It has been reported that pathological complete response is an important surrogate marker for disease-free survival and overall survival in patients with triple-negative breast cancer. This study investigates predictors of the response to neoadjuvant platinum-based or anthracycline-based treatment, and of the prognosis, in patients with triple-negative breast cancer. A total of 121 patients with triple-negative breast cancer received neoadjuvant treatment with either platinum or anthracycline between 2008 and 2013. Pathological complete response was assessed relative to different treatments using logistic regression models with age, clinical tumor stage, grading, and Ki-67 as predictors and interaction terms, to obtain adjusted and subgroup-specific results. The impact of the pathological complete response rate on disease-free survival and overall survival was also analyzed. The pathological complete response rate was higher after platinum/taxane treatment compared with anthracycline/taxane (50.0% vs. 41.8%), but this was not significant in the adjusted analysis (OR 1.44; 95% CI, 0.68 to 3.09). A high histological grade (G3) was a predictor for higher pathological complete response in platinum-based therapy (OR 2.27; 95% CI, 1.00 to 5.30). The effect of neoadjuvant chemotherapy on pathological complete response was significantly different for G1–2 vs. G3 (Pinteraction = 0.013), and additional subgroup-specific differences were noted. Pathological complete response was a predictor for improved disease-free survival and overall survival in both treatment groups, with and without platinum chemotherapy. This retrospective study of patients with triple-negative breast cancer adds to the evidence that the treatment effect of platinum may be greatest particularly in G3 tumors. In addition, the effect of pathological complete response on the prognosis does not depend on the treatment used.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Patient-Centered Innovations, Education and Technology for Cancer Care and Cancer Research

The appropriate surgical technique to treat patients with uterine fibroids is still a matter of debate as is the potential risk of incorrect treatment if histological examination detects a uterine sarcoma instead of uterine fibroids. The published epidemiology for uterine sarcoma is set against the incidence of accidental findings during surgery for uterine fibroids. International comments on this topic are discussed and are incorporated into the assessment by the German Society for Gynecology and Obstetrics (DGGG). The ICD-O-3 version of 2003 was used for the anatomical and topographical coding of uterine sarcomas, and the “Operations- und Prozedurenschlüssel” (OPS) 2014, the German standard for process codes and interventions, was used to determine surgical extirpation methods. Categorical qualifiers were defined to analyze the data provided by the Robert Koch Institute (RKI), the German Federal Bureau of Statistics (DESTATIS; Hospital and Causes of Death Statistics), the population-based Cancer Register of Bavaria. A systematic search was done of the MEDLINE database and the Cochrane collaboration, covering the period from 1966 until November 2014. The incidence of uterine sarcoma and uterine fibroids in uterine surgery was compared to the literature and with the different registries. The incidence of uterine sarcoma in 2010, standardized for age, was 1.53 for Bavaria, or 1.30 for every 100 000 women, respectively, averaged for the years 2002–2011, and 1.30 for every 100 000 women in Germany. The mean incidence collated from various surveys was 2.02 for every 100 000 women (0.35–7.02; standard deviation 2.01). The numbers of inpatient surgical procedures such as myoma enucleation, morcellation, hysterectomy or cervical stump removal to treat the indication “uterine myoma” have steadily declined in Germany across all age groups (an absolute decrease of 17 % in 2012 compared to 2007). There has been a shift in the preferred method of surgical access from an abdominal/vaginal approach to endoscopic or endoscopically assisted procedures to treat uterine fibroids, with the use of morcellation increasing by almost 11 000 coded procedures in 2012. Based on international statements (AAGL, ACOG, ESGE, FDA, SGO) on the risk of uterine sarcoma as an coincidental finding during uterine fibroid surgery and the associated risk of a deterioration of prognosis (in the case of morcellation procedures), this overview presents the opinion of the DGGG in the form of four Statements, five Recommendation and four Demands. In der Behandlung der Patientin mit Uterus myomatosus gibt es Diskussionen über die Art der Operationstechnik und das damit verbundene Risiko der eventuellen falschen Behandlung, wenn sich in der histologischen Aufarbeitung keine Uterusmyome, sondern ein Uterussarkom herausstellt. Die publizierte Epidemiologie von Uterussarkomen wird hier ins Verhältnis zu Zufallsbefunden bei Operationen zur Behandlung von Uterusmyomen gesetzt. Die internationalen Stellungnahmen zu diesem Thema werden diskutiert, um eine Bewertung seitens der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) abzugeben. Zur anatomischen und topografischen Codierung der Uterussarkome wurde der ICD-O-3 in der Ausgabe von 2003 und für die Operations- und Prozedurenschlüssel der exstirpierenden Verfahren der OPS 2014 benutzt. Um die übermittelten Daten des Robert Koch-Instituts (RKI), des Statistischen Bundesamts (DESTATIS; Abteilung Krankenhausstatistik und Todesursachenstatistik), des bevölkerungsbezogenen Krebsregisters Bayern auswerten zu können, wurden eindeutige Abfragekriterien definiert. Zusätzlich wurde eine systematische Literaturrecherche in MEDLINE von 1966 bis November 2014 und bei der Cochrane Collaboration durchgeführt. Die Inzidenz von Uterussarkomen und Uterusmyomen bei Operationen der Gebärmutter wurden in den verschiedenen Registern und in der Literatur verglichen. Die altersstandardisierte Inzidenz im Jahr 2010 für Uterussarkome war für Bayern 1,53, respektive 1,30 auf 100 000 Frauen gemittelt über die Jahre 2002–2011, in Deutschland bei 1,30 auf 100 000 Frauen. Die mittlere Inzidenz aus verschiedenen Erhebungen beträgt 2,02 auf 100 000 Frauen (0,35–7,02; Standardabweichung 2,01). Stationär durchgeführte Operationen wie Myomenukleation, Morcellation, Hysterektomie oder Zervixstumpfresektion sind bei der Indikation Uterusmyom in Deutschland gleichbleibend über alle Altersgruppen hinweg zurückgegangen (absoluter Rückgang von 17 % im Jahr 2012 zum Jahr 2007). Es zeigt sich eine Verschiebung des operativen Zugangswegs von abdominal/vaginal zu endoskopisch bzw. endoskopisch assistierten zur Behandlung von Uterusmyomen mit einer ansteigenden Benutzung der Morcellation von fast 11 000 codierten Prozeduren im Jahr 2012. Nach den Veröffentlichungen von internationalen Stellungnahmen (AAGL, ACOG, ESGE, FDA, SGO) zum Risiko Uterussarkom als Zufallsbefund im Rahmen einer Myomoperation und dem damit verbundenen Risiko einer Prognoseverschlechterung (im Falle einer Morcellation) wird in dieser Übersichtsarbeit die DGGG-Stellungnahme in Form von 4 Statements, 5 Empfehlungen und 4 Forderungen dargestellt.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The most frequent malignant disease in women is breast cancer. In the metastatic setting, quality of life is the primary therapeutic goal and systematic treatment has only limited effect on survival rates; therefore, the concept of Health-related Quality of Life (HRQoL) and measurement of Patient Reported Outcomes (PRO) is gaining more and more importance in the therapy setting of diseases such as breast cancer. One of the frequently used questionnaires for measuring HRQoL in breast cancer patients is the Functional Assessment of Cancer Therapy - Breast (FACT-B). Currently, paper-based surveys still predominate as only a few reliable and validated electronic-based questionnaires are available. EPRO tools of the FACT-B questionnaire with proven reliability are missing so far. Objective: The aim of this study was to analyze the reliability of tablet-based measurement of FACT-B in German language in adjuvant (curative) and metastatic breast cancer patients. Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female adjuvant and metastatic breast cancer patients, recruited as part of the ePROCOM and PEPPER study. All patients were required to complete the electronically based (ePRO) and paper-based version of the FACT-B. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability [parallel forms reliability (Wilcoxon test) and test of internal consistency (Spearman’s rho)] and agreement rates for single items, Kendall’s tau for each subscale and total score were analyzed. Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patient’s response behavior between paper-based and electronically based questionnaires. Regarding the reliability test of parallel forms no significant differences were found in 35 of 37 single items, while significant correlations in the test for consistency were found in all 37 single items, in all 5 sum individual item subscale scores, as well as in total FACT B score. Conclusions: The ePRO version of the FACT-B questionnaire is reliable for breast cancer patients in both the adjuvant and metastatic setting, showing highly significant correlations with the paper-based version in almost all questions all subscales and the total score.