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Liu M, Li W, Ma X, Che Y, Wei B, Chen M, Zhong L, Zhao S, Chen A, Pang Y, Zeng J, Guo J. Gradient differences of immunotherapy efficacy in metastatic melanoma related to sunlight exposure pattern: A population-based study. Front Oncol 2023; 12:1086664. [PMID: 36686834 PMCID: PMC9850161 DOI: 10.3389/fonc.2022.1086664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) have revolutionized metastatic melanoma (MM) treatment in just a few years. Ultraviolet (UV) in sunlight is the most significant environmental cause of melanoma, which is considered to be the main reason for tumor mutation burden (TMB) increase in melanoma. High TMB usually predicts that PD-1 inhibitors are effective. The sunlight exposure pattern of MM might be a clinical feature that matches TMB. The relationship between sunlight exposure patterns and immunotherapy response in MM is unclear. This study aims to investigate the correlation between sunlight exposure patterns and immunotherapy response in MM and establish nomograms that predict 3- and 5-year overall survival (OS) rate. Methods We searched the Surveillance, Epidemiology, and End Results (SEER) database and enrolled MM cases from 2005-2016. According to the advent of ICIs in 2011, the era was divided into the non-ICIs era (2005-2010) and the ICIs era (2011-2016). Patients were divided into three cohorts according to the primary site sunlight exposure patterns: head and neck in the first cohort, trunk arms and legs in the second cohort, and acral sites in the third cohort. We compared survival differences for each cohort between the two eras, performed stratified analysis, established nomograms for predicting 3- and 5-year OS rate, and performed internal validation. Results Comparing the survival difference between the ICIs and non-ICIs era, head and neck melanoma showed the greatest improvement in survival, with 3- and 5-year OS rate increasing by 10.2% and 9.1%, respectively (P=0.00011). In trunk arms and legs melanoma, the 3- and 5-year OS rate increased by 4.6% and 3.9%, respectively (P<0.0001). There is no improvement in survival in acral melanoma (AM) between the two eras (P=0.78). The receiver operating characteristic (ROC) curve, area under the ROC curve (AUC) and calibration graphs show good discrimination and accuracy of nomograms. Decision curve analysis (DCA) suggests good clinical utility of nomograms. Conclusions Based on the classification of sunlight exposure patterns, there is a gradient difference in immunotherapy efficacy for MM. The degree of sunlight exposure is positively correlated with immunotherapy response. The nomograms are sufficiently accurate to predict 3- and 5-year OS rate for MM, allowing for individualized clinical decisions for future clinical work.
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Affiliation(s)
- Mengsong Liu
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenyuan Li
- Sichuan Evidence-Based Medicine Center of Traditional Chinese Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao Ma
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuhui Che
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bo Wei
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mulan Chen
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lin Zhong
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siqi Zhao
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Anjing Chen
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yaobin Pang
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinhao Zeng
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,*Correspondence: Jinhao Zeng, ; Jing Guo,
| | - Jing Guo
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China,*Correspondence: Jinhao Zeng, ; Jing Guo,
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Önefäldt D, Zommorodi S, Falk Delgado A. "Location of cutaneous malignant melanoma in Sweden 2004-2018 - mortality and sex differences". J Plast Reconstr Aesthet Surg 2022; 75:3398-3405. [PMID: 35803850 DOI: 10.1016/j.bjps.2022.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cutaneous malignant melanoma (CMM) is one of the most common causes of cancer-related death in Sweden. There is increasing evidence that localisation of the primary CMM lesion differs between sexes and is associated with different outcomes. However, definitive convincing data is lacking. AIMS To describe changes in the distribution of CMM anatomical location over time according to sex and determine differences in mortality by location. METHOD This is a retrospective nation-wide cohort study of all patients diagnosed with CMM in Sweden between 2004 and 2018. Hazard ratios (HRs) were calculated using a multivariate cox regression model adjusting for age, sex, T-stage, multiple melanomas and comorbidities. RESULTS A total of 68,666 patients were included. In males, trunk CMM was the most common location (51% of all male CMM), with an increasing proportion over time. In females, lower extremity CMM had the largest proportion in 2004 (33%) followed by trunk CMM (27%). By 2018, trunk CMM became more common than lower extremity CMM in females. Upper and lower extremity CMMs had lower HR for all-cause mortality compared with trunk CMM (0.896 and 0.887, respectively, p<0.001), while head and neck CMM had higher HR compared with trunk CMM (1.090, p<0.001). Males had greater risk than females (HR 1.352, p<0.001). CONCLUSIONS Head and neck CMMs were associated with increased risk of all-cause mortality, while both upper and lower extremity CMMs were associated with decreased risk. Both sexes had increasing proportions of trunk and upper extremity CMM over time, with corresponding decreases in lower extremity and, head and neck CMM.
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Affiliation(s)
- Daniel Önefäldt
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital; Uppsala, Sweden
| | | | - Alberto Falk Delgado
- Head of Dept, Associate Professor. Plastic and Craniofacial Surgery, Theme Acute and Reparative Medicine, Karolinska University Hospital; Solna, Sweden.
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Almeida FM, Colosimo EA, Mayrink VD. Modified score function for monotone likelihood in the semiparametric mixture cure model. Biom J 2021; 64:635-654. [PMID: 34845768 DOI: 10.1002/bimj.202000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/06/2021] [Accepted: 05/01/2021] [Indexed: 11/07/2022]
Abstract
The cure fraction models are intended to analyze lifetime data from populations where some individuals are immune to the event under study, and allow a joint estimation of the distribution related to the cured and susceptible subjects, as opposed to the usual approach ignoring the cure rate. In situations involving small sample sizes with many censored times, the detection of nonfinite coefficients may arise via maximum likelihood. This phenomenon is commonly known as monotone likelihood (ML), occurring in the Cox and logistic regression models when many categorical and unbalanced covariates are present. An existing solution to prevent the issue is based on the Firth correction, originally developed to reduce the estimation bias. The method ensures finite estimates by penalizing the likelihood function. In the context of mixture cure models, the ML issue is rarely discussed in the literature; therefore, this topic can be seen as the first contribution of our paper. The second major contribution, not well addressed elsewhere, is the study of the ML issue in cure mixture modeling under the flexibility of a semiparametric framework to handle the baseline hazard. We derive the modified score function based on the Firth approach and explore finite sample size properties of the estimators via a Monte Carlo scheme. The simulation results indicate that the performance of coefficients related to the binary covariates are strongly affected to the imbalance degree. A real illustration, in the melanoma dataset, is discussed using a relatively novel data set collected in a Brazilian university hospital.
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Affiliation(s)
- Frederico M Almeida
- Departamento de Estatística, ICEx, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Enrico A Colosimo
- Departamento de Estatística, ICEx, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vinícius D Mayrink
- Departamento de Estatística, ICEx, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Košec A, Rašić I, Pegan A, Solter D, Ćurković M, Bedeković V. Sex- and Site-Related Significance in Cutaneous Head and Neck Melanoma. EAR, NOSE & THROAT JOURNAL 2021; 100:343-349. [PMID: 31547714 DOI: 10.1177/0145561319875949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cutaneous head and neck melanoma is a separate subgroup of cutaneous melanoma that has a worse prognosis than other primary sites. The aim of this article is to examine the significance of sex and site of primary lesion as additional risk factors. Primary localization distribution and metastatic disease in the neck in a retrospective cohort of 159 patients with cutaneous head and neck malignant melanoma were analyzed. Men develop primary melanoma more frequently than women in the left peripheral head and neck regions (P = .0364), as well as clinically visible and occult metastatic disease in the left side of the neck (P = .0138). Patients with clinically occult regional metastatic disease showed a significantly poorer survival rate than the rest of the group that underwent elective neck dissections (P = .0270). Left-sided disease in male patients may be an additional risk factor in cutaneous head and neck melanoma. Performing elective neck dissections in high-risk patients might identify patients with occult metastatic disease and worse prognosis but does not offer any significant therapeutic benefit.
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Affiliation(s)
- Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Ivan Rašić
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Alan Pegan
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Darko Solter
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Marko Ćurković
- Department for Diagnostics and Intensive Care, University Psychiatric Hospital Vrapče, Zagreb, Croatia
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Almeida FM, Colosimo EA, Mayrink VD. Firth adjusted score function for monotone likelihood in the mixture cure fraction model. LIFETIME DATA ANALYSIS 2021; 27:131-155. [PMID: 33184683 DOI: 10.1007/s10985-020-09510-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
Models for situations where some individuals are long-term survivors, immune or non-susceptible to the event of interest, are extensively studied in biomedical research. Fitting a regression can be problematic in situations involving small sample sizes with high censoring rate, since the maximum likelihood estimates of some coefficients may be infinity. This phenomenon is called monotone likelihood, and it occurs in the presence of many categorical covariates, especially when one covariate level is not associated with any failure (in survival analysis) or when a categorical covariate perfectly predicts a binary response (in the logistic regression). A well known solution is an adaptation of the Firth method, originally created to reduce the estimation bias. The method provides a finite estimate by penalizing the likelihood function. Bias correction in the mixture cure model is a topic rarely discussed in the literature and it configures a central contribution of this work. In order to handle this point in such context, we propose to derive the adjusted score function based on the Firth method. An extensive Monte Carlo simulation study indicates good inference performance for the penalized maximum likelihood estimates. The analysis is illustrated through a real application involving patients with melanoma assisted at the Hospital das Clínicas/UFMG in Brazil. This is a relatively novel data set affected by the monotone likelihood issue and containing cured individuals.
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Affiliation(s)
- Frederico Machado Almeida
- Departamento de Estatística, ICEx, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Enrico Antônio Colosimo
- Departamento de Estatística, ICEx, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Vinícius Diniz Mayrink
- Departamento de Estatística, ICEx, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Belo Horizonte, MG, 31270-901, Brazil.
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6
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Špirić Z, Vještica M, Erić M. Survival prediction in patients with cutaneous melanoma by tumour lymphangiogenesis. Acta Clin Belg 2020; 75:379-387. [PMID: 31210586 DOI: 10.1080/17843286.2019.1629076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Melanoma induces lymphangiogenesis by secreting lymphangiogenic growth factors. The aim of this study was to examine the role of tumour lymphangiogenesis in survival of patients with cutaneous melanoma. Methods: Immunostaining of one hundred melanoma specimens was done with lymphatic-specific antibody D2-40. The quantification of tumour lymphangiogenesis - lymphatic vessel density (LVD) and lymphatic vessel area (LVA) - was calculated by computer-assisted morphometric analysis. Results: High intratumoural LVD, high peritumoural LVD, male gender, greater tumour thickness and Clark level IV/V were significantly associated with shorter disease-free survival (p= 0.001, p= 0.004, p= 0.004, p= 0.000 and p= 0.008, respectively) and melanoma-specific survival (p= 0.002, p= 0.002, p= 0.001, p= 0.000 and p= 0.017, respectively), while the trunk melanoma site was significantly associated only with shorter disease-free survival (p= 0.033). No significant association of LVA with survival was found. At multivariate analysis, peritumoural LVD [hazard ratio (HR) = 2.143, 95% confidence interval (CI) 1.097-4.189, p= 0.026)] and melanoma thickness (HR = 1.276, 95%CI 1.106-1.473, p= 0.001) were independent predictors of disease-free survival, while intratumoural LVD (HR = 3.446, 95%CI 1.465-8.109, p= 0.005), peritumoural LVD (HR = 2.742, 95%CI 1.313-5.725, p= 0.007) and gender (HR = 2.880, 95%CI 1.304-6.362, p= 0.009) were independent predictors of melanoma-specific survival. Conclusion: Тhis study shows that LVD enables better prediction of survival than melanoma thickness and other clinical-pathological parameters. Intratumoural LVD is the most significant predictor of melanoma-specific survival, while only peritumoural LVD has a significant impact on both, a disease-free survival and a melanoma-specific survival.
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Affiliation(s)
- Zorica Špirić
- Department of Nuclear Medicine and Thyroid Gland Diseases, University Clinical Centre of the Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Milka Vještica
- Department of Oncology, University Clinical Centre of the Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Mirela Erić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Ni JS, Janz TA, Nguyen SA, Lentsch EJ. Predictors of occult lymph node metastasis in cutaneous head and neck melanoma. World J Otorhinolaryngol Head Neck Surg 2020; 5:200-206. [PMID: 32083247 PMCID: PMC7015849 DOI: 10.1016/j.wjorl.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/26/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To use the Surveillance, Epidemiology, and End Results (SEER) database to verify the findings of a recent National Cancer Database (NCDB) study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma (CHNM) while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases. Methods Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified. Demographic information and oncologic data were obtained. Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity. Results There were 34002 patients with CHNM identified. Within this population, 16232 were clinically node-negative, 1090 of which were found to be pathologically node-positive. On multivariate analysis, factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion (stepwise increase in adjusted odds ratio [OR]), nodular histology (aOR: 1.47 [95% CI: 1.21-1.80]), ulceration (aOR: 1.74 [95% CI: 1.48-2.05]), and mitoses (aOR: 1.86 [95% CI: 1.36-2.54]). Factors associated with a decreased risk of occult nodal metastasis included female sex (aOR: 0.80 [0.67-0.94]) and desmoplastic histology (aOR: 0.37 [95% CI: 0.24-0.59]). Between the SEER database and the NCDB, factors associated with occult nodal involvement were similar except for nodular histology and female sex, which did not demonstrate significance in the NCDB. Conclusion Regarding clinically node-negative CHNM, the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases. Level of evidence 4.
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Affiliation(s)
- Jonathan S. Ni
- Corresponding author. 135 Rutledge Avenue, Charleston, SC, 29425, USA.
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Yang J, Pan Z, Zhou Q, Liu Q, Zhao F, Feng X, Lyu J. Nomogram for predicting the survival of patients with malignant melanoma: A population analysis. Oncol Lett 2019; 18:3591-3598. [PMID: 31516573 PMCID: PMC6732986 DOI: 10.3892/ol.2019.10720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/10/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of the current study was to develop and validate a nomogram based on a large population to estimate the 3- and 5-year survival rates of patients with malignant melanoma (MM). Patients were selected from the Surveillance, Epidemiology and End Results database and randomly divided into the training and validation cohorts. A nomogram was developed, and was used to assess the accuracy of the model. Independent prognostic factors associated with overall survival (OS) rate were identified through multivariate analysis, and were included in the internal validation of the nomogram. The nomogram provided high C-indexes for the training cohort [area under the time-dependent receiver operating characteristic curve (AUC) of 0.877 for 3-year OS rate and 0.872 for 5-year OS rate] and the validation cohort (AUC of 0.880 for 3-year OS rate and 0.874 for 5-year OS rate), indicating that the model had good discrimination ability. Calibration plots showed that the predicted 3- and 5-year OS rates probabilities for the training and validation groups were almost identical to the actual observations. The 3- and 5-year decision curves indicated net benefits for both the training and validation cohorts. The nomogram may aid clinicians to provide more accurate prognosis prediction in patient consultations and more personalized postoperative management plans.
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Affiliation(s)
- Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Zhenyu Pan
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China.,Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Quan Zhou
- Department of Science and Education, The First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Fanfan Zhao
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaojie Feng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China.,Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, Henan 475000, P.R. China
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King BBT, Chapman BC, Gleisner A, Stewart C, Friedman C, Kwak JJ, McCarter MD, Kounalakis N. Postbiopsy Pigmentation is Prognostic in Head and Neck Melanoma. Ann Surg Oncol 2019; 26:1046-1054. [PMID: 30706226 DOI: 10.1245/s10434-019-07185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess postbiopsy pigmentation (PBP) as a prognostic feature in patients with cutaneous head and neck (H&N) melanoma. METHODS Retrospective review of patients undergoing sentinel lymph node biopsy (SLNB) for H&N melanoma (1998-2018). PBP was defined as visible remaining pigment at the scar or biopsy site that was documented on physical exam by both a medical oncologist and a surgeon at initial consultation. Variables associated with disease-free survival (DFS) and overall survival (OS) were analyzed using multivariable Cox proportional hazards models. RESULTS Among 300 patients, 34.3% (n = 103) had PBP and 44.7% (n = 134) had microscopic residual disease on final pathology after wide local excision. Prognostic factors associated with DFS included advanced age, tumor depth, ulceration, PBP, and positive SLNB (p < 0.05). Patients with PBP fared worse than their counterparts without PBP in 5-year DFS [44.1% (31.1-56.3%) vs. 73.0% (64.1-80.0%); p < 0.001] and 5-year OS [65.0% (50.0-76.6%) vs. 83.6% (75.7-89.2%); p = 0.005]. After multivariable adjustment, PBP remained associated with shorter DFS [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.01-2.93; p = 0.047], but was not prognostic of OS. CONCLUSIONS In patients with H&N melanoma, PBP is associated with significantly shorter DFS. Patients with PBP may warrant greater consideration for SLNB and closer postoperative surveillance.
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Affiliation(s)
- Becky B T King
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ana Gleisner
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Camille Stewart
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chloe Friedman
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer J Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Martin D McCarter
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Kounalakis
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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Janz TA, Neskey DM, Nguyen SA, Lentsch EJ. Is imaging of the brain necessary at diagnosis for cutaneous head and neck melanomas? Am J Otolaryngol 2018; 39:631-635. [PMID: 29929862 DOI: 10.1016/j.amjoto.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/03/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To evaluate the frequency of brain metastasis at the time of diagnosis for patients with cutaneous head and neck melanoma (CHNM). METHODS Patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 2010 to 2014 based on a diagnosis of CHNM using ICD O-3 histology codes and primary site location documentation. Patients were also included if they had a "yes" or "no" documented in the "Mets at Dx-Brain" category. RESULTS In this study, 46 out of 19,066 (0.2%) patients diagnosed with CHNM presented with brain metastasis at diagnosis. Of the 19,066 patients, 14,124 (74.1%) were male. Caucasian race was noted in 18,299 cases (96.0%). 16.8% of patients with AJCC 7 Stage IV/M1 CHNM had brain metastasis at the time of diagnosis as compared to 0% in Stage I-III/M0 lesions (p < .001). CONCLUSIONS AND RELEVANCE The 2018 NCCN guidelines recommend healthcare providers consider ordering a baseline brain MRI for patients with stage IIIC or greater melanoma. This study demonstrates the very low frequency of brain metastasis at time of diagnosis in patients with CHNM and supports the NCCN recommendations demonstrating that only very advanced stages of CHNM require baseline brain imaging.
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Xu Z, Shi P, Yibulayin F, Feng L, Zhang H, Wushou A. Spindle cell melanoma: Incidence and survival, 1973-2017. Oncol Lett 2018; 16:5091-5099. [PMID: 30250577 PMCID: PMC6144801 DOI: 10.3892/ol.2018.9247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/11/2018] [Indexed: 12/27/2022] Open
Abstract
Spindle cell melanoma (SCM) is a rare morphological subtype of melanoma, which is relatively uncharacterized. The aim of the present study was to investigate the incidence of SCM, its general demographics, basic clinico-pathologic features, treatment outcomes and disease-specific prognostic factors. SCM cases were sampled from the Surveillance, Epidemiology and End Results (SEER) Program (1973–2017). A total of 4761 SCM cases were identified, with a median age of 66 years. The female:male ratio was 0.62:1. Statistically significant overall survival (OS) and disease-specific survival (DSS) rate differences were identified depending on age, sex, ethnicity, tumor location, T stage, N stage, M stage, pathological grade, AJCC stage, SEER stages and surgical treatment (P<0.05). Multivariate Cox regression analysis revealed that age >66 years, T3+T4 stage disease, positive N stage and SEER historic stage of regional and distant metastasis tumor were associated with poor DSS and OS rates. In summary, SCM was most common in Caucasian people of 60~80 years of age with a predominance in males. Patient's age, ethnicity, T stage, N stage, and SEER historic stage were identified as independent prognostic factors of SCM in terms of DSS and OS.
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Affiliation(s)
- Zhe Xu
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Guangdong Medical University, Shenzhen, Guangdong 518110, P.R. China
| | - Ping Shi
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Guangdong Medical University, Shenzhen, Guangdong 518110, P.R. China
| | - Feiluore Yibulayin
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China.,Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200001, P.R. China
| | - Lei Feng
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China.,Department of Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China
| | - Hao Zhang
- Department of Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China.,Epidemiology and Biostatistics, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China
| | - Alimujiang Wushou
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China.,Department of Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China
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12
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Yuan TA, Yourk V, Farhat A, Ziogas A, Meyskens FL, Anton-Culver H, Liu-Smith F. A Case-Control Study of the Genetic Variability in Reactive Oxygen Species-Metabolizing Enzymes in Melanoma Risk. Int J Mol Sci 2018; 19:ijms19010242. [PMID: 29342889 PMCID: PMC5796190 DOI: 10.3390/ijms19010242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 11/16/2022] Open
Abstract
Recent studies have shown that ultraviolet (UV)-induced chemiexcitation of melanin fragments leads to DNA damage; and chemiexcitation of melanin fragments requires reactive oxygen species (ROS), as ROS excite an electron in the melanin fragments. In addition, ROS also cause DNA damages on their own. We hypothesized that ROS producing and metabolizing enzymes were major contributors in UV-driven melanomas. In this case-control study of 349 participants, we genotyped 23 prioritized single nucleotide polymorphisms (SNPs) in nicotinamide adenine dinucleotide phosphate (NADPH) oxidases 1 and 4 (NOX1 and NOX4, respectively), CYBA, RAC1, superoxide dismutases (SOD1, SOD2, and SOD3) and catalase (CAT), and analyzed their associated melanoma risk. Five SNPs, namely rs1049255 (CYBA), rs4673 (CYBA), rs10951982 (RAC1), rs8031 (SOD2), and rs2536512 (SOD3), exhibited significant genotypic frequency differences between melanoma cases and healthy controls. In simple logistic regression, RAC1 rs10951982 (odds ratio (OR) 8.98, 95% confidence interval (CI): 5.08 to 16.44; p < 0.001) reached universal significance (p = 0.002) and the minor alleles were associated with increased risk of melanoma. In contrast, minor alleles in SOD2 rs8031 (OR 0.16, 95% CI: 0.06 to 0.39; p < 0.001) and SOD3 rs2536512 (OR 0.08, 95% CI: 0.01 to 0.31; p = 0.001) were associated with reduced risk of melanoma. In multivariate logistic regression, RAC1 rs10951982 (OR 6.15, 95% CI: 2.98 to 13.41; p < 0.001) remained significantly associated with increased risk of melanoma. Our results highlighted the importance of RAC1, SOD2, and SOD3 variants in the risk of melanoma.
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Affiliation(s)
- Tze-An Yuan
- Program in Public Health, University of California Irvine, Irvine, CA 92697, USA.
| | - Vandy Yourk
- Department of Neurobiology and Behavior, School of Biological Sciences, University of California Irvine, Irvine, CA 92697, USA.
| | - Ali Farhat
- Department of Biomedical Engineering, The Henry Samueli School of Engineering, University of California Irvine, Irvine, CA 92697, USA.
| | - Argyrios Ziogas
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA 92697, USA.
| | - Frank L Meyskens
- Program in Public Health, University of California Irvine, Irvine, CA 92697, USA.
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA 92697, USA.
- Chao Family Comprehensive Cancer Center, Irvine, CA 92697, USA.
| | - Hoda Anton-Culver
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA 92697, USA.
| | - Feng Liu-Smith
- Department of Epidemiology, School of Medicine, University of California, Irvine, CA 92697, USA.
- Chao Family Comprehensive Cancer Center, Irvine, CA 92697, USA.
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13
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Enninga EAL, Moser JC, Weaver AL, Markovic SN, Brewer JD, Leontovich AA, Hieken TJ, Shuster L, Kottschade LA, Olariu A, Mansfield AS, Dronca RS. Survival of cutaneous melanoma based on sex, age, and stage in the United States, 1992-2011. Cancer Med 2017; 6:2203-2212. [PMID: 28879661 PMCID: PMC5633552 DOI: 10.1002/cam4.1152] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/02/2017] [Accepted: 07/06/2017] [Indexed: 01/08/2023] Open
Abstract
Women diagnosed with cutaneous melanoma have a survival advantage compared to men, which has been hypothesized to be due to difference in behavior and/or biology (sex hormones). It remains controversial whether this advantage is dependent on age or stage of disease. We sought to compare melanoma-specific survival between females in pre, peri, and postmenopausal age groups to males in the same age group, adjusting for stage of disease. This is a retrospective population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed from 1 January 1992 through 31 January 2011 with primary invasive cutaneous melanoma were included in our cohort. Melanoma-specific survival was the main outcome studied. Of the 106,511 subjects that were included, 45% were female. Females in all age groups (18-45, 46-54, and ≥55) with localized and regional disease, were less likely to die from melanoma compared to males in the same age group. Among patients with localized and regional disease, the relative risk of death due to melanoma increased with advancing age at diagnosis; this increase was more pronounced among females than males. In contrast, we observed no female survival advantage among patients with distant disease and no effect of age on relative risk of death from melanoma. Females with localized and regional melanoma have a decreased risk of death compared to males within all age groups. Our data show no differences in survival between men and women with metastatic melanoma, indicating that the influence of sex on survival is limited to early stage disease but not confined to pre or perimenopausal age groups.
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Affiliation(s)
- Elizabeth Ann L. Enninga
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Justin C. Moser
- Huntsman Cancer InstituteDivisions of Hematology and OncologyUniversity of Utah30 N 1900 ESalt Lake CityUtah84132France
| | - Amy L. Weaver
- Biomedical Statistics and InformaticsMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Svetomir N. Markovic
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Jerry D. Brewer
- Department of DermatologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Alexey A. Leontovich
- Biomedical Statistics and InformaticsMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Tina J. Hieken
- Department of SurgeryMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Lynne Shuster
- Huntsman Cancer InstituteDivisions of Hematology and OncologyUniversity of Utah30 N 1900 ESalt Lake CityUtah84132France
| | - Lisa A. Kottschade
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Ariadna Olariu
- Department of SurgeryNotre Dame des AydesNotre Dame des Aydes 11 Rue FranciadeBlois41000France
| | - Aaron S. Mansfield
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Roxana S. Dronca
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
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14
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Kılıç S, Unsal AA, Chung SY, Samarrai R, Kılıç SS, Baredes S, Eloy JA. Geographic region: Does it matter in cutaneous melanoma of the head and neck? Laryngoscope 2017; 127:2763-2769. [PMID: 28581118 DOI: 10.1002/lary.26663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The head and neck are two of the most common locations for cutaneous melanoma. We present the first population-based analysis of geographic differences in anatomic subsite, clinicopathologic and demographical traits, histopathologic subtype, treatment modality, and disease-specific survival (DSS) of cutaneous head and neck melanoma (CHNM). STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results database was queried for cases of CHNM reported between 2000 and 2013. Patients were grouped into East, Midwest, South, and West regions of the United States. Overall incidence, demographic traits, primary tumor site, clinicopathologic traits, histopathologic subtype, treatment modality, and DSS were compared among regions. RESULTS There were 49,365 patients with CHNM identified. The West (4.60) and the South (4.42) had significantly higher incidence (per 100,000) than the East (3.84) and Midwest (3.65) (P < .05). DSS was significantly different among regions (P < .0066). The East (5 years: 89.4%, 10 years: 84.1%) had the highest DSS rate, and the South (5 years: 87.0%, 10 years: 81.8%) had the lowest DSS rate. The Midwest (5 years: 88.4%, 10 years: 84.3%) and West (5 years: 88.3%, 10 years: 83.5%) had intermediate DSS. On multivariate analysis, the South had an elevated hazard ratio (1.17, 95% confidence interval: 1.05-1.30) when compared to the West. CONCLUSIONS Geographic region may play a significant role in CHNM. Incidence is higher in the South and the West. Incidence, histologic subtype, treatment modality, and DSS vary among regions. DSS is lower in the South than the West, even after accounting for other major prognostic factors. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2763-2769, 2017.
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Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Aykut A Unsal
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Sei Y Chung
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Ruwaa Samarrai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Sarah S Kılıç
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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15
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Kadakia S, Chan D, Mourad M, Ducic Y. The Prognostic Value of Age, Sex, and Subsite in Cutaneous Head and Neck Melanoma: A Clinical Review of Recent Literature. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e5079. [PMID: 27703647 PMCID: PMC5038835 DOI: 10.17795/ijcp-5079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/21/2016] [Accepted: 06/05/2016] [Indexed: 12/29/2022]
Abstract
Context Cutaneous head and neck melanoma is a challenging disease owing to its aggressive nature and often times advanced stage at presentation. Age, sex, and subsite are three prognostic indicators which can be determined prior to treatment or testing, and can allow the practitioner to counsel the patient before initiating therapy. Evidence Acquisition A PubMed search was conducted utilizing various terms relating to the subject matter. Articles over the past 25 years were analyzed and appropriately selected for review. Results It appears that patients older than 65 have a decreased overall 5 year survival compared to their younger counterparts. Male patients have poorer prognosis compared to female patients as noted by the decreased overall survival, decreased disease specific survival, and shorter time to distant metastasis. Scalp subsite was most uniformly accepted as having the worst prognosis in the head and neck, and may even serve as an independent prognostic indicator. Conclusions Advanced age, male sex, and scalp subsite all portend poor prognosis in patients with cutaneous head and neck melanoma.
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Affiliation(s)
- Sameep Kadakia
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - David Chan
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery Associates, Dallas-Fort Worth, Texas
| | - Moustafa Mourad
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Yadranko Ducic
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery Associates, Dallas-Fort Worth, Texas
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16
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Srisuttiyakorn C, Bulloch K, Rodic N, Bosenberg M, Ariyan S, Narayan D, Gould Rothberg BE, Galan A. Intratumoral multinucleated giant cells are not a prognostic pathologic feature in cutaneous melanoma. J Cutan Pathol 2016; 43:821-9. [DOI: 10.1111/cup.12750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Chutika Srisuttiyakorn
- Department of Medicine, Division of DermatologyPhramongkutklao Hospital Bangkok Thailand
- Department of DermatologyYale School of Medicine New Haven CT USA
| | - Kaleigh Bulloch
- Department of Internal Medicine, Medical Oncology DivisionYale School of Medicine New Haven CT USA
| | - Nemanja Rodic
- Department of DermatologyYale School of Medicine New Haven CT USA
| | - Marcus Bosenberg
- Department of DermatologyYale School of Medicine New Haven CT USA
- Department of PathologyYale School of Medicine New Haven CT USA
| | - Stephen Ariyan
- Department of Surgery, Section of Plastic and Reconstructive SurgeryYale School of Medicine New Haven CT USA
| | - Deepak Narayan
- Department of Surgery, Section of Plastic and Reconstructive SurgeryYale School of Medicine New Haven CT USA
| | - Bonnie E. Gould Rothberg
- Department of Internal Medicine, Medical Oncology DivisionYale School of Medicine New Haven CT USA
- Department of PathologyYale School of Medicine New Haven CT USA
- Department of EpidemiologyYale School of Medicine New Haven CT USA
| | - Anjela Galan
- Department of DermatologyYale School of Medicine New Haven CT USA
- Department of PathologyYale School of Medicine New Haven CT USA
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17
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Chevalier V, Barbe C, Le Clainche A, Arnoult G, Bernard P, Hibon E, Grange F. Comparison of anatomical locations of cutaneous melanoma in men and women: a population‐based study in
F
rance. Br J Dermatol 2014; 171:595-601. [DOI: 10.1111/bjd.13052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 01/19/2023]
Affiliation(s)
- V. Chevalier
- Service de Dermatologie Hôpital Robert Debré CHU de Reims Avenue du Général Koenig 51092 Reims Cedex France
| | - C. Barbe
- Unité d'Aide Méthodologique Hôpital Robert Debré CHU de Reims Avenue du Général Koenig 51092 Reims Cedex France
| | - A. Le Clainche
- Unité d'Aide Méthodologique Hôpital Robert Debré CHU de Reims Avenue du Général Koenig 51092 Reims Cedex France
| | - G. Arnoult
- Centre de Recherche et d'Investigation Clinique Hôpital Maison Blanche CHU de Reims France
| | - P. Bernard
- Service de Dermatologie Hôpital Robert Debré CHU de Reims Avenue du Général Koenig 51092 Reims Cedex France
- Laboratory of Dermatology Faculty of Medicine of Reims, EA‐7319, University of Reims‐Champagne‐Ardenne Reims France
| | - E. Hibon
- Laboratoire de Pathologie Centre de Regroupement Informatique des Statistiques Anatomo‐pathologiques de Champagne Reims France
| | - F. Grange
- Service de Dermatologie Hôpital Robert Debré CHU de Reims Avenue du Général Koenig 51092 Reims Cedex France
- Laboratory of Dermatology Faculty of Medicine of Reims, EA‐7319, University of Reims‐Champagne‐Ardenne Reims France
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18
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Catovsky D, Wade R, Else M. The clinical significance of patients' sex in chronic lymphocytic leukemia. Haematologica 2014; 99:1088-94. [PMID: 24658818 PMCID: PMC4040913 DOI: 10.3324/haematol.2013.101378] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/18/2014] [Indexed: 12/12/2022] Open
Abstract
We examined the prognostic influence of gender in chronic lymphocytic leukemia. Data from four randomized trials (involving 1821 patients) and three registration studies of stage-A disease (involving 1299 patients) were analyzed. Overall survival at 10 years was better for women than men in all trials (27% versus 15%; P=0.0001) and in the registration series (55% versus 43%; P<0.0001). More women than men in the trials were Binet stage A-progressive (26% versus 15%), but gender was an independent predictor of survival in multivariate analysis of clinical variables (P<0.0001). Women responded better to treatment (overall response 83%) than men (71%; P<0.0001), within each stage and age group, although fewer women than men received the full treatment dose (79% versus 85%; P=0.01). Women were more likely than men to experience toxicity (85% versus 78%, P=0.01), particularly gastro-intestinal toxicity (57% versus 42%, P<0.0001). Laboratory markers in the LRF CLL4 trial showed a significantly lower incidence in women than men of unmutated IGHV genes, raised beta-2 microglobulin, CD38 and Zap-70 positivity and TP53 deletions/mutations and/or 11q deletions. We also highlight the higher male:female ratios in randomized trials versus studies of early chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis. Chronic lymphocytic leukemia in women runs a more benign clinical course than in men. Gender was also an independent predictor of response, suggesting that pharmacokinetic differences between the sexes and a possible effect of estrogens may contribute to the better outcome. Understanding the reasons for the different outcome by gender may improve patients' management. (LRF CLL4 controlled-trials.com identifier: ISRCTN58585610).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Female
- Humans
- Incidence
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Registries
- Sex Factors
- Treatment Outcome
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Affiliation(s)
- Daniel Catovsky
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, London
| | | | - Monica Else
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, London
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