Steroid hormone receptor expression in ovarian cancer: progesterone receptor B as prognostic marker for patient survival

Background: There is partially conflicting evidence on the influence of the steroid hormones estrogen (E) and progesterone (P) on the development of ovarian cancer (OC). The aim of this study was to assess the expression of the receptor isoforms ER-alpha/-beta and PR-A/-B in OC tissue and to analyze its impact on clinical and pathological features and patient outcome. Methods: 155 OC patients were included who had been diagnosed and treated between 1990 and 2002. Patient characteristics, histology and follow-up data were available. ER-alpha/-beta and PR-A/-B expression were determined by immunohistochemistry. Results: OC tissue was positive for ER-alpha/-beta in ER-alpha/-beta and 60.1% and PR-A/-B in 36.2% and 33.8%, respectively. We identified significant differences in ER beta expression related to the histological subtype (p=0.041), stage (p=0.002) and grade (p=0.011) as well as PR-A and tumor stage (p=0.03). Interestingly, median receptor expression for ER-alpha and PR-A/-B was significantly higher in G1 vs. G2 OC. Kaplan Meier analysis revealed a good prognosis for ER-alpha positive (p=0.039) and PR-B positive (<0.001) OC. In contrast, ER-beta negative OC had a favorable outcome (p=0.049). Besides tumor grade and stage, Cox-regression analysis showed PR-B to be an independent prognostic marker for patient survival (p=0.009, 95% CI 0.251-0.823, HR 0.455). Conclusion: ER-alpha/-beta and PR-A/-B are frequently expressed in OC with a certain variability relating to histological subtype, grade and stage. Univariate analysis indicated a favorable outcome for ER-alpha positive and PR-B positive OC, while multivariate analysis showed PR-B to be the only independent prognostic marker for patient survival. In conclusion, ER and PR receptors may be useful targets for a more individualized OC therapy

Local Resection of Primary Tumor in Upfront Stage IV Breast Cancer

Background: This study aimed to identify the association of local surgery of the primary tumor in metastatic breast cancer (MBC) patients with overall survival (OS) and prognostic factors. Patients and Methods: Patients with primary MBC (1990-2006) were included in our retrospective analysis (n = 236). 83.1% had surgery for the primary tumor. OS was evaluated using Kaplan-Meier estimates. Predictive factors for OS were determined. Results: Median follow-up was 123 months for all patients still alive at the time of analysis. In univariate analysis, patients with surgery of the primary tumor had significantly prolonged OS (28.9 vs. 23.9 months). Within the surgery group, patients with MBC limited to 1 organ system had a better outcome (39.3 vs. 24.9 months), as did asymptomatic patients. Independent risk factors for shorter OS were hormone receptor negativity, symptoms, and involvement of > 1 organ system. Conclusion: Patient selection for local therapy was confounded by a more favorable profile and a lesser tumor burden before surgery, which might implicate a bias. Nevertheless, our univariate results indicate that local surgery of the primary tumor in MBC patients could be considered as part of the therapeutic regimen in selected patients. However, larger patient numbers are needed to prove these findings in the multivariate model. (C) 2016 S. Karger GmbH, Freibur

Prelamination of an axial flap with a chondrocutaneous composite graft.

Seit Einführung der Knorpeltransplantation in der plastisch - rekonstruktiven Chirurgie wird die Knorpeltransplantationstechnik optimiert. Ziel der Studie ist es, die Neovaskularisation im chondrokutanen Lappen unter dem Einfluss zweier Präparationstechniken zu untersuchen. An 12 Kaninchen wurde autologer, elastischer Knorpel jeweils einer Kontroll- (KO) und zwei Stanzgruppen (GL,KL) zugeordnet. Die Gruppen GL, KL, KO wurden auf die A. epigastrica superficialis, gefolgt von einer Vollhauttransplantation implantiert. Es wurden angiographische, planimetrische und histologische Untersuchungen durchgeführt. Der angiographische Gefäßnachweis und die planimetrisch ermittelte Hautfläche waren signifikant günstiger in der Gruppe GL. Histologisch konnten signifikant mehr Gefäßanschnitte im Stanzbereich der Gruppe GL verglichen mit KL nachgewiesen werden. Neoangiogenese mit signifikant verbesserter Haut- und Knorpelvitalität in gestanztem Knorpel konnte nachgewiesen werden.Since the beginnings of cartilage transplantation in plastic and reconstructive surgery the transplantation techniques have been improved. The study aims for the evaluation of neovascularization in the chondrocutaneous flap with comparison of two different surgical techniques. Autologous elastic cartilage of 12 rabbits was examined in two groups with different perforation techniques (GL, KL) and in a control group (KO). The different cartilage groups were transplanted as prelaminated flap on the epigastric superficial artery, followed by a cutaneous full thickness graft to create a prelaminated cartilagineous-cutaneous composite graft. This composite graft was evaluated by angiography, planimetry and histology. The angiographic quantitative evaluation of vascularisation and the planimetric determination of the transplanted skin surface were significantly better in the GL group. The histologic results revealed significantly more vessel sections in the perforated area of the GL group compared to KL group. In perforated cartilage neoangiogenesis with significant better skin and cartilage viability could be demonstrated

Acceptance of routine or case-based inquiry for intimate partner violence: a mixed method study.

BACKGROUND: The prevalence and detrimental health effects of intimate partner violence have resulted in international discussions and recommendations that health care professionals should screen women for intimate partner violence during general and antenatal health care visits. Due to the lack of discussion on routine or case-based inquiry for intimate partner violence during antenatal care in Germany, this study seeks to explore its acceptability among pregnant German women. METHODS: A mixed methods approach was used, utilizing a self-administered survey on the acceptability of routine or case-based inquiry for intimate partner violence in a university hospital's maternity ward in Munich and in-depth interviews with seven women who experienced violence during pregnancy. RESULTS: Of the 401 women who participated in the survey, 92 percent were in favor of routine or case-based inquiry for intimate partner violence during antenatal care. Acceptance of routine or case-based inquiry for intimate partner violence during antenatal care was significantly associated with women's experiences of child sexual abuse, being young, less educated, single or divorced and smoking during pregnancy. Open-ended survey questions and in-depth interviews stressed adequate training for screening, sufficient time and provision of referral information as important conditions for routine or case-based inquiry for intimate partner violence. CONCLUSIONS: Women in this study showed an overwhelming support for routine or case-based screening for intimate partner violence in antenatal care in Germany. Until adequate training is in place to allow providers to inquire for intimate partner violence in a professional manner, this study recommends that health care providers are made aware of the prevalence and health consequences of violence during pregnancy

Thyroid hormone receptor (TR)alpha and TRbeta expression in breast cancer

There is evidence that breast cancer patients suffer from thyroid disorders. However, the relation between thyroid receptor (TR) expression and breast cancer remains unknown so far. Therefore, the aim of this study was an immunohistochemical analysis of TR expression in breast cancer patients. Materials and methods: The expression of the combined antibody TRalpha1 and 2 and TRalpha1 or 2 alone as well as the expression of combined TRbeta1 and 2 and TRbeta1 or 2 alone was investigated with specific monoclonal or polyclonal antibodies in 82 patients. All patients presented with a first diagnosis of sporadic breast cancer. The ABC method was used for staining and staining intensities were analyzed using the IRS score. Results: Both TRalpha and TRbeta were expressed in the nuclei of breast cancer cells. In 24% (28/78) of the slides TRalpha1 and 2 IRS was positive. Immunopositivity for TRalpha1 was found in 55/78 slides, for TRalpha 2 in 54/79 slides (71 and 68%, respectively). The expression of TRbeta1 and 2 showed a positive detection in 33/77 (43%) of the slides, for TRbeta1 it was 43/79 (54%), for TRbeta2 60/76 (79%). Significant correlations of the expression of TRs - especially TRalpha2 - were found with further prognostic histopathological parameters such as tumor size, axillary lymph node involvement, grading and hormone receptor status. Multivariate analysis showed a trend for TRalpha2 as an independent predictor of disease-free and overall survival. Discussion: Our results revealed specific alterations in the expression of TRs - especially of TRalpha2 - in breast cancer patients, suggesting it as a marker with possible prognostic validity