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  • 1
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    Online Resource
    Influence of the New FIGO Classification for Cervical Cancer on Patient Survival: A Retrospective Analysis of 265 Histologically Confirmed Cases with FIGO Stages IA to IIB
    S. Karger AG ; 2020
    In:  Oncology Vol. 98, No. 2 ( 2020), p. 91-97
    Details
    In: Oncology, S. Karger AG, Vol. 98, No. 2 ( 2020), p. 91-97
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 At the end of the year 2018, a new FIGO classification for cervical cancer was published, mainly revising stage IB and introducing a new stage IIIC, which includes irrespectively of tumor size and local spread all patients with lymph node metastasis. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We retrospectively analyzed all cases of cervical cancer stage I to IIB who underwent surgery as primary treatment at our institution from 2000 until 2016 and therefore had a histological confirmation of tumor stage. We reclassified all histologies according to the new FIGO classification and calculated outcome according to the new stages. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Out of 265 patients, 146 (55%) patients were reclassified into a higher FIGO stage. Most changes appeared within stage IB and from any stage to stage IIIC1. Kaplan-Meier curves for new stages showed a significant difference in disease-free survival (DFS) and overall survival (OS) between stages I versus II versus III (log-rank test, both 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Overall, patients that were upstaged had a significant worse DFS ( 〈 i 〉 p 〈 /i 〉 = 0.012) and OS ( 〈 i 〉 p 〈 /i 〉 = 0.008) than patients whose stage did not change. Similar observations were made within sub-stages, when node-positive IB or IIB tumors were upstaged to IIIC tumors. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The new FIGO classification for cervical cancer reflects the strong impact of lymph node metastases on survival and is a clear improvement compared to the old FIGO classification with regard to risk stratification.
    Type of Medium: Online Resource
    ISSN: 0030-2414 , 1423-0232
    URL: Article
    DOI: 10.1159/000503149
    RVK:
    XH 3305
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1483096-6
    detail.hit.zdb_id: 250101-6
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  • 2
    Online Resource
    Online Resource
    Comparison of Fetomaternal Outcome between 47 Deliveries Following Successful External Cephalic Version for Breech Presentation and 7456 Deliveries Following Spontaneous Cephalic Presentation
    S. Karger AG ; 2018
    In:  Gynecologic and Obstetric Investigation Vol. 83, No. 5 ( 2018), p. 477-481
    Details
    In: Gynecologic and Obstetric Investigation, S. Karger AG, Vol. 83, No. 5 ( 2018), p. 477-481
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Achieving a cephalic position after a successful external cephalic version (ECV) is desired to result in delivery and fetal outcomes that are similar to those of deliveries following spontaneous cephalic presentation. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We performed a retrospective cohort study including patients with successful ECV following fetal breech position (ECV cohort, 〈 i 〉 n 〈 /i 〉 = 47) or with a singleton spontaneous cephalic pregnancy at ≥37 weeks of gestational age (control group, 〈 i 〉 n 〈 /i 〉 = 7,456) attempting a vaginal delivery between 2010 and 2013 at the University Hospital Ulm. The mode of delivery and fetal outcome parameters were compared between these 2 groups using nonparametric statistics. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 ECV cohort and control group did not differ with respect to maternal age, parity, gestational age at birth, and fetal gender. There were no significant differences between the 2 groups with regard to all parameters indicating fetal outcome. However, the rate of cesarean sections was higher after successful ECV compared to spontaneous cephalic presentation (27.7 vs. 12.8%, OR 2.615). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 While vaginal delivery is less likely to happen after a successful ECV compared to spontaneous cephalic singleton pregnancies, fetal outcome parameters showed no difference between the 2 groups. Physicians should be counseling and encouraging women to attempt ECV, as it is a safe and effective procedure.
    Type of Medium: Online Resource
    ISSN: 0378-7346 , 1423-002X
    URL: Article
    DOI: 10.1159/000480013
    RVK:
    XA 45603
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1482695-1
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  • 3
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    Online Resource
    Use of Calcium Channel Blockers is Associated with Mortality in Patients with Chronic Kidney Disease
    S. Karger AG ; 2015
    In:  Kidney and Blood Pressure Research Vol. 40, No. 6 ( 2015), p. 630-637
    Details
    In: Kidney and Blood Pressure Research, S. Karger AG, Vol. 40, No. 6 ( 2015), p. 630-637
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 The use of antihypertensive medicines has been shown to reduce proteinuria, morbidity, and mortality in patients with chronic kidney disease (CKD). A specific recommendation for a class of antihypertensive drugs is not available in this population, despite the pharmacodynamic differences. We have therefore analysed the association between antihypertensive medicines and survival of patients with chronic kidney disease. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Out of 2687 consecutive patients undergoing kidney biopsy a cohort of 606 subjects with retrievable medical therapy was included into the analysis. Kidney function was assessed by glomerular filtration rate (GFR) estimation at the time point of kidney biopsy. Main outcome variable was death. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Overall 114 (18.7%) patients died. In univariate regression analysis the use of alpha-blockers and calcium channel antagonists, progression of disease, diabetes mellitus (DM) type 1 and 2, arterial hypertension, coronary heart disease, peripheral vascular disease, male sex and age were associated with mortality (all p 〈 0.05). In a multivariate Cox regression model the use of calcium channel blockers (HR 1.89), age (HR 1.04), DM type 1 (HR 8.43) and DM type 2 (HR 2.17) and chronic obstructive pulmonary disease (HR 1.66) were associated with mortality (all p 〈 0.05). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The use of calcium channel blockers but not of other antihypertensive medicines is associated with mortality in primarily GN patients with CKD.
    Type of Medium: Online Resource
    ISSN: 1420-4096 , 1423-0143
    URL: Article
    DOI: 10.1159/000368539
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 1482922-8
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  • 4
    Online Resource
    Online Resource
    Ki67 as Proliferative Marker in Patients with Early Breast Cancer and Its Association with Clinicopathological Factors
    S. Karger AG ; 2021
    In:  Oncology Vol. 99, No. 12 ( 2021), p. 780-789
    Details
    In: Oncology, S. Karger AG, Vol. 99, No. 12 ( 2021), p. 780-789
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Ki67 as a proliferative marker has prognostic and therapeutic relevance in early breast cancer (EBC). However, standard cutoffs for distinguishing low and high Ki67 do not exist. 〈 b 〉 〈 i 〉 Material and Methods: 〈 /i 〉 〈 /b 〉 Data from all patients treated at the University Hospital Ulm for EBC between January 2013 and December 2015 with documented results for internal Ki67 assessment of the primary ( 〈 i 〉 n 〈 /i 〉 = 917) tumor were retrospectively analyzed evaluating the associations between Ki67 and other clinicopathological factors. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 595 (64.9%) patients had a Ki67 & #x3c;20% and 322 (35.1%) a Ki67 ≥20%. The median Ki67 was 10% (range 1–90%). Median Ki67 values according to the hormone receptor (HR)/ human epidermal growth factor receptor 2 (HER2) subtypes were 10% for HR-positive/HER2 negative (HR+/HER2−) disease ( 〈 i 〉 n 〈 /i 〉 = 717), 20% for HR+/HER2+ ( 〈 i 〉 n 〈 /i 〉 = 76), 30% for HR−/HER2+ ( 〈 i 〉 n 〈 /i 〉 = 45), and 60% for HR−/HER2− ( 〈 i 〉 n 〈 /i 〉 = 75). 75.2% or 89.3% of all patients with HER2-positive or triple-negative disease had a Ki67 ≥20%, respectively. Using a multivariable logistic regression with Ki67 ( & #x3c;20% vs. ≥20%) as binary dependent variable, younger age, positive nodal status, higher grading, histological nonspecific type carcinoma, negative HR status, and positive HER2 status were shown to be significantly associated with a higher proliferative index (Ki67 ≥20%). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 This analysis described Ki67 in different subtypes in EBC and its association with clinicopathological factors. According to more aggressive tumor biology, the respective subgroups also showed higher median Ki67 levels. However, definition of low and high proliferation index itself is difficult. It is essential to interpret Ki67 indices carefully with regard to the own institutional values and other clinicopathological factors.
    Type of Medium: Online Resource
    ISSN: 0030-2414 , 1423-0232
    URL: Article
    DOI: 10.1159/000517490
    RVK:
    XH 3305
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1483096-6
    detail.hit.zdb_id: 250101-6
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  • 5
    Online Resource
    Online Resource
    Endocrine Treatment with 2 Years of Tamoxifen versus 2 Years of Exemestane in Postmenopausal Patients with High-Risk Early Breast Cancer and Persisting Circulating Tumor Cells - First Results of the SUCCESS C Endocrine Treatment Sub-Study
    S. Karger AG ; 2018
    In:  Oncology Research and Treatment Vol. 41, No. 3 ( 2018), p. 93-98
    Details
    In: Oncology Research and Treatment, S. Karger AG, Vol. 41, No. 3 ( 2018), p. 93-98
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Optimal choice and sequence of endocrine treatment following adjuvant chemotherapy in postmenopausal early breast cancer patients are still under discussion and treatment stratification factors are missing. 〈 b 〉 〈 i 〉 Patients and Methods: 〈 /i 〉 〈 /b 〉 Postmenopausal women with HER2-negative, hormone receptor-positive tumors and persisting circulating tumor cells (CTCs; assessed using the FDA-approved CellSearch® System, Janssen Diagnostics, LLC) after chemotherapy were randomized to 2 years of tamoxifen followed by 3 years of exemestane (tamoxifen-exemestane group, n = 54) or 5 years of exemestane (exemestane-only group, n = 54). CTCs were again assessed after the first 2 years of endocrine treatment. In addition, safety data were compared between the 2 groups. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The 2 groups were well-balanced with regard to baseline characteristics. The CTC clearance rate after 2 years was 89% in the exemestane-only group and 97% in the tamoxifen-exemestane group (exact Fisher test, p = 0.36). The safety profile showed good tolerability with few grade 3 or 4 adverse events in both groups. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The similar CTC clearance rate after 2 years of endocrine therapy with exemestane or tamoxifen, and the safety profiles obtained may indicate comparable efficacy and tolerability of both endocrine treatment regimens. However, these results have to be confirmed by final survival and safety analysis.
    Type of Medium: Online Resource
    ISSN: 2296-5270 , 2296-5262
    URL: Article
    DOI: 10.1159/000485566
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 2749752-5
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  • 6
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    Online Resource
    Lymph Node Ratio Can Better Predict Prognosis than Absolute Number of Positive Lymph Nodes in Operable Cervical Carcinoma
    S. Karger AG ; 2020
    In:  Oncology Research and Treatment Vol. 43, No. 3 ( 2020), p. 87-95
    Details
    In: Oncology Research and Treatment, S. Karger AG, Vol. 43, No. 3 ( 2020), p. 87-95
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Nodal status is the most important prognostic factor in cervical cancer. However, further risk stratification in node positive cervical cancer patients is warranted for optimal therapeutic decisions. 〈 b 〉 〈 i 〉 Material and Methods: 〈 /i 〉 〈 /b 〉 Nodal positive patients ( 〈 i 〉 n 〈 /i 〉 = 86) were retrospectively stratified into two groups according to either number of positive nodes ( & #x3e;3 vs. 1–3) or lymph node ratio (LNR) (≥10 vs. & #x3c;10% and & #x3e;6.6 vs. ≤6.6%). Univariable log-rank tests and both univariable and adjusted multivariable Cox regression models were used to evaluate the association between number of positive nodes or LNR and disease-free survival (DFS) and overall survival (OS). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 LNR was significantly associated with worse DFS in adjusted multivariable analysis, both when categorized as ≥10 versus & #x3c;10% (HR 2.25, 95% CI 1.06–4.76, 〈 i 〉 p 〈 /i 〉 = 0.034) and when categorized as & #x3e;6.6 versus ≤6.6% (HR 2.79, 95% CI 1.23–6.37, 〈 i 〉 p 〈 /i 〉 = 0.015). However, we found no significant association between number of positive nodes or LNR and OS. 〈 b 〉 〈 i 〉 Discussion: 〈 /i 〉 〈 /b 〉 In operable node-positive cervical cancer, both number of positive lymph nodes and LNR can be used for further risk stratification with regard to DFS but not OS.
    Type of Medium: Online Resource
    ISSN: 2296-5270 , 2296-5262
    URL: Article
    DOI: 10.1159/000505032
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 2749752-5
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