BackgroundSelf-administered health-status questionnaires are important tools in epidemiology. The objective of the presented validation study is to measure the agreement between breast cancer patients’ self-reports and their physicians’ information on late cardiac events, and to investigate determinants of agreement. To estimate possible misclassification is an important requirement for observational studies on cardiovascular endpoints.MethodsA retrospective, multi-center cohort study included 11,982 women diagnosed with breast cancer in Germany in 1998–2008. In 2014, a questionnaire survey assessed cardiovascular risk factors and incident cardiac events after therapy. A validation study was conducted, based on a sample of 3091 breast cancer patients from two university hospitals. Among them, 2261 women (73%) sent back the questionnaire on cardiovascular events, and 1316 women gave consent to request medical records from their general practitioners. A total of 1212/1316 (92.1%) medical records could be obtained for validation. Cohen’s kappa coefficient was calculated, and multivariate regression was applied to study the influence of patient characteristics on agreement between both data sources.ResultsOverall agreement for the composite endpoint of any cardiac event was 84.5% (kappa 0.35). Of 1055 breast cancer patients reporting no cardiac event, 950 (90%) had no such diagnosis in physicians’ medical records. A total of 157 breast cancer survivors indicated a cardiac event, and the same diagnosis was confirmed by GPs for 74 (47%) women. For specific diagnoses, moderate to substantial agreement of self-reports was found for myocardial infarction (kappa 0.54) and stroke (kappa 0.61). Poor to fair agreement was present for angina pectoris, valvular heart disease, arrhythmia, and congestive heart failure. Younger age, higher education and a more recent cancer diagnosis were found to be associated with greater total agreement.ConclusionsFor the composite endpoint, survivors of breast cancer report the absence of cardiac disease accurately. However, for specific diagnoses, self-reported morbidity data from breast cancer patients may not fully agree with information from physicians. The agreement is moderate for acute events like myocardial infarction and stroke, but poor to fair for chronic diseases.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0961-7) contains supplementary material, which is available to authorized users.
Introduction: In Germany, commercial CAR-T cell therapies are registered with the German Registry for Stem Cell Transplantation (DRST), which is the National partner organization of the EBMT registry. Here, we present the first risk factor analysis of standard-ofcare (SOC) CAR-T cell therapies for large B-cell lymphoma (LBCL) based on DRST data.
The capacity of solid tumors to invade surrounding tissue and to metastasize is correlated with the formation and degradation of structural elements in the vicinity of the tumor cells. Evidence has accumulated that proteases play a crucial role in tumor cell invasion and metastasis. Four different classes of proteases are involved: 1. serine proteases, 2. metalloproteases, 3. cysteine proteases, and 4. aspartyl proteases. It has been shown that the content of some tumor-associated proteolytic factors in tumor extracts have a strong prognostic value. Especially the urokinase-type plasminogen activator (uPA) and the plasminogen activator inhibitor type-1 (PAI-1), predicting relapse-free and overall survival of patients with breast, gastric and ovarian cancer, allow to classify high-risk cancer patients. A prospective clinical study currently investigates whether lymph-node-negative breast cancer patients with either high uPA and/or PAI-1 level will benefit from adjuvant chemotherapy. Based on the present knowledge of basic and clinical aspects of tumor-associated proteases, new potential therapeutic strategies have emerged targeting these proteolytic enzyme systems.
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