Evangelische Huyssens Stiftung

Bad Essen, Germany

Evangelische Huyssens Stiftung

Bad Essen, Germany
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Schneider S.,Evangelische Huyssens Stiftung | Heikaus S.,Center for Pathology | Harter P.,Evangelische Huyssens Stiftung | Heitz F.,Evangelische Huyssens Stiftung | And 7 more authors.
International Journal of Gynecological Cancer | Year: 2017

Objective: The evolving knowledge of ovarian carcinogenesis sets the stage for our understanding of high-grade serous pelvic carcinoma (HGSC). Findings in prophylactic surgery introduced serous tubal intraepithelial carcinoma (STIC) as potential precursor of HGSC. The present study explores whether STIC instead should already be considered as an early stage of HGSC with a need for comprehensive staging and therapy. Patients and Methods We identified all consecutive patients with HGSC who received first-line therapy in our referral center for gynecologic oncology from January 2011 to April 2016. All chemo-naive patients with upfront debulking surgery in whom an association of STIC and tumor lesions could be analyzed were included. Patients with previous removal of the adnexa or overgrown of the fallopian tube by the tumor were excluded. Pathological workup of the fallopian tubes according to the SEE-FIM protocol was conducted. Results: We analyzed a series of 231 consecutive patients with HGSC of whom 121 (52.4%) had ovarian cancer, 74 (32.0%) had cancer of the fallopian tubes and 36 patients (15.6%) had primary peritoneal cancer. Serous tubal intraepithelial carcinoma could be identified in 158 (68.4%) of 231 patients; of 22 patients, 28.1% is ovarian cancer, 30.8% cancer of the fallopian tubes, and 9.5% peritoneal cancer. Four patients without any further intra-abdominal disease were identified of whom 2 patients had stage FIGO IA and 2 patients had lymph node metastases only. Conclusions: Our data suggest that STIC should be regarded as a malignant lesion with metastatic potential. Therefore, we recommend a comprehensive surgical staging including lymphadenectomy. Copyright © 2017 by IGCS and ESGO.


Ataseven B.,Evangelische Huyssens Stiftung | Kummel S.,The Interdisciplinary Center | Weikel W.,Dr. Horst Schmidt Kliniken | Heitz F.,Evangelische Huyssens Stiftung | And 8 more authors.
Archives of Gynecology and Obstetrics | Year: 2015

Purpose: Although the impact of lymph node ratio (LNR: ratio of metastatic to resected LNs) in breast cancer (BC) has been investigated, its prognostic value in molecular subtypes remains unclear. Our aim was to evaluate the impact of LNR compared to pN-stage in BC subtypes.Patients/methods: We analyzed the impact of LNR and pN-stage on disease-free (DFS) and overall survival (OS) in 1,656 patients with primary BC who underwent primary axillary surgery (removal of ≥10 LNs) between 1998 and 2011. The cut-off points for LNR were previously published. Using immunohistochemical parameters tumors were grouped in luminalA, luminalB/HER2−, luminalB/HER2+, HER2+ and triple negative (TNBC).Results: For the entire cohort 5/10-year DFS and OS rates were 88/77 % and 88/75 %, respectively. LNR and pN-stage were independent prognostic parameters for DFS/OS in multivariate analysis in the entire cohort and each molecular subgroup (p < 0.001). However, increasing LNR seemed to discriminated 10-year DFS slightly better than pN-stage in luminalA (intermediate/high LNR 65/44 % versus pN2/pN3 71/53 %), luminalB/HER2− (intermediate/high LNR 48/24 % versus pN2/pN3 41/42 %), and TNBC patients (intermediate/high LNR 49/24 % versus pN2/pN3 56/33 %).Conclusions: LNR is an important prognostic parameter for DFS/OS and might provide potentially more information than pN-stage in different molecular subtypes. © 2014, European Union.


Heitz F.,Evangelische Huyssens Stiftung | Barinoff J.,Evangelische Huyssens Stiftung | Du Bois O.,Dr. Horst Schmidt Kliniken | Hils R.,Dr. Horst Schmidt Kliniken | And 6 more authors.
Oncology (Switzerland) | Year: 2013

Objective: Receptor discordances between primary and recurrent breast cancer have been described for years, but only a few analyses have elucidated the factors that influence receptor changes. Methods: Explorative analyses of prospective data from a breast cancer database of a tertiary breast cancer unit. Results: Recurrent tumours that had expressed oestrogen (ER) and progesterone receptors (PR) and human epidermal growth factor receptor 2 (HER2) as primary tumours were negative for the respective receptor in 22.8, 41.4 and 40.8% of cases. ER, PR and HER2 expression was found in 19.8, 16.7 and 11.5% of recurrent tumours, although no expression had been observed in primary tumours. Receptor discordances in recurrent disease leading to different therapeutic approaches were noted in 126 of 411 patients (30.7%). In patients with tumours expressing primary ER and HER2, independent factors associated with discordance were endocrine therapy and treatment with trastuzumab. Conclusion: High rates of receptor discordance were found. The impact of factors that influence receptor changes is small so that no subgroup of patients with recurrent breast cancer should be excluded from biopsy. Whenever possible, a biopsy should be taken to confirm the diagnosis of a possible relapse as well as the receptor status of patients with breast cancer. Copyright © 2013 S. Karger AG, Basel.


Ataseven B.,Evangelische Huyssens Stiftung | Harter P.,Evangelische Huyssens Stiftung | Grimm C.,Evangelische Huyssens Stiftung | Grimm C.,Medical University of Vienna | And 7 more authors.
Gynecologic Oncology | Year: 2016

Objective: The revised 2014 FIGO staging system for epithelial ovarian cancer (EOC) included many changes of the previous system, particularly dividing FIGO stage IV in two subgroups. We evaluated if classifying patients with EOC in FIGO stage IVA and IVB has any prognostic implication. © 2016 Elsevier Inc.


Ataseven B.,Evangelische Huyssens Stiftung | Du Bois A.,Evangelische Huyssens Stiftung | Reinthaller A.,Medical University of Vienna | Traut A.,Evangelische Huyssens Stiftung | And 7 more authors.
Gynecologic Oncology | Year: 2015

Objective Hypoalbuminemia has been reported as a risk factor for post-operative complications and unfavorable survival in cancer patients. We aimed to evaluate the predictive value of preoperative serum albumin levels on post-operative complication rate and the impact on overall survival (OS) in patients with epithelial ovarian cancer (EOC) undergoing primary cytoreductive surgery. Methods The present retrospective study included 604 consecutive patients with EOC who underwent primary cytoreductive surgery at two tertiary cancer centers specialized in gynecologic oncology. Hypoalbuminemia was defined as a pre-operative serum albumin level ≤ 35 g/L. Post-operative surgical complications were graded according to the Clavien-Dindo-Classification (CDC). Fisher-test was used to investigate the predictive value of hypoalbuminemia on the rate of severe post-operative complications. Survival analyses were calculated using log-rank test and Cox regression models. Results The incidence of pre-operative hypoalbuminemia in the entire cohort was 16.4%. Hypoalbuminemia was a predictive factor for severe post-operative complications (CDC 3-5) (OR 3.65, (CI95% 1.59 - 8.39); p = 0.002). Furthermore, median overall survival time of patients with hypoalbuminemia was 24 months compared to 83 months in patients with normal albumin (p < 0.001), respectively. Hypoalbuminemia was independently associated with shortened overall survival (HR 2.2 (95% CI 1.6-3.0); p < 0.001) even after adjusting established prognostic factors such as age, tumor stage, performance status, and post-operative residual disease. Conclusion Pre-operative hypoalbuminemia can be used as both an independent predictive factor for severe post-operative complications and as prognostic parameter regarding overall survival in EOC patients. Therefore, albumin levels may be incorporated into future clinical trials as stratification factor. © 2015 Elsevier Inc.


PubMed | Evangelische Huyssens Stiftung
Type: Journal Article | Journal: Gynecologic oncology | Year: 2016

Some authors have claimed a significant impact of -blocking agents on outcome in epithelial ovarian cancer (EOC). This study investigated the impact of concurrent medication with selective beta blockers (SBB) in patients undergoing primary treatment for EOC.The study included all consecutive patients with primary EOC treated in two tertiary gynecological-oncologic units between 1999 and 2014. Medication was retrospectively analyzed by chart review.The study cohort comprised 801 patients, of whom 141 (17.6%) had received SBB. Median age of patients without SBB medication was 56years (range: 19-90years) and 64years (range: 41-84years) in patients taking SBB (p<0.001). The main prognostic factor FIGO stage did not differ between both cohorts. 63.8% of patients taking SBB underwent complete tumor resection compared to 74.2% of patients without SBB (p=0.012). Patients without SBB experienced less severe post-operative complications according to the Clavien-Dindo classification (18.8% vs 29.0%; p=0.003). Between the both groups without and with SBB intake, PFS and OS did not differ significantly (PFS: 27months and 24months, p=0.40; OS: 56months and 44, p=0.15). Multivariate analyses did not yield any association between SBB intake and prognosis but confirmed well-known prognostic factors.Intake of selective -blockers did not influence the prognosis of patients with EOC.


PubMed | Evangelische Huyssens Stiftung
Type: Clinical Trial | Journal: Clinical cancer research : an official journal of the American Association for Cancer Research | Year: 2012

The aim of this study was to evaluate the feasibility of phase 0 trials in the setting of a routine surgical procedure. Logistic considerations, tissue sampling and tissue handling, and variability of a biomarker during surgery, in here PARP, were evaluated.Patients with highly suspicious or proven diagnosis of advanced ovarian cancer, planned for debulking surgery were asked to allow sequential tumor biopsies during surgery. Biopsies were frozen immediately and PARP activity was measured subsequently.Baseline biopsies were obtained from eight patients after a median time of 88 minutes (minimum of 50 to maximum of 123 minutes). Second and third biopsies were obtained after a median of 60 (32-96) and 101 (79-130) minutes, respectively. Mean tumor load was 44% (5%-100%), with a cellular viability of 98% (85%-100%). Median baseline PARP activity was 1035 pg/mL (range, 429-2663 pg/mL). The observed interpatient variability at baseline was large: SD was 0.59 after natural logarithm transformation.Conducting phase 0 trials during surgery seems to be feasible in terms of logistic considerations. In preparation of a phase 0 trial during surgery, a feasibility study like this should be conducted to rule out major interactions of the surgical intervention with respect to the targeted biomarker.


PubMed | Evangelische Huyssens Stiftung and Medical University of Vienna
Type: Journal Article | Journal: Gynecologic oncology | Year: 2016

To determine the impact of debulking surgery (DS) and residual disease (RD) on outcome in patients with FIGO stage IV epithelial ovarian cancer (EOC).This exploratory study included 326 consecutive patients with FIGO IV EOC treated in our centers from 2000 to 2014. Data were extracted from our prospectively maintained registry.In patients, who underwent DS (n=286; 87.7%), complete macroscopic resection was achieved in 54.9% (RD0; n=157), RD of 1-10mm in 30.8% (RD1-10; n=88), and RD of >10mm in 14.3% (RD>10, n=41). Forty patients without surgery (NoCS; 12.3%) underwent either primary chemotherapy or palliative care only. Median overall survival (OS) in NoCS was 19months compared to 16, 25, and 50months in RD>10, RD1-10, and RD0, respectively (p<0.001). Multivariate analysis confirmed an inferior OS for NoCS (HR 2.51, 95% CI 1.25-3.57; p=0.001), RD>10 (HR 2.17, 95% CI 1.43-3.70; p=0.002), and RD1-10 (HR 1.50, 95% CI 1.01-2.23; p=0.046) when compared with RD0. Additional independent prognostic factors were poor performance status, ascites >500mL, and advanced intraabdominal tumor stage.Our results confirm the prognostic impact of optimal DS in FIGO stage IV disease. Survival benefit was greatest for patients with complete resection. Although not to the same extent patients do benefit from DS with RD10mm. Of note, patients with RD>10mm after DS seemed not to profit from surgery showing comparable OS to patients without DS. Selecting patients who benefit from DS is as crucial in stage IV EOC patients as it is in any other patients with advanced EOC.


PubMed | Evangelische Huyssens Stiftung
Type: Journal Article | Journal: Archives of gynecology and obstetrics | Year: 2015

Although the impact of lymph node ratio (LNR: ratio of metastatic to resected LNs) in breast cancer (BC) has been investigated, its prognostic value in molecular subtypes remains unclear. Our aim was to evaluate the impact of LNR compared to pN-stage in BC subtypes.We analyzed the impact of LNR and pN-stage on disease-free (DFS) and overall survival (OS) in 1,656 patients with primary BC who underwent primary axillary surgery (removal of 10 LNs) between 1998 and 2011. The cut-off points for LNR were previously published. Using immunohistochemical parameters tumors were grouped in luminalA, luminalB/HER2-, luminalB/HER2+, HER2+ and triple negative (TNBC).For the entire cohort 5/10-year DFS and OS rates were 88/77% and 88/75%, respectively. LNR and pN-stage were independent prognostic parameters for DFS/OS in multivariate analysis in the entire cohort and each molecular subgroup (p < 0.001). However, increasing LNR seemed to discriminated 10-year DFS slightly better than pN-stage in luminalA (intermediate/high LNR 65/44% versus pN2/pN3 71/53%), luminalB/HER2- (intermediate/high LNR 48/24% versus pN2/pN3 41/42%), and TNBC patients (intermediate/high LNR 49/24% versus pN2/pN3 56/33%).LNR is an important prognostic parameter for DFS/OS and might provide potentially more information than pN-stage in different molecular subtypes.


PubMed | Evangelische Huyssens Stiftung
Type: Journal Article | Journal: Oncology | Year: 2013

Receptor discordances between primary and recurrent breast cancer have been described for years, but only a few analyses have elucidated the factors that influence receptor changes.Explorative analyses of prospective data from a breast cancer database of a tertiary breast cancer unit.Recurrent tumours that had expressed oestrogen (ER) and progesterone receptors (PR) and human epidermal growth factor receptor 2 (HER2) as primary tumours were negative for the respective receptor in 22.8, 41.4 and 40.8% of cases. ER, PR and HER2 expression was found in 19.8, 16.7 and 11.5% of recurrent tumours, although no expression had been observed in primary tumours. Receptor discordances in recurrent disease leading to different therapeutic approaches were noted in 126 of 411 patients (30.7%). In patients with tumours expressing primary ER and HER2, independent factors associated with discordance were endocrine therapy and treatment with trastuzumab.High rates of receptor discordance were found. The impact of factors that influence receptor changes is small so that no subgroup of patients with recurrent breast cancer should be excluded from biopsy. Whenever possible, a biopsy should be taken to confirm the diagnosis of a possible relapse as well as the receptor status of patients with breast cancer.

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