The study pursues the objective of drawing a comparison between the data of gyne-oncology, gynecology, and obstetrics patient collectives of a German university hospital regarding the progression of patient number and corresponding treatment data during the five-year period of 2017–2021 to assess the impact of the COVID-19 pandemic on gyne-oncological treatment. Descriptive assessment is based on data extracted from the database of the hospital controlling system QlikView® for patients hospitalized at the Department of Gynecology and Obstetrics of Marburg University Hospital. Gynecology and gyne-oncology experience a maintained decline in patient number (nGynecology: −6% 2019 to 2020, −5% 2019 to 2021; nGyne-Oncology: −6% 2019 to 2020, −2% 2019 to 2021) with varying effects on the specific gyne-oncological main diagnoses. Treatment parameters remain unchanged in relative assessment, but as gyne-oncology constitutes the dominating revenue contributor in gynecology (35.1% of patients, 52.9% of revenue, 2021), the extent of the decrease in total revenue (−18%, 2019 to 2020, −14%, 2019 to 2021) surpasses the decline in patient number. The study displays a negative impact on the gynecology care situation of a German university hospital for the entire pandemic, with an even greater extent on gyne-oncology. This development not only endangers the quality of medical service provision but collaterally pressurizes gynecology service providers.
The aim of this study was to analyze the prevalence of breast cancer in relation to body height and to investigate associations between body height and breast cancer in Germany.This retrospective cohort study included 135,741 adult women followed in one of 161 gynecology practices in Germany between January 2019 and December 2021. The 3 year prevalence of breast cancer (ICD-10: C50) during the study period was shown in relation to body height, which was included in this study as a five-category variable for women: ≤ 160 cm, 161-165 cm, 166-170 cm, 171-175 cm, > 175 cm. The associations between height and breast cancer were analyzed using logistic regression models adjusted for age and BMI.The prevalence of breast cancer increased from 5.1% in women ≤ 160 cm to 6.8% in women > 175 cm in the age group 51-60, and from 9.2% in women ≤ 160 cm to 12.2% in women 171-175 cm in the age group > 60 years. The OR for breast cancer was 1.18 (95% CI 1.12-1.24) for every 10 cm increase in height. Compared to height ≤ 160 cm, the OR for height 166-170 cm was 1.26 (1.15-1.39), for 171-175 cm 1.43 (1.27-1.61), and for > 175 cm 1.49 (1.28-1.74).The results of this study suggest that greater body height in women is significantly related to an increased breast cancer risk.
Beim Mammakarzinom sieht die aktuelle S3-Leitlinie für die pathologische Aufarbeitung neben der immunhistochemischen Basisdiagnostik eine weiterführende molekulare Diagnostik zur Bestimmung prädiktiver Biomarker vor, die abhängig vom Tumorstadium zum Einsatz kommt und neben immunhistochemischen Methoden auch Sequenzierungstechniken umfasst. Dazu gehört die systematische Untersuchung molekularer Veränderungen wie PIK3CA- oder BRCA1/2-Mutationen, NTRK-Fusionen oder Mikrosatelliteninstabilität als Basis für zielgerichtete Therapiestrategien. Weitere Veränderungen, z. B. im PI3K-Signalweg, ESR1-Alterationen oder ERBB2-Mutationen u. a., können ebenfalls für individuelle Therapieentscheidungen speziell im Rahmen einer Resistenzsituation relevant sein. Besonders in fortgeschrittenen Stadien kann eine umfassendere molekulare Charakterisierung des Tumors genetische Alterationen aufdecken, die als Tumortreiber fungieren und Angriffspunkte für individualisierte Therapien bieten können. Aufgrund der Vielzahl an molekularen Targets bietet sich hierbei eine Next-Generation-Sequencing(NGS)-Paneldiagnostik an, die diese möglichen Biomarker umfasst und deren Ergebnisse in Verbindung mit der immunhistologischen Charakterisierung interpretiert werden sollten. Alle molekularen Therapiestrategien außerhalb der direkten Zulassungen sollten im Rahmen eines molekularen Tumorboards interdisziplinär geplant werden.
Zusammenfassung Zielsetzung Ziel der Studie ist es die Auswirkungen der COVID-19 Pandemie auf die stationär behandelten Patienten eines universitären Maximalversorgers mit einer Krebs- und/oder COVID-19-Erkrankung zu untersuchen. Unterscheiden sich die Patientenkollektive gesundheitsökonomisch und ergeben sich aus den Resultaten administrative Konsequenzen für eine proaktive Steuerung der regionalen Krebsversorgung. Methodik Es wurde eine retrospektive, deskriptive Datenanalyse klinischer und gesundheitsökonomischer Parameter aller am Universitätsklinikum Marburg stationär aufgenommenen onkologischen und COVID-19-postiven Patienten sowie der Kombination von onkologischen Patienten mit einer COVID-19-Erkrankung innerhalb des Beobachtungszeitraums von 2017 bis 2021 durchgeführt. Ergebnisse Es wurde ein Rückgang onkologisch behandelter Patienten über den gesamten Zeitraum der COVID-19-Pandemie beobachtet. Onkologische Patienten mit einer COVID-19-Erkrankung stellen das Patientenkollektiv mit dem höchsten Schweregrad der Erkrankung dar, gefolgt von der COVID-19- und rein onkologischen Patienten. Dies spiegelt sich gleichsam in den ökonomischen Leistungskennzahlen wider. Die chronologischen Verläufe des DRG-Erlöses und Case Mix Index pro COVID-19-Patienten weisen Unterschiede für Zeitabschnitte des Pandemiegeschehens in Deutschland auf. Schlussfolgerung Der Vergleich der Patientenkollektive bestätigt das hohes Gefährdungspotential von onkologischen Patienten, welches sich in einer gesundheitsökonomisch aufwendigen Behandlung widerspiegelt. Nationale Maßnahmen, Kontaktbeschränkungen oder pandemische Ereignisse lassen sich am chronologischen Verlauf der klinischen und wirtschaftlichen Parameter nachvollziehen. Trotz des internationalen Rückgangs an ambulanten und stationären onkologischen Patienten ist die „state-of-the-art“ Krebsversorgung in pandemischen Zeiten realisierbar. Aufgrund dessen besteht die Handlungsnotwendigkeit für einen stationären Maximalversorger durch Kommunikation und Versorgungsmodellierung die onkologische Versorgung proaktiver zu steuern.
The aim of this study was to identify the mean age at which breast cancer (BC) was first diagnosed in 2010 or 2022, and to evaluate whether there were any changes in age groups at first BC diagnosis.This retrospective cross-sectional study included adult women (18 years or older) who were diagnosed with BC (ICD-10: C50) for the first time in 2010 or 2022 in office-based practices in Germany (in 300 general practices or 95 gynecological practices). We examined the mean age at diagnosis and the percentage of patients in three age groups (18-49, 50-65, and > 65) for both 2010 and 2022. The average age difference between 2010 and 2022 was analyzed using Wilcoxon rank tests, and the proportions of the three age groups were analyzed using chi-squared tests. These analyses were performed separately for patients in general and gynecological practices.The mean age at which BC was initially diagnosed in 2022 was found to be significantly greater than that in 2010 for both general practices (66.9 years vs. 64.0 years p < 0.001) and gynecological practices (62.2 years vs. 60.3 years, p < 0.001). Early-onset BC decreased from 15.6 to 12.0% in general practices and from 23.2 to 18.2% in gynecological practices between 2010 and 2022. The proportion of new BC diagnoses in the age group 50-65 increased from 36.6 to 40.9% in gynecological practices, but did not increase in general practices.The study found that BC was diagnosed at an older age in 2022 than in 2010. In addition, the proportion of early-onset BC cases decreased, while the proportion of cases in the age group 50-65 increased in gynecological practices in Germany.
The aim of this retrospective cohort study was to measure the proportion of women with an initial prescription of an antiresorptive drug (bisphosphonates or denosumab) during five years of endocrine breast cancer therapy.The study included women with an initial prescription of tamoxifen (TAM) or aromatase inhibitors (AIs) between January 2016 and December 2020. Kaplan-Meier analyses were performed to show the cumulative incidence of antiresorptive drug prescription for TAM and AIs separately for four age groups. A univariable Cox proportional hazards regression model was also used to estimate the relationship between initial endocrine drug (AIs vs. TAM) and antiresorptive drug prescription.Within 5 years, 14.1% of patients on AI and 6.1% on TAM received their first prescription for an antiresorptive drug (p < 0.001). The difference between AI and TAM was greatest in women ≤50 years (12.9% of AI and 2.8% of patients on TAM), and smallest in women >80 years (14.5% of AI and 10.3% of patients on TAM). The proportion of denosumab was 46.2% among AI patients vs. 29.1% among patients on TAM (p < 0.001) as alendronate was prescribed to 36.9% of AI vs. 50.0% of patients on TAM.Across all age groups, the cumulative incidence of antiresorptive drug prescriptions was higher in patients with BC treated with AI than those receiving TAM. Denosumab was most frequently used as an antiresorptive drug in patients treated with AI, while alendronate was administered more often in patients treated with TAM.
Background: The occurrence of autonomic dysfunctions (e.g., urological dysfunctions) is a common phenomenon during the course of Parkinson’s disease (PD) and resulting complications such as lower urinary tract infections (LUTI) are one of the leading causes of hospitalizations and mortality in patients with the condition. Therefore, the aim of this retrospective cohort study was to compare the most common levodopa-based treatment regimens (DOPA decarboxylase inhibitor (DCI) + carbidopa or benserazide) and to analyze the incidence of LUTI and antibiotic prescriptions in patients receiving the respective treatments. Methods: This study was based on data from the Disease Analyzer database (IQVIA) and included adult patients (≥18 years) with an initial prescription of levodopa therapy including fixed-dose levodopa/DCI combinations in 1284 general practices in Germany between January 2010 and December 2020. Conditional Cox regression models were used to analyze the association between levodopa/DCI combinations and LUTI incidence and antibiotic prescriptions. Results: Compared to levodopa + carbidopa, levodopa + benserazide therapy was significantly and negatively associated with LUTI (HR: 0.82; 95% CI: 0.71–0.95). This association was stronger in women (HR: 0.77; 95% CI: 0.65–0.92) than in men (HR: 0.93, not significant). Conclusions: Especially in women, receiving levodopa + benserazide prescriptions was associated with a lower LUTI incidence. It is important for clinicians to keep this in mind, since LUTI is a leading cause of hospitalizations, morbidity, and mortality in patients with PD.
Abstract Purpose The aim of the study was to evaluate the baseline data of women with breast cancer (BC) undergoing treatment in an intercontinental comparison. Methods This study included 99,571 women with BC from Europe (70,834), Asia (18,208), and Latin America (10,529) enrolled between 2017 and 2021, based on data from IQVIA’s Oncology Dynamics database. This source is supplied with information by means of a cross-sectional partially retrospective survey collecting anonymized data on inpatients and outpatients treated by a representative panel of oncologists. A multivariable logistic regression model was used to investigate the probability of metastases. Results The data available in Asia (98%) and Latin America (100%) were hospital data, while in Europe, patients were treated both in hospitals and in office-based practices (62%, 38%). The mean age in Asia and Latin America (57 ± 13) was lower than in Europe (61 ± 13; p < 0.001). Lobular BC was diagnosed twice as often in Europe compared to Asia and Latin America (15.2%, 9.8%, 8.0%). The number of patients with metastasized hormone receptor-positive (HR +) BC was significantly higher in Europe and Latin America than in Asia (76%, 68%; p < 0.001). The highest number of women with metastasized BC was reported in Europe (26% compared to 14% and 20%, respectively, in Asia and Latin America). Across the continents, the percentage of women with BC who experienced metastases was 51–61% for bone, 30–39% for lung and 25–32% for liver, followed by 3–6% for skin and 3% for brain. Conclusion Women with BC treated in Europe tend to be significantly older and more likely to develop metastases than women in Asia and Latin America, except for lung metastases.
Abstract Autophagy allows cells to temporarily tolerate energy stress by replenishing critical metabolites through self-digestion, thereby attenuating the cytotoxic effects of anticancer drugs that target tumor metabolism. Autophagy defects could therefore mark a metabolically vulnerable cancer state and open a therapeutic window. While mutations of autophagy genes (ATGs) are notably rare in cancer, haploinsufficiency network analyses across many cancers have shown that the autophagy pathway is frequently hit by somatic copy number losses of ATGs like MAP1LC3B/ATG8F ( LC3 ), BECN1/ATG6 (Beclin-1), and ATG10 . Here, we used CRISPR/Cas9 technology to delete increasing numbers of copies of one or more of these ATGs in non-small cell lung cancer cells and examined the effects on sensitivity to compounds targeting aerobic glycolysis, a hallmark of cancer metabolism. Whereas complete knock-out of one ATG blocked autophagy and led to profound metabolic vulnerability, this was not the case for combinations of different non-homozygous deletions. In cancer patients, the effect of ATG copy number loss was blunted at the protein level and did not lead to accumulation of p62 as a sign of reduced autophagic flux. Thus, the autophagy pathway is shown to be markedly robust and resilient, even with concomitant copy number loss of key autophagy genes.
