The purpose of this systematic review and meta‐analysis was to assess the prevalence, incidence and risk factors of peri‐implantitis in the current literature. An electronic search was performed to ...identify publications from January 1980 until March 2016 on 9 databases. The prevalence and incidence of peri‐implantitis were assessed in different subgroups of patients and the prevalences were adjusted for sample size (SSA) of studies. For 12 of 111 identified putative risk factors and risk indicators, forest plots were created. Heterogeneity analysis and random effect meta‐analysis were performed for selected potential risk factors of peri‐implantitis. The search retrieved 8357 potentially relevant studies. Fifty‐seven studies were included in the systematic review. Overall, the prevalence of peri‐implantitis on implant level ranged from 1.1% to 85.0% and the incidence from 0.4% within 3 years, to 43.9% within 5 years, respectively. The median prevalence of peri‐implantitis was 9.0% (SSA 10.9%) for regular participants of a prophylaxis program, 18.8% (SSA 8.8%) for patients without regular preventive maintenance, 11.0% (SSA 7.4%) for non‐smokers, 7.0% (SSA 7.0%) among patients representing the general population, 9.6% (SSA 9.6%) for patients provided with fixed partial dentures, 14.3% (SSA 9.8%) for subjects with a history of periodontitis, 26.0% (SSA 28.8%) for patients with implant function time ≥5 years and 21.2% (SSA 38.4%) for ≥10 years. On a medium and medium‐high level of evidence, smoking (effect summary OR 1.7, 95% CI 1.25‐2.3), diabetes mellitus (effect summary OR 2.5; 95% CI 1.4‐4.5), lack of prophylaxis and history or presence of periodontitis were identified as risk factors of peri‐implantitis. There is medium‐high evidence that patient’s age (effect summary OR 1.0, 95% CI 0.87‐1.16), gender and maxillary implants are not related to peri‐implantitis. Currently, there is no convincing or low evidence available that identifies osteoporosis, absence of keratinized mucosa, implant surface characteristics or edentulism as risk factors for peri‐implantitis. Based on the data analyzed in this systematic review, insufficient high‐quality evidence is available to the research question. Future studies of prospective, randomized and controlled type including sufficient sample sizes are needed. The application of consistent diagnostic criteria (eg, according to the latest definition by the European Workshop on Periodontology) is particularly important. Very few studies evaluated the incidence of peri‐implantitis; however, this study design may contribute to examine further the potential risk factors.
Response rates in HER2-overexpressing EBC treated with neoadjuvant chemotherapy and trastuzumab (T) have been improved by addition of pertuzumab (P). The prospective, phase II, neoadjuvant WSG-ADAPT ...HER2+/HR− trial assessed whether patients with strong early response to dual blockade alone might achieve pathological complete response (pCR) comparable to that of patients receiving dual blockade and chemotherapy.
Female patients with HER2+/HR− EBC (M0) were randomized (5:2) to 12weeks of T+P±weekly paclitaxel (pac) at 80mg/m2. Early response was defined as proliferation decrease≥30% of Ki-67 (versus baseline) or low cellularity (<500 invasive tumor cells) in the 3-week biopsy. The trial was designed to test non-inferiority for pCR in early responding patients of the T+P arm versus all chemotherapy-treated patients.
From February 2014 to December 2015, 160 patients were screened, 92 were randomized to T+P and 42 to T+P+pac. Baseline characteristics were well balanced (median age 54 versus 51.5years, cT251.1 versus 52.4%, cN054.3 versus 61.9%); 91.3% of patients completed T+P per protocol and 92.9% T+P+pac. The pCR rate in the T+P+pac arm was 90.5%, compared with 36.3% in the T+P arm as a whole. In the T+P arm, 24/92 were classified as non-responders, and their pCR rate was only 8.3% compared with 44.7% in responders (38/92) and 42.9% in patients with unclassified early response (30/92). No new safety signals were observed in the study population.
Addition of taxane monotherapy to dual HER2 blockade in a 12-week neoadjuvant setting substantially increases pCR rates in HER2+/HR− EBC compared with dual blockade alone, even within early responders to dual blockade. Early non-response under dual blockade strongly predicts failure to achieve pCR.
Abstract
Background:
Administered either alone or in combination with various cytostatic, endocrine
or targeted therapies, trastuzumab significantly improves the prognosis of patients with
...HER2-positive breast cancer. As trastuzumab is effective across multiple lines of therapy in the
metastatic setting (treatment beyond progression: TBP), it is often administered over a long
period of time. The aim of this study was to evaluate the tolerability and clinical practice of
long-term trastuzumab administration (> 1 year) in metastatic breast cancer patients treated
in a large university breast center.
Methods:
Metastatic breast cancer patients who
received at least 18 cycles of trastuzumab administered every three weeks at the University
Gynecological Hospital of Tuebingen between 1999 and 2012 were included in this retrospective
study. Typical combination drugs, side effects, and the impact of administration on left
ventricular ejection fraction (LVEF) were investigated.
Results:
72 patients were
eligible for inclusion in the study. The mean number of administrations was 50.14 (SD: 27.51).
In 53 patients the principle of TBP was followed across an average of 2.4 therapy lines. Classic
cardiac risk factors were present at the beginning of trastuzumab treatment in 34 patients
(47 %). Seven patients (10 %) experienced a decrease in LVEF during treatment, 9 patients (13 %)
had hypersensitivity reactions. Treatment was discontinued in two patients due to side effects
(1 × progressive LVEF decrease, 1 × intolerance).
Summary:
The administration of
trastuzumab across multiple lines of therapy was generally tolerated well. Cardiac risk factors
were not a limiting factor. If regular cardiac monitoring is done, trastuzumab appears not only
to improve survival but also helps preserve the quality of life of patients with HER2-positive
metastatic breast cancer.
Purpose
Prognostic impact of nodal status or lymphadenectomy in advanced ovarian cancer is still unclear. Known best prognostic impact in advanced ovarian cancer has the residual tumor mass. The aim ...of this retrospective study is to examine the importance of nodal status in correlation with residual tumor mass.
Methods
One hundred and fifty-seven consecutive patients with primary stage III ovarian cancer underwent surgery between 01/2000 and 06/2007 at the Department of gynecology and obstetrics, University Hospital, Tübingen, Germany. All patients got stage-related surgery and platin-based chemotherapy. Median follow-up time was 53.5 months, and all patients were included in the study.
Results
Resection status and nodal status are significant prognostic factors in our study (
P
< 0.001). In FIGO III, patients without residual tumor (
R
0) had significant best OS and PFS independent to node status (
N
0/
N
+;
P
= 0.002) compared to patients with residual tumor. In contrast, node status had significant positive impact on PFS in patients without residual tumor and node negativity. With theincrease in residual tumor, the influence of lymphnode metastases on prognosis is decreasing.
Conclusion
Main intention of primary surgery is
R
0 resection with best prognosis in advanced stages. A systematic lymphadenectomy in cases with
R
0 resection or residual tumor <1 cm seems to be reasonable with positive impact on prognosis. Node status has impact on prognosis in patients with negative node after
R
0 resection with best PFS in FIGO III. Further prospective studies had to show whether systematic lymphadenectomy in suboptimally tumor-reduced patients can improve prognosis.
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