHODS: A screening tool is necessary for the structured assessment of quality of life/needs in the routine of tumor therapy and follow-up. As part of a mixed-methods study, focus groups with health professionals/patients were organized to specify the needs of cancer patients. On this basis, the literature was searched for questionnaires covering these needs in order to adapt an ICT-specific questionnaire and integrate it with the help of a workflow. RESULTS: A total of 333 individual aspects were brought up by the participants in focus groups on the needs of cancer patients in various phases of treatment/with various tumor entities. Since none of the questionnaires identified in the literature met our requirements, a new screening tool containing elements from different standardized forms and the results of the focus groups was developed and a new workflow created to integrate the questionnaire into the ICT routine. DISCUSSION: By interviewing health experts from different areas and patients with different tumor entities, the needs of cancer patients over different stages of the disease and additional possible differences between the cancer entities were identified and recorded. Through the implementation of a quality-of-life guide in the ICT, a structured assessment of the quality of life and an analysis of patient needs can take place with the help of the screening. A workflow was created to integrate screening into routine care. In addition, the questionnaire was designed in such a way that it can be used repeatedly at various points in time. In order to cover important stages in the course of therapy and to determine how patient needs change over the course, patients should be asked to complete the questionnaire several times after specified time intervals. CONCLUSION: The questionnaire is intended to assess the needs of cancer patients receiving outpatient treatment in a structured manner. Now it needs to be explored how the new screening tool and workflow interact and perform in clinical practice and how they help to improve patients' quality of life. It is also interesting to analyze which patients accept the advice offered by the quality-of-life guide and which needs are expressed most frequently.
DOI
https://www.doi.org/10.1016/j.zefq.2021.04.004
Keywords
Germany; Humans; *Neoplasms/diagnosis/therapy; *Quality of Life; Surveys and Questionnaires; Workflow; Ambulante Tumortherapie; Lebensqualitat; Outpatient tumor therapy; Patient needs; Patient*innenbedurfnisse; Psycho-oncological care; Psychoonkologische Versorgung; Quality of life; Screening
[Development of a screening workflow to identify patient needs in an interdisciplinary oncological day clinic]
Publication date
2021
Abstract
INTRODUCTION: The diagnosis of cancer leads to high levels of emotional distress in many patients. Quality of life is an important therapeutic goal in this context. A quality-of-life guide was implemented in the oncological day clinic (ICT) at the University Hospital of Regensburg (UKR) in order to individually support outpatients, help them with their questions and needs and improve their quality of life. METHODS: A screening tool is necessary for the structured assessment of quality of life/needs in the routine of tumor therapy and follow-up. As part of a mixed-methods study, focus groups with health professionals/patients were organized to specify the needs of cancer patients. On this basis, the literature was searched for questionnaires covering these needs in order to adapt an ICT-specific questionnaire and integrate it with the help of a workflow. RESULTS: A total of 333 individual aspects were brought up by the participants in focus groups on the needs of cancer patients in various phases of treatment/with various tumor entities. Since none of the questionnaires identified in the literature met our requirements, a new screening tool containing elements from different standardized forms and the results of the focus groups was developed and a new workflow created to integrate the questionnaire into the ICT routine. DISCUSSION: By interviewing health experts from different areas and patients with different tumor entities, the needs of cancer patients over different stages of the disease and additional possible differences between the cancer entities were identified and recorded. Through the implementation of a quality-of-life guide in the ICT, a structured assessment of the quality of life and an analysis of patient needs can take place with the help of the screening. A workflow was created to integrate screening into routine care. In addition, the questionnaire was designed in such a way that it can be used repeatedly at various points in time. In order to cover important stages in the course of therapy and to determine how patient needs change over the course, patients should be asked to complete the questionnaire several times after specified time intervals. CONCLUSION: The questionnaire is intended to assess the needs of cancer patients receiving outpatient treatment in a structured manner. Now it needs to be explored how the new screening tool and workflow interact and perform in clinical practice and how they help to improve patients' quality of life. It is also interesting to analyze which patients accept the advice offered by the quality-of-life guide and which needs are expressed most frequently.
DOI
https://www.doi.org/10.1016/j.zefq.2021.04.004
Keywords
Germany; Humans; *Neoplasms/diagnosis/therapy; *Quality of Life; Surveys and Questionnaires; Workflow; Ambulante Tumortherapie; Lebensqualitat; Outpatient tumor therapy; Patient needs; Patient*innenbedurfnisse; Psycho-oncological care; Psychoonkologische Versorgung; Quality of life; Screening
Yang, K.; Doege, D.; Thong, M. S. Y.; et al. (2023) Diabetes mellitus in long-term survivors with colorectal, breast, or prostate cancer: Prevalence and prognosis. A population-based study. Cancer. https://www.doi.org/10.1002/cncr.35133
Title
Diabetes mellitus in long-term survivors with colorectal, breast, or prostate cancer: Prevalence and prognosis. A population-based study
Publication date
2023
Abstract
BACKGROUND: Patients with cancer are at increased risk of diabetes mellitus (DM). Previous studies on the prevalence and prognostic impact of DM in cancer survivors were limited by small sample sizes or short follow-up times. We aimed to compare the patient-reported prevalence of DM in long-term cancer survivors (LTCS), who survived 5 years or more after cancer diagnosis, with that in cancer-free controls, and to estimate the mortality risk among LTCS according to DM status. METHODS: Our population-based cohort comprised 6952 LTCS diagnosed with breast, colorectal, or prostate cancer between 1994 and 2004, recruited in 2008-2011 (baseline), and followed until 2019. A total of 1828 cancer-free individuals served as controls. Multivariable logistic regression was used to compare the prevalence of DM in LTCS and controls, and according to covariates at baseline. Mortality among LTCS according to DM was assessed by Cox proportional hazards regression. RESULTS: A total of 962 (13.8%) LTCS at baseline reported DM. Prevalence of DM in LTCS was not higher than in cancer-free controls, both at baseline (odds ratio, 0.80; 95% CI, 0.66-0.97) and at follow-up (odds ratio, 0.83; 95% CI, 0.67-1.04). Prevalence of DM in LTCS was associated with cancer site, older age, lower education, higher socioeconomic deprivation, higher body mass index, physical inactivity, other comorbidities, and poorer prognosis (adjusted hazard ratio [all-cause mortality] = 1.29; 95% CI, 1.15-1.44). CONCLUSION: DM in LTCS is prevalent, but not higher than in cancer-free population controls. Cancer survivors with concurrent DM are at a potentially higher risk of death. PLAIN LANGUAGE SUMMARY: Cancer and diabetes mellitus (DM) are two serious threats to global health. In our study, prevalence of DM in long-term cancer survivors who survived 5 years or more after cancer diagnosis was not higher than in cancer-free controls. This should not be interpreted as an indication of a lower risk of DM in cancer survivors. Rather, it highlights the potentially poor prognosis in diabetic cancer survivors. Therefore, keeping a continuous satisfactory DM and hyperglycemia management is essential during long-term cancer survivorship.
DOI
https://www.doi.org/10.1002/cncr.35133
Keywords
cancer survivors; control group; diabetes mellitus; mortality; prevalence
Diabetes mellitus in long-term survivors with colorectal, breast, or prostate cancer: Prevalence and prognosis. A population-based study
Publication date
2023
Abstract
BACKGROUND: Patients with cancer are at increased risk of diabetes mellitus (DM). Previous studies on the prevalence and prognostic impact of DM in cancer survivors were limited by small sample sizes or short follow-up times. We aimed to compare the patient-reported prevalence of DM in long-term cancer survivors (LTCS), who survived 5 years or more after cancer diagnosis, with that in cancer-free controls, and to estimate the mortality risk among LTCS according to DM status. METHODS: Our population-based cohort comprised 6952 LTCS diagnosed with breast, colorectal, or prostate cancer between 1994 and 2004, recruited in 2008-2011 (baseline), and followed until 2019. A total of 1828 cancer-free individuals served as controls. Multivariable logistic regression was used to compare the prevalence of DM in LTCS and controls, and according to covariates at baseline. Mortality among LTCS according to DM was assessed by Cox proportional hazards regression. RESULTS: A total of 962 (13.8%) LTCS at baseline reported DM. Prevalence of DM in LTCS was not higher than in cancer-free controls, both at baseline (odds ratio, 0.80; 95% CI, 0.66-0.97) and at follow-up (odds ratio, 0.83; 95% CI, 0.67-1.04). Prevalence of DM in LTCS was associated with cancer site, older age, lower education, higher socioeconomic deprivation, higher body mass index, physical inactivity, other comorbidities, and poorer prognosis (adjusted hazard ratio [all-cause mortality] = 1.29; 95% CI, 1.15-1.44). CONCLUSION: DM in LTCS is prevalent, but not higher than in cancer-free population controls. Cancer survivors with concurrent DM are at a potentially higher risk of death. PLAIN LANGUAGE SUMMARY: Cancer and diabetes mellitus (DM) are two serious threats to global health. In our study, prevalence of DM in long-term cancer survivors who survived 5 years or more after cancer diagnosis was not higher than in cancer-free controls. This should not be interpreted as an indication of a lower risk of DM in cancer survivors. Rather, it highlights the potentially poor prognosis in diabetic cancer survivors. Therefore, keeping a continuous satisfactory DM and hyperglycemia management is essential during long-term cancer survivorship.
DOI
https://www.doi.org/10.1002/cncr.35133
Keywords
cancer survivors; control group; diabetes mellitus; mortality; prevalence
Zeissig, S. R.; Emrich, K.; Reinwald, F.; et al. (2023) Sarcoma Research with Cancer Registry Data: Data and Peculiarities of Germany in the Light of Other Countries. Oncol Res Treat. https://www.doi.org/10.1159/000531724
Title
Sarcoma Research with Cancer Registry Data: Data and Peculiarities of Germany in the Light of Other Countries
Publication date
2023
Abstract
INTRODUCTION: Sarcomas are documented in population-based and in clinic-associated databases. This study evaluated the status quo regarding the potential and obstacles of cancer registry-based research on sarcomas exemplified by Germany in comparison to similar databases in the US and Europe. Completeness and quality of data are discussed based on statistical analyses of a pooled data set established for the German Cancer Congress 2020. METHODS: We analyzed data derived from 16 German institutions (federal state cancer registries and some facility-based registries). Malignant sarcomas in adults diagnosed between 2000 and 2018 with information on histology were grouped according to the WHO classification of soft tissue and bone tumors. Descriptive analyses of the study population regarding the distribution of age, sex, histology, localization of primary tumors, and metastases were performed. Survival for the ten most frequent histological groups and UICC stages was evaluated according to Kaplan-Meier and Cox regression. Time interval between surgery and subsequent radiation was calculated. RESULTS: The initial data set contained 35,091 sarcomas. After several steps of data cleaning, 28,311 patients with known sex and unambiguous assignment to a histological subgroup remained (13,682 women and 14,629 men). Between 40 and 54 years, women were more likely to develop sarcomas, whereas in the older age groups more men were affected. Gastrointestinal stromal tumors, fibroblastic, and myofibroblastic tumors, smooth muscle tumors (mostly non-uterine leiomyosarcomas), and adipocytic tumors represented 48% of all sarcomas. Preferential sites for fibrosarcomas were the limbs, the trunk, and the head and neck region. The liposarcoma occurred most frequently on the trunk and limbs. Distant primary metastases were mostly located in the lung (43%), followed by the liver (14%), and bones (13%). Vascular and smooth muscle tumors showed the worst survival prognosis (5-year survival: approx. 15%, median survival approx. 8-16 months), whereas in low stages, the probability of survival of many sarcoma patients was beyond 5 years. Adjuvant radiotherapy was applied within 90 days in 71% of patients (n = 2,534). CONCLUSION: Our results correspond to the data from the literature. However, a lack of data quality and completeness hampers further meaningful analyses, especially nonspecific or missing information about morphology and stage. Compared to some other countries, a comprehensive database is presently missing in Germany. However, currently, there are important efforts and legislative initiatives to create a comprehensive database on a national level within the near future.
DOI
https://www.doi.org/10.1159/000531724
Keywords
Adult; Male; Humans; Female; Aged; *Sarcoma; Registries; *Bone Neoplasms; *Soft Tissue Neoplasms/pathology; Germany; Retrospective Studies; Cancer registration; Registry data; Sarcoma research
Sarcoma Research with Cancer Registry Data: Data and Peculiarities of Germany in the Light of Other Countries
Publication date
2023
Abstract
INTRODUCTION: Sarcomas are documented in population-based and in clinic-associated databases. This study evaluated the status quo regarding the potential and obstacles of cancer registry-based research on sarcomas exemplified by Germany in comparison to similar databases in the US and Europe. Completeness and quality of data are discussed based on statistical analyses of a pooled data set established for the German Cancer Congress 2020. METHODS: We analyzed data derived from 16 German institutions (federal state cancer registries and some facility-based registries). Malignant sarcomas in adults diagnosed between 2000 and 2018 with information on histology were grouped according to the WHO classification of soft tissue and bone tumors. Descriptive analyses of the study population regarding the distribution of age, sex, histology, localization of primary tumors, and metastases were performed. Survival for the ten most frequent histological groups and UICC stages was evaluated according to Kaplan-Meier and Cox regression. Time interval between surgery and subsequent radiation was calculated. RESULTS: The initial data set contained 35,091 sarcomas. After several steps of data cleaning, 28,311 patients with known sex and unambiguous assignment to a histological subgroup remained (13,682 women and 14,629 men). Between 40 and 54 years, women were more likely to develop sarcomas, whereas in the older age groups more men were affected. Gastrointestinal stromal tumors, fibroblastic, and myofibroblastic tumors, smooth muscle tumors (mostly non-uterine leiomyosarcomas), and adipocytic tumors represented 48% of all sarcomas. Preferential sites for fibrosarcomas were the limbs, the trunk, and the head and neck region. The liposarcoma occurred most frequently on the trunk and limbs. Distant primary metastases were mostly located in the lung (43%), followed by the liver (14%), and bones (13%). Vascular and smooth muscle tumors showed the worst survival prognosis (5-year survival: approx. 15%, median survival approx. 8-16 months), whereas in low stages, the probability of survival of many sarcoma patients was beyond 5 years. Adjuvant radiotherapy was applied within 90 days in 71% of patients (n = 2,534). CONCLUSION: Our results correspond to the data from the literature. However, a lack of data quality and completeness hampers further meaningful analyses, especially nonspecific or missing information about morphology and stage. Compared to some other countries, a comprehensive database is presently missing in Germany. However, currently, there are important efforts and legislative initiatives to create a comprehensive database on a national level within the near future.
DOI
https://www.doi.org/10.1159/000531724
Keywords
Adult; Male; Humans; Female; Aged; *Sarcoma; Registries; *Bone Neoplasms; *Soft Tissue Neoplasms/pathology; Germany; Retrospective Studies; Cancer registration; Registry data; Sarcoma research