A Teufel

Universität Regensburg, Ratisbon, Bavaria, Germany

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Publications (250)1026.05 Total impact

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    ABSTRACT: Background The routine care of cancer patients differs from the setting of randomized controlled clinical trials. In routine care patients of all age groups are treated and often suffer from multiple comorbidities, therefore results from clinical trials cannot always be directly applied to the routine care setting. The aim of this review is to collate the clinical cancer registry data regarding questions of quality of care and health services research. By the implementation of the further development of the early detection of cancer and quality assurance through clinical cancer registries Act (KFRG §65c Social Code V, SGB V) in 2013 the gap between the results from clinical trials and comprehensive routine care settings will be filled and the “last mile” (H. Pfaff) with the many facets of quality of process and results will be reflected by healthcare research. Objective The instruments necessary to collate, combine and evaluate the quality of oncological treatment according to clearly defined questions, are systematic documentation and analysis of the routine care setting. This report gives an introduction to the methodology of cancer registries and shows which types of questions can be investigated with such register data based on two examples. Methods Outcome data from nationwide clinical cancer registries were collected and are presented according to existing quality indicators from the guidelines on treatment quality. The distribution and survival benefit of stage II colon cancer patients were reviewed based on the quality indicators for the number of lymph nodes examined nationwide (12 or more lymph nodes should be removed and examined). Similarly, the outcome of adjuvant chemotherapy in patients with stage II colon cancer is presented using a population-based regional cancer registry. Results The nationwide analysis of the quality indicators showed a significantly better survival for patients when more than 12 lymph nodes were removed and examined than for patients when less than 12 lymph nodes were removed. In the regional analysis patients with stage II colon cancer and T4 tumors showed a significantly benefit from adjuvant chemotherapy. This report identifies ways in which register data for the measurement of the quality of treatment and for health services research can be utilized.
    No preview · Article · Jan 2016 · Der Onkologe
  • T Maass · T Itzel · S Kanzler · A Teufel

    No preview · Article · Dec 2015 · Zeitschrift für Gastroenterologie

  • No preview · Article · Dec 2015 · Zeitschrift für Gastroenterologie

  • No preview · Article · Dec 2015 · Zeitschrift für Gastroenterologie
  • A. Teufel · S. Kanzler
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    ABSTRACT: Autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC) are referred to as autoimmune liver diseases. An association with other autoimmune diseases, so-called overlap syndromes is frequently described, whereby the overlap between autoimmune liver diseases themselves is the most frequently observed overlap. In well-defined groups of patients with classical autoimmune hepatitis, the frequency of overlap syndromes to PBC or PSC was estimated to occur in up to 19 %. Only a few case reports exist on overlap of PBC and PSC. No uniform criteria for the diagnosis of overlap syndromes have been established. However, it is important to characterize the clinically leading disease, since this may be important for treatment and prognosis. In this review, we summarize the current state of diagnosis and therapy of autoimmune liver diseases with special consideration of overlap syndromes.
    No preview · Article · Oct 2015 · Der Gastroenterologe
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    ABSTRACT: Background & aims: Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC. Methods: This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks. Results: A simplified autoimmune hepatitis (AIH) score >5 (HR of 36, p<0.0001) and a modified histological activity index (mHAI) greater than 3/18 points (HR 3.6, p = 0.0274) were associated with the initiation of IT during the course of PSC. Of note, PSC patients who subsequently received IT differed already at the time of PSC diagnosis from those patients, who did not receive IT during follow-up: they presented with increased levels of IgG (p = 0.004) and more frequently had clinical signs of cirrhosis (p = 0.0002). Conclusions: This is the first study which investigates the parameters associated with IT in patients with PSC in clinical practice. A simplified AIH score >5 and a mHAI score >3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines.
    Full-text · Article · Oct 2015 · PLoS ONE
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    ABSTRACT: Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a hepatocyte-specific MRI contrast agent. Because the hepatic uptake of Gd-EOB-DTPA depends on the integrity of the hepatocyte mass, this uptake can be quantified to assess liver function. We report the relationship between the extent of Gd-EOB-DTPA uptake and the degree of liver fibrosis. T1-weighted volumeinterpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 minutes after contrast injection. Strong correlations of the uptake characteristics of Gd- EOB-DTPA with the relative enhancement (RE) of the liver parenchyma and the grade of fibrosis/ cirrhosis, classified using the Ishak scoring system, were observed. The subdivisions between the grades of liver fibrosis based on RE were highly significant for all combinations, and a ROC revealed sensitivities ≥82% and specificities ≥87% for all combinations. MR imaging is a satisfactorily sensitive method for the assessment of liver fibrosis/cirrhosis.
    Full-text · Article · Oct 2015 · Scientific Reports
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    ABSTRACT: Liver transplantation (LT) is the only definitive treatment for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC) but a high rate of biliary strictures (BS) and of recurrence (recPSC) has been reported. In this multicenter study we analyzed a large patient cohort with a long follow-up in order to evaluate the incidence of BS and of recPSC, to assess the impact on survival after LT and to identify risk factors. We collected clinical, surgical and laboratory data, records on inflammatory bowel disease (IBD), on immunosuppression, on recipient and graft outcome and on biliary complications (based on cholangiography and histology) of all patients who underwent LT for PSC in 10 German transplant centers between 01/1990 and 12/2006. 335 patients (68.4% men, mean age 38.9 years, 73.5% with IBD) were transplanted 8.8 years after PSC diagnosis and followed for 98.8 months. The one-, five- and ten-year recipient and graft survival was 90.7%, 84.8%, 79.4% and 79.2%, 69.1%, 62.4% respectively. BS were diagnosed in 36.1% after a mean time of 3.9 years and recPSC in 20.3% after 4.6 years. Both entities had a significant impact on long-term graft and recipient-survival. Independent risk factors for BS were donor age, ulcerative colitis, chronic ductopenic rejection, bilirubin and INR at LT. Independent risk factors for recPSC were donor age, IBD and INR at LT. These variables were able to categorize patients into risk groups for BS and recPSC. Conclusion: BS and recPSC impact on long-term graft and patient survival after LT for PSC. Donor age, IBD and the INR at LT are independent risk factors for BS and recPSC and allow the risk estimation depending on the recipient-donor-constellation. This article is protected by copyright. All rights reserved.
    No preview · Article · Oct 2015 · Liver Transplantation
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    ABSTRACT: To evaluate risk factors associated with alterations in venous structures adjacent to an ablation zone after percutaneous irreversible electroporation (IRE) of hepatic malignancies at subacute follow-up (1 to 3 days after IRE) and to describe evolution of these alterations at mid-term follow-up. 43 patients (men/women, 32/11; mean age, 60.3 years) were identified in whom venous structures were located within a perimeter of 1.0 cm of the ablation zone at subacute follow-up after IRE of 84 hepatic lesions (primary/secondary hepatic tumors, 31/53). These vessels were retrospectively evaluated by means of pre-interventional and post-interventional contrast-enhanced magnetic resonance imaging or computed tomography or both. Any vascular changes in flow, patency, and diameter were documented. Correlations between vascular change (yes/no) and characteristics of patients, lesions, and ablation procedures were assessed by generalized linear models. 191 venous structures were located within a perimeter of 1.0 cm of the ablation zone: 55 (29%) were encased by the ablation zone, 78 (41%) abutted the ablation zone, and 58 (30%) were located between 0.1 and 1.0 cm from the border of the ablation zone. At subacute follow-up, vascular changes were found in 19 of the 191 vessels (9.9%), with partial portal vein thrombosis in 2, complete portal vein thrombosis in 3, and lumen narrowing in 14 of 19. At follow-up of patients with subacute vessel alterations (mean, 5.7 months; range, 0 to 14 months) thrombosis had resolved in 2 of 5 cases; vessel narrowing had completely resolved in 8 of 14 cases, and partly resolved in 1 of 14 cases. The encasement of a vessel by ablation zone (OR = 6.36, p<0.001), ablation zone being adjacent to a portal vein (OR = 8.94, p<0.001), and the usage of more than 3 IRE probes (OR = 3.60, p = 0.035) were independently associated with post-IRE vessel alterations. Venous structures located in close proximity to an IRE ablation zone remain largely unaffected by this procedure, and thrombosis is rare.
    Full-text · Article · Aug 2015 · PLoS ONE
  • A. Teufel · S. Kanzler
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    ABSTRACT: Autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC) are referred to as autoimmune liver diseases. An association with other autoimmune diseases, so-called overlap syndromes is frequently described, whereby the overlap between autoimmune liver diseases themselves is the most frequently observed overlap. In well-defined groups of patients with classical autoimmune hepatitis, the frequency of overlap syndromes to PBC or PSC was estimated to occur in up to 19 %. Only a few case reports exist on overlap of PBC and PSC. No uniform criteria for the diagnosis of overlap syndromes have been established. However, it is important to characterize the clinically leading disease, since this may be important for treatment and prognosis. In this review, we summarize the current state of diagnosis and therapy of autoimmune liver diseases with special consideration of overlap syndromes.
    No preview · Article · Jul 2015
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    ABSTRACT: Colorectal cancer is the third most common cancer and a major cause of morbidity and mortality worldwide. Adjuvant chemotherapy is considered the standard of care in patients with UICC stage III colon cancer after R0 resection. Adjuvant therapy was not shown to be beneficial in patients with UICC stage II colon cancer. However, there is an ongoing discussion as to whether adjuvant chemotherapy may be beneficial for a subgroup of UICC II patients in a "high-risk situation" (such as T4). We investigated a Bavarian population-based (2.1 million inhabitants) cohort of 1937 patients with UICC II CRC treated between 2002 and 2012 in regard of the benefit of adjuvant chemotherapy for large (T4) tumors. Patients older than 80 years of age were excluded. Of 1937 patients, 240 had a T4 tumor (12 %); 77 of all T4 patients received postoperative chemotherapy (33 %). Kaplan-Meier analysis and Cox regression models were used for survival analyses. Patients with a T4 tumor who received postoperative chemotherapy had a highly significant survival benefit in respect of overall survival (p < 0.001) and recurrence-free survival (p = 0.008). However, no difference was observed between oxaliplatin-containing and non-oxaliplatin-containing treatment regimens. G2 and G3 tumors were found to particularly benefit from adjuvant treatment. Chemotherapy, age at diagnosis, and tumor grading remained independent risk factors in the multivariate cox regression analysis. Our retrospective study demonstrated the significant benefit of adjuvant chemotherapy in the T4 subgroup of patients with UICC II colon cancer. Our data suggest that adjuvant chemotherapy should be seriously considered in these patients.
    Full-text · Article · May 2015 · BMC Cancer
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    ABSTRACT: Inter-cellular communication with stromal cells is vital for cancer cells. Molecules involved in the communication are potential drug targets. To identify them systematically, we applied a systems level analysis that combined reverse network engineering with causal effect estimation. Using only observational transcriptome profiles we searched for paracrine factors sending messages from activated hepatic stellate cells (HSC) to hepatocellular carcinoma (HCC) cells. We condensed these messages to predict ten proteins that, acting in concert, cause the majority of the gene expression changes observed in HCC cells. Among the 10 paracrine factors were both known and unknown cancer promoting stromal factors, the former including Placental Growth Factor (PGF) and Periostin (POSTN), while Pregnancy-Associated Plasma Protein A (PAPPA) was among the latter. Further support for the predicted effect of PAPPA on HCC cells came from both in vitro studies that showed PAPPA to contribute to the activation of NFκB signaling, and clinical data, which linked higher expression levels of PAPPA to advanced stage HCC. In summary, this study demonstrates the potential of causal modeling in combination with a condensation step borrowed from gene set analysis [Model-based Gene Set Analysis (MGSA)] in the identification of stromal signaling molecules influencing the cancer phenotype.
    Full-text · Article · May 2015 · PLoS Computational Biology

  • No preview · Article · Apr 2015 · RöFo - Fortschritte auf dem Gebiet der R
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    ABSTRACT: In patients with diabetes mellitus, abdominal ultrasonography is the appropriate diagnostic technique to detect and to follow-up secondary and accompanying diseases of the liver, the kidneys, the pancreas, the gastrointestinal tract and of abdominal vessels. Moreover, pancreatic and hepatic diseases may be realized which are of etiological importance for diabetes mellitus. Based on a systematic survey of the published literature, this review in 3 parts will describe the value of abdominal ultrasonography in patients with diabetes mellitus. Part 1 deals with the diagnostic relevance and particular findings of ultrasonographic methods in hepatic manifestations and complications of diabetes mellitus. © Georg Thieme Verlag KG Stuttgart · New York.
    Full-text · Article · Apr 2015 · Zeitschrift für Gastroenterologie
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    ABSTRACT: Unlabelled: Interleukin-33 (IL-33), a cytokine with pleiotropic functions, is elevated in serum of patients with hepatocellular carcinoma (HCC). This study investigated the effects of local IL-33 expression in resected HCC on patient survival and on the immunological and molecular tumor microenvironment. Tissue of resected HCCs was stained for hematoxylin and eosin, Masson trichrome, alpha-smooth muscle actin, IL-33, CD8, and IL-13 and analyzed by flow cytometry. Besides histomorphologic evaluation, the immunohistochemical stainings were analyzed for the respective cell numbers separately for tumor area, infiltrative margin, and distant liver stroma. These findings were correlated with clinical data and patient outcome. Further, gene expression of different HCC risk groups was compared using microarrays. In multivariable analysis, infiltration of HCCs by IL-33(+) cells (P = 0.032) and CD8(+) cells (P = 0.014) independently was associated with prolonged patient survival. Flow cytometry demonstrated that cytotoxically active subpopulations of CD8(+) cells, in particular CD8(+) CD62L(-) KLRG1(+) CD107a(+) effector-memory cells, are the main producers of IL-33 in these HCC patients. Using infiltration by IL-33(+) and CD8(+) cells as two separate factors, an HCC immune score was designed and evaluated that stratified patient survival (P = 0.0004). This HCC immune score identified high- and low-risk patients who differ in gene expression profiles (P < 0.001). Conclusion: Infiltration of HCCs by IL-33(+) and CD8(+) cells is independently associated with prolonged patient survival. We suggest that this is due to an induction of highly effective, cytotoxically active CD8(+) CD62L(-) KLRG1(+) CD107a(+) effector-memory cells producing IL-33. Based on these two independent factors, we established an HCC immune score that provides risk stratification for HCC patients and can be used in the clinical setting.
    No preview · Article · Jan 2015 · Hepatology
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    ABSTRACT: TGF-β is cytostatic towards damage induced compensatory hepatocyte proliferation. This function is frequently lost during hepatocarcinogenesis, thereby switching the TGF-β role from tumor suppressor to tumor promoter. Here, we investigate Smad7 overexpression as pathophysiological mechanism for cytostatic TGF-β inhibition in liver damage and HCC. Transgenic hepatocyte specific Smad7 overexpression in damaged liver of fumarylacetoacetate hydrolase (FAH) deficient mice increased compensatory proliferation of hepatocytes. Similarly, modulation of Smad7 expression changed the sensitivity of Huh7, FLC-4, HLE and HLF HCC cell lines for cytostatic TGF-β effects. In our cohort of 140 HCC patients, Smad7 transcripts were elevated in 41.4% of HCC samples as compared to adjacent tissue, with significant positive correlation to tumor size, whereas low Smad7 expression levels were significantly associated with worse clinical outcome. Univariate and multivariate analyses indicate Smad7 levels as independent predictor for overall (p<0.001) and disease free survival (p=0.0123). Delineating a mechanism for Smad7 transcriptional regulation in HCC, we identified cold shock Y-box protein-1 (YB-1), a multifunctional transcription factor. YB-1 RNAi reduced TGF-β induced and endogenous Smad7 expression in Huh7 and FLC-4 cells, respectively. YB-1 and Smad7 mRNA expression levels correlated positively (p<0.0001). Furthermore, nuclear colocalization of Smad7 and YB-1 proteins was present in cancer cells of those patients. In summary, our study provides a YB-1/Smad7-mediated mechanism that interferes with anti-proliferative/tumor suppressive TGF-β actions in a subgroup of HCC cells, that may facilitate aspects of tumor progression.
    Full-text · Article · Jan 2015 · Clinical Science

  • No preview · Article · Jan 2015 · Zeitschrift für Gastroenterologie

  • No preview · Article · Jan 2015 · Zeitschrift für Gastroenterologie

  • No preview · Article · Jan 2015 · Zeitschrift für Gastroenterologie
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    ABSTRACT: Purpose: The purpose of this study was to identify clinical factors influencing Gd-EOB-DTPA liver uptake in patients with healthy liver parenchyma. Materials and Methods: A total of 124 patients underwent contrast-enhanced MRI with a hepatocyte-specific contrast agent at 3T. T1-weighted volume interpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 minutes after contrast injection. The relative enhancement (RE) between plain and contrast-enhanced signal intensity was calculated. Simple and multiple linear regression analyses were performed to evaluate clinical factors influencing the relative enhancement. Patients were subdivided into three groups according to their relative liver enhancement (HRE, RE 100%; MRE, 100% > RE >50%; NRE, RE 50%) and were analyzed according to the relevant risk factors. Results: Simple regression analyses revealed patient age, transaminases (AST, ALT, GGT), liver, spleen and delta-liver volume (the difference between the volumetrically measured liver volume and the estimated liver volume based on body weight) as significant factors influencing relative enhancement. In the multiple analysis the transaminase AST, spleen and delta liver volume remained significant factors influencing relative enhancement. Delta liver volume showed a significant difference between all analyzed groups. Conclusion: Liver enhancement in the hepatobiliary phase depends on a variety of factors. Body weight-adapted administration of Gd-EOB-DTPA may lead to inadequate liver enhancement after 20 minutes especially when the actual liver volume differs from the expected volume.
    No preview · Article · Jan 2015 · RöFo - Fortschritte auf dem Gebiet der R

Publication Stats

4k Citations
1,026.05 Total Impact Points

Institutions

  • 2013-2015
    • Universität Regensburg
      • Department of Internal Medicine I
      Ratisbon, Bavaria, Germany
    • University Hospital Regensburg
      • Klinik und Poliklinik für Innere Medizin I
      Ratisbon, Bavaria, Germany
  • 2004-2015
    • Johannes Gutenberg-Universität Mainz
      • I. Department of Medicine
      Mayence, Rheinland-Pfalz, Germany
  • 2011
    • University of Bonn
      Bonn, North Rhine-Westphalia, Germany
  • 2008-2011
    • Universitätsklinikum Erlangen
      Erlangen, Bavaria, Germany
  • 2002-2010
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      Erlangen, Bavaria, Germany
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
    • National Institute of Child Health and Human Development
      Maryland, United States
  • 2007
    • University of Freiburg
      • Institute of Physics
      Freiburg, Baden-Württemberg, Germany
    • Bielefeld University
      Bielefeld, North Rhine-Westphalia, Germany
  • 2002-2003
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Роквилл, Maryland, United States