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Der Große Höckerflohkrebs Dikerogammarus villosus und die Körbchenmuschel Corbicula fluminea zeigen in den Bundeswasserstraßen Rhein, Main, Donau, Neckar und Mosel seit Mitte der 1990er Jahre invasorische Ausbreitungstendenzen. Beide Arten wurden nun auch im Bodensee nachgewiesen. Zwischen Juni und November 2004 wurde ihre Ausbreitung im Rahmen des vorliegenden Untersuchungsprogramms dokumentiert. Mit Hilfe eines dichten Probestellennetzes konnten die aktuellen Verbreitungsgrenzen der beiden Arten unterschiedlich genau abgegrenzt werden. Durch flächenbezogene Proben und Proben aus verschiedenen Wassertiefen wurden Informationen über ihre relative Besiedlungsdichte und Biomasse gewonnen. Die Proben von Uferabschnitten außerhalb der aktuellen Verbreitung der beiden Arten lieferten Referenzdaten zur Zusammensetzung der bisherigen Benthosbiozönose. Die Überprüfung (Screening) bisher noch nicht bearbeiteter Proben von Dauerbeobachtungsstellen des Limnologischen Instituts der Universität Konstanz erbrachte, dass Dikerogammarus villosus bereits im Oktober 2002 bei Immenstaad am nördlichen Bodenseeufer mit wenigen Exemplaren vorkam. Auf der Westseite des Überlingersees (Wallhausen) wurde Dikerogammarus in Uferproben seit August 2003 nachgewiesen; hier wurde er jedoch bereits seit Februar 2003 lokal beobachtet. Dikerogammarus breitete sich seither über den gesamten nordwestlichen Teil des Bodensees aus. Seine westliche Ausbreitungsgrenze lag im November 2004 im Konstanzer Trichter oberhalb des Seerheins. Seit Februar 2004 zeigte diese Krebspopulation eine Arealvergrösserung von rund 4 km Uferlänge. Seine nordöstliche Verbreitungsgrenze liegt bei Langenargen, möglicherweise handelt es sich hier um eine zweite Inizialpopulation. Dikerogammarus zeigte innerhalb seiner Verbreitungsgrenzen eine auffällige Habitatkonkurrenz gegenüber anderen Benthosorganismen, vor allem gegenüber der bisher im See dominierenden Flohkrebsart Gammarus roeseli. Die durchschnittlichen Besiedlungsdichten von Dikerogammarus liegen zwar bisher unter denen der zuvor an gleicher Stelle siedelnden G. roeseli; auf geeignetem Substrat zeigte jedoch auch Dikerogammarus Massenvorkommen mit über 2000 Individuen/m2. Corbicula fluminea besiedelte im September 2004 am vorarlbergischen Rohrspitz einen Flachwasserbereich von rund 5 km Länge. Die Art kommt im ganzen Bodensee bisher nur in diesem Bereich vor und zeigt dort ohne ihre mindestens ebenso häufigen Individuen 2mm zu berücksichtigen, maximale Besiedlungsdichten von rund 600 Individuen/m2. Eine im Rahmen des vorliegenden Programms konzipierte Datenbankstruktur dient künftig dazu, recherchierte, aktuelle und gesammelte Informationen zur Neozoenausbreitung - auch über regionale Grenzen hinweg - zentral zusammenzustellen und mit Hilfe eines geografischen Informationssystems darzustellen. Mit dem Untersuchungsprogramm sollte die Grundlage für Langzeitbeobachtungen invasorischer Neozoen im Bodensee und seinem Einzugsgebiet bereitstellt werden. Neben den Benthosuntersuchungen am Bodenseeufer wurde auch begonnen, weitere Informationen über Bodensee-Neozoen zusammen zu stellen. Ein Informationsaustausch erfolgt seither mit allen namhaften Forschungsinstitutionen und Gewässerschutzfachstellen am Bodensee und in seinem Einzugsgebiet.
Simple Summary: The incidence of brain metastases from breast cancer is increasing and the treatment is still a major challenge. Several scores have been developed in order to estimate the prognosis of patients with brain metastases by objective criteria. Here, we validated all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer patients with brain metastases in the Brain Metastases in the German Breast Cancer (BMBC) registry. Although all three available GPA-scores were associated with OS, they all show limitations mainly in predicting short-term (below 3 months) survival but also in long-term (above 12 months) survival. We discuss the test performances of all scores in our work and provide evidence how physicians should use them as a tool to select patients for different treatment options.
Abstract: Several scores have been developed in order to estimate the prognosis of patients with brain metastases (BM) by objective criteria. The aim of this analysis was to validate all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer (BC) patients with BM in the Brain Metastases in the German Breast Cancer (BMBC) registry. The median age at diagnosis of BM was 57 years. All in all, 22.3% of patients (n = 197) had triple-negative, 33.4% (n = 295) luminal A like, 25.1% (n = 221) luminal B/HER2-enriched like and 19.2% (n = 169) HER2 positive like BC. Age ≥60 years, evidence of extracranial metastases (ECM), higher number of BM, triple-negative subtype and low Karnofsky-Performance-Status (KPS) were all associated with worse overall survival (OS) in univariate analysis (p < 0.001 each). All three GPA-scores were associated with OS. The breast-GPA showed the highest probability of classifying patients with survival above 12 months in the best prognostic group (specificity 68.7% compared with 48.1% for the updated breast-GPA and 21.8% for the original GPA). Sensitivities for predicting 3 months survival were very low for all scores. In this analysis, all GPA-scores showed only moderate diagnostic accuracy in predicting the OS of BC patients with BM.
Characteristics and clinical outcome of breast cancer patients with asymptomatic brain metastases
(2020)
Simple Summary: The prognosis for patients with breast cancer that has spread to the brain is poor, and survival for these women hasn’t improved over the last few decades. We do not currently test for asymptomatic brain metastases in breast cancer patients, although this does happen in some other types of cancer. In this study we wanted to find out more about breast cancer that has spread to the brain and in particular to see whether there might be any advantage to spotting brain metastases before the development of neurological symptoms. Overall, our results suggest that women could be better off if their brain metastases are diagnosed before they begin to cause symptoms. We now need to carry out a clinical trial to see what happens if we screen high-risk breast cancer patients for brain metastases. This will verify whether doing so could increase survival, symptom control or quality of life.
Abstract: Background: Brain metastases (BM) have become a major challenge in patients with metastatic breast cancer. Methods: The aim of this analysis was to characterize patients with asymptomatic BM (n = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. Results: Compared to symptomatic patients, asymptomatic patients were slightly younger at diagnosis (median age: 55.5 vs. 57.0 years, p = 0.01), had a better performance status at diagnosis (Karnofsky index 80–100%: 68.4% vs. 57%, p < 0.001), a lower number of BM (>1 BM: 56% vs. 70%, p = 0.027), and a slightly smaller diameter of BM (median: 1.5 vs. 2.2 cm, p < 0.001). Asymptomatic patients were more likely to have extracranial metastases (86.7% vs. 81.5%, p = 0.003) but were less likely to have leptomeningeal metastasis (6.3% vs. 10.9%, p < 0.001). Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs. 6.9 months, p < 0.001). Conclusions: These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, although a lead time bias of the earlier diagnosis cannot be ruled out. Our analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of BM.
Background: Unlike metastatic colorectal cancer (CRC) there are to date few reports concerning the predictive value of molecular biomarkers on the clinical outcome in stage II/III CRC patients receiving adjuvant chemotherapy. Aim of this study was to assess the predictive value of proteins related with the EGFR- and VEGFR- signalling cascades in these patients.
Methods: The patients' data examined in this study were from the collective of the 5-FU/FA versus 5-FU/FA/irinotecan phase III FOGT-4 trial. Tumor tissues were stained by immunohistochemistry for VEGF-C, VEGF-D, VEGFR-3, Hif-1 α, PTEN, AREG and EREG expression and evaluated by two independent, blinded investigators. Survival analyses were calculated for all patients receiving adjuvant chemotherapy in relation to expression of all makers above.
Results: Patients with negative AREG and EREG expression on their tumor had a significant longer DFS in comparison to AREG/EREG positive ones (p< 0.05). The benefit on DFS in AREG-/EREG- patients was even stronger in the group that received 5-FU/FA/irinotecan as adjuvant treatment (p=0.002). Patients with strong expression of PTEN profited more in terms of OS under adjuvant treatment containing irinotecan (p< 0.05). Regarding markers of the VEGFR- pathway we found no correlation of VEGF-C- and VEGFR-3 expression with clinical outcome. Patients with negative VEGF-D expression had a trend to live longer when treated with 5-FU/FA (p=0.106). Patients who were negative for Hif-1 α, were disease-free in more than 50% at the end of the study and showed significant longer DFS-rates than those positive for Hif-1 α (p=0.007). This benefit was even stronger at the group treated with 5-FU/FA/irinotecan (p=0.026). Finally, AREG-/EREG-/PTEN+ patients showed a trend to live longer under combined treatment combination.
Conclusions: The addition of irinotecan to adjuvant treatment with 5-FU/FA does not provide OS or DFS benefit in patients with stage II/III CRC. Nevertheless, AREG/EREG negative, PTEN positive and Hif-1 α negative patients might profit significantly in terms of DFS from a treatment containing fluoropyrimidines and irinotecan. Our results suggest a predictive value of these biomarkers concerning adjuvant chemotherapy with 5-FU/FA +/− irinotecan in stage II/III colorectal cancer.
The project focuses on the efficiency of combined technologies to reduce the release of micropollutants and bacteria into surface waters via sewage treatment plants of different size and via stormwater overflow basins of different types. As a model river in a highly populated catchment area, the river Schussen and, as a control, the river Argen, two tributaries of Lake Constance, Southern Germany, are under investigation in this project. The efficiency of the different cleaning technologies is monitored by a wide range of exposure and effect analyses including chemical and microbiological techniques as well as effect studies ranging from molecules to communities.