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  • 1
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2022
    In:  Surgical Endoscopy Vol. 36, No. 12 ( 2022-12), p. 9179-9185
    In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 36, No. 12 ( 2022-12), p. 9179-9185
    Abstract: Trocar insertion during laparoscopy may lead to complications such as bleeding, bowel puncture and fascial defects with subsequent trocar site hernias. It is under discussion whether there is a difference in the extent of the trauma and thus in the size of the fascia defect between blunt and sharp trocars. But the level of evidence is low. Hence, we performed a Porcine Model. Methods A total of five euthanized female pigs were operated on. The average weight of the animals was 37.85 (Standard deviation SD 1.68) kg. All pigs were aged 90 ± 5 days. In alternating order five different conical 12-mm trocars (3 × bladeless, 2 × bladed) on each side 4 cm lateral of the mammary ridge were placed. One surgeon performed the insertions after conducting a pneumoperitoneum with 12 mmHg using a Verres’ needle. The trocars were removed after 60 min. Subsequently, photo imaging took place. Using the GSA Image Analyser (v3.9.6) the respective abdominal wall defect size was measured. Results The mean fascial defect size was 58.3 (SD 20.2) mm 2 . Bladed and bladeless trocars did not significant differ in terms of caused fascial defect size [bladed, 56.6 (SD 20) mm 2 vs. bladeless, 59.5 (SD 20.6) mm 2 , p  = 0.7]. Without significance the insertion of bladeless trocars led to the largest (Kii Fios™ First entry, APPLIEDMEDICAL©, 69.3 mm 2 ) and smallest defect size (VersaOne™ (COVIDIEN©, 54.1 mm 2 ). Conclusion Bladed and bladeless conical 12-mm trocars do not differ in terms of caused fascial defect size in the Porcine Model at hand. The occurrence of a trocar site hernia might be largely independent from trocar design.
    Type of Medium: Online Resource
    ISSN: 0930-2794 , 1432-2218
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2020
    In:  Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie Vol. 145, No. 04 ( 2020-08), p. 390-398
    In: Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Georg Thieme Verlag KG, Vol. 145, No. 04 ( 2020-08), p. 390-398
    Abstract: Hintergrund Vor 2 Jahrzehnten wurde die Single-Incision-Chirurgie als neues Konzept in der minimalinvasiven Chirurgie etabliert. Die Cholezystektomie ist die am häufigsten durchgeführte Prozedur in dieser Technik. Die meisten Erkenntnisse beruhen auf randomisierten Studien. Es existieren keine groß angelegten multizentrischen Datenanalysen aus der klinischen Routine. Diese Analyse der klinischen Versorgungsforschung basiert auf der SILAP-Studie („single-incision multiport/single port laparoscopic abdominal surgery“). Patienten und Methode Die vorliegende Registerauswertung basiert auf Daten von 47 Kliniken im Zeitraum 2012 bis 2014. Die primären Endpunkte waren Gesamtmorbidität/Letalität. Multiple lineare und logistische Regressionsanalysen wurden durchgeführt. Die statistische Signifikanz war angegeben mit p  〈  0,05. Ergebnisse In der SILAP-Studie wurden die Daten von 975 Patienten mit Single Incision laparoscopic Cholecystectomy (SILC) in der klinischen Routine in einem Register erfasst. Die intraoperativen Komplikationen betrugen 3,2%. Die Rate der Gallengangverletzungen lag bei 0,1%. Postoperative Komplikationen traten in 3,7% der Fälle auf. Die Letalität war bei 0,2%. Die Operationszeit (Median) fiel im Studienverlauf von 60,0 auf 51,5 min (p = 0,001). Ein Zusatztrokar war in 10,3% der Fälle erforderlich. Die Konversionsrate zur konventionellen Cholezystektomie betrug 0,7%. In der multivariaten Analyse zeigten der Body-Mass-Index (p = 0,024), das männliche Geschlecht (p = 0,012) und die Operationszeit (p  〈  0,001) einen signifikanten Einfluss auf die intraoperativen Komplikationen. Patienten der ASA-Gruppe III (p = 0,001) und Patienten mit Zusatztrokaren oder der Konversion zur offenen Operation (p = 0,001) wurden als signifikante Faktoren bei den postoperativen Komplikationen ermittelt. Schlussfolgerung Die Registeranalyse dieser prospektiv multizentrisch erhobenen Daten zeigen, dass auch außerhalb der Selektionskriterien von randomisierten Studien die SILC in der klinischen Routine sicher durchführbar ist. Einzige Einschränkung ist ein BMI 〉  30 kg/m2, der einen signifikanten Einfluss auf die intraoperative Rate von Minorkomplikationen hatte.
    Type of Medium: Online Resource
    ISSN: 0044-409X , 1438-9592
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 3
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2021
    In:  Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie Vol. 146, No. 01 ( 2021-02), p. 76-82
    In: Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Georg Thieme Verlag KG, Vol. 146, No. 01 ( 2021-02), p. 76-82
    Abstract: Hintergrund Die Qualitätssicherung in der Schilddrüsenchirurgie ist seit Langem Bestandteil des Handelns endokriner Chirurgen. Dabei wurden und werden überwiegend Register- und Studiendaten genutzt. Zunehmend kommen administrative Daten im Rahmen der Qualitätssicherung aus Routinedaten zur Auswertung. Ziel dieser Studie ist die Bestimmung der Reliabilität von Routinedaten zur Analyse von Behandlungsergebnissen und Komplikationen im Rahmen der Schilddrüsenchirurgie. Patienten und Methode In einer Querschnittsstudie der Klinik wurden die Patientenaktendaten von 121 Patienten mit Schilddrüsenoperation eines Jahres mit den Qualitätssicherungsdaten aus Routinedaten (QSR) verglichen. Daraus wurde die Sensitivität, Spezifität und positive und negative prädiktive Werte (PPV/NPV) spezifischer Komplikationen ermittelt. Ergebnisse In der Auswertung administrativer Daten wurden 40 spezifische Komplikationen identifiziert, dagegen 84 in der Auswertung der Patientenakten. Die Sensitivität für die Detektion der Komplikationen mit Routinedaten schwankte zwischen 31,3 und 60,0%. Die Spezifität reichte von 97,0 bis 100%. Der PPV betrug 0,77 – 1,0 und der NPV 0,56 – 1,0. Schlussfolgerung Die QSR zur Schilddrüsenchirurgie zeigt Defizite in der Sensitivität bei einer hohen Spezifität. Um eine zuverlässige Qualitätsanalyse in der Klinik vorzunehmen oder in der Versorgungsforschung daraus Volume-Outcome-Analysen zu erstellen, ist eine Steigerung der Validität der Routinedaten erforderlich. Der Parameter Hypokalzämie weist die größten Limitationen für Analysen im QSR auf.
    Type of Medium: Online Resource
    ISSN: 0044-409X , 1438-9592
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
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  • 4
    In: Journal of Hepato-Biliary-Pancreatic Sciences, Wiley, Vol. 26, No. 12 ( 2019-12), p. 548-556
    Abstract: Approximately one‐quarter of patients with colorectal carcinoma develop colorectal liver metastases (CRLM). Surgical treatment with curative intent by hepatic resection is the standard medical care. While some studies with small sample sizes have investigated the relationship between hospital procedure volume and in‐hospital mortality for this diagnosis, no population‐based study has been conducted. The present study was aimed at closing this gap. Methods Based on administrative population‐based hospital discharge data (Diagnosis Related Group Statistic), patients diagnosed with CRLM and treated with hepatic resection from 2011 to 2015 were identified. The hospital operation‐volume effect on risk‐adjusted in‐hospital mortality was examined by logistic regression models. Results During the study period, 5900 patients with CRLM were treated with hepatic resection, of whom 189 (3.2%) died before hospital discharge. Hospitals of different operation‐volume quartiles did not differ in terms of mortality rates. Sensitivity analysis investigating the volume–mortality relationship separately for every resection procedure showed no clear result. Procedure frequencies vary among hospitals of different volume quartiles, with low‐volume hospitals performing systematically more low‐risk procedures (in terms of reduced mortality rate), than high‐volume hospitals. Conclusion Based on almost complete German hospital discharge data, the results did not confirm unconditional volume–outcome relationship for CRLM patients.
    Type of Medium: Online Resource
    ISSN: 1868-6974 , 1868-6982
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2536390-6
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  • 5
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 4_suppl ( 2012-02-01), p. 393-393
    Abstract: 393 Background: We previously reported on the discovery and prospective validation of a blood based test (Detector C) for early detection of colorectal cancer (CRC). Detector C measures 202 RNA markers in white blood cells as a response of the host to tumor formation and growth. Detector C was validated using a prospective, multicenter case-control study with 343 patients (pts), 210 cases with confirmed CRC and 133 controls undergoing a complete screening colonoscopy. Detector C has a validated sensitivity (S + ) of 90% (95% CI 0.851-0.937) and specificity (S - ) of 88% (95% CI 0.812-0.930) (Rosental A. et al, J Clin Oncol 28:7s, 2010 (suppl; abstr 3580)). We now present the discovery of Detector C 2.0 based on 445 samples representing most of the pts previously used in the discovery and validation sets of Detector C. Methods: We used Affymetrix U133 plus 2.0 expression data of 291 CRC cases and 154 controls for discovery of Detector C 2.0. Random forest was used for feature (gene) selection and the support vector machine algorithm was employed as classifier in 600 repetitions of double-nested bootstraps to discriminate between cases and controls. Within each repetition, randomly chosen 23 controls and 160 CRC cases served as prospective validation set. The most frequent chosen genes for discrimination between cases and controls formed the consensus signature, namely Detector C 2.0. Results: Choosing a signature length of 1000 genes resulted in the following second order unbiased prospective performance estimates: S + =0.916 (95% CI 0.863-0.954) and S - = 0.948 (95% CI 0.773-0.994). S + for UICC stage I and stage II cases were 0.93 and 0.94. S + for high-grade intraepithelial neoplasia was ∼ 0.67 and S + for adenoma ≥ 10 mm was ∼ 0.45. Conclusions: Using a three times larger discovery set for Detector C 2.0 than for Detector C we improved S + (cancer detection rate) by 1.6% to 91.6%. The most important enhancement is the high S - of 94.8% of Detector C 2.0 which is six percent higher than the S- of Detector C. Detector C 2.0 is based on a much larger pts set and should be even more robust than Detector C. We will prospectively validate this test in the largest case-control study ever performed in early detection of CRC.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
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  • 6
    In: Journal of Cancer Research and Clinical Oncology, Springer Science and Business Media LLC, Vol. 149, No. 13 ( 2023-10), p. 12591-12596
    Abstract: The treatment paradigm for locally advanced rectal cancer (LARC) is shifting toward the total neoadjuvant therapy (TNT) concept, which administered systemic chemotherapy in the neoadjuvant setting, either before or after chemoradiotherapy (CRT) or short-course radiotherapy (SCRT). First results have shown higher pathologic complete response (pCR) rates and a favorable impact on disease-free survival (DFS). Our study aimed to evaluate the current clinical practice and expert opinion regarding TNT for locally advanced rectal cancer across DKG (German Cancer Society)-certified colorectal cancer centers. Methods A comprehensive online questionnaire, constituted of 14 TNT-focused queries targeting patients with locally advanced rectal cancer, was conducted among DKG-certified colorectal cancer centers registered within the database of the Addz (Arbeitsgemeinschaft Deutscher Darmzentren) between December 2022 and January 2023. Results A significant majority (68%) indicated that they treated between 0 and 10 patients using a TNT protocol. Only a third (36%) of these centers participated in patient enrollment for a TNT study. Despite this, 84% of centers reported treating patients in a manner analogous to a TNT study, with the RAPIDO regimen being the most prevalent approach, employed by 60% of the respondents. The decision to adopt a TNT approach was primarily influenced by factors, such as the lower third of the rectum (93% of centers), cT4 stage (86% of centers), and a positive circumferential resection margin (80% of centers). Regarding concerns, 65% of the survey respondents expressed no reservations about the TNT concept, while 35% had concerns. In particular, there appears to be disagreement and uncertainty in regard to a clinical complete response and the “Watch and Wait” approach. While some centers adopt the watch-and-wait approach (42%), others only utilize it when extirpation is otherwise necessary (39%), and a portion still proceeds with surgery as initially planned (19%). The survey also addressed unmet needs, which were elaborated in the free-text responses. Overall, there was high interest in participating in planned observational studies. Conclusions This study presents an overview of current clinical practice and unmet needs within DKG-certified German colorectal cancer centers. It is noteworthy that total neoadjuvant therapy (TNT) is predominantly performed outside of clinical trials. Moreover, across the centers, there is significant heterogeneity in handling clinical complete response and adopting the “watch and wait” approach. Further research is needed to establish standardization in the care of locally advanced rectal cancer.
    Type of Medium: Online Resource
    ISSN: 0171-5216 , 1432-1335
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    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 7
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 78, No. 13_Supplement ( 2018-07-01), p. 2960-2960
    Abstract: Introduction: Determining mutations in plasma (cfDNA) is a noninvasive method of profiling tumor genomic alterations. In this study, concordance of SNVs using NGS between matched plasma and formalin-fixed, paraffin-embedded (FFPE) tissue samples was investigated across all four stages of CRC. We focused primarily on stages I, II and III to determine the feasibility of using plasma for minimal residual disease (MRD) surveillance after surgical resection and for early detection of CRC. Methods: From a CRC biobank of & gt;9,000 subjects, 299 subjects (47 stage I, 131 stage II, 102 stage III, and 19 stage IV) were selected for whom paired treatment-naïve FFPE tumor tissue and 4mL of plasma was available. MSI was determined by PCR (Promega). DNA was isolated from plasma and FFPE using cobas® extraction kits. Sequencing was performed using the AVENIO ctDNA Surveillance Kit (Research Use Only) and AVENIO FFPET Surveillance kit (under development). The AVENIO kit detects four mutation classes. In this analysis only SNVs data is presented. Three different filtering methods for concordance were used for this analysis: (i) by adaptive call, (ii) by duplex support, and (iii) by single read. Concordance is defined as at least the presence of one identical SNV between matched tissue and plasma sample. Results: The most frequently mutated COSMIC genes in the tumor tissues of this cohort are TP53, APC, KRAS, PIK3CA, and BRAF with frequencies of 59%, 53%, 20%, 19% and 17% respectively. Using the most sensitive method (“by single read”), overall concordance in this cohort was 79.26%. The concordance for various stages (Stage I to Stage IV) ranges from 50-100%. If a more stringent criterion of adaptive call is used, then the concordance ranges from 21-89%. The mean number of somatic variants for MSI-low tumors (n=247) was 5.2 compared to 15.5 in MSI-high tumors (n=52) p-value 3.3e-14. Multivariate analysis showed that in addition to the clinical stage, tumor size was the most important clinical variable associated with concordance of SNVs between the matched tissue and plasma. Conclusions: This study demonstrated an overall concordance of 79.26%. Concordance was associated with the disease stage and most significantly with tumor size and T stage. High concordance for subjects with localized disease (stages IB; IIA-IIC, and IIIA-IIIC) suggests that cfDNA sequencing can be potentially used for surveillance monitoring of patients after surgery, in particular for the detection of MRD. High tissue-plasma concordance for localized CRC may allow the use of cfDNA sequencing for early detection. Prospective clinical studies are required for validation of this application. Citation Format: Preeti Lal, John Lee, Hans-Peter Adams, Lijing Yao, Frederike Fuhlbrück1, Stephanie Yaung, Sylvie McNamara, Corinna Wöstmann, Sebastian Fröhler, LiTai Fang, Rainer Kube, Frank Marusch, Michael Heise, Thomas Steinmüller, Matthias Pross, René Mantke, John Palma, André Rosenthal1. Concordance of genomic single-nucleotide variations (SNV) by next-generation sequencing (NGS) in paired tumor tissue and plasma in colorectal cancer (CRC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2960.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2018
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 8
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. 3634-3634
    Abstract: 3634 Background: Circulating cell-free DNA (cf-DNA) isolated from plasma samples of cancer patients (pts) is a promising source for noninvasive examination of tumor-specific mutation patterns. We examined the efficiency of ultra-deep amplicon sequencing (UDAS) of cf-DNA isolated from plasma and tumor DNA isolated from matched primary tumor tissue of pts with colorectal cancer (CRC). Methods: Blood was drawn prior to surgery from 44 pts: 20 male, 24 female; 44-79 years of age (median: 67.5); 11 stage III, 33 stage IV; 36 colon, 8 rectum tumors; no neo-adjuvant therapy. Cf-DNA was isolated from 2 ml of EDTA plasma. UDAS was applied to 72 DNA samples (44 plasma, 28 matched snap-frozen primary tumors) using the MiSeq platform (Illumina). A panel of 49 highly multiplexed amplicons was designed (Life Technologies) representing 9 cancer genes frequently mutated in CRC. For 16 primary tumors the mutation profile was determined using the TruSeq Amplicon Cancer Panel (Illumina). Results: Median cf-DNA yield was 310 ng / 2 ml plasma (1ng – 6.600 ng). There was no significant relation between cf-DNA yield and any clinical characteristic. Median amplicon coverage was 20.162 reads per bp (2.913 - 115.782). 33/49 amplicons (67%) had a coverage of 〉 10.000 reads. Altogether 61 high quality COSMIC-cited mutations were confirmed in plasma of 29/44 (66%) pts: 24/33 (73%) pts in stage IV, 5/11 (45%) pts in stage III. Confirmed mutations are: APC-17; BRAF-2, FBXW7-1, KRAS-15, NRAS-1, PIK3CA-4, SMAD4-2, and TP53-19 mutations. No high quality mutations were found in CTNNB1 and HRAS. Moreover two pts exhibited four high quality plasma mutations which were not detected in the matched primary tumor: APC (R216X), KRAS (Q61K), and SMAD4 (D355E); PIK3CA (E545K). Conclusions: Ultra deep amplicon sequencing is suitable to detect mutations in plasma samples of CRC pts with a high concordance to matched primary tumors. The concordance rate can be further increased by extending the spectrum of analyzed mutations or by the enrichment of cf-DNA tumor copies. This method could be applied to detect and monitor metastasis thus opening a new paradigm for the selection of pts for targeted therapies.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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  • 9
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. 3591-3591
    Abstract: 3591 Background: Adjuvant chemotherapy is offered to most pts with Stage III CRC, and to a subset with Stage II disease deemed at high-risk for recurrence. Nevertheless, risk stratification strategies remain suboptimal. Detection of minimal residual disease (MRD) through ctDNA analysis has been shown to identify pts at high recurrence risk in Stage II CRC, but not Stage III disease. Methods: The next-generation sequencing based AVENIO ctDNA Surveillance Kit (Research Use Only) was used to identify single nucleotide variants (SNVs) in tumor tissue within a cohort of 145 Stage II and III CRC pts following R0 surgical resection (n = 86 and 59 respectively; median follow-up = 32.1 mo). The same assay was used to monitor ctDNA with a single post-operative blood sample (mean surgery-to-phlebotomy time: 10 days). Regions from 197 genes recurrently mutated in CRC were interrogated, and pts were classified as ctDNA positive (+) or negative (-) in plasma based on the detection of SNVs previously identified in tumor tissue. Results: Variants were identified in 99% of tumors (n = 144) with a median of 4 SNVs/sample (range 1-24) and all post-operative plasma samples were successfully profiled. Pts with detectable ctDNA (n = 12) displayed a significantly shorter 2-year relapse-free survival (RFS; 17% vs 88%; HR 10.3; 95% CI 2.3-46.9; p 〈 0.00001), time to recurrence (TTR; HR 20.6; 95% CI 3.1-139.0; p 〈 0.00001) and overall survival (OS; HR 3.4; 95% CI 0.5-25.8; p = 0.041) than ctDNA- pts (n = 132). 11 (92%) of ctDNA+ pts developed recurrence compared to 9 (7%) of ctDNA- pts. Monitoring multiple variants doubled sensitivity of MRD detection compared to tracking a single driver mutation. TTR was shorter in ctDNA+ vs ctDNA- Stage II (HR 23.1, 95% CI 0.28-1900.4; p 〈 0.00001) and stage III pts (HR 17.9; 95% CI 2.7-117.3, p 〈 0.00001). TTR of Stage II and III ctDNA- pts was similar (p = 0.7). Conclusions: Our results indicate that ctDNA analysis can detect MRD within days after complete resection of CRC and accurately identifies pts at high risk of recurrence in both Stage II and III CRC. MRD detection via ctDNA sequencing may allow personalization of adjuvant treatment strategies.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
    detail.hit.zdb_id: 2005181-5
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  • 10
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 4_suppl ( 2013-02-01), p. 377-377
    Abstract: 377 Background: Assignment of patients (pts) with UICC-stage II colorectal cancer (CRC) to adjuvant therapy remains controversial. The clinical utility of histo-pathological parameters (pT 4 , L+, V+) as well as tumor RNA expression signatures like Oncotype Dx Colon Cancer Assay, ColoPrint, or Predictor C is low given their positive predictive value (PPV) of 0.13, 0.22, 0.19, and 0.33, respectively, when adjusted to an incidence of 10% for occurrence of metastatic disease (mets) within 3 years after diagnosis. Methods: We applied deep amplicon sequencing of 48 well-known cancer genes to DNA samples of primary tumors from 173 pts with UICC-stage II CRC using the Illumina MiSeq technology. Patients were selected from a prospective, multicenter clinical diagnostic study named MSKK. More than 6,500 patients with CRC have been recruited into this study conducted by 39 hospitals in Germany. 79 of the 173 pts had progression of disease events within 3 years after R0 resection including 40 pts with mets, 12 pts with local recurrences, and 27 pts with secondary malignancies. 94 pts remained progression-free. Results: Deep sequencing revealed a total of 2,221 sequence variations (SV) including missense, stop, InDel, noncoding, nonsense SV. 401 SV were in COSMIC, 750 SV in normal tissue. The remaining 1471 SV served as basis for development of SV-signatures (SVS) for prediction of progression events in a classical double-nested bootstrap approach in order to generate second order unbiased estimates of performance of SVS, namely sensitivity(S + ), specificity (S - ), PPV, and negative predictive value (NPV). The best SVS for prediction of metastases contained SV in less than 15 genes and has a S + of 0.41, S - of 0.93, PPV of 0.40, and NPV of 0.93 (incidence of metastasis: 10%). The best SVS for prediction any progression event has a S + of 0.33, S - of 0.93, PPV of 0.54, and NPV of 0.84 (incidence for any progression = 20.5%). Conclusions: This deep sequencing based prognostic tissue test with a PPV of 40% and a NPV of 93% represents a milestone over prognostic tests based on RNA expression. The increased PPV leads to more patients being treated correctly with adjuvant therapy.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
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