Geburtshilfe Und Frauenheilkunde最新文献

{"title":"Identification of Patients with Early HR+ HER2- Breast Cancer at High Risk of Recurrence.","authors":"Peter A Fasching, Hans Kreipe, Lucia Del Mastro, Eva Ciruelos, Gilles Freyer, Agnieszka Korfel, Nadia Chouaki, Clemens Stoffregen, Francisco Sapunar, David Cameron","doi":"10.1055/a-2238-3199","DOIUrl":"https://doi.org/10.1055/a-2238-3199","url":null,"abstract":"<p><p>Breast cancer incidence has increased in the last two decades and, simultaneously, survival has improved due to earlier detection and improved treatment options. Despite this improvement, locoregional recurrences and distant metastases occur in up to 10 and 30% of women diagnosed with early breast cancer, respectively. Around 70% of breast cancers are hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), and associated with a persistent risk of relapse up to 20 years after diagnosis/initial treatment. We conducted a narrative review by combining PubMed searches with our clinical experience to describe patient characteristics, biomarkers, and genomic profiling tools available to clinicians for the identification of patients with HR+, HER2- early breast cancer at high risk of recurrence and to provide recommendations to classify patients into recurrence risk categories. National and international treatment guidelines are also summarised. Accurate assessment of the risk of recurrence in these patients is crucial as the predicted risk guides treatment decisions; imprecise estimations can result in over- or undertreatment, with either scenario having negative consequences for patients. Multiple prognostic tools and factors are recommended for early breast cancer, and no single test provides accurate prognosis in isolation. Since no single test can provide accurate prognosis in isolation, a combination of tools should be used. Risk thresholds are important to guide optimised and balanced therapeutic decisions in HR+, HER2- early breast cancer. However, prognostic assessment should be performed on a case-by-case basis, making patient-specific prognostic approaches essential to avoid over- or undertreatment.</p>","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"84 2","pages":"164-184"},"PeriodicalIF":2.7,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Rheumatic Diseases During Pregnancy and Breastfeeding: Position Paper of the Working Group for Obstetrics and Prenatal Medicine in the German Society for Gynecology and Obstetrics e. V. (AGG - Section Maternal Diseases in Pregnancy).","authors":"Bettina Kuschel, Ute Margaretha Schäfer-Graf, Markus Schmidt, Maritta Kühnert, Carsten Hagenbeck, Klaus Thürmel","doi":"10.1055/a-2201-2680","DOIUrl":"https://doi.org/10.1055/a-2201-2680","url":null,"abstract":"<p><p><b>Purpose</b> These recommendations issued by the AGG (Section Maternal Diseases in Pregnancy) were developed as a rapid orientation on maternal rheumatic diseases for counselling and disease management in pregnancy and breastfeeding. <b>Methods</b> The standard literature, consensus and position papers, guidelines and recommendations by other specialist associations were evaluated by a task force of the Section and summarized in these recommendations following a joint consensus process. <b>Recommendations</b> This paper provides an orientating overview of the physiology, pathophysiology and definitions of rheumatic diseases which is relevant for gynecologists and obstetricians. The recommendations focus on the maternal, fetal and neonatal diagnostic workup in cases with underlying maternal rheumatic disease.</p>","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"84 2","pages":"130-143"},"PeriodicalIF":2.7,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Follow-up and Safety of Patients after an Upfront Therapy with Letrozole for Early Breast Cancer in Routine Clinical Care - The PreFace Study.","authors":"Carolin C Hack, Nicolai Maass, Bahriye Aktas, Sherko Kümmel, Christoph Thomssen, Christopher Wolf, Hans-Christian Kolberg, Cosima Brucker, Wolfgang Janni, Peter Dall, Andreas Schneeweiss, Frederik Marme, Matthias Ruebner, Anna-Katharin Theuser, Nadine M Hofmann, Sybille Böhm, Katrin Almstedt, Sara Kellner, Paul Gass, Marc W Sütterlin, Hans-Joachim Lück, Sabine Schmatloch, Matthias Kalder, Christoph Uleer, Ingolf Juhasz-Böss, Volker Hanf, Christian Jackisch, Volkmar Müller, Brigitte Rack, Erik Belleville, Diethelm Wallwiener, Achim Rody, Claudia Rauh, Christian M Bayer, Sabrina Uhrig, Chloë Goossens, Hanna Huebner, Sara Y Brucker, Lothar Häberle, Tanja N Fehm, Alexander Hein, Peter A Fasching","doi":"10.1055/a-2238-3153","DOIUrl":"10.1055/a-2238-3153","url":null,"abstract":"<p><strong>Introduction: </strong>Adjuvant treatment of patients with early-stage breast cancer (BC) should include an aromatase inhibitor (AI). Especially patients with a high recurrence risk might benefit from an upfront therapy with an AI for a minimum of five years. Nevertheless, not much is known about the patient selection for this population in clinical practice. Therefore, this study analyzed the prognosis and patient characteristics of postmenopausal patients selected for a five-year upfront letrozole therapy.</p><p><strong>Patients and methods: </strong>From 2009 to 2011, 3529 patients were enrolled into the adjuvant phase IV PreFace clinical trial (NCT01908556). Postmenopausal hormone receptor-positive BC patients, for whom an upfront five-year therapy with letrozole (2.5 mg/day) was indicated, were eligible. Disease-free survival (DFS), overall survival (OS) and safety in relation to patient and tumor characteristics were assessed.</p><p><strong>Results: </strong>3297 patients started letrozole therapy. The majority of patients (n = 1639, 57%) completed the five-year treatment. 34.5% of patients continued with endocrine therapy after the mandated five-year endocrine treatment. Five-year DFS rates were 89% (95% CI: 88-90%) and five-year OS rates were 95% (95% CI: 94-96%). In subgroup analyses, DFS rates were 83%, 84% and 78% for patients with node-positive disease, G3 tumor grading, and pT3 tumors respectively. The main adverse events (any grade) were pain and hot flushes (66.8% and 18.3% of patients).</p><p><strong>Conclusions: </strong>The risk profile of postmenopausal BC patients selected for a five-year upfront letrozole therapy showed a moderate recurrence and death risk. However, in subgroups with unfavorable risk factors, prognosis warrants an improvement, which might be achieved with novel targeted therapies.</p>","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"84 2","pages":"185-195"},"PeriodicalIF":2.7,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment in Certified Breast Cancer Centers Improves Chances of Survival of Patients with Breast Cancer: Evidence Based on Health Care Data from the WiZen Study.","authors":"Olaf Schoffer, Pauline Wimberger, Michael Gerken, Veronika Bierbaum, Christoph Bobeth, Martin Rößler, Patrik Dröge, Thomas Ruhnke, Christian Günster, Kees Kleihues-van Tol, Theresa Link, Anton Scharl, Elisabeth C Inwald, Karin Kast, Thomas Papathemelis, Olaf Ortmann, Monika Klinkhammer-Schalke, Jochen Schmitt","doi":"10.1055/a-1869-1772","DOIUrl":"https://doi.org/10.1055/a-1869-1772","url":null,"abstract":"<p><strong>Introduction: </strong>Certified breast cancer centers offer specific quality standards in terms of their structure, diagnostic and treatment approaches with regards to breast surgery, drug-based cancer therapy, radiotherapy, and psychosocial support. Such centers aim to improve treatment outcomes of breast cancer patients. The question investigated here was whether patients with primary breast cancer have a longer overall survival if they are treated in a certified breast cancer center compared to treatment outside these centers.</p><p><strong>Methods: </strong>We used patient-specific data (demographics, diagnoses, treatments) obtained from data held by mandatory health insurance companies ( <i>gesetzliche Krankenversicherung</i> , GKV) and clinical cancer registries (KKR) for the period 2009-2017 as well as hospital characteristics recorded in standardized quality reports. Using multivariable Cox regression analysis, we investigated differences in survival between patients treated in hospitals certified as breast cancers centers by the German Cancer Society (DKG) and patients treated in hospitals which had not been certified by the DKG.</p><p><strong>Results: </strong>The sample population consisted of 143720 (GKV data) and 59780 (KKR data) patients with breast cancer, who were treated in 1010 hospitals across Germany (280 DKG-certified, 730 not DKG-certified). 63.5% (GKV data) and 66.7% (KKR data) of patients, respectively, were treated in DKG-certified breast cancer centers. Cox regression analysis for overall survival which included patient and hospital characteristics found a significantly lower mortality risk for patients treated in DKG-certified breast cancer centers (GKV data: HR = 0.77, 95% CI = 0.74-0.81; KKR data: HR = 0.88, 95% CI = 0.85-0.92). This result remained stable even after several sensitivity analyses including stratified estimates for subgroups of patients and hospitals. The effect was even more pronounced for recurrence-free survival (KKR data: HR = 0.78, 95% CI = 0.74-0.82).</p><p><strong>Conclusions: </strong>Patients who are treated by an interdisciplinary team in a DKG-certified breast cancer had clear and statistically significantly better survival rates. Certification is therefore an effective means of improving the quality of care, and more patients should be treated in certified breast cancer centers.</p>","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"84 2","pages":"153-163"},"PeriodicalIF":2.7,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139722215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Multiple Gestation as a Risk Factor for SARS-CoV-2-Associated Adverse Maternal Outcome: Data From the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS)","authors":"M. Sourouni, Ariane Germeyer, Manuel Feißt, Alexandra Balzer, Helen Köster, Annemarie Minte, Dörthe Brüggmann, Celine Kohll, Kristin Reinhardt, Michaela Möginger, Anja Leonhardt, Constanze Banz-Jansen, Michael Bohlmann, Christiane Fröhlich, Clara Backes, Dietrich Hager, Lisa Kaup, Elsa Hollatz-Galuschki, Charlotte Engelbrecht, F. Markfeld-Erol, C. Hagenbeck, Hening Schäffler, Jennifer Winkler, Johannes Stubert, K. Rathberger, Laura Lüber, Linda Hertlein, Antonia Machill, Manuela Richter, Martin Berghäuser, Michael Weigel, Mirjam Morgen, Nora Horn, P. Jakubowski, B. Riebe, B. Ramsauer, Robert Sczesny, Ute Schäfer-Graf, Susanne Schrey, Sven Kehl, J. Lastinger, S. Seeger, Olaf Parchmann, A. Iannaccone, Jens Rohne, Luise Gattung, Christine A. Morfeld, Michael Abou-Dakn, Markus Schmidt, Michaela Glöckner, Anja Jebens, K. Sondern, U. Pecks, Ralf Schmitz, M. Möllers","doi":"10.1055/a-2232-5598","DOIUrl":"https://doi.org/10.1055/a-2232-5598","url":null,"abstract":"","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"32 33","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139388762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statement of the Obstetrics and Prenatal Medicine Working Group (AGG - Preterm Birth Section) on \"Outpatient Management for Pregnant Women with Preterm Premature Rupture of Membranes (PPROM)\".","authors":"Mirjam Kunze, Holger Maul, Ioannis Kyvernitakis, Patrick Stelzl, Werner Rath, Richard Berger","doi":"10.1055/a-2205-1725","DOIUrl":"10.1055/a-2205-1725","url":null,"abstract":"<p><p>Preterm premature rupture of membranes (PPROM) is one of the leading causes of perinatal morbidity and mortality. After a PPROM, more than 50% of pregnant women are delivered within 7 days. Fetal and maternal risks are primarily due to infection and inflammation, placental abruption, umbilical cord complications and preterm birth. Standard care usually consists of an expectant approach. Management includes the administration of antenatal steroids and antibiotic therapy. Patients with PPROM require close monitoring. The management of pregnant women with PPROM (inpatient vs. outpatient) is still the subject of controversial debate. The international guidelines also do not offer a clear stance. The statement presented here discusses the current state of knowledge.</p>","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"84 1","pages":"43-47"},"PeriodicalIF":2.7,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10764122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139097712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Administration of Antenatal Corticosteroids: Optimal Timing.","authors":"Richard Berger, Patrick Stelzl, Holger Maul","doi":"10.1055/a-2202-5363","DOIUrl":"10.1055/a-2202-5363","url":null,"abstract":"<p><p>The effectiveness of antenatal corticosteroids (ACS) in significantly reducing respiratory distress syndrome (RDS) depends crucially on the timing. It is successful if delivery takes place between 24 hours and seven days following administration; after this period, the side effects seem to predominate. In addition, an increased rate of mental impairment and behavioral disorders are observed in children born full-term after ACS administration. The optimal timing of ACS administration depends crucially on the given indication; to date, it has been achieved in only 25-40% of cases. ACS administration is always indicated in PPROM, in severe early pre-eclampsia, in fetal IUGR with zero or reverse flow in the umbilical artery, in placenta previa with bleeding, and in patients experiencing premature labor with a cervical length < 15 mm. The risk of women with asymptomatic cervical insufficiency giving birth within seven days is very low. In this case, ACS should not be administered even if the patient's cervical length is less than 15 mm, provided that the cervix is closed and there are no other risk factors for a premature birth. The development of further diagnostic methods with improved power to predict premature birth is urgently needed in order to optimize the timing of ACS administration in this patient population. Caution when administering ACS is also indicated in women experiencing premature labor who have a cervical length ≥ 15 mm. Further studies using amniocentesis are needed in order to identify the patient population with microbial invasion of the amniotic cavity/intra-amniotic infection (MIAC/IAI), and to define threshold values at which delivery is indicated. ACS administration is not performed as an emergency measure, usually not even before transfer to a perinatal center. Therefore, whenever possible, the indication for ACS administration should be determined by a clinician who is highly experienced in perinatology.</p>","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"84 1","pages":"48-58"},"PeriodicalIF":2.4,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10781581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Trimester Contingent Screening for Aneuploidies with Cell-Free Fetal DNA in Singleton Pregnancies - a Swiss Single Centre Experience.","authors":"Alice Proto, Fabienne Trottmann, Sophie Schneider, Sofia Amylidi-Mohr, Florent Badiqué, Lorenz Risch, Daniel Surbek, Luigi Raio, Beatrice Mosimann","doi":"10.1055/a-2202-5282","DOIUrl":"10.1055/a-2202-5282","url":null,"abstract":"<p><strong>Introduction: </strong>Switzerland was amongst the first countries to offer cell-free fetal DNA (cffDNA) testing covered by the health insurance to pregnant women with a risk ≥ 1:1000 for trisomies at first trimester combined screening (FTCS). The aim of this study is to evaluate the implementation of this contingent model in a single tertiary referral centre and its effect on gestational age at diagnosing trisomy 21.</p><p><strong>Materials and methods: </strong>Between July 2015 and December 2020 all singleton pregnancies at 11-14 weeks of gestation without major fetal malformation were included and stratified according to their risk at FTCS. Statistical analysis was performed by GraphPad Version 9.1 for Windows.</p><p><strong>Results: </strong>4424 pregnancies were included. Of 166 (3.8%) pregnancies with a NT ≥ 3.5 mm and/or a risk ≥ 1:10 at FCTS, 130 (78.3%) opted for direct invasive testing. 803 (18.2%) pregnancies had an intermediate risk, 692 (86.2%) of them opted for cffDNA first. 3455 (78.1%) pregnancies had a risk < 1:1000. 63 fetuses were diagnosed with trisomy 21, 47 (74.6%) directly by invasive procedures after FTCS, 16 (25.4%) by cffDNA first.</p><p><strong>Conclusions: </strong>Most women choose cffDNA or invasive testing as second tier according to national guidelines. Despite the delay associated with cffDNA testing after FCTS, 75% of all trisomy 21 are still diagnosed in the first trimester with this contingent screening model.</p>","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"84 1","pages":"68-76"},"PeriodicalIF":2.7,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10764121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139097710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spermienqualität und Konzeptionschancen","authors":"","doi":"10.1055/a-2168-1201","DOIUrl":"https://doi.org/10.1055/a-2168-1201","url":null,"abstract":"","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":"28 20","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unterschiedliche Virustransmission und klinischer Verlauf einer Zytomegalievirus-Infektion bei dichorialer Geminigravidität","authors":"G. Kirov, SE Alsat-Krenz, M. Enders, Mechthild Hubert, Markus Pingel, F. Dede","doi":"10.1055/a-2060-9091","DOIUrl":"https://doi.org/10.1055/a-2060-9091","url":null,"abstract":"","PeriodicalId":12481,"journal":{"name":"Geburtshilfe Und Frauenheilkunde","volume":" 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139392310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}