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Tan SX, Aung TN, Claeson M, Acs B, Zhou C, Brown S, Lambie D, Baade PD, Pandeya N, Soyer HP, Smithers BM, Whiteman DC, Rimm DL, Khosrotehrani K. Automated scoring of tumor-infiltrating lymphocytes informs risk of death from thin melanoma: A nested case-case study. J Am Acad Dermatol 2024; 90:179-182. [PMID: 37730017 DOI: 10.1016/j.jaad.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/14/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Samuel X Tan
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Thazin N Aung
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Magdalena Claeson
- Frazer Institute, University of Queensland, Brisbane, Australia; Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Balazs Acs
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Chenhao Zhou
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Susan Brown
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Duncan Lambie
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | | | - Nirmala Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, Faculty of Medicine, University of Queensland
| | - H Peter Soyer
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - David C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Kiarash Khosrotehrani
- Frazer Institute, University of Queensland, Brisbane, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia.
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Hackett C, Denehy L, Kruger P, Ripley N, Reid N, Smithers BM, Walker RM, Hope L, Boden I. PHYSIO+++: protocol for a pilot randomised controlled trial assessing the feasibility of physiotherapist-led non-invasive ventilation for patients with hypoxaemia following abdominal surgery. BMJ Open 2023; 13:e078175. [PMID: 38101825 DOI: 10.1136/bmjopen-2023-078175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Few clinical trials have investigated physiotherapy interventions to treat hypoxaemia following abdominal surgery. The objective of this study is to determine the feasibility and safety of conducting a clinical trial of physiotherapist-led non-invasive ventilation (NIV). METHODS AND ANALYSIS This single-centre, 50-patient, parallel-group, assessor blinded, pilot feasibility randomised controlled trial with concealed allocation will enrol spontaneously ventilating adults with hypoxaemia within 72 hours of major abdominal surgery. Participants will receive either (1) usual care physiotherapy of a single education session (talk), daily walking of 10-15 min (walk) and four sessions of coached deep breathing and coughing (breathe) or (2) usual care physiotherapy plus four 30 min sessions of physiotherapist-led NIV delivered over 2 postoperative days. Primary feasibility and safety outcome measures are; number of eligible patients recruited per week, total time of NIV treatment delivered, acceptability of treatments to patients and clinicians and incidence of adverse events. Secondary feasibility outcomes include measures of recruitment and treatment adherence. Exploratory outcome measures include change in respiratory parameters, postoperative pulmonary complications, length of hospital stay, health-related quality of life, postoperative activity levels and mortality. ETHICS AND DISSEMINATION Ethics approval has been obtained from the relevant institution. Results will be published to inform future research. TRIAL REGISTRATION NUMBER ACTRN12622000839707.
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Affiliation(s)
- Claire Hackett
- Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Kruger
- Department of Intensive Care, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Nina Ripley
- Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - B Mark Smithers
- Upper Gastro-intestinal Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Discipline of Surgery, The School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel M Walker
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Louise Hope
- Consumer representative, Brisbane, Queensland, Australia
| | - Ianthe Boden
- School of Health Science, University of Tasmania, Launceston, Tasmania, Australia
- Department of Physiotherapy, Launceston General Hospital, Launceston, Tasmania, Australia
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Tan SX, Chong S, Rowe C, Claeson M, Dight J, Zhou C, Rodero MP, Malt M, Smithers BM, Green AC, Khosrotehrani K. pSTAT5 is associated with improved survival in patients with thick or ulcerated primary cutaneous melanoma. Melanoma Res 2023; 33:506-513. [PMID: 37890182 DOI: 10.1097/cmr.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Identifying prognostic biomarkers to predict clinical outcomes in stage I and II cutaneous melanomas could guide the clinical application of adjuvant and neoadjuvant therapies. We aimed to investigate the prognostic value of phosphorylated signal transducer and activator of transcription 5 (pSTAT5) as a biomarker in early-stage melanoma. This study evaluated all initially staged Ib and II melanoma patients undergoing sentinel node biopsy at a tertiary centre in Brisbane, Australia between 1994 and 2007, with survival data collected from the Queensland Cancer Registry. Primary melanoma tissue from 189 patients was analysed for pSTAT5 level through immunohistochemistry. Cox regression modelling, with adjustment for sex, age, ulceration, anatomical location, and Breslow depth, was applied to determine the association between pSTAT5 detection and melanoma-specific survival. Median duration of follow-up was 7.4 years. High pSTAT5 detection was associated with ulceration and increased tumour thickness. However, multivariate analysis indicated that high pSTAT5 detection was associated with improved melanoma-specific survival (hazard ratio: 0.15, 95% confidence interval: 0.03-0.67) as compared to low pSTAT5 detection. This association persisted when pSTAT5 detection was limited to immune infiltrate or the vasculature, as well as when sentinel node positivity was accounted for. In this cohort, staining for high-pSTAT5 tumours identified a subset of melanoma patients with increased survival outcomes as compared to low-pSTAT5 tumours, despite the former having higher-risk clinicopathological characteristics at diagnosis. pSTAT5 is likely an indicator of local immune activation, and its detection could represent a useful tool to stratify the risk of melanoma progression.
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Affiliation(s)
- Samuel X Tan
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Sharene Chong
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Casey Rowe
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Magdalena Claeson
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Population Health, QIMR Berghofer Medical Research Institute
| | - James Dight
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Chenhao Zhou
- Frazer Institute, University of Queensland, Brisbane, Australia
| | | | - Maryrose Malt
- Department of Population Health, QIMR Berghofer Medical Research Institute
| | - B Mark Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Adele C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute
- Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kiarash Khosrotehrani
- Frazer Institute, University of Queensland, Brisbane, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Cook MG, Grant M, Sylvestre Y, Akhras V, Khosrotehrani K, Hughes MCB, Malt M, Smithers BM, Massi D, De Giorgi V, Marais R, Green AC. Prognosis of naevoid melanomas. Pathol Res Pract 2023; 251:154881. [PMID: 37832354 DOI: 10.1016/j.prp.2023.154881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION There appear to be several variants of naevoid melanoma suspected as having different outcomes, but follow-up studies have been few. We aimed to assess the prognosis of naevoid melanomas in a multi-centre study. MATERIAL AND METHODS From histopathology records we ascertained patients in the UK, Australia and Italy diagnosed with maturing naevoid melanoma (n = 65; 14; 7 respectively) and nodular/papillomatous naevoid melanoma (12; 6; 0), and patients with superficial spreading melanoma (SSM) from UK (73) and Australia (26). Melanoma deaths in UK patients were obtained from NHS Digital; in Australia, via the National Death Index and cancer registry; and in Italy, through clinical records. For maturing naevoid vs. SSM, we used Cox-proportional hazard regression models to compare survival adjusted for age, sex, tumour thickness, and ulceration, and additionally Fine-Gray regression analysis, to calculate sub-hazard ratios (SHR) in the UK cohort, accounting for competing causes of death. RESULTS Among UK patients, there was a non-significantly lower risk of melanoma death in maturing naevoid vs SSM, including after accounting for competing causes of death (SHR 0.40, 95% confidence interval (CI) 0.12-1.31), while among nodular/papillomatous naevoid melanoma patients, there were no melanoma deaths on follow-up. Two melanoma deaths occurred in Australian SSM patients, and none in maturing or nodular/papillomatous naevoid melanoma patients, after 5 years' minimum follow-up. None of the 7 Italian patients with maturing naevoid melanoma died of melanoma after nearly 12 years' average follow-up. CONCLUSIONS There was no significant difference in risk of death from melanomas with naevoid features, and SSM. Nodular/ papillomatous naevoid melanoma patients did not carry higher risk of death than SSM patients though the very few cases of the papillomatous naevoid variant limited our assessment.
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Affiliation(s)
- Martin G Cook
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK; Royal Surrey NHS Foundation Trust, Guildford, UK; Division of Clinical Medicine, University of Surrey, Guildford, Surrey, UK; Members of EORTC Melanoma Pathology Working Group, Belgium
| | - Megan Grant
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK
| | - Yvonne Sylvestre
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK
| | | | - Kiarash Khosrotehrani
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; The University of Queensland, Frazer Institute, Brisbane, Queensland, Australia
| | | | - Maryrose Malt
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Australia
| | - Daniela Massi
- Members of EORTC Melanoma Pathology Working Group, Belgium; Section of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, Italy
| | - Richard Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK
| | - Adele C Green
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
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Faron M, Cheugoua-Zanetsie M, Tierney J, Thirion P, Nankivell M, Winter K, Yang H, Shapiro J, Vernerey D, Smithers BM, Walsh T, Piessen G, Nilsson M, Boonstra J, Ychou M, Law S, Cunningham D, de Vathaire F, Stahl M, Urba S, Valmasoni M, Williaume D, Thomas J, Lordick F, Tepper J, Roth J, Gebski V, Burmeister B, Paoletti X, van Sandick J, Fu J, Pignon JP, Ducreux M, Michiels S. Individual Participant Data Network Meta-Analysis of Neoadjuvant Chemotherapy or Chemoradiotherapy in Esophageal or Gastroesophageal Junction Carcinoma. J Clin Oncol 2023; 41:4535-4547. [PMID: 37467395 PMCID: PMC10553121 DOI: 10.1200/jco.22.02279] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE The optimal neoadjuvant treatment for resectable carcinoma of the thoracic esophagus (TE) or gastroesophageal junction (GEJ) remains a matter of debate. We performed an individual participant data (IPD) network meta-analysis (NMA) of randomized controlled trials (RCTs) to study the effect of chemotherapy or chemoradiotherapy, with a focus on tumor location and histology subgroups. PATIENTS AND METHODS All, published or unpublished, RCTs closed to accrual before December 31, 2015 and having compared at least two of the following strategies were eligible: upfront surgery (S), chemotherapy followed by surgery (CS), and chemoradiotherapy followed by surgery (CRS). All analyses were conducted on IPD obtained from investigators. The primary end point was overall survival (OS). The IPD-NMA was analyzed by a one-step mixed-effect Cox model adjusted for age, sex, tumor location, and histology. The NMA was registered in PROSPERO (CRD42018107158). RESULTS IPD were obtained for 26 of 35 RCTs (4,985 of 5,807 patients) corresponding to 12 comparisons for CS-S, 12 for CRS-S, and four for CRS-CS. CS and CRS led to increased OS when compared with S with hazard ratio (HR) = 0.86 (0.75 to 0.99), P = .03 and HR = 0.77 (0.68 to 0.87), P < .001 respectively. The NMA comparison of CRS versus CS for OS gave a HR of 0.90 (0.74 to 1.09), P = .27 (consistency P = .26, heterogeneity P = .0038). For CS versus S, a larger effect on OS was observed for GEJ versus TE tumors (P = .036). For the CRS versus S and CRS versus CS, a larger effect on OS was observed for women (P = .003, .012, respectively). CONCLUSION Neoadjuvant chemotherapy and chemoradiotherapy were consistently better than S alone across histology, but with some variation in the magnitude of treatment effect by sex for CRS and tumor location for CS. A strong OS difference between CS and CRS was not identified.
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Affiliation(s)
- Matthieu Faron
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Maurice Cheugoua-Zanetsie
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Jayne Tierney
- MRC Clinical Trial Unit at UCL, London, United Kingdom
| | | | | | - Kathryn Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Hong Yang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Joel Shapiro
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - B. Mark Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - Thomas Walsh
- Connolly Hospital Blanchardstown, Dublin, Ireland
| | | | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technoglogy, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Simon Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David Cunningham
- National Institute for Health Research, Biomedical Research Centres, Royal Marsden, London, United Kingdom
| | - Florent de Vathaire
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | | | | | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Center for Esophageal Diseases, Padova, Italy
| | | | - Janine Thomas
- Princess Alexandra Hospital, Woolloongabba, Australia
| | | | - Joel Tepper
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | | | - Johanna van Sandick
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jianhua Fu
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jean-Pierre Pignon
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Michel Ducreux
- Departement d’Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
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Aoude LG, Brosda S, Ng J, Lonie JM, Belle CJ, Patel K, Koufariotis LT, Wood S, Atkinson V, Smithers BM, Pearson JV, Waddell N, Barbour AP, Bonazzi VF. Circulating Tumor DNA: A Promising Biomarker for Predicting Recurrence in Patients with BRAF-Negative Melanoma. J Mol Diagn 2023; 25:771-781. [PMID: 37544359 DOI: 10.1016/j.jmoldx.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
For patients with BRAF wild-type stage III and IV melanoma, there is an urgent clinical need to identify prognostic biomarkers and biomarkers predictive of treatment response. Circulating tumor DNA (ctDNA) is emerging as a blood-based biomarker and has shown promising results for many cancers, including melanoma. The purpose of this study was to identify targetable, tumor-derived mutations in patient blood that may lead to treatment alternatives and improved outcomes for patients with BRAF-negative melanoma. Using a CAncer Personalized Profiling by deep Sequencing (CAPP-seq) pan-cancer gene panel, ctDNA from 150 plasma samples (n = 106 patients) was assessed, including serial blood collections for a subset of patients (n = 16). ctDNA variants were detected in 85% of patients, all in targetable pathways, such as vascular endothelial growth factor receptor, epidermal growth factor receptor, phosphatidylinositol 3-kinase/AKT, Bcl2/mammalian target of rapamycin (mTOR), ALK/MET, and cyclin-dependent kinase 4/6. Patients with stage IV melanoma with low ctDNA concentrations, <10 ng/mL, had significantly better disease-specific survival and progression-free survival. Patients with both a high concentration of ctDNA and any detectable ctDNA variants had the worst prognosis. In addition, these results indicated that longitudinal changes in ctDNA correlated with treatment response and disease progression determined by radiology. This study confirms that ctDNA may be used as a noninvasive liquid biopsy to identify recurrent disease and detect targetable variants in patients with late-stage melanoma.
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Affiliation(s)
- Lauren G Aoude
- Frazer Institute, University of Queensland, Woolloongabba, Queensland.
| | - Sandra Brosda
- Frazer Institute, University of Queensland, Woolloongabba, Queensland
| | - Jessica Ng
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland
| | - James M Lonie
- Frazer Institute, University of Queensland, Woolloongabba, Queensland
| | - Clemence J Belle
- Frazer Institute, University of Queensland, Woolloongabba, Queensland
| | - Kalpana Patel
- Frazer Institute, University of Queensland, Woolloongabba, Queensland
| | | | - Scott Wood
- QIMR Berghofer Medical Research Institute, Herston, Queensland
| | - Victoria Atkinson
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Herston, Queensland
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Herston, Queensland
| | - Andrew P Barbour
- Frazer Institute, University of Queensland, Woolloongabba, Queensland; Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland
| | - Vanessa F Bonazzi
- Frazer Institute, University of Queensland, Woolloongabba, Queensland.
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Wong J, Moore J, Soyer HP, Mar V, Smithers BM. Trends and patterns of care of sentinel node biopsy in cutaneous melanoma: a population-based study in Queensland. ANZ J Surg 2023; 93:2172-2179. [PMID: 36972255 DOI: 10.1111/ans.18372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Sentinel node biopsy (SNB) has evolved from offering staging and prognostication to a procedure that guides therapeutic management. The aim was to evaluate the rate of SNB for patients with high-risk melanoma and assess factors that may have impacted on the procedure being performed. METHODS Data of patients with primary invasive cutaneous melanoma from 01 January 2009 to 31 December 2019 were obtained from the Queensland Oncology Repository. High-risk melanoma was defined as ≥0.8 mm thick or < 0.8 mm with ulceration present (AJCC eighth edition pT1b -pT4 ). RESULTS 14 006 (33.8%) of 41 412 patients diagnosed with cutaneous invasive melanoma were in the high-risk group. 2923(20.9%) patients had SNB, with the rate increasing from 14.2% (2009) to 36.8% (2019) (P = 0.002), and an increasing proportion being performed in public hospitals over the 11 year period (P = 0.02). Older age (OR0.96 (0.959-0.964) (P < 0.001)), female (OR0.91 (0.830-0.998) (P = 0.03)), head and neck primary (OR0.38 (0.33-0.45) (P < 0.001)), and pT1b (OR0.22 (0.19-0.25) (P < 0.001)) were factors associated with SNB not being performed. Travel out of the Hospital and Health Services of residence for SNB occurred in 26.2%. Although the travel rate decreased from 24.7% (2009) to 23.0% (2019) (P = 0.04), the absolute number increased due to the increase in SNB rate. Those most likely to travel were younger, from remote areas, or from affluent backgrounds. CONCLUSION In this first Australian population-based study, there was an increased adherence to SNB guideline, although overall SLNB rates remain low, with nearly 2/3 of eligible cases not having the procedure in 2019. Although travel rates decreased marginally, the overall number increased. This study highlights the crucial need to further improve access to SNB for melanoma surgery for the Queensland population.
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Affiliation(s)
- Jessica Wong
- Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Australia
- Academy of Surgery, The University of Queensland, Medical School, Herston, Queensland, Australia
| | - Julie Moore
- Cancer Alliance Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Queensland, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Australia
- Academy of Surgery, The University of Queensland, Medical School, Herston, Queensland, Australia
- Cancer Alliance Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Wu MY, McGregor RJ, Scott J, Smithers BM, Thomas J, Frankel A, Barbour A, Thomson I. Textbook outcomes for oesophagectomy: A valid composite measure assessment tool for surgical performance in a specialist unit. Eur J Surg Oncol 2023; 49:106897. [PMID: 37032271 DOI: 10.1016/j.ejso.2023.03.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/06/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION In 2017 the Dutch Upper Gastrointestinal Cancer Audit Group proposed a ten-item composite measure for a 'textbook outcome' (TBO) following oesophago-gastric resection. Studies have shown associations between TBO and improved conditional and overall survival. The aim of this study was to evaluate the use of TBO to assess the outcomes from a single specialist unit in a country, with low incidence of disease, allowing comparisons with international specialist centres. MATERIALS AND METHODS Retrospective analysis of prospectively collected oesophageal cancer surgery data at a single centre, in Australia, between 2013 and 2018. Multivariable logistical regression assessed association between baseline factors and TBO. Post-operative complications were analysed in two separate groups as Clavien-Dindo ≥2 (CD ≥ 2) and Clavien-Dindo ≥3 (CD ≥ 3). Cox-proportional hazards regression analysis determined the association between TBO and survival. RESULTS 246 patients were analysed, with 50.8% (n = 125) achieving a TBO when complications were defined as CD ≥ 2 and 58.9% (n = 145) when using CD ≥ 3. Patients aged ≥75, and those with a pre-operative respiratory co-morbidity were less likely to achieve a TBO. Overall survival was not influenced by TBO when complications were defined as CD ≥ 2, however it was higher when a TBO was achieved, and complications were defined as CD ≥ 3 (HR 0.54, 95% CI, 0.35 to 0.84, P = 0.007). CONCLUSION TBO is a multi-parameter metric that allowed benchmarking of the quality of oesophageal cancer surgery in our unit, providing favourable outcomes compared with other published data. There was an association between TBO and improved overall survival when the definition of severe complications was CD ≥ 3.
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Affiliation(s)
- Michael Yulong Wu
- Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia
| | - Richard J McGregor
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Justin Scott
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Australia
| | - B Mark Smithers
- Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia; Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
| | - Janine Thomas
- Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia
| | - Adam Frankel
- Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia; Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
| | - Andrew Barbour
- Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia; Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
| | - Iain Thomson
- Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, 4102, Australia; Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, 4102, Australia
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9
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Claeson M, Tan SX, Lambie D, Brown S, Walsh MD, Baade PD, Pandeya N, Whitehead KJ, Soyer HP, Smithers BM, Whiteman DC, Khosrotehrani K. The association between BRAF-V600E mutations and death from thin (≤1.00 mm) melanomas: A nested case-case study from Queensland, Australia. J Eur Acad Dermatol Venereol 2023; 37:e1168-e1172. [PMID: 37147869 DOI: 10.1111/jdv.19173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Affiliation(s)
- M Claeson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S X Tan
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - D Lambie
- Anatomical Pathology, Princess Alexandra Hospital, Pathology Queensland, Brisbane, Queensland, Australia
- University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - S Brown
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - M D Walsh
- Histopathology Department, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - P D Baade
- Cancer Council Queensland, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - N Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K J Whitehead
- Histopathology Department, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B M Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K Khosrotehrani
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Thompson JF, Hyngstrom J, Caracò C, Zager JS, Jahkola T, Bowles TL, Pennacchioli E, Hoekstra HJ, Moncrieff M, Ingvar C, van Akkooi A, Sabel MS, Levine EA, Henderson M, Dummer R, Rossi CR, Kane JM, Trocha S, Wright F, Byrd DR, Matter M, MacKenzie-Ross A, Kelley MC, Terheyden P, Huston TL, Wayne JD, Neuman H, Smithers BM, Desai D, Gershenwald JE, Schneebaum S, Gesierich A, Jacobs LK, Lewis JM, O'Donoghue C, Sardi A, McKinnon JG, Slingluff CL, Farma JM, Schultz E, Scheri RP, Vidal-Sicart S, Testori AAE, Scolyer RA, Elashoff DE, Cochran AJ, Faries MB. Regarding: Predicting Regional Lymph Node Recurrence in The Modern Age of Tumor-Positive Sentinel Node Melanoma. Ann Surg Oncol 2023; 30:4359-4360. [PMID: 37149545 DOI: 10.1245/s10434-023-13570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 05/08/2023]
Affiliation(s)
- John F Thompson
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | | | | | | | | | | | | | | | | | - Christian Ingvar
- Swedish Melanoma Study Group-University Hospital Lund, Lund, Sweden
| | | | | | | | | | | | | | - John M Kane
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Steven Trocha
- Greenville Hospital System Cancer Center, Greenville, SC, USA
| | | | | | - Maurice Matter
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - Patrick Terheyden
- University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany
| | - Tara L Huston
- SUNY at Stony Brook Hospital Medical Center, Stony Brook, NY, USA
| | - Jeffrey D Wayne
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Darius Desai
- St. Luke's University Health, Bethlehem, PA, USA
| | | | | | | | - Lisa K Jacobs
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James M Lewis
- University of Tennessee Medical Center, Knoxville, TN, USA
| | | | | | | | | | | | | | | | | | | | - Richard A Scolyer
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | | | | | - Mark B Faries
- Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA.
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11
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Smithers BM. Quality indicators in surgery for cancer: not just the operation. ANZ J Surg 2023; 93:1765-1767. [PMID: 37232501 DOI: 10.1111/ans.18516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Affiliation(s)
- B Mark Smithers
- Academy of Surgery, Upper GI/Soft Tissue Unit, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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12
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M Naeini M, Newell F, Aoude LG, Bonazzi VF, Patel K, Lampe G, Koufariotis LT, Lakis V, Addala V, Kondrashova O, Johnston RL, Sharma S, Brosda S, Holmes O, Leonard C, Wood S, Xu Q, Thomas J, Walpole E, Tao Mai G, Ackland SP, Martin J, Burge M, Finch R, Karapetis CS, Shannon J, Nott L, Bohmer R, Wilson K, Barnes E, Zalcberg JR, Mark Smithers B, Simes J, Price T, Gebski V, Nones K, Watson DI, Pearson JV, Barbour AP, Waddell N. Multi-omic features of oesophageal adenocarcinoma in patients treated with preoperative neoadjuvant therapy. Nat Commun 2023; 14:3155. [PMID: 37258531 DOI: 10.1038/s41467-023-38891-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
Oesophageal adenocarcinoma is a poor prognosis cancer and the molecular features underpinning response to treatment remain unclear. We investigate whole genome, transcriptomic and methylation data from 115 oesophageal adenocarcinoma patients mostly from the DOCTOR phase II clinical trial (Australian New Zealand Clinical Trials Registry-ACTRN12609000665235), with exploratory analysis pre-specified in the study protocol of the trial. We report genomic features associated with poorer overall survival, such as the APOBEC mutational and RS3-like rearrangement signatures. We also show that positron emission tomography non-responders have more sub-clonal genomic copy number alterations. Transcriptomic analysis categorises patients into four immune clusters correlated with survival. The immune suppressed cluster is associated with worse survival, enriched with myeloid-derived cells, and an epithelial-mesenchymal transition signature. The immune hot cluster is associated with better survival, enriched with lymphocytes, myeloid-derived cells, and an immune signature including CCL5, CD8A, and NKG7. The immune clusters highlight patients who may respond to immunotherapy and thus may guide future clinical trials.
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Affiliation(s)
- Marjan M Naeini
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Felicity Newell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Lauren G Aoude
- Frazer Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Vanessa F Bonazzi
- Frazer Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Kalpana Patel
- Frazer Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Guy Lampe
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | | | - Vanessa Lakis
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Venkateswar Addala
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Olga Kondrashova
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Rebecca L Johnston
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Sowmya Sharma
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia
- Anatomical Pathology, Australian Clinical Labs, 2153, Sydney, Australia
| | - Sandra Brosda
- Frazer Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Oliver Holmes
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Conrad Leonard
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Scott Wood
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Qinying Xu
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Janine Thomas
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
- Mater Research Institute, Mater Misericordiae, South Brisbane, QLD, 4101, Australia
| | - Euan Walpole
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - G Tao Mai
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Stephen P Ackland
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, 2298, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, 2298, Australia
| | - Matthew Burge
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Robert Finch
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Christos S Karapetis
- Flinders University Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, 5042, Australia
| | - Jenny Shannon
- Nepean Cancer Care Centre, Nepean Hospital, Sydney, NSW, 2747, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Robert Bohmer
- Department of General Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Kate Wilson
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - John R Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - B Mark Smithers
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Timothy Price
- Medical Oncology Unit, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, 5011, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Katia Nones
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - David I Watson
- Flinders University Discipline of Surgery, Flinders Medical Centre, Adelaide, SA, 5042, Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Andrew P Barbour
- Frazer Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia.
- Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia.
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13
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Tedman AJ, Liyanage UE, Chong S, Rowe C, von Schuckmann LA, Malt M, Green AC, Smithers BM, Khosrotehrani K. Conditional survival in patients with stage IB-IIIA melanoma undergoing sentinel node biopsy in Queensland: A longitudinal study. Australas J Dermatol 2023; 64:e34-e40. [PMID: 36651479 DOI: 10.1111/ajd.13974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tumour characteristics such as thickness and ulceration, along with sentinel lymph node (SLN) status, have been essential in predicting survival in patients with locally invasive melanomas at the time of diagnosis. It is unclear if these prognostic factors are relevant 1, 2 or 5 years after diagnosis. OBJECTIVES The key aim of this project was to analyse conditional survival in a cohort of Queensland patients with stage IB to IIIA melanomas (American Joint Committee on Cancer's staging system, 8th version) and to test the relevance of clinicopathological prognostic factors for melanoma outcome after varying intervals of survival time. METHODS Patients with primary invasive cutaneous melanoma who were referred to a tertiary melanoma clinic and underwent SLN biopsy between 1994 and 2011 were ascertained. The effect of patient and tumour characteristics on melanoma survival were calculated using multivariate Cox proportional hazard models at diagnosis and at variable times after diagnosis. RESULTS The final analysis included 651 patients (average age 49 years, 55.5% male) with stage IB to IIIA melanoma. At diagnosis, and after 1 and 2 years survived, SLN positivity, thickness and ulceration were predictive of 10-year survival since diagnosis. However, once patients survived 5 years, only SLN status was predictive. Overall conditional melanoma survival improved with increasing time survived. Five years after diagnosis, 10-year conditional melanoma survival (MSS) was 91% (95% CI 86%-95%) compared with 85% (82%-88%) predicted at diagnosis. The improvement in MSS was observed mainly for Stage II melanoma patients and not for those with a positive SLN biopsy. CONCLUSIONS This study confirms the improvement of prognosis according to time survived since diagnosis suggesting that after 5 years survival the classic prognostic indicators may not have the same influence.
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Affiliation(s)
| | - Upekha E Liyanage
- Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Sharene Chong
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Casey Rowe
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Lena A von Schuckmann
- School of Public Health, The University of Queensland, Brisbane, Australia.,UQ Frazer Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Maryrose Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - B Mark Smithers
- Academy of Surgery, University of Queensland, Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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14
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Frankel A, Ong HS, Smithers BM, Nathanson LK, Gotley DC. Efficacy of laparoscopic fundoplication in patients with chronic cough and gastro-oesophageal reflux. Esophagus 2023; 20:170-177. [PMID: 36201134 PMCID: PMC9813203 DOI: 10.1007/s10388-022-00953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The outcome of anti-reflux surgery in patients with suspected gastro-oesophageal reflux-induced cough is frequently uncertain. The aims of this study were to assess the efficacy of laparoscopic fundoplication for controlling cough in patients with chronic cough without asthma, who have pathologic gastro-oesophageal reflux, and to identify predictors of response. METHODS From a prospective database of 1598 patients who have undergone laparoscopic fundoplication, 66 (4%) with proven gastro-oesophageal reflux disease (GORD) and chronic cough without asthma were studied. All patients underwent gastroscopy and 24-h pH monitoring before operation. Heartburn and regurgitation were assessed using a modified DeMeester score. Severity of cough before and after surgery was self-assessed by the patient using a visual analog scale at a minimum of 12 months post-operatively (median 43 mo; range: 14-104 mo). Patients were considered to have responded to fundoplication if they had no cough or the cough had improved by 50% or more after operation. RESULTS Cough and heartburn/regurgitation were relieved in 61% (40/66) and 90% (44/49) of the patients, respectively. The presence of typical GORD symptoms or oesophagitis, and pH study variables did not predict the response of the cough to fundoplication. CONCLUSION Refinement in the aetiological diagnosis of chronic cough due to GORD is necessary for improved outcome. Patients diagnosed with GORD-related chronic cough need to be counseled regarding their expectations from anti-reflux surgery.
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Affiliation(s)
- Adam Frankel
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia.
| | - Hock Soo Ong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - B Mark Smithers
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- Mater Private Hospital, South Brisbane, QLD, Australia
| | - Les K Nathanson
- Department of Surgery, Royal Brisbane Hospital, Herston, QLD, Australia
| | - David C Gotley
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- Mater Private Hospital, South Brisbane, QLD, Australia
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15
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Frankel A, Thomson I, Shah A, Chen C, Zahir SF, Barbour A, Holtmann G, Mark Smithers B. Laparoscopic fundoplication versus laparoscopic Roux-en-Y gastric bypass for gastro-oesophageal reflux disease in obese patients: protocol for a randomized clinical trial. BJS Open 2022; 6:6849402. [PMID: 36440813 PMCID: PMC9703586 DOI: 10.1093/bjsopen/zrac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Laparoscopic fundoplication (LF) is the standard surgical procedure for the treatment of gastro-oesophageal reflux disease (GORD). Laparoscopic Roux-en-Y gastric bypass (LRYGB) is commonly performed to achieve weight loss in obese patients, but it also has anti-reflux properties. Hence, in the obese population suffering from GORD, LRYGB could be an alternative to LF. The aim of this trial will be to compare LF and LRYGB in an obese population presenting with GORD and being considered for surgery. METHODS This will be an investigator-initiated randomized clinical trial. The research population will be obese patients (BMI 30-34.9 with waist circumference more than 88 cm (women) or more than 102 cm (men), or BMI 35-40 with any waist circumference) referred to a public hospital for consideration of anti-reflux surgery. The primary aim of the study will be to determine the efficacy of LF compared with LRYGB on subjective and objective control of GORD. Secondary aims include determining early and late surgical morbidity and the side-effect profile of LF compared with LRYGB and to quantify any non-reflux benefits of LRYGB (including overall quality of life) compared with LF. CONCLUSION This trial will determine whether LRYGB is effective and acceptable as an alternative to LF for the surgical treatment of GORD in obese patients Registration number: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000636752p (https://www.anzctr.org.au/).
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Affiliation(s)
- Adam Frankel
- Correspondence to: Adam Frankel, Princess Alexandra Hospital, Upper GI Surgery, Ward 4D, 199 Ipswich Rd, Woolloongabba, Brisbane, Queensland, Australia 4102 (e-mail: )
| | - Iain Thomson
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Ayesha Shah
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Syeda Farah Zahir
- Queensland Facility for Advanced Bioinformatics, Queensland Cyber Infrastructure Foundation, Queensland, Australia
| | - Andrew Barbour
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerald Holtmann
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - B Mark Smithers
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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16
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Crystal JS, Thompson JF, Hyngstrom J, Caracò C, Zager JS, Jahkola T, Bowles TL, Pennacchioli E, Beitsch PD, Hoekstra HJ, Moncrieff M, Ingvar C, van Akkooi A, Sabel MS, Levine EA, Agnese D, Henderson M, Dummer R, Neves RI, Rossi CR, Kane JM, Trocha S, Wright F, Byrd DR, Matter M, Hsueh EC, MacKenzie-Ross A, Kelley M, Terheyden P, Huston TL, Wayne JD, Neuman H, Smithers BM, Ariyan CE, Desai D, Gershenwald JE, Schneebaum S, Gesierich A, Jacobs LK, Lewis JM, McMasters KM, O'Donoghue C, van der Westhuizen A, Sardi A, Barth R, Barone R, McKinnon JG, Slingluff CL, Farma JM, Schultz E, Scheri RP, Vidal-Sicart S, Molina M, Testori AAE, Foshag LJ, Van Kreuningen L, Wang HJ, Sim MS, Scolyer RA, Elashoff DE, Cochran AJ, Faries MB. Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial. JAMA Surg 2022; 157:835-842. [PMID: 35921122 PMCID: PMC9475390 DOI: 10.1001/jamasurg.2022.2055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/19/2022] [Indexed: 12/12/2022]
Abstract
Importance Sentinel lymph node (SLN) biopsy is a standard staging procedure for cutaneous melanoma. Regional disease control is a clinically important therapeutic goal of surgical intervention, including nodal surgery. Objective To determine how frequently SLN biopsy without completion lymph node dissection (CLND) results in long-term regional nodal disease control in patients with SLN metastases. Design, Setting, and Participants The second Multicenter Selective Lymphadenectomy Trial (MSLT-II), a prospective multicenter randomized clinical trial, randomized participants with SLN metastases to either CLND or nodal observation. The current analysis examines observation patients with regard to regional nodal recurrence. Trial patients were aged 18 to 75 years with melanoma metastatic to SLN(s). Data were collected from December 2004 to April 2019, and data were analyzed from July 2020 to January 2022. Interventions Nodal observation with ultrasonography rather than CLND. Main Outcomes and Measures In-basin nodal recurrence. Results Of 823 included patients, 479 (58.2%) were male, and the mean (SD) age was 52.8 (13.8) years. Among 855 observed basins, at 10 years, 80.2% (actuarial; 95% CI, 77-83) of basins were free of nodal recurrence. By univariable analysis, freedom from regional nodal recurrence was associated with age younger than 50 years (hazard ratio [HR], 0.49; 95% CI, 0.34-0.70; P < .001), nonulcerated melanoma (HR, 0.36; 95% CI, 0.36-0.49; P < .001), thinner primary melanoma (less than 1.5 mm; HR, 0.46; 95% CI, 0.27-0.78; P = .004), axillary basin (HR, 0.61; 95% CI, 0.44-0.86; P = .005), fewer positive SLNs (1 vs 3 or more; HR, 0.32; 95% CI, 0.14-0.75; P = .008), and SLN tumor burden (measured by diameter less than 1 mm [HR, 0.39; 95% CI, 0.26-0.60; P = .001] or less than 5% area [HR, 0.36; 95% CI, 0.24-0.54; P < .001]). By multivariable analysis, younger age (HR, 0.57; 95% CI, 0.39-0.84; P = .004), thinner primary melanoma (HR, 0.40; 95% CI, 0.22-0.70; P = .002), axillary basin (HR, 0.55; 95% CI, 0.31-0.96; P = .03), SLN metastasis diameter less than 1 mm (HR, 0.52; 95% CI, 0.33-0.81; P = .007), and area less than 5% (HR, 0.58; 95% CI, 0.38-0.88; P = .01) were associated with basin control. When looking at the identified risk factors of age (50 years or older), ulceration, Breslow thickness greater than 3.5 mm, nonaxillary basin, and tumor burden of maximum diameter of 1 mm or greater and/or metastasis area of 5% or greater and excluding missing value cases, basin disease-free rates at 5 years were 96% (95% CI, 88-100) for patients with 0 risk factors, 89% (95% CI, 82-96) for 1 risk factor, 86% (95% CI, 80-93) for 2 risk factors, 80% (95% CI, 71-89) for 3 risk factors, 61% (95% CI, 48-74) for 4 risk factors, and 54% (95% CI, 36-72) for 5 or 6 risk factors. Conclusions and Relevance This randomized clinical trial was the largest prospective evaluation of long-term regional basin control in patients with melanoma who had nodal observation after removal of a positive SLN. SLN biopsy without CLND cleared disease in the affected nodal basin in most patients, even those with multiple risk factors for in-basin recurrence. In addition to its well-validated value in staging, SLN biopsy may also be regarded as therapeutic in some patients. Trial Registration ClinicalTrials.gov Identifier: NCT00297895.
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Affiliation(s)
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - John Hyngstrom
- Department of Surgery, University of Utah, Salt Lake City
| | - Corrado Caracò
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale," Napoli, Italy
| | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Tiina Jahkola
- Department of Plastic and Reconstructive Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tawnya L Bowles
- Department of Surgical Oncology, Intermountain Medical Center, Salt Lake City, Utah
| | - Elisabetta Pennacchioli
- Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, European Institute of Oncology, Milano, Italy
| | | | - Harald J Hoekstra
- Department of Surgery, University Hospital Groningen, Groningen, the Netherlands
| | - Marc Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Alexander van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Edward A Levine
- Department of Surgical Oncology, Wake Forest University, Winston-Salem, North Carolina
| | - Doreen Agnese
- Department of Surgery, Ohio State University, Columbus
| | - Michael Henderson
- Department of Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Rogerio I Neves
- Department of Surgery, Pennsylvania State University Milton S. Hershey Medical Center, Hershey
- Now at Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - John M Kane
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Steven Trocha
- Department of Surgical Oncology, Prisma Health, Columbia, South Carolina
| | - Frances Wright
- Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David R Byrd
- Department of Surgery, University of Washington, Seattle
| | - Maurice Matter
- Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Eddy C Hsueh
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Alastair MacKenzie-Ross
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark Kelley
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Tara L Huston
- Department of Surgery, Stony Brook University, Stony Brook, New York
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Heather Neuman
- Department of Surgery, University of Wisconsin at Madison
| | - B Mark Smithers
- Department of Surgery, University of Queensland, Brisbane, Australia
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Darius Desai
- Department of Surgery, Saint Luke's University Hospital, Bethlehem, Pennsylvania
| | | | - Shlomo Schneebaum
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anja Gesierich
- Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - James M Lewis
- Department of Surgery, University of Tennessee Medical Center, Knoxville
| | - Kelly M McMasters
- Department of Surgery, University of Louisville, Louisville, Tennessee
| | | | | | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, Maryland
| | - Richard Barth
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
| | - Robert Barone
- Surgical Oncology, Sharp Hospital, San Diego, California
| | - J Greg McKinnon
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Erwin Schultz
- Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical Center, Nuremberg, Germany
| | | | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Manuel Molina
- Department of Surgery, Lakeland Regional Health, Lakeland, Florida
| | | | - Leland J Foshag
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Lisa Van Kreuningen
- Manager of Research Operations, Saint John's Cancer Institute, Santa Monica, California
| | - He-Jing Wang
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Myung-Shin Sim
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Richard A Scolyer
- Melanoma Institute Australia, Department of Medicine, University of Sydney, Sydney, Australia
| | - David E Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Alistair J Cochran
- Department of Anatomic Pathology, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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17
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Clayton B, Muneeb F, Hughes MCB, Grant ME, Khosrotehrani K, Smithers BM, Spina R, Campana LG, Oudit D, Green AC. Hypothesised cutaneous sites of origin of stage III melanomas with unknown primary: A multicentre study. Int J Cancer 2022; 151:396-401. [PMID: 35403698 PMCID: PMC9325056 DOI: 10.1002/ijc.34020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
Abstract
Based on molecular evidence that melanomas with unknown primary (MUPs) arise from the skin, we hypothesised that sites of MUPs are disproportionately on trunk and lower limbs, sites that are not readily visible to patients and clinicians. We tested this hypothesis by inferring the anatomic site of origin of MUPs from the corresponding known cutaneous sites of melanoma patients with known primary tumours (MKPs). We analysed data from three separate cohorts of patients from Brisbane, Australia (n = 236); Manchester, UK (n = 51) and Padova, Italy (n = 33), respectively, who first presented with stage III melanoma with lymph node metastases. We matched two MKP patients to each MUP patient based on lymph node dissection (LND) site, age and sex, and imputed cutaneous sites of origin of MUPs from their two matched MKPs for study countries, giving two possible sites for each MUP per centre. Overall, results showed that MUP patients were predominantly male, and trunk was the most likely origin, comprising around a third to a half of MUPs across the three cohorts. The remaining MUP inferred sites varied by country. In the Australian cohort, the legs accounted for a third of imputed sites of MUPs, while in the UK and Italian cohorts, the most frequent site was the arms followed by the legs. Our findings suggest the need for regular and thorough skin examination on trunk and limbs, especially in males, to improve early detection of cutaneous melanoma and reduce the risk of metastatic disease at the time of presentation.
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Affiliation(s)
- Bethan Clayton
- Department of SurgeryThe Christie NHS Foundation TrustManchesterUK
| | - Ferhan Muneeb
- Department of SurgeryThe Christie NHS Foundation TrustManchesterUK
| | - Maria Celia B. Hughes
- Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | - Megan E. Grant
- Molecular Oncology GroupCRUK Manchester Institute, University of ManchesterManchesterUK
| | - Kiarash Khosrotehrani
- Experimental Dermatology GroupThe University of Queensland Diamantina Institute, Translational Research InstituteBrisbaneAustralia
- Department of DermatologyPrincess Alexandra HospitalBrisbaneAustralia
| | - B. Mark Smithers
- Queensland Melanoma ProjectPrincess Alexandra Hospital, The University of QueenslandBrisbaneAustralia
| | - Romina Spina
- Department of SurgeryVeneto Institute of Oncology IOV‐IRCCSPaduaItaly
- Psychology UnitUniversity Hospital of PadovaPadovaItaly
| | - Luca G. Campana
- Department of SurgeryThe Christie NHS Foundation TrustManchesterUK
- Department of Surgical Oncological and Gastroenterological Sciences (DISCOG)University of PadovaPadovaItaly
| | - Deemesh Oudit
- Department of SurgeryThe Christie NHS Foundation TrustManchesterUK
| | - Adele C. Green
- Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
- Molecular Oncology GroupCRUK Manchester Institute, University of ManchesterManchesterUK
- Faculty of BiologyMedicine and Health, University of ManchesterManchesterUK
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18
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Chidambaram S, Patel NM, Sounderajah V, Alfieri R, Bonavina L, Cheong E, Cockbain A, D’Journo XB, Ferri L, Griffiths EA, Grimminger P, Gronnier C, Gutschow C, Hedberg J, Kauppila JH, Lagarde S, Low D, Nafteux P, Nieuwenhuijzen G, Nilsson M, Rosati R, Schroeder W, Smithers BM, van Berge Henegouwen MI, van Hillegesberg R, Watson DI, Vohra R, Maynard N, Markar SR. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process. Dis Esophagus 2022; 36:6647503. [PMID: 35858213 PMCID: PMC9817822 DOI: 10.1093/dote/doac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. METHODS A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. RESULTS 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. CONCLUSION There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value.
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Affiliation(s)
| | - Nikhil M Patel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Rita Alfieri
- Department of Surgical Oncology, Veneto Institute of Oncology-IRCCS, Padova, Italy
| | - Luigi Bonavina
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS Padua, Italy
| | - Edward Cheong
- Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Andy Cockbain
- Department of Upper Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Xavier Benoit D’Journo
- Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, France
| | - Lorenzo Ferri
- Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montréal, Canada
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter Grimminger
- Department of General Surgery, University of Mainz, Mainz, Germany
| | | | - Christian Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jakob Hedberg
- Section of Gastrointestinal Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Joonas H Kauppila
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Department of Surgery, Oulu University Hospital, University of Oulu, Oulo, Finland
| | - Sjoerd Lagarde
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Donald Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Philippe Nafteux
- Department of Thoracic Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Wolfgang Schroeder
- Department of General, Visceral, Cancer and Transplantation Surgery, University of Cologne, Cologne, Germany
| | - B Mark Smithers
- Upper GI and Soft Tissue Unit, Academy of Surgery, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | | | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia,Department of Surgery, Flinders Medical Center, Adelaide, Australia
| | - Ravinder Vohra
- Department of Esophagogastric Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nick Maynard
- Department of Upper GI Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sheraz R Markar
- Address correspondence to: Sheraz R. Markar, Department of Upper Gastrointestinal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford OX3 7LE, UK.
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19
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Green AC, Hughes MCB, Williams GM, Malt M, Beesley VL, Khosrotehrani K, Smithers BM. Increased melanoma recurrence in patients with multiple primary invasive melanomas. J Am Acad Dermatol 2022; 86:1366-1369. [PMID: 34052336 DOI: 10.1016/j.jaad.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/04/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Cancer Research UK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Gail M Williams
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Maryrose Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Brisbane, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
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20
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Hughes MCB, Malt M, Khosrotehrani K, Smithers BM, Green AC. Diet quality is associated with primary melanoma thickness. J Eur Acad Dermatol Venereol 2022; 36:1745-1750. [PMID: 35462440 PMCID: PMC9544655 DOI: 10.1111/jdv.18174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- MCB Hughes
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
| | - M Malt
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
| | - K Khosrotehrani
- Experimental Dermatology Group The University of Queensland Diamantina Institute Brisbane Australia
- Department of Dermatology, Princess Alexandra Hospital Brisbane Australia
| | - BM Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital The University of Queensland Australia
| | - AC Green
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
- CRUK Manchester Institute and Faculty of Biology, Medicine and Health University of Manchester Manchester UK
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21
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Muir J, McCormack C, De'Ambrosis B, Brown H, Kennedy D, Louie B, Smithers BM. Reply to: A practical guide on the use of imiquimod cream to treat lentigo maligna. Australas J Dermatol 2022; 63:e197-e198. [PMID: 35262178 DOI: 10.1111/ajd.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- James Muir
- Department of Dermatology, Mater Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Bri, Queensland, Australia
| | - Chris McCormack
- Surgical Oncology Department, Peter MacCallum Cancer Centre, Parkvile, Victoria, Australia.,Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Brian De'Ambrosis
- Faculty of Medicine, University of Queensland, Bri, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Hilary Brown
- Department of Dermatology, Mater Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Bri, Queensland, Australia
| | - Daniel Kennedy
- Pacific Plastic Surgery Clinic, Brisbane, Queensland, Australia
| | - Brendan Louie
- Department of Plastic Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - B Mark Smithers
- Faculty of Medicine, University of Queensland, Bri, Queensland, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
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22
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Cochran AJ, Wen DR, Huang RR, Abrishami P, Smart C, Binder S, Scolyer RA, Thompson JF, Stern S, Van Kreuningen L, Elashoff DE, Sim MS, Wang HJ, Faries MB, Kirkwood J, Daly J, Kutner M, Mihm M, Smith G, Urist M, Beegun N, Thompson JF, Mozzillo N, Nieweg OE, Roses DF, Hoekstra HJ, Karakousis CP, Reintgen DS, Leong SP, Coventry BJ, Kraybill WG, Smithers BM, Nathanson SD, Huth JF, Wong JH, Fraker DL, McKinnon JG, Paul E, Morton DL, Botti G, Tiebosch A, Strutton GM, Whitehead FJ, Peterse HJ, Epstein HD, Goodloe S, Scolyer RA, McCarthy SW, Melamed J, Messina J, Moffitt HL, Turner RR, Wunsch PH. Sentinel lymph node melanoma metastases: Assessment of tumor burden for clinical prediction of outcome in the first Multicenter Selective Lymphadenectomy Trial (MSLT-I). Eur J Surg Oncol 2022; 48:1280-1287. [DOI: 10.1016/j.ejso.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/22/2021] [Accepted: 01/19/2022] [Indexed: 02/05/2023] Open
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23
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Scolyer RA, Atkinson V, Gyorki DE, Lambie D, O'Toole S, Saw RP, Amanuel B, Angel CM, Button-Sloan AE, Carlino MS, Ch'ng S, Colebatch AJ, Daneshvar D, Pires da Silva I, Dawson T, Ferguson PM, Foster-Smith E, Fox SB, Gill AJ, Gupta R, Henderson MA, Hong AM, Howle JR, Jackett LA, James C, Lee CS, Lochhead A, Loh D, McArthur GA, McLean CA, Menzies AM, Nieweg OE, O'Brien BH, Pennington TE, Potter AJ, Prakash S, Rawson RV, Read RL, Rtshiladze MA, Shannon KF, Smithers BM, Spillane AJ, Stretch JR, Thompson JF, Tucker P, Varey AH, Vilain RE, Wood BA, Long GV. BRAF mutation testing for patients diagnosed with stage III or stage IV melanoma: practical guidance for the Australian setting. Pathology 2021; 54:6-19. [DOI: 10.1016/j.pathol.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 01/19/2023]
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24
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Bulamu NB, Vissapragada R, Chen G, Ratcliffe J, Mudge LA, Smithers BM, Isenring EA, Smith L, Jamieson GG, Watson DI. Responsiveness and convergent validity of QLU-C10D and EQ-5D-3L in assessing short-term quality of life following esophagectomy. Health Qual Life Outcomes 2021; 19:233. [PMID: 34600554 PMCID: PMC8487554 DOI: 10.1186/s12955-021-01867-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/17/2021] [Indexed: 11/12/2022] Open
Abstract
Aim This study assessed the responsiveness and convergent validity of two preference-based measures; the newly developed cancer-specific EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D) relative to the generic three-level version of the EuroQol 5 dimensions (EQ-5D-3L) in evaluating short-term health related quality of life (HRQoL) outcomes after esophagectomy. Methods Participants were enrolled in a multicentre randomised controlled trial to determine the impact of preoperative and postoperative immunonutrition versus standard nutrition in patients with esophageal cancer. HRQoL was assessed seven days before and 42 days after esophagectomy. Standardized Response Mean and Effect Size were calculated to assess responsiveness. Ceiling effects for each dimension were calculated as the proportion of the best level responses for that dimension at follow-up/post-operatively. Convergent validity was assessed using Spearman’s correlation and the level of agreement was explored using Bland–Altman plots. Results Data from 164 respondents (mean age: 63 years, 81% male) were analysed. HRQoL significantly reduced on both measures with large effect sizes (> 0.80), and a greater mean difference (0.29 compared to 0.16) on QLU-C10D. Both measures had ceiling effects (> 15%) on all dimensions at baseline. Following esophagectomy, ceiling effects were observed with self-care (86%), mobility (67%), anxiety/depression (55%) and pain/discomfort (19%) dimensions on EQ-5D-3L. For QLU-C10D ceiling effects were observed with emotional function (53%), physical function (16%), nausea (35%), sleep (31%), bowel problems (21%) and pain (20%). A strong correlation (r = 0.71) was observed between EQ-5D-3L anxiety and QLU-C10D emotional function dimensions. Good agreement (3.7% observations outside the limits of agreement) was observed between the utility scores. Conclusion The QLU-C10D is comparable to the more widely applied generic EQ-5D-3L, however, QLU-C10D was more sensitive to short-term utility changes following esophagectomy. Cognisant of requirements by policy makers to apply generic utility measures in cost effectiveness studies, the disease-specific QLU-C10D should be used alongside the generic measures like EQ-5D-3L. Trial registration: The trial was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12611000178943) on the 15th of February 2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01867-w.
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Affiliation(s)
- Norma B Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ravi Vissapragada
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Louise A Mudge
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - B Mark Smithers
- Upper GI and Soft Tissue Unit, Academy of Surgery, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Lorelle Smith
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Glyn G Jamieson
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - David I Watson
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. .,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
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25
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Tian K, Baade PD, Aitken JF, Narendra A, Smithers BM. Procedure-specific outcomes following gastrectomy for cancer compared by hospital volume and service capability. ANZ J Surg 2021; 91:2430-2435. [PMID: 34405517 DOI: 10.1111/ans.17132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND International literature recommends centralising gastric cancer surgery, however, with volumes that define 'high-volume resection' being higher than those in most major centres in Australia and New Zealand. These reports rarely focus on the difference between total (TG) and partial gastrectomy (PG). We assessed the impact of resection volume and service capability on operative mortality, morbidity and surgical quality in patients who had a PG and TG. METHODS Patients who had gastrectomy for adenocarcinoma, between 2001 and 2015, were collected from the Queensland Oncology Repository. Hospitals were characterised by cases-per-annum (high-volume [HV] ≥ 5 and low-volume [LV] < 5) and hospital service capability as (high-service [HS] and low-service [LS]), giving three hospital groups: HVHS, LVHS and LVLS. Chi-squared tests were used to compare post-operative mortality, morbidity, failure to rescue (FTR) from complications and surgical quality between these three groups. RESULTS There were 426 patients who had a TG and 827 having PG. HVHS centres performed 59% of PG with high surgical quality rates of: HVHS = 53%, LVHS = 34% and LVLS = 46% (p < 0.01). Surgical complications were highest in LVLS (LVLS = 19%, LVHS = 11%, HVHS = 11%; p = 0.02). There was no difference in 30-day mortality nor in FTR. For TG, HVHS performed 67% of these procedures, with lower 30-day mortality (2%) and FTR rates (5%) compared with LVHS (7%, 22%) and LVLS (12%, 28%; p < 0.01). There was no difference in operative morbidity and surgical quality between hospital groups. CONCLUSION Despite the 'high-volume' threshold for gastrectomy being the lowest described in the literature, we have shown that centralisation to HVHS centres was associated with lower operative mortality for TG and improved quality of surgery for PG.
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Affiliation(s)
- Kevin Tian
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Department of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Peter D Baade
- Cancer Council Queensland, Fortitude Valley, Queensland, Australia
| | - Joanne F Aitken
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Aaditya Narendra
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Department of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Cancer Alliance Queensland, Woolloongabba, Queensland, Australia
| | - B Mark Smithers
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Cancer Alliance Queensland, Woolloongabba, Queensland, Australia.,Upper Gastrointestinal, Soft Tissue and Melanoma Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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26
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Smithers BM, Saw RPM, Gyorki DE, Martin RCW, Atkinson V, Haydon A, Roberts-Thomson R, Thompson JF. Contemporary management of locoregionally advanced melanoma in Australia and New Zealand and the role of adjuvant systemic therapy. ANZ J Surg 2021; 91 Suppl 2:3-13. [PMID: 34288329 DOI: 10.1111/ans.17051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 12/19/2022]
Abstract
Australia and New Zealand have the highest incidence and mortality rates for melanoma in the world. Local surgery is still the standard treatment of primary cutaneous melanoma, and it is therefore important that surgeons understand the optimal care pathways for patients with melanoma. Accurate staging is critical to ensure a reliable assessment of prognosis and to guide treatment selection. Sentinel node biopsy (SNB) plays an important role in staging and the provision of reliable prognostic estimates for patients with cutaneous melanoma. Patients with stage III melanoma have a substantial risk of disease recurrence following surgery, leading to poor long-term outcomes. Systemic immunotherapies and targeted therapies, known to be effective for stage IV melanoma, have now also been shown to be effective as adjuvant post-surgical treatments for resected stage III melanoma. These patients should be made aware of this and preferably managed in an integrated multidisciplinary model of care, involving the surgeon, medical oncologists and radiation oncologists. This review considers the impact of a recent update to the American Joint Committee on Cancer (AJCC) staging system, the role of SNB for patients with high-risk primary melanoma and recent advances in adjuvant systemic therapies for high-risk patients.
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Affiliation(s)
- B Mark Smithers
- Queensland Melanoma Project, Faculty of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David E Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Victoria Atkinson
- Queensland Melanoma Project, Faculty of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | | | - John F Thompson
- Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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27
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Claeson M, Baade P, Marchetti M, Brown S, Soyer HP, Smithers BM, Green AC, Whiteman DC, Khosrotehrani K. Comparative performance of predictors of death from thin (≤ 1·0 mm) melanoma. Br J Dermatol 2021; 185:849-851. [PMID: 33982292 DOI: 10.1111/bjd.20480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- M Claeson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Baade
- Cancer Council Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - M Marchetti
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - S Brown
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - H P Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia.,Department of Dermatology, Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - B M Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - A C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Khosrotehrani
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia.,Department of Dermatology, Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
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28
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Aoude LG, Wong BZY, Bonazzi VF, Brosda S, Walters SB, Koufariotis LT, Naeini MM, Pearson JV, Oey H, Patel K, Bradford JJ, Bloxham CJ, Atkinson V, Law P, Strutton G, Bayley G, Yang S, Smithers BM, Waddell N, Miles K, Barbour AP. Radiomics Biomarkers Correlate with CD8 Expression and Predict Immune Signatures in Melanoma Patients. Mol Cancer Res 2021; 19:950-956. [PMID: 33811161 DOI: 10.1158/1541-7786.mcr-20-1038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022]
Abstract
Treatment for metastatic melanoma includes targeted and/or immunotherapy. Although many patients respond, only a subset has complete response. As late-stage patients often have multiple tumors in difficult access sites, non-invasive techniques are necessary for the development of predictive/prognostic biomarkers. PET/CT scans from 52 patients with stage III/IV melanoma were assessed and CT image parameters were evaluated as prognostic biomarkers. Analysis indicated patients with high standard deviation or high mean of positive pixels (MPP) had worse progression-free survival (P = 0.00047 and P = 0.0014, respectively) and worse overall survival (P = 0.0223 and P = 0.0465, respectively). Whole-exome sequencing showed high MPP was associated with BRAF mutation status (P = 0.0389). RNA-sequencing indicated patients with immune "cold" signatures had worse survival, which was associated with CT biomarker, MPP4 (P = 0.0284). Multiplex immunofluorescence confirmed a correlation between CD8 expression and image biomarkers (P = 0.0028). IMPLICATIONS: CT parameters have the potential to be cost-effective biomarkers of survival in melanoma, and reflect the tumor immune-microenvironment. VISUAL OVERVIEW: http://mcr.aacrjournals.org/content/molcanres/19/6/950/F1.large.jpg.
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Affiliation(s)
- Lauren G Aoude
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia.
| | - Bernadette Z Y Wong
- Princess Alexandra Hospital, Department of Medical Imaging, Woolloongabba, Queensland, Australia
- Department of Medical Imaging, Gold Coast University Hospital, Southport, Australia
| | - Vanessa F Bonazzi
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Sandra Brosda
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Shaun B Walters
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | | | - Marjan M Naeini
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Harald Oey
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Kalpana Patel
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Julia J Bradford
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Conor J Bloxham
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Victoria Atkinson
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Phillip Law
- Princess Alexandra Hospital, Department of Medical Imaging, Woolloongabba, Queensland, Australia
| | - Geoffrey Strutton
- Department of Anatomical Pathology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Gerard Bayley
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Samuel Yang
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Kenneth Miles
- Princess Alexandra Hospital, Department of Medical Imaging, Woolloongabba, Queensland, Australia
| | - Andrew P Barbour
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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29
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Abstract
Metastatic melanoma is a fatal malignancy with a high mortality and morbidity. Since the early 1970s, available medical therapies were limited in improving survival. Surgery represented the best chance for a cure. However, surgery could only be offered to selected patients. The current landscape of treatment has radically evolved since the introduction of targeted and immunotherapies including BRAF and MEK inhibitors, and checkpoint blockers, like PD-1 and CTLA-4 antibodies. These new therapies have seen survival rates matching, and in some cases surpassing, that of surgery. Anti-PD1 and CTLA-4 combination treatments are associated with severe side effects and BRAF and MEK inhibitor combinations may trigger initial tumour responses but prolonged use have resulted in the development of resistant tumour clones and disease relapse. This review examines the role of pulmonary metastasectomy for lung metastasis from malignant melanoma in the current landscape of effective targeted therapy and immunotherapy.
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Affiliation(s)
- Christopher Y Bong
- Department of Surgery, Logan Hospital, Metro South Health, Meadowbrook, Queensland, Australia
| | - B Mark Smithers
- Upper Gastrointestinal and Soft Tissue Unit, Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Discipline of Surgery, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Terence C Chua
- Department of Surgery, Logan Hospital, Metro South Health, Meadowbrook, Queensland, Australia.,Discipline of Surgery, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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30
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Veenstra MMK, Smithers BM, Visser E, Edholm D, Brosda S, Thomas JM, Gotley DC, Thomson IG, Wijnhoven BPL, Barbour AP. Complications and survival after hybrid and fully minimally invasive oesophagectomy. BJS Open 2021; 5:6133613. [PMID: 33609389 PMCID: PMC7893474 DOI: 10.1093/bjsopen/zraa033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes. Methods Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival. Results There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach. Conclusion MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.
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Affiliation(s)
- M M K Veenstra
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - B M Smithers
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia
| | - E Visser
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - D Edholm
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - S Brosda
- Diamantina Institute, Translational Research Institute, The University of Queensland, Queensland, Australia
| | - J M Thomas
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia
| | - D C Gotley
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - I G Thomson
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - A P Barbour
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Diamantina Institute, Translational Research Institute, The University of Queensland, Queensland, Australia
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31
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Narendra A, Baade PD, Aitken JF, Fawcett J, Leggett B, Leggett C, Tian K, Sklavos T, Smithers BM. Hospital characteristics associated with better 'quality of surgery' and survival following oesophagogastric cancer surgery in Queensland: a population-level study. ANZ J Surg 2020; 91:323-328. [PMID: 33155394 DOI: 10.1111/ans.16397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of hospital characteristics on the quality of surgery and survival following oesophagogastric cancer surgery has not been well established in Australia. We assessed the interaction between hospital volume, service capability and surgical outcomes, with the hypothesis that both the quality of surgery and survival are better following treatment in high-volume, high service capability hospitals. METHODS All patients undergoing oesophagectomy and gastrectomy for cancer in Queensland, between 2001 and 2015, were included. Demographic, pathology and outcome data were collected. Hospitals were categorized into high (HV) (≥5 gastrectomies; ≥6 oesophagectomies) and low volume (LV). Hospital service capability was defined as high (HS) and low (LS), and then linked to hospital volume: HVHS, LVHS and LVLS. Higher quality surgery was defined using six perioperative parameters. Univariable comparisons of quality of surgery between hospital groups used chi-squared tests. The 5-year overall survival was compared using log-rank tests and Cox proportional hazard models. RESULTS For both gastrectomy and oesophagectomy, higher quality surgery occurred more frequently in HVHS hospitals (gastrectomy: HVHS = 44.2%, LVHS = 23.1%, LVLS = 29.1% (P < 0.01); oesophagectomy: HVHS = 34.5%, LVHS = 24.4%, LVLS = 21.7% (P = 0.01)). Following oesophagectomy, the 3- and 5-year overall survival was better following treatment in HVHS (P < 0.01). There was no difference between the groups following gastrectomy. CONCLUSION In Queensland, the quality of surgery was higher in HVHS hospitals performing gastrectomy and oesophagectomy; however, the impact on cancer survival was only seen following oesophagectomy.
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Affiliation(s)
- Aaditya Narendra
- The University of Queensland, Princess Alexandra Hospital, Cancer Alliance Queensland, Burke Street Centre, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- The University of Queensland, The University of Southern Queensland, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Jonathan Fawcett
- Hepato-Pancreatico-Biliary Unit, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Brandon Leggett
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Callum Leggett
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kevin Tian
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - B Mark Smithers
- Upper-GI, Soft Tissue and Melanoma Unit, Princess Alexandra Hospital, Cancer Alliance Queensland, The University of Queensland, Brisbane, Queensland, Australia
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32
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Aoude LG, Bonazzi VF, Brosda S, Patel K, Koufariotis LT, Oey H, Nones K, Wood S, Pearson JV, Lonie JM, Arneil M, Atkinson V, Smithers BM, Waddell N, Barbour AP. Pathogenic germline variants are associated with poor survival in stage III/IV melanoma patients. Sci Rep 2020; 10:17687. [PMID: 33077847 PMCID: PMC7572377 DOI: 10.1038/s41598-020-74956-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
Patients with late stage resected cutaneous melanoma have poor overall survival (OS) and experience irreversible adverse events from systemic therapy. There is a clinical need to identify biomarkers to predict outcome. Performing germline/tumour whole-exome sequencing of 44 stage III/IV melanoma patients we identified pathogenic germline mutations in CDKN2A, CDK4, ATM, POLH, MRE11A, RECQL4 and XPC, affecting 7/44 patients. These mutations were associated with poor OS (p = 0.0082). We confirmed our findings in The Cancer Genome Atlas (TCGA) human skin cutaneous melanoma cohort where we identified pathogenic variants in 40/455 patients (p = 0.0203). Combining these cohorts (n = 499) further strengthened these findings showing germline carriers had worse OS (p = 0.0009). Additionally, we determined whether tumour mutation burden (TMB) or BRAF status were prognostic markers of survival. Low TMB rate (< 20 Mut/Mb; p = 0.0034) and BRAF p.V600 mutation (p = 0.0355) were associated with worse progression-free survival. Combining these biomarkers indicated that V600 mutant patients had significantly lower TMB (p = 0.0155). This was confirmed in the TCGA (n = 443, p = 0.0007). Integrative analysis showed germline mutation status conferred the highest risk (HR 5.2, 95% CI 1.72–15.7). Stage IV (HR 2.5, 0.74–8.6) and low TMB (HR 2.3, 0.57–9.4) were similar, whereas BRAF V600 status was the weakest prognostic biomarker (HR 1.5, 95% CI 0.44–5.2).
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Affiliation(s)
- Lauren G Aoude
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia.
| | - Vanessa F Bonazzi
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Sandra Brosda
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Kalpana Patel
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | | | - Harald Oey
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Katia Nones
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - Scott Wood
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - James M Lonie
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Melissa Arneil
- Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Victoria Atkinson
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.,Faculty of Medicine, University of Queensland, St Lucia, QLD, 4067, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.,Faculty of Medicine, University of Queensland, St Lucia, QLD, 4067, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
| | - Andrew P Barbour
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
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33
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Ghiasvand R, Khosrotehrani K, Hughes MCB, von Schuckmann LA, Beesley VL, Malt M, Smithers BM, Green AC. Patient age and risk of recurrence of primary melanoma at high risk of spread. Br J Dermatol 2020; 184:566-568. [PMID: 33053218 DOI: 10.1111/bjd.19601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- R Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Brisbane, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - M C B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - V L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - M Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - B M Smithers
- Queensland Melanoma Project (Princess Alexandra Hospital), The University of Queensland, Brisbane, Australia
| | - A C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Cancer Research UK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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34
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Beesley VL, Hughes MCB, Smithers BM, Khosrotehrani K, Malt MK, von Schuckmann LA, Green AC. Anxiety and depression after diagnosis of high-risk primary cutaneous melanoma: a 4-year longitudinal study. J Cancer Surviv 2020; 14:712-719. [PMID: 32519121 DOI: 10.1007/s11764-020-00885-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/11/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To quantify the prevalence of anxiety or depression (overall; melanoma-related) among people with high-risk primary melanoma, their related use of mental health services and medications, and factors associated with persistent new-onset symptoms across 4 years post-diagnosis. METHODS A longitudinal study of 675 patients newly diagnosed with tumor-stage 1b-4b melanoma. Participants completed the Hospital Anxiety and Depression Scale and answered questions about fear of cancer recurrence, use of medication, and support, serially over 4 years. We identified anxiety and depression trajectories with group-based trajectories models and factors associated with persistent symptoms with logistic regression. RESULTS At diagnosis, 93 participants (14%) had melanoma-related anxiety or depression, and 136 (20%) were affected by anxiety and/or depression unrelated to melanoma. After 6 months, no more than 27 (5%) reported melanoma-related anxiety or depression at any time, while the point prevalence of anxiety and depression unrelated to melanoma was unchanged (16-21%) among the disease-free. Of 272 participants reporting clinical symptoms of any cause, 34% were taking medication and/or seeing a psychologist or psychiatrist. Of the participants, 11% (n = 59) had new-onset symptoms that persisted; these participants were more likely aged < 70. CONCLUSIONS Melanoma-related anxiety or depression quickly resolves in high-risk primary melanoma patients after melanoma excision, while prevalence of anxiety or depression from other sources remains constant among the disease-free. However, one-in-ten develop new anxiety or depression symptoms (one-in-twenty melanoma-related) that persist. IMPLICATIONS FOR CANCER SURVIVORS Chronic stress has been linked to melanoma progression. Survivors with anxiety and depression should be treated early to improve patient and, potentially, disease outcomes.
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Affiliation(s)
- Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiarash Khosrotehrani
- The University of Queensland, UQ Centre for Clinical Research & The University of Queensland Diamantina Institute, Experimental Dermatology Group, QLD, Brisbane, Australia
| | - Maryrose K Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Lena A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Cancer Research UK Manchester Institute, and School of Biology, Medicine and Health, University of Manchester, Manchester, UK
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35
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Rayner JE, Duffy DL, Smit DJ, Jagirdar K, Lee KJ, De’Ambrosis B, Smithers BM, McMeniman EK, McInerney-Leo AM, Schaider H, Stark MS, Soyer HP, Sturm RA. Germline and somatic albinism variants in amelanotic/hypomelanotic melanoma: Increased carriage of TYR and OCA2 variants. PLoS One 2020; 15:e0238529. [PMID: 32966289 PMCID: PMC7510969 DOI: 10.1371/journal.pone.0238529] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022] Open
Abstract
Amelanotic/hypomelanotic melanoma is a clinicopathologic subtype with absent or minimal melanin. This study assessed previously reported coding variants in albinism genes (TYR, OCA2, TYRP1, SLC45A2, SLC24A5, LRMDA) and common intronic, regulatory variants of OCA2 in individuals with amelanotic/hypomelanotic melanoma, pigmented melanoma cases and controls. Exome sequencing was available for 28 individuals with amelanotic/hypomelanotic melanoma and 303 individuals with pigmented melanoma, which were compared to whole exome data from 1144 Australian controls. Microarray genotyping was available for a further 17 amelanotic/hypomelanotic melanoma, 86 pigmented melanoma, 147 melanoma cases (pigmentation unknown) and 652 unaffected controls. Rare deleterious variants in TYR/OCA1 were more common in amelanotic/hypomelanotic melanoma cases than pigmented melanoma cases (set mixed model association tests P = 0.0088). The OCA2 hypomorphic allele p.V443I was more common in melanoma cases (1.8%) than controls (1.0%, X2 P = 0.02), and more so in amelanotic/hypomelanotic melanoma (4.4%, X2 P = 0.007). No amelanotic/hypomelanotic melanoma cases carried an eye and skin darkening haplotype of OCA2 (including rs7174027), present in 7.1% of pigmented melanoma cases (P = 0.0005) and 9.4% controls. Variants in TYR and OCA2 may play a role in amelanotic/hypomelanotic melanoma susceptibility. We suggest that somatic loss of function at these loci could contribute to the loss of tumor pigmentation, consistent with this we found a higher rate of somatic mutation in TYR/OCA2 in amelanotic/hypomelanotic melanoma vs pigmented melanoma samples (28.6% vs 3.0%; P = 0.021) from The Cancer Genome Atlas Skin Cutaneous Melanoma collection.
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Affiliation(s)
- Jenna E. Rayner
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
| | - David L. Duffy
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Darren J. Smit
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Kasturee Jagirdar
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Katie J. Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Brian De’Ambrosis
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
- South East Dermatology, Annerley, Brisbane, Qld, Australia
| | - B. Mark Smithers
- Queensland Melanoma Project, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Erin K. McMeniman
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Aideen M. McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Helmut Schaider
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Mitchell S. Stark
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Richard A. Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia
- * E-mail:
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Carr MJ, Sun J, Kroon HM, Miura JT, Beasley GM, Farrow NE, Mosca PJ, Lowe MC, Farley CR, Kim Y, Naqvi SMH, Kirichenko DA, Potdar A, Daou H, Mullen D, Farma JM, Henderson MA, Speakman D, Serpell J, Delman KA, Smithers BM, Coventry BJ, Tyler DS, Thompson JF, Zager JS. Oncologic Outcomes After Isolated Limb Infusion for Advanced Melanoma: An International Comparison of the Procedure and Outcomes Between the United States and Australia. Ann Surg Oncol 2020; 27:5107-5118. [PMID: 32918177 DOI: 10.1245/s10434-020-09051-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/13/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose chemotherapy to extremities affected by locally advanced or in-transit melanoma. This study compared the outcomes of melanoma patients treated with ILI in the United States of America (USA) and Australia (AUS). METHODS Patients with locally recurrent in-transit melanoma treated with ILI at USA or AUS centers between 1992 and 2018 were identified. Demographic and clinicopathologic characteristics were collected. Primary outcomes of treatment response, in-field progression-free survival (IPFS), distant progression-free survival (DPFS), and overall survival (OS) were evaluated by the Kaplan-Meier method. Multivariable analysis evaluated whether availability of new systemic therapies affected outcomes. RESULTS More ILIs were performed in AUS (n = 411, 60 %) than in the USA (n = 276, 40 %). In AUS, more ILIs were performed for stage 3B disease than in the USA (62 % vs 46 %; p < 0.001). The reported complete response rates were similar (AUS 30 % vs USA 29 %). Among the stage 3B patients, AUS patients had better IPFS (p = 0.001), whereas DPFS and OS were similar between the two countries. Among the stage 3C patients, the USA patients had better OS (p < 0.001), whereas IPFS and DPFS were similar. Availability of new systemic therapies did not affect IPFS or DPFS in either country. However, the USA patients who received ILI after ipilimumab approval in 2011 had significantly improved OS (hazard ratio, 0.62; p = 0.013). CONCLUSIONS AUS patients were treated at an earlier disease stage than the USA patients with better IPFS for stage 3B disease. The USA patients treated after the availability of new systemic therapies had a better OS.
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Affiliation(s)
- Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hidde M Kroon
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - John T Miura
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania Perelman, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Paul J Mosca
- Department of Surgery, Duke University, Durham, NC, USA
| | - Michael C Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Clara R Farley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Dennis A Kirichenko
- University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Aishwarya Potdar
- University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Hala Daou
- University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Dean Mullen
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael A Henderson
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - David Speakman
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan Serpell
- Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Keith A Delman
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Brendon J Coventry
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. .,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Ng RL, Thomson IG, Smithers BM, Booth AWG. Intraoperative fluid restriction during enhanced recovery after surgery versus liberal fluids for esophagectomy: A single center retrospective pilot study. J Clin Anesth 2020; 67:110030. [PMID: 32891894 DOI: 10.1016/j.jclinane.2020.110030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/04/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rachel L Ng
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia; Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Iain G Thomson
- Upper Gastrointestinal Unit, Princess Alexandra Hospital, Brisbane, Australia; Academy of Surgery, Faculty of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.
| | - B Mark Smithers
- Upper Gastrointestinal Unit, Princess Alexandra Hospital, Brisbane, Australia; Academy of Surgery, Faculty of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.
| | - Anton W G Booth
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia; Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
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Kenyon-Smith TJ, Kroon HM, Miura JT, Teras J, Beasley GM, Mullen D, Farrow NE, Mosca PJ, Lowe MC, Farley CR, Potdar A, Daou H, Sun J, Farma JM, Henderson MA, Speakman D, Serpell J, Delman KA, Smithers BM, Barbour A, Coventry BJ, Tyler DS, Zager JS, Thompson JF. Factors predicting toxicity and response following isolated limb infusion for melanoma: An international multi-centre study. Eur J Surg Oncol 2020; 46:2140-2146. [PMID: 32739218 DOI: 10.1016/j.ejso.2020.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Isolated limb infusion (ILI) is a minimally-invasive procedure for delivering high-dose regional chemotherapy to treat melanoma in-transit metastases confined to a limb. The aim of this international multi-centre study was to identify predictive factors for toxicity and response. METHODS Data of 687 patients who underwent a first ILI for melanoma in-transit metastases confined to the limb between 1992 and 2018 were collected at five Australian and four US tertiary referral centres. RESULTS After ILI, predictive factors for increased limb toxicity (Wieberdink grade III/IV limb toxicity, n = 192, 27.9%) were: female gender, younger age, procedures performed before 2005, lower limb procedures, higher melphalan dose, longer drug circulation and ischemia times, and increased tissue hypoxia. No patient experienced grade V toxicity (necessitating amputation). A complete response (n = 199, 28.9%) was associated with a lower stage of disease, lower burden of disease (BOD) and thinner Breslow thickness of the primary melanoma. Additionally, an overall response (combined complete and partial response, n = 441, 64.1%) was associated with female gender, Australian centres, procedures performed before 2005, lower limb procedures and lower actinomycin-D doses. On multivariate analysis, higher melphalan dose remained a predictive factor for toxicity, while lower stage of disease and lower BOD remained predictive factors for overall response. CONCLUSION ILI is safe and effective to treat melanoma in-transit metastases. Predictive factors for toxicity and response identified in this study will allow improved patient selection and optimization of intra-operative parameters to increase response rates, while keeping toxicity low.
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Affiliation(s)
- Timothy J Kenyon-Smith
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Hidde M Kroon
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
| | - John T Miura
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA; Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jüri Teras
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia; Department of Surgical Oncology, North Estonian Medical Centre Foundation, Tallinn, Estonia; Tallinn University of Technology, Tallinn, Estonia
| | | | - Dean Mullen
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | | | - Paul J Mosca
- Department of Surgery, Duke University, Durham, NC, USA
| | - Michael C Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Clara R Farley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Aishwarya Potdar
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - Hala Daou
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael A Henderson
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - David Speakman
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan Serpell
- Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Barbour
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Brendon J Coventry
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Douglas S Tyler
- Department of Surgery, University Texas Medical Branch, Galveston, TX, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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van Hootegem SJM, Smithers BM, Gotley DC, Brosda S, Thomson IG, Thomas JM, Gartside M, Barbour AP. Baseline neutrophil-lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy. Dis Esophagus 2020; 33:5610875. [PMID: 31676907 DOI: 10.1093/dote/doz082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/24/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several studies have reported that neutrophil-lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery. METHODS We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998-2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan-Meier. Cox regression analysis was performed to assess the prognostic value of NLR. RESULTS The median OS and DFS times were 46 months (interquartile range [IQR]: 19-166) and 30 months (IQR: 13-166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses. CONCLUSION Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.
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Affiliation(s)
- S J M van Hootegem
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - B M Smithers
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, Mater Health Services, South Brisbane, Australia
| | - D C Gotley
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - S Brosda
- The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - I G Thomson
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - J M Thomas
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,Mater Research Institute, Mater Health Services, South Brisbane, Australia
| | - M Gartside
- The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - A P Barbour
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
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40
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Mahamat-Saleh Y, Hughes MCB, Miura K, Malt MK, von Schuckmann L, Khosrotehrani K, Smithers BM, Green AC. Patterns of Omega-3 and Omega-6 Fatty Acid Dietary Intake and Melanoma Thickness at Diagnosis. Cancer Epidemiol Biomarkers Prev 2020; 29:1647-1653. [PMID: 32430338 DOI: 10.1158/1055-9965.epi-20-0319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/05/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Experimental evidence suggests that dietary intakes of omega-3 and omega-6 polyunsaturated fatty acids have divergent effects on melanoma growth, but epidemiologic evidence on their combined effect is lacking. METHODS In 634 Australian patients with primary melanoma, we assessed prediagnosis consumption of 39 food groups by food frequency questionnaires completed within 2 months of diagnosis. We derived, by reduced rank regression, dietary patterns that explained variability in selected omega-3 and omega-6 fatty acid intakes. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between tertiles of dietary patterns and melanoma thickness >2 mm versus ≤2 mm were estimated using Poisson regression. RESULTS Overall omega-3 fatty acid intakes were low. Two major fatty acid dietary patterns were identified: "meat, fish, and fat," positively correlated with intakes of all fatty acids; and "fish, low-meat, and low-fat," positively correlated with long-chain omega-3 fatty acid intake, and inversely with medium-chain omega-3 and omega-6 fatty acid intakes. Prevalence of thick melanomas was significantly higher in those in the highest compared with lowest tertile of the "meat, fish, and fat" pattern (PR, 1.40; 95% CI, 1.01-1.94), especially those with serious comorbidity (PR, 1.83; 95% CI, 1.15-2.92) or a family history (PR, 2.32; 95% CI, 1.00-5.35). The "fish, low-meat, and low-fat" pattern was not associated with melanoma thickness. CONCLUSIONS People with high meat, fish, and fat intakes, who thus consumed relatively high levels of omega-3 and high omega-6 fatty acid intakes, are more likely to be diagnosed with thick than thin melanomas. IMPACT High omega-3 and omega-6 fatty acid intakes may contribute to patients' presentation with thick melanomas.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Centre for Research in Epidemiology and Population Health (CESP) - School of Medicine, Universite Paris Sud - School of Medicine, Universite Versailles Saint-Quentin-en-Yvelines (UVSQ); INSERM French National Institute for Health and Medical Research, Universite Paris Saclay, Villejuif, France.,Gustave Roussy, Villejuif, France
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Kyoko Miura
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maryrose K Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lena von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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von Schuckmann LA, Khosrotehrani K, Ghiasvand R, Hughes MCB, van der Pols JC, Malt M, Smithers BM, Green AC. Statins may reduce disease recurrence in patients with ulcerated primary melanoma. Br J Dermatol 2020; 183:1049-1055. [PMID: 32133622 DOI: 10.1111/bjd.19012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Statins may restrict the cellular functions required for melanoma growth and metastasis. OBJECTIVES To determine whether long-term statin use commenced before diagnosis of a primary melanoma is associated with reduced risk of melanoma recurrence. METHODS We prospectively followed a cohort of patients newly diagnosed between 2010 and 2014 with localized tumour-stage T1b to T4b melanoma in Queensland, Australia. We used Cox regression analyses to examine associations between long-term statin use and melanoma recurrence for the entire cohort, and then separately by sex and by presence of ulceration, due to evidence of effect modification. RESULTS Among 700 patients diagnosed with stage T1b to T4b primary melanoma (mean age 62 years, 59% male, 28% with ulcerated tumours), 94 patients (13%) developed melanoma recurrence within 2 years. Long-term statin users (n = 204, 29%) had a significantly lower risk of disease recurrence than nonusers [adjusted hazard ratio (HRadj ) 0·55, 95% confidence Interval (CI) 0·32-0·97] regardless of statin subtype or potency. Compared with nonusers of statins, risk of recurrence was significantly decreased in male statin users (HRadj 0·39, 95% CI 0·19-0·79) but not in female statin users (HRadj 0·82, 95% CI 0·29-2·27) and in statin users with ulcerated (HRadj 0·17, 95% CI 0·05-0·52) but not nonulcerated (HRadj 0·91, 95% CI 0·46-1·81) primary melanoma. CONCLUSIONS Statins commenced before melanoma diagnosis may reduce the risk of melanoma recurrence, especially in men and in those with ulcerated tumours. Clinical trial evaluation of the potential role of statins in improving the prognosis of high-risk melanoma is warranted.
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Affiliation(s)
- L A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - K Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - R Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - M C B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - J C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - M Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - B M Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - A C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,CRUK Manchester and Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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42
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Theile H, Moore J, Dunn N, Cossio D, Forristal CE, Green AC, Smithers BM. Regional nodal metastasis and 5-year survival in patients with thin melanoma in Queensland: a population-based study. ANZ J Surg 2020; 90:503-507. [PMID: 32162780 DOI: 10.1111/ans.15804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Optimal management of regional lymph nodes for thin cutaneous melanoma is uncertain. We evaluated regional lymph node involvement and 5-year melanoma-specific survival (MSS) in patients with thin (≤1 mm) primary melanoma. METHODS Patients with a melanoma, American Joint Committee on Cancer Staging 8th Edition pT1a (<0.8 mm) or pT1b (ulceration; and/or 0.8-1.0 mm), diagnosed during 2001-2015 were identified from the Queensland Oncology Repository. We extracted demographic, pathology and clinical details, including sentinel lymph node biopsy (SLNB), regional nodal dissection and nodal recurrence. Poisson regression was used to assess recurrence risk in patients who did not undergo SLNB. The 5-year MSS was calculated using the Kaplan-Maier method with Cox regression to compare survival outcomes according to SLNB performance. RESULTS Of the 27 824 eligible patients, 240 (0.9%) underwent SLNB. One hundred and seventy-eight patients (0.6%) without SLNB had nodal recurrence. Of the 4848 patients with a pT1b lesion, 166 (3.4%) had SLNB with 12 (7.2%) positive; of the remainder, 99 (2.1%) had clinical recurrence. Risk of recurrence was higher in males, nodular subtype and T1b lesions and lower if patients were aged >60 years. The 5-year MSS was similar for observed and SLNB cohorts (99.66% versus 98.92%) but worse for T1b lesions (98.90%) and clinical nodal recurrence (66.89%). CONCLUSION Overall prognosis for T1 melanoma is excellent with nodal involvement being rare. However, the American Joint Committee on Cancer 8th Edition T1b melanoma correlates with significantly worse 5-year MSS and increased regional nodal recurrence (notably for 0.8-1.0 mm lesions with ulceration). Further characterization of high-risk groups for nodal positivity that impacts patient outcome is needed for the pT1 melanoma cohort.
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Affiliation(s)
- Harrison Theile
- Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Julie Moore
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Nathan Dunn
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Danica Cossio
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Catherine E Forristal
- Queensland Melanoma Collaborative, Brisbane, Queensland, Australia.,Mater Research Institute, Brisbane, Queensland, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - B Mark Smithers
- Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Queensland Melanoma Collaborative, Brisbane, Queensland, Australia.,Mater Research Institute, Brisbane, Queensland, Australia
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Teras J, Kroon HM, Miura JT, Kenyon-Smith T, Beasley GM, Mullen D, Farrow NE, Mosca PJ, Lowe MC, Farley CR, Potdar A, Daou H, Sun J, Carr M, Farma JM, Henderson MA, Speakman D, Serpell J, Delman KA, Smithers BM, Barbour A, Tyler DS, Coventry BJ, Zager JS, Thompson JF. International Multicenter Experience of Isolated Limb Infusion for In-Transit Melanoma Metastases in Octogenarian and Nonagenarian Patients. Ann Surg Oncol 2020; 27:1420-1429. [PMID: 32152775 DOI: 10.1245/s10434-020-08312-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Isolated limb infusion (ILI) is used to treat in-transit melanoma metastases confined to an extremity. However, little is known about its safety and efficacy in octogenarians and nonagenarians (ON). PATIENTS AND METHODS ON patients (≥ 80 years) who underwent a first ILI for American Joint Committee on Cancer seventh edition stage IIIB/IIIC melanoma between 1992 and 2018 at nine international centers were included and compared with younger patients (< 80 years). A cytotoxic drug combination of melphalan and actinomycin-D was used. RESULTS Of the 687 patients undergoing a first ILI, 160 were ON patients (median age 84 years; range 80-100 years). Compared with the younger cohort (n = 527; median age 67 years; range 29-79 years), ON patients were more frequently female (70.0% vs. 56.9%; p = 0.003), had more stage IIIB disease (63.8 vs. 53.3%; p = 0.02), and underwent more upper limb ILIs (16.9% vs. 9.5%; p = 0.009). ON patients experienced similar Wieberdink limb toxicity grades III/IV (25.0% vs. 29.2%; p = 0.45). No toxicity-related limb amputations were performed. Overall response for ON patients was 67.3%, versus 64.6% for younger patients (p = 0.53). Median in-field progression-free survival was 9 months for both groups (p = 0.88). Median distant progression-free survival was 36 versus 23 months (p = 0.16), overall survival was 29 versus 40 months (p < 0.0001), and melanoma-specific survival was 46 versus 78 months (p = 0.0007) for ON patients compared with younger patients, respectively. CONCLUSIONS ILI in ON patients is safe and effective with similar response and regional control rates compared with younger patients. However, overall and melanoma-specific survival are shorter.
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Affiliation(s)
- Jüri Teras
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia.,Department of Surgical Oncology, North Estonian Medical Centre Foundation, Tallinn, Estonia.,Tallinn University of Technology, Tallinn, Estonia
| | - Hidde M Kroon
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. .,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
| | - John T Miura
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Tim Kenyon-Smith
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | | | - Dean Mullen
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | | | - Paul J Mosca
- Department of Surgery, Duke University, Durham, NC, USA
| | - Michael C Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Clara R Farley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Aishwarya Potdar
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hala Daou
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael A Henderson
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - David Speakman
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan Serpell
- Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Barbour
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Douglas S Tyler
- Department of Surgery, University Texas Medical Branch, Galveston, TX, USA
| | - Brendon J Coventry
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Janda M, Horsham C, Vagenas D, Loescher LJ, Gillespie N, Koh U, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Halpern A, Whiteman DC, Whitty JA, Smithers BM, Soyer HP. Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial. Lancet Digit Health 2020; 2:e129-e137. [PMID: 33334577 DOI: 10.1016/s2589-7500(20)30001-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/16/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Skin self-examinations supplemented with mobile teledermoscopy might improve early detection of skin cancers compared with naked-eye skin self-examinations. We aimed to assess whether mobile teledermoscopy-enhanced skin self-examination can improve sensitivity and specificity of self-detection of skin cancers when compared with naked-eye skin self-examination. METHODS This randomised, controlled trial was done in Brisbane (QLD, Australia). Eligible participants (aged ≥18 years) had at least two skin cancer risk factors as self-reported in the eligibility survey and had to own or have access to an iPhone compatible with a dermatoscope attachment (iPhone versions 5-8). Participants were randomly assigned (1:1), via a computer-generated randomisation procedure, to the intervention group (mobile dermoscopy-enhanced self-skin examination) or the control group (naked-eye skin self-examination). Control group and intervention group participants received web-based instructions on how to complete a whole body skin self-examination. All participants completed skin examinations at baseline, 1 month, and 2 months; intervention group participants submitted photographs of suspicious lesions to a dermatologist for telediagnosis after each skin examination and control group participants noted lesions on a body chart that was sent to the research team after each skin examination. All participants had an in-person whole-body clinical skin examination within 3 months of their last skin self-examination. Primary outcomes were sensitivity and specificity of skin self-examination, patient selection of clinically atypical lesions suspicious for melanoma or keratinocyte skin cancers (body sites examined, number of lesions photographed, types of lesions, and lesions missed), and diagnostic concordance of telediagnosis versus in-person whole-body clinical skin examination diagnosis. All primary outcomes were analysed in the modified intention-to-treat population, which included all patients who had a clinical skin examination within 3 months of their last skin self-examination. This trial was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12616000989448. FINDINGS Between March 6, 2017, and June 7, 2018, 234 participants consented to enrol in the study, of whom 116 (50%) were assigned to the intervention group and 118 (50%) were assigned to the control group. 199 participants (98 participants in the intervention group and 101 participants in the control group) attended the clinical skin examination and thus were eligible for analyses. Participants in the intervention group submitted 615 lesions (median 6·0 per person; range 1-24) for telediagnosis and participants in the control group identified and recorded 673 lesions (median 6·0 per person; range 1-16). At the lesion level, sensitivity for lesions clinically suspicious for skin cancer was 75% (95% CI 63-84) in the intervention group and 88% (95% CI 80-91) in the control group (p=0·04). Specificity was 87% (95% CI 85-90) in the intervention group and 89% (95% CI 87-91) in the control group (p=0·42). At the individual level, the intervention group had a sensitivity of 87% (95% CI 76-99) compared with 97% (95% CI 91-100) in the control group (p=0·26), and a specificity of 95% (95% CI 90-100) compared with 96% (95% CI 91-100) in the control group. The overall diagnostic concordance between the telediagnosis and in-person clinical skin examination was 88%. INTERPRETATION The use of mobile teledermoscopy did not increase sensitivity for the detection of skin cancers compared with naked-eye skin self-examination; thus, further evidence is necessary for inclusion of skin self-examination technology for public health benefit. FUNDING National Health and Medical Research Council (Australia).
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lois J Loescher
- Mel and Enid Zuckerman College of Public Health, Colleges of Nursing and Public Health, The University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, QLD, Australia
| | - Uyen Koh
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Allan Halpern
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David C Whiteman
- QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| | - Jennifer A Whitty
- Department of Population Health, University of East Anglia, Norwich, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Cambridge, UK
| | - B Mark Smithers
- Queensland Melanoma Project, The University of Queensland, Brisbane, QLD, Australia
| | - H Peter Soyer
- The Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia; Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
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45
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von Schuckmann LA, Hughes MCB, Ghiasvand R, Malt M, van der Pols JC, Beesley VL, Khosrotehrani K, Smithers BM, Green AC. Risk of Melanoma Recurrence After Diagnosis of a High-Risk Primary Tumor. JAMA Dermatol 2020; 155:688-693. [PMID: 31042258 DOI: 10.1001/jamadermatol.2019.0440] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance With emerging new systemic treatments for metastatic melanoma, early detection of disease recurrence is increasingly important. Objective To investigate the risk of melanoma recurrence in patients with a localized melanoma at a high risk of metastasis. Design, Setting, and Participants A total of 1254 patients with newly diagnosed, histologically confirmed tumor category T1b to T4b melanoma in Queensland, Australia, were recruited prospectively between October 1, 2010, and October 1, 2014, for participation in a cohort study. Data analysis was conducted from February 8, 2018, to February 20, 2019. We used Cox proportional hazards regression analysis to examine associations between patient and tumor factors and melanoma recurrence. Exposures Disease-free survival (DFS) by melanoma tumor category defined by the 7th vs 8th editions of the AJCC Cancer Staging Manual (AJCC 7 vs AJCC 8). Main Outcomes and Measures Melanoma recurrences were self-reported through follow-up questionnaires administered every 6 months and confirmed by histologic or imaging findings. Results Of 1254 patients recruited, 825 individuals (65.8%) agreed to participate. Thirty-six were found to be ineligible after providing consent and a further 89 patients were excluded after reclassifying tumors using AJCC 8, leaving 700 participants with high-risk primary melanoma (mean [SD] age, 62.2 [13.5] years; 410 [58.6%] men). Independent predictors of recurrence were head or neck site of primary tumor, ulceration, thickness, and mitotic rate greater than 3/mm2 (hazard ratio, 2.36; 95% CI, 1.19-4.71). Ninety-four patients (13.4%) developed a recurrence within 2 years of diagnosis: 66 tumors (70.2%) were locoregional, and 28 tumors (29.8%) developed at distant sites. After surgery for locoregional disease, 37 of 64 patients (57.8%) remained disease free at 2 years, 7 patients (10.9%) developed new locoregional recurrence, and 20 patients (31.3%), developed distant disease. Two-year DFS was similar when comparing AJCC 7 and AJCC 8, for T1b (AJCC 7, 253 [93.3% DFS]; AJCC 8, 242 [93.0% DFS]) and T4b (AJCC 7 and AJCC 8, 50 [68.0% DFS] category tumors in both editions. Patients with T2a to T4a tumors who did not have a sentinel lymph node biopsy (SLNB) at diagnosis had lower DFS than patients with the same tumor category and a negative SLNB (T2a: 136 [91.1%; 95% CI, 86.4-95.9] vs 96 [96.9%; 95 % CI, 93.4-100.0]; T4a: 33 [78.8%; 95% CI, 64.8-92.7] vs 6 [83.3; 95% CI, 53.5-100.0]). Conclusions and Relevance These findings suggest that 13.4% of patients with a high-risk primary melanoma will experience disease recurrence within 2 years. Head or neck location of initial tumor, SLNB positivity, and signs of rapid tumor growth may be associated with primary melanoma recurrence.
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Affiliation(s)
- Lena A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Reza Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maryrose Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Cancer Research UK Manchester, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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46
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McMeniman EK, Duffy DL, Jagirdar K, Lee KJ, Peach E, McInerney-Leo AM, De'Ambrosis B, Rayner JE, Smithers BM, Soyer HP, Sturm RA. The interplay of sun damage and genetic risk in Australian multiple and single primary melanoma cases and controls. Br J Dermatol 2020; 183:357-366. [PMID: 31794051 DOI: 10.1111/bjd.18777] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Skin phenotype, host genotype and ultraviolet (UV) damage play a role in the development of melanoma. OBJECTIVES To ascertain whether the level of UV damage at the site of melanomas was associated with genetic polymorphisms. METHODS Deep phenotyping was performed on 1244 individuals; 281 with multiple primary melanomas (MPMs), 304 with single primary melanoma (SPM) and 659 convenience controls. Genotype data was generated using the Illumina CoreExome microarray platform, assaying over 500 000 single-nucleotide polymorphisms. A subset of variants were combined to assess a polygenic risk score (PRS) for melanoma. RESULTS Most MPM cases were diagnosed in patients aged > 40 years, in sites with visible chronic UV damage. Women and those diagnosed at age ≤ 40 years were less likely to have perilesional UV damage. Patients with MPM had higher frequencies of MITF E318K, MC1R R-alleles and the ASIP risk haplotype. Individuals who had melanoma in a visibly UV-damaged site were more likely to carry MC1R rs75570604 [odds ratio (OR) 2·5], 9q31.2 rs10816595 (OR 1·4) and MTAP rs869329 (OR 1·4). These same alleles were more common in patients with MPM who were diagnosed at age ≤ 40 years. The mean PRS was significantly higher in MPM than in SPM and controls. Naevus count was comparable in early-onset MPM cases and those diagnosed at age > 40 years. CONCLUSIONS Our cohort demonstrated higher frequencies of previously reported alleles associated with melanoma. MPM melanomas more commonly occur in UV-damaged areas, and these individuals are more likely to carry MC1R red hair colour alleles. Awareness of the interplay of genetic vulnerability with UV damage can stratify risk and guide recommendations for melanoma screening. What's already known about this topic? Skin phenotype, host genotype and ultraviolet (UV) damage all play a role in melanoma development. One of the main risk factors is a personal history of melanoma; second and subsequent primary melanomas account for over 20% of all melanomas registered in Queensland. Multiple loci are associated with melanoma risk, including many low-penetrance loci, which may have a cumulatively significant risk. Population-wide screening programmes for melanoma are not yet economically viable. What does this study add? Patients diagnosed with melanoma at age ≤ 40 years were more likely than older patients to have melanomas in non-UV-damaged sites. Patients with multiple melanomas had higher frequencies of MITF E318K, MC1R R-alleles, and the ASIP extended risk haplotype than patients with single melanoma. CDKN2A, MC1R and MTAP variants were more frequent in patients who developed melanomas at a younger age, but also in those whose melanomas were all on visibly UV-damaged sites. What is the translational message? Incorporating these genetic findings into the known risk factors of skin phenotype and visible UV damage may allow for a more customized and economically feasible approach to early detection of melanoma, particularly in younger patients. Plain language summary available online.
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Affiliation(s)
- E K McMeniman
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D L Duffy
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - K J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - E Peach
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B De'Ambrosis
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,South East Dermatology, Annerley Square, Annerley, Brisbane, Queensland, Australia
| | - J E Rayner
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B M Smithers
- Queensland Melanoma Project, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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47
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von Schuckmann LA, Khosrotehrani K, Hughes MCB, van der Pols JC, Malt M, Smithers BM, Green AC. Prognostic implications of biopsy with tumor transection for patients with high-risk primary melanoma. J Am Acad Dermatol 2020; 82:1521-1524. [PMID: 32032688 DOI: 10.1016/j.jaad.2020.01.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Lena A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | - Maryrose Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Cancer Research UK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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48
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Teras J, Kroon HM, Miura JT, Beasley GM, Mullen D, Farrow NE, Mosca PJ, Lowe MC, Farley CR, Naqvi SMH, Sun J, Farma JM, Henderson MA, Speakman D, Serpell J, Smithers BM, Tyler D, Coventry BJ, Zager JS, Thompson JF. International Multi-Center Experience of Isolated Limb Infusion for In-Transit Melanoma Metastases in the Octogenarian Patient. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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49
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Narendra A, Baade PD, Aitken JF, Fawcett J, Smithers BM. Impact of hospital resection volume and service capability on post‐operative mortality following gastrectomy. ANZ J Surg 2019; 90:86-91. [DOI: 10.1111/ans.15616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Aaditya Narendra
- Upper‐GI, Soft Tissue and Melanoma Unit, Princess Alexandra HospitalThe University of Queensland Brisbane Queensland Australia
| | | | - Joanne F. Aitken
- Cancer Council Queensland Brisbane Queensland Australia
- The University of Queensland, University of Southern Queensland Brisbane Queensland Australia
| | - Jonathan Fawcett
- Hepato‐Pancreatico‐Biliary Unit, Princess Alexandra HospitalThe University of Queensland Brisbane Queensland Australia
| | - B. Mark Smithers
- Upper‐GI, Soft Tissue and Melanoma Unit, Princess Alexandra HospitalThe University of Queensland Brisbane Queensland Australia
- Cancer Alliance QueenslandThe University of Queensland Brisbane Queensland Australia
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50
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Claeson M, Baade P, Brown S, Soyer HP, Smithers BM, Green AC, Whiteman DC, Khosrotehrani K. Clinicopathological factors associated with death from thin (≤ 1·00 mm) melanoma. Br J Dermatol 2019; 182:927-931. [PMID: 31562769 DOI: 10.1111/bjd.18560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thin cutaneous melanomas (≤ 1·00 mm) are increasing worldwide, causing around a quarter of all melanoma deaths in the U.S.A. and Australia. Identification of predictive factors for potentially fatal thin melanomas could allow better use of resources for follow-up. OBJECTIVES To identify the clinicopathological factors associated with fatal thin melanomas. METHODS This large, nested case-case study extracted data from the population-based Queensland Cancer Registry, Australia. Our cohort consisted of Queensland residents aged 0-89 years who were diagnosed with a single, locally invasive thin melanoma (≤ 1·00 mm) between 1995 and 2014. Fatal cases (eligible patients who died from melanoma) were individually matched to three nonfatal cases (eligible patients who were not known to have died from melanoma) according to sex, age, year of diagnosis and follow-up interval. Using conditional logistic regression, we calculated odds ratios (ORs) for melanoma-specific death, adjusting for all collected clinicopathological variables. RESULTS In the cohort, 27 660 eligible patients were diagnosed with a single, thin melanoma. The final case-case series included 424 fatal cases and 1189 nonfatal cases. Fatal cases were sixfold as likely to arise on the scalp as on the back [OR 6·39, 95% confidence interval (CI) 2·57-15·92] and six times as likely to be of thickness 0·80-1·00 mm as of < 0·30 mm (OR 6·00, 95% CI 3·55-10·17). CONCLUSIONS Scalp location is a strong prognostic factor of death from thin melanoma. Further, this study provides support that melanomas with a thickness of 0·80-1·00 mm are the more hazardous thin lesions. Patients with these tumour characteristics require specific attention during follow-up. What's already known about this topic? Thin invasive melanomas (≤ 1·00 mm) contribute a substantial proportion of melanoma fatalities, owing to the high volume of disease. There is a need to find prognostic factors that will better identify fatal thin melanomas at the time of diagnosis. What does this study add? In this large population-based study, fatal thin tumours were sixfold as likely to be located on the scalp as on the back. Thin melanomas of 0·80-1·00 mm thickness were six times as likely to be associated with death as tumours < 0·30 mm. Scalp location and increasing thickness are strong predictive factors of fatal thin melanomas, indicating that patients with these tumour characteristics require close follow-up.
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Affiliation(s)
- M Claeson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Baade
- Cancer Council Queensland, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - S Brown
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - B M Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - A C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - D C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - K Khosrotehrani
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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