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Márquez-Rodas I, Muñoz Couselo E, Rodríguez Moreno JF, Arance Fernández AM, Berciano Guerrero MÁ, Campos Balea B, de la Cruz Merino L, Espinosa Arranz E, García Castaño A, Berrocal Jaime A. SEOM-GEM clinical guidelines for cutaneous melanoma (2023). Clin Transl Oncol 2024; 26:2841-2855. [PMID: 38748192 PMCID: PMC11467041 DOI: 10.1007/s12094-024-03497-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 10/11/2024]
Abstract
Cutaneous melanoma incidence is rising. Early diagnosis and treatment administration are key for increasing the chances of survival. For patients with locoregional advanced melanoma that can be treated with complete resection, adjuvant-and more recently neoadjuvant-with targeted therapy-BRAF and MEK inhibitors-and immunotherapy-anti-PD-1-based therapies-offer opportunities to reduce the risk of relapse and distant metastases. For patients with advanced disease not amenable to radical treatment, these treatments offer an unprecedented increase in overall survival. A group of medical oncologists from the Spanish Society of Medical Oncology (SEOM) and Spanish Multidisciplinary Melanoma Group (GEM) has designed these guidelines, based on a thorough review of the best evidence available. The following guidelines try to cover all the aspects from the diagnosis-clinical, pathological, and molecular-staging, risk stratification, adjuvant therapy, advanced disease therapy, and survivor follow-up, including special situations, such as brain metastases, refractory disease, and treatment sequencing. We aim help clinicians in the decision-making process.
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Affiliation(s)
| | - Eva Muñoz Couselo
- Hospital Vall d'Hebron & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | | | - Luis de la Cruz Merino
- Cancer Immunotherapy, Biomedicine Institute of Seville (IBIS)/CSIC, Clinical Oncology Department, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville, Spain
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Morrell S, Roder D, Currow D, Engel A, Hovey E, Lewis CR, Liauw W, Martin JM, Patel M, Thompson SR, O'Brien T. Estimated incidence of disruptions to event-free survival from non-metastatic cancers in New South Wales, Australia - a population-wide epidemiological study of linked cancer registry and treatment data. Front Oncol 2024; 14:1338754. [PMID: 39234396 PMCID: PMC11371594 DOI: 10.3389/fonc.2024.1338754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/25/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Population cancer registries record primary cancer incidence, mortality and survival for whole populations, but not more timely outcomes such as cancer recurrence, secondary cancers or other complications that disrupt event-free survival. Nonetheless, indirect evidence may be inferred from treatment data to provide indicators of recurrence and like events, which can facilitate earlier assessment of care outcomes. The present study aims to infer such evidence by applying algorithms to linked cancer registry and treatment data obtained from hospitals and universal health insurance claims applicable to the New South Wales (NSW) population of Australia. Materials and methods Primary invasive cancers from the NSW Cancer Registry (NSWCR), diagnosed in 2001-2018 with localized or regionalized summary stage, were linked to treatment data for five common Australian cancers: breast, colon/rectum, lung, prostate, and skin (melanomas). Clinicians specializing in each cancer type provided guidance on expected treatment pathways and departures to indicate remission and subsequent recurrence or other disruptive events. A sample survey of patients and clinicians served to test initial population-wide results. Following consequent refinement of the algorithms, estimates of recurrence and like events were generated. Their plausibility was assessed by their correspondence with expected outcomes by tumor type and summary stage at diagnosis and by their associations with cancer survival. Results Kaplan-Meier product limit estimates indicated that 5-year cumulative probabilities of recurrence and other disruptive events were lower, and median times to these events longer, for those staged as localized rather than regionalized. For localized and regionalized cancers respectively, these were: breast - 7% (866 days) and 34% (570 days); colon/rectum - 15% (732 days) and 25% (641 days); lung - 46% (552 days) and 66% (404 days); melanoma - 11% (893 days) and 38% (611 days); and prostate - 14% (742 days) and 39% (478 days). Cases with markers for these events had poorer longer-term survival. Conclusions These population-wide estimates of recurrence and like events are approximations only. Absent more direct measures, they nonetheless may inform service planning by indicating population or treatment sub-groups at increased risk of recurrence and like events sooner than waiting for deaths to occur.
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Affiliation(s)
- Stephen Morrell
- Division of Cancer Services and Information, Cancer Institute NSW, St Leonards, NSW, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, SA, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Alexander Engel
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Elizabeth Hovey
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Winston Liauw
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
- Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Jarad M Martin
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Department of Radiation Oncology, Calvary Mater Hospital Newcastle, Newcastle, NSW, Australia
- GenesisCare Maitland, Maitland, NSW, Australia
| | - Manish Patel
- Western Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Faculty of Health Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Stephen R Thompson
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
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3
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Butrimas G, Cibulskaitė R, Janonytė U, Silickytė R. Associations Between Cutaneous Melanoma Traits and the Likelihood of Metastasis. Cureus 2024; 16:e65754. [PMID: 39211683 PMCID: PMC11361285 DOI: 10.7759/cureus.65754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Objective This study aims to analyze melanoma characteristics and their correlation with metastasis in 604 patients diagnosed at the Hospital of Lithuanian University of Health Sciences (2018-2023). Materials and methods This retrospective study used coded data from the HLUHS Skin and Venereal Diseases Department database. Data was analyzed using IBM SPSS Statistics; significance was set at p < 0.05. Results Nodal metastases were more prevalent in T4 (43.3%) and T3 (29.7%) tumours compared to other thickness groups (p<0.001). Distant metastases increased with tumour thickness (3.0% in T1 to 21.1% in T4) (p<0.001). Ulceration correlated significantly with nodal (32.3% vs. 14.1%) and distant (16.6% vs. 5.7%) metastases (p<0.001). Males exhibit higher rates of advanced stages, nodal and distant metastases, larger tumours, and torso localization; females show higher rates of superficial spreading melanoma and extremity localization. Conclusions In Lithuanian cases, T1 melanomas prevailed, but T4 thickness was notably frequent, suggesting potential early detection issues. Tumour thickness correlated with nodal (21.2%) and distant metastases (9.9%), highlighting its predictive significance. Ulceration emerged as a prognostic indicator for distant metastases, with males showing thicker tumours and higher metastasis rates, stressing targeted interventions.
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Affiliation(s)
- Grinvydas Butrimas
- Dermatology, Lithuanian University of Health Sciences (LSMU), Kaunas, LTU
| | | | - Ugnė Janonytė
- Gastroenterology and Hepatology, Lithuanian University of Health Sciences (LSMU), Kaunas, LTU
| | - Rūta Silickytė
- Dermatology, Lithuanian University of Health Sciences (LSMU), Kaunas, LTU
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Egger ME, Alexander E, Van Meter T, Kong M, Maung AA, Valdes R, Hall MB, Linder MW. Corresponding ctDNA and tumor burden dynamics in metastatic melanoma patients on systemic treatment. Transl Oncol 2024; 42:101883. [PMID: 38306914 PMCID: PMC10850110 DOI: 10.1016/j.tranon.2024.101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
Radiographic imaging is the current standard for monitoring progression of tumor-burden and therapeutic resistance in patients with metastatic melanoma. Plasma circulating tumor DNA (ctDNA) has shown promise as a survelience tool, but longitudinal data on the dynamics between plasma ctDNA concentrations and radiographic imaging is lacking. We evaluated the relationship between longitudinal radiographic measures of tumor burden and ctDNA concentrations in plasma on 30 patients with metastatic melanoma on systemic treatment. In 9 patients with no radiographic evidence of disease over a total of 15 time points, ctDNA concentrations were undetectable. In 21 patients with radiographic tumor burden, ctDNA was detected in 81 % of 58 time points. Plasma ctDNA concentrations demonstrated a modest positive correlation with total tumor burden (TTB) measurements (R2= 0.49, p < 0.001), with the greatest degree of correlation observed under conditions of progressive disease (PD) (R2 = 0.91, p = 0.032). Plasma ctDNA concentrations were significantly greater at times of RECIST v1.1 progression (PD; 22.1 % ± 5.7 %) when compared to samples collected during stable disease (SD; 4.99 % ± 3.0 %) (p = 0.012); this difference was independent of total tumor burden (p = 0.997). Changes in plasma ctDNA showed a strong correlation with changes in TTB (R2= 0.88, p<0.001). These data suggest that measurements of plasma ctDNA during therapy are a better surrogate for responding versus non-responding disease compared to absolute tumor burden.
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Affiliation(s)
- Michael E Egger
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Evan Alexander
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Tracy Van Meter
- Department of Radiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Maiying Kong
- Biostatistics and Bioinformatics Facility, James Graham Brown Cancer Center, Louisville, KY, USA; Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Aye Aye Maung
- Biostatistics and Bioinformatics Facility, James Graham Brown Cancer Center, Louisville, KY, USA; Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Roland Valdes
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA; Department of Biochemistry and Molecular Biology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Melissa Barousse Hall
- UofL Health Brown Cancer Center, Louisville, KY, USA; Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Mark W Linder
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA; UofL Health Brown Cancer Center, Louisville, KY, USA.
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Reitmajer M, Leiter U, Nanz L, Amaral T, Flatz L, Garbe C, Forschner A. Long-term survival of stage IV melanoma patients: evaluation on 640 melanoma patients entering stage IV between 2014 and 2017. J Cancer Res Clin Oncol 2024; 150:15. [PMID: 38238578 PMCID: PMC10796594 DOI: 10.1007/s00432-023-05533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Since the introduction of immune checkpoint inhibitors (ICI) and targeted therapies (TT), survival rates of metastatic melanoma patients have increased significantly and complete remissions are no longer rarities. Consequently, there is an increasing number of long-term survivors who have not yet been comprehensively characterized. METHODS We included melanoma patients who entered stage IV between 2014 and 2017 and survived at least 5 years after entering stage IV. Descriptive statistics were performed to characterize the applied systemic therapies, response rates and to report which of these patients are still alive today. RESULTS 640 patients entered stage IV at the University Hospital Tuebingen. Of these, 207 patients (32%) were still alive at least 5 years after entering stage IV. Details of applied therapies and response rates were available in 176 patients (85%). About 90% of patients (n = 159) were still alive at the time of analysis. Median survival since first stage IV diagnosis was 6.0 years (range 5-9 years). An impressive majority of patients (n = 146, 83%) were no longer receiving systemic therapy at the time of evaluation. Complete remission under first line systemic therapy was seen in 36% of the patients. CONCLUSION This dataset comprises the largest available cohort of long-term surviving stage IV melanoma patients. Since 90% of patients in our cohort are still alive today, we expect an increasing number of long-term survivors in the future. Our data indicate the need for specific follow-up programs addressing the needs of long-term survivors.
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Affiliation(s)
- Markus Reitmajer
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany.
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Lena Nanz
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Teresa Amaral
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Lukas Flatz
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstraße 25, 72076, Tuebingen, Germany
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Koch A, Hofschröer V, Schwab A. Na + /H + exchanger NHE1 is active at cell-cell contacts and facilitates cell dissemination during collective migration of melanoma cells. Exp Dermatol 2024; 33:e14983. [PMID: 38009253 DOI: 10.1111/exd.14983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
Tumour cell detachment from the primary tumour is an early and crucial step of the metastatic cascade. At the single cell level, it was already shown that migrating melanoma cells establish both intra- and extracellular pH gradients and that the Na+ /H+ exchanger NHE1 accumulates at the leading edges to strengthen cell-matrix interactions. However, less is known about the role of NHE1 in collective cell migration and the specific pH microenvironment at tumour cell-cell contacts. We used MV3 melanoma cells transfected with a NHE1-expressing vector or a control vector. NHE1 localization at cell-cell contacts was assessed via immunofluorescence imaging. Collective migration was analysed by live-cell imaging. The NHE1 activity and the perimembranous pH were measured both intra- and extracellularly by ratiometric fluorescence microscopy. NHE1 clearly localizes at cell-cell contacts. Its overexpression further increases migratory speed and translocation in multidirectional pathway analyses. NHE1 overexpressing MV3 cells also move further away from their neighbouring cells during wound closure assays. pH measurements revealed that the NHE1 is highly active at cell-cell contacts of melanoma cells. NHE1-mediated pH dynamics at such contact sites are more prominent in NHE1-overexpressing melanoma cells. Our findings highlight the contribution of the NHE1 towards modulation and plasticity of melanoma cell-cell contacts. We propose that its localization and functional activity at cell-cell contacts promotes evasion of single melanoma cells from the primary tumour.
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Affiliation(s)
- Alexander Koch
- Institute of Physiology II, University of Münster, Münster, Germany
| | | | - Albrecht Schwab
- Institute of Physiology II, University of Münster, Münster, Germany
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Cai S, Li W, Deng C, Tang Q, Zhou Z. Predicting cutaneous malignant melanoma patients' survival using deep learning: a retrospective cohort study. J Cancer Res Clin Oncol 2023; 149:17103-17113. [PMID: 37755576 DOI: 10.1007/s00432-023-05421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Cutaneous malignant melanoma (CMM) has the worst prognosis among skin cancers, especially metastatic CMM. Predicting its prognosis accurately could direct clinical decisions. METHODS The Surveillance, Epidemiology, and End Results database was screened to collect CMM patients' data. According to diagnosed time, patients were subdivided into three cohorts, train cohort (diagnosed between 2010 and 2013), validation cohort (diagnosed in 2014), and test cohort (diagnosed in 2015). Train cohort was used to train deep learning survival model for cutaneous malignant melanoma (DeepCMM). DeepCMM was then evaluated in train cohort and validation cohort internally, and validated in test cohort externally. RESULTS DeepCMM showed 0.8270 (95% CI, confidence interval, CI 0.8260-0.8280) as area under the receiver operating characteristic curve (AUC) in train cohort, 0.8274 (95% CI 0.8286-0.8298) AUC in validation cohort, and 0.8303 (95% CI 0.8289-0.8316) AUC in test cohort. Then DeepCMM was packaged into a Windows 64-bit software for doctors to use. CONCLUSION Deep learning survival model for cutaneous malignant melanoma (DeepCMM) can offer a reliable prediction on cutaneous malignant melanoma patients' overall survival.
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Affiliation(s)
- Siyu Cai
- Dermatology Department, General Hospital of Western Theater Command PLA, No. 270, Rongdu Avenue, Chengdu, 610083, Sichuan, China
| | - Wei Li
- Cancer Research Center, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9 Beiguan Street, Tongzhou District, Beijing, 101149, China
| | - Cong Deng
- Department of Respiratory and Critical Care Medicine, General Hospital of Western Theater Command, No. 270 Rongdu Avenue, Chengdu, 610083, Sichuan, China
| | - Qiao Tang
- Dermatology Department, Medical Center Hospital of Qionglai City, No. 172 Xinglin Road, Qionglai City, Chengdu, 611500, Sichuan, China
| | - Zhou Zhou
- Dermatology Department, General Hospital of Western Theater Command PLA, No. 270, Rongdu Avenue, Chengdu, 610083, Sichuan, China.
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Pedersen AB, Johnsen SP, Horváth-Puhó E. Long-Term Temporal Trends in Survival Among Danish Patients with Advanced Cutaneous Melanoma: A Nationwide Follow-Up Study. Clin Epidemiol 2023; 15:733-742. [PMID: 37342868 PMCID: PMC10278652 DOI: 10.2147/clep.s407060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Population-based data on survival trends over time among patients with advanced cutaneous melanoma are lacking. We examined changes in mortality for patients diagnosed from 1980 to 2011 in a nationwide historical follow-up study using population-based medical registries from Denmark. Material and Methods The study population included all Danish patients with an incident diagnosis of advanced (metastatic or unresectable stage IIIA, IIIB, IIIC, or IV) cutaneous melanoma (ie, initial diagnosis for melanoma at stage III/IV) between 1980-2011 and who were followed-up until 2013. For each patient, we randomly matched 100 individuals from the general population on sex and year of birth. Age-standardized mortality rates were calculated by calendar year of diagnosis overall, 30 days after diagnosis, and during 31 to 364 days and 0-10 years after diagnosis. Stratified Cox's proportional hazards regression was used to compute hazard ratios. Results We identified a total of 1236 patients and 123,600 comparison cohort members. We observed that the standardized mortality rates of patients with advanced melanoma dropped from the 1980s onwards, but remain high (eg, 74.3 and 248.4 per 1000 person-years in 0-30 days and 31-364 days after diagnosis, respectively, for patients diagnosed during 2008-2011). Compared with the general population, patients with advanced melanoma had a 10.4-fold increased hazard of death during 0-10 years of follow-up. The highest relative mortality was found for the first year following melanoma diagnosis. No improvements in survival compared to the general population were observed in the most recent years of the study period, thus in 2004-2007 and 2008-2011. Discussion and Conclusion Survival of patients with advanced cutaneous melanoma in Denmark improved between 1980 and 2013 but appears to have leveled off in the years leading up to more widespread introduction of newer immuno-oncology therapies.
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Affiliation(s)
- Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Søren P Johnsen
- Center for Clinical Health Services Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Bailey CN, Martin BJ, Petkov VI, Schussler NC, Stevens JL, Bentler S, Cress RD, Doherty JA, Durbin EB, Gomez SL, Gonsalves L, Hernandez BY, Liu L, Morawski BM, Schymura MJ, Schwartz SM, Ward KC, Wiggins C, Wu XC, Goldberg MS, Siegel JJ, Cook RW, Covington KR, Kurley SJ. 31-Gene Expression Profile Testing in Cutaneous Melanoma and Survival Outcomes in a Population-Based Analysis: A SEER Collaboration. JCO Precis Oncol 2023; 7:e2300044. [PMID: 37384864 PMCID: PMC10530886 DOI: 10.1200/po.23.00044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE The DecisionDx-Melanoma 31-gene expression profile (31-GEP) test is validated to classify cutaneous malignant melanoma (CM) patient risk of recurrence, metastasis, or death as low (class 1A), intermediate (class 1B/2A), or high (class 2B). This study aimed to examine the effect of 31-GEP testing on survival outcomes and confirm the prognostic ability of the 31-GEP at the population level. METHODS Patients with stage I-III CM with a clinical 31-GEP result between 2016 and 2018 were linked to data from 17 SEER registries (n = 4,687) following registries' operation procedures for linkages. Melanoma-specific survival (MSS) and overall survival (OS) differences by 31-GEP risk category were examined using Kaplan-Meier analysis and the log-rank test. Crude and adjusted hazard ratios (HRs) were calculated using Cox regression model to evaluate variables associated with survival. 31-GEP tested patients were propensity score-matched to a cohort of non-31-GEP tested patients from the SEER database. Robustness of the effect of 31-GEP testing was assessed using resampling. RESULTS Patients with a 31-GEP class 1A result had higher 3-year MSS and OS than patients with a class 1B/2A or class 2B result (MSS: 99.7% v 97.1% v 89.6%, P < .001; OS: 96.6% v 90.2% v 79.4%, P < .001). A class 2B result was an independent predictor of MSS (HR, 7.00; 95% CI, 2.70 to 18.00) and OS (HR, 2.39; 95% CI, 1.54 to 3.70). 31-GEP testing was associated with a 29% lower MSS mortality (HR, 0.71; 95% CI, 0.53 to 0.94) and 17% lower overall mortality (HR, 0.83; 95% CI, 0.70 to 0.99) relative to untested patients. CONCLUSION In a population-based, clinically tested melanoma cohort, the 31-GEP stratified patients by their risk of dying from melanoma.
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Affiliation(s)
| | | | - Valentina I Petkov
- Surveillance Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, MD
| | | | | | | | - Rosemary D Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA
| | - Jennifer A Doherty
- Hunstman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Eric B Durbin
- Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, Kentucky Cancer Registry, University of Kentucky, KY
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Lou Gonsalves
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT
| | | | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY
- School of Public Health Epidemiology & Biostatistics, University at Albany, State University of New York, New York, NY
| | - Stephen M Schwartz
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Charles Wiggins
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Xiao-Cheng Wu
- Louisiana State University, School of Medicine, New Orleans, LA
| | - Matthew S Goldberg
- Castle Biosciences, Inc, Friendswood, TX
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY
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Alves da Costa F, Ramos A, Bernardo C, Cardoso Borges F, Costa Miranda A. Epidemiological and clinical characterization of a population-based cohort of cutaneous malignant melanoma patients in the South Region of Portugal. Sci Rep 2023; 13:5641. [PMID: 37024631 PMCID: PMC10079850 DOI: 10.1038/s41598-023-32434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
An historical population-based cohort study was conducted aiming to estimate the incidence of cutaneous malignant melanoma in the South Region of Portugal between Jan 2016 and June 2017; to clinically characterize the diagnosed individuals; to describe instituted treatment; and to estimate survival outcomes. Data were extracted from a cancer registry (ROR-Sul) covering 4,800,000 inhabitants (46% of the Portuguese population) and included a total of 789 individuals meeting eligibility criteria. The crude incidence rate (18 months) of melanoma was 13.36/100,000 inhabitants and the Age-Standardized Incidence Rate per 100,000 World population was 9.65/100,000 inhabitants. The most common histological subtypes identified were superficial extension, followed by malignant melanoma and nodular melanoma. Most cases were diagnosed in stage I (50.39%), equally distributed by sex and with a median age of 65 years. During the study period, 174 recurrence events were recorded (23.45%) and recurrence-free survival rate was significantly lower in more advanced stages. Patients had a two-fold risk of recurrence/death when in presence of ulcerated tumors [adjusted hazard ratio (adj HR) = 2.28; 95% confidence interval (CI) 1.40-3.70]. Overall survival rate at 3-years was 80.54% (95% CI 77.58-83.15), higher than previous national reports, and considerably higher for individuals diagnosed at earlier stages (p < 0.001). We have also identified differential survival outcomes in stages II-III explained by the uptake of sentinel lymph node biopsy. The epidemiologic and clinical characteristics of malignant melanoma patients studied are consistent with international literature. The incidence and rates observed suggests additional public health campaigns are needed to modify behaviours of the Portuguese population and thus reduce their risk.
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Affiliation(s)
- Filipa Alves da Costa
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal.
- Research Institute for Medicines (iMED), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
| | - Adriana Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Catarina Bernardo
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Fábio Cardoso Borges
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Ana Costa Miranda
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
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Sandmann S, Richter S, Jiang X, Varghese J. Reconstructing Clonal Evolution-A Systematic Evaluation of Current Bioinformatics Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5128. [PMID: 36982036 PMCID: PMC10049679 DOI: 10.3390/ijerph20065128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
The accurate reconstruction of clonal evolution, including the identification of newly developing, highly aggressive subclones, is essential for the application of precision medicine in cancer treatment. Reconstruction, aiming for correct variant clustering and clonal evolution tree reconstruction, is commonly performed by tedious manual work. While there is a plethora of tools to automatically generate reconstruction, their reliability, especially reasons for unreliability, are not systematically assessed. We developed clevRsim-an approach to simulate clonal evolution data, including single-nucleotide variants as well as (overlapping) copy number variants. From this, we generated 88 data sets and performed a systematic evaluation of the tools for the reconstruction of clonal evolution. The results indicate a major negative influence of a high number of clones on both clustering and tree reconstruction. Low coverage as well as an extreme number of time points usually leads to poor clustering results. An underlying branched independent evolution hampers correct tree reconstruction. A further major decline in performance could be observed for large deletions and duplications overlapping single-nucleotide variants. In summary, to explore the full potential of reconstructing clonal evolution, improved algorithms that can properly handle the identified limitations are greatly needed.
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Affiliation(s)
- Sarah Sandmann
- Institute of Medical Informatics, University of Münster, 48149 Münster, Germany
| | - Silja Richter
- Institute of Medical Informatics, University of Münster, 48149 Münster, Germany
| | - Xiaoyi Jiang
- Department of Computer Science, University of Münster, 48149 Münster, Germany
| | - Julian Varghese
- Institute of Medical Informatics, University of Münster, 48149 Münster, Germany
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12
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Koczkodaj P, Sulkowska U, Didkowska J, Rutkowski P, Mańczuk M. Melanoma Mortality Trends in 28 European Countries: A Retrospective Analysis for the Years 1960-2020. Cancers (Basel) 2023; 15:cancers15051514. [PMID: 36900305 PMCID: PMC10001381 DOI: 10.3390/cancers15051514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND In 2020, in 27 European Union (EU) Member States, melanoma accounted for 4% of all new cancer cases and 1.3% of all cancer deaths, making melanoma the fifth most common malignancy and placing it in the 15 most frequent causes of cancer deaths in the EU-27. The main aim of our study was to investigate melanoma mortality trends in 25 EU Member States and three non-EU countries (Norway, Russia, and Switzerland) in a broad time perspective (1960-2020) in a younger (45-74 years old) vs. older age group (75+). METHODS We identified melanoma deaths defined by ICD-10 codes C-43 for individuals aged 45-74 and 75+ years old between 1960-2020 in 25 EU Member States (excluding Iceland, Luxembourg, and Malta) and in 3 non-EU countries-Norway, Russia, and Switzerland. Age-standardized melanoma mortality rates (ASR) were computed using the direct age-standardization for Segi's World Standard Population. To determine melanoma-mortality trends with 95% confidence intervals (CI), Joinpoint regression was applied. Our analysis used the Join-point Regression Program, version 4.3.1.0 (National Cancer Institute, Bethesda, MD, USA). RESULTS Regardless of the considered age groups, in all investigated countries, in general, melanoma standardized mortality rates were higher for men than women. Considering the age group 45-74, the highest number of countries was characterized by decreasing melanoma-mortality trends in both sexes-14 countries. Contrarily, the highest representation of countries in the age group 75+ was connected with increasing melanoma-mortality trends in both sexes-26 countries. Moreover, considering the older age group-75+-there was no country with a decreasing melanoma mortality in both sexes. CONCLUSIONS Investigated melanoma-mortality trends vary in individual countries and age groups; however, a highly concerning phenomenon-increasing melanoma-mortality rates in both sexes-was observed in 7 countries for the younger age group and in as many as 26 countries for the older age group. There is a need for coordinated public-health actions to address this issue.
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Affiliation(s)
- Paweł Koczkodaj
- Cancer Epidemiology and Primary Prevention Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-57-09-478
| | - Urszula Sulkowska
- National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Joanna Didkowska
- Cancer Epidemiology and Primary Prevention Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Marta Mańczuk
- Cancer Epidemiology and Primary Prevention Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
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13
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Jarell A, Gastman BR, Dillon LD, Hsueh EC, Podlipnik S, Covington KR, Cook RW, Bailey CN, Quick AP, Martin BJ, Kurley SJ, Goldberg MS, Puig S. Optimizing treatment approaches for patients with cutaneous melanoma by integrating clinical and pathologic features with the 31-gene expression profile test. J Am Acad Dermatol 2022; 87:1312-1320. [PMID: 35810840 DOI: 10.1016/j.jaad.2022.06.1202] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Many patients with low-stage cutaneous melanoma will experience tumor recurrence, metastasis, or death, and many higher staged patients will not. OBJECTIVE To develop an algorithm by integrating the 31-gene expression profile test with clinicopathologic data for an optimized, personalized risk of recurrence (integrated 31 risk of recurrence [i31-ROR]) or death and use i31-ROR in conjunction with a previously validated algorithm for precise sentinel lymph node positivity risk estimates (i31-SLNB) for optimized treatment plan decisions. METHODS Cox regression models for ROR were developed (n = 1581) and independently validated (n = 523) on a cohort with stage I-III melanoma. Using National Comprehensive Cancer Network cut points, i31-ROR performance was evaluated using the midpoint survival rates between patients with stage IIA and stage IIB disease as a risk threshold. RESULTS Patients with a low-risk i31-ROR result had significantly higher 5-year recurrence-free survival (91% vs 45%, P < .001), distant metastasis-free survival (95% vs 53%, P < .001), and melanoma-specific survival (98% vs 73%, P < .001) than patients with a high-risk i31-ROR result. A combined i31-SLNB/ROR analysis identified 44% of patients who could forego sentinel lymph node biopsy while maintaining high survival rates (>98%) or were restratified as being at a higher or lower risk of recurrence or death. LIMITATIONS Multicenter, retrospective study. CONCLUSION Integrating clinicopathologic features with the 31-GEP optimizes patient risk stratification compared to clinicopathologic features alone.
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Affiliation(s)
- Abel Jarell
- Northeast Dermatology Associates, PC, Portsmouth, New Hampshire
| | | | - Larry D Dillon
- Surgical Oncology & General Surgery, Colorado Springs, Colorado
| | - Eddy C Hsueh
- Department of Surgery, St Louis University, St Louis, Missouri
| | - Sebastian Podlipnik
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain. & Centro de investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Kyle R Covington
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Robert W Cook
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas.
| | | | - Ann P Quick
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Brian J Martin
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Sarah J Kurley
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | | | - Susana Puig
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain. & Centro de investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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14
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Ke X, Wu T, Gao G, Yang S, Lin W, Xiao Y, Shen M, Chen M, Chen X, Zhao S, Su J. Delay in Seeking Medical Attention and Diagnosis in Chinese Melanoma Patients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14916. [PMID: 36429635 PMCID: PMC9690906 DOI: 10.3390/ijerph192214916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Melanoma is a highly malignant skin tumor, and prolonged delay in seeking medical attention (DSMA) and delay in diagnosis (DD) may result in poor prognoses. Through a web-based questionnaire, we explored the related factors affecting the DSMA and DD of melanoma in a Chinese population. A total of 112 valid answer sheets were received. After obtaining the relevant information, we analyzed the factors associated with DSMA and DD. The median time of DSMA was 8.0 (quartiles: 1.0, 29.3) months, and the median of patients' DD was 1.0 (quartiles: 1.0, 8.3) month. The subsequent analysis showed that DSMA and DD were positively correlated to age and negatively correlated to education background and annual household income. Patients with a history of tumors or previous health-seeking behavior because of other skin lesions had significantly longer DSMA than those without. Patients who sought medical help at general tertiary hospitals for the first time had a significantly shorter DD than those who chose other hospitals. Our study found that DSMA and DD are associated with factors such as age, education, income, and patients' histories. Secondary prevention of Chinese melanoma should be strengthened to reduce DSMA and DD to improve patients' prognoses.
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Affiliation(s)
- Xinchen Ke
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Tianhao Wu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guiyun Gao
- Department of Dermatology, Hunan Aerospace Hospital, Changsha 410205, China
| | - Songchun Yang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wenrui Lin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
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15
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Di Carlo V, Stiller CA, Eisemann N, Bordoni A, Matz M, Curado MP, Daubisse‐Marliac L, Valkov M, Bulliard J, Morrison D, Johnson C, Girardi F, Marcos‐Gragera R, Šekerija M, Larønningen S, Sirri E, Coleman MP, Allemani C. Does the morphology of cutaneous melanoma help to explain the international differences in survival? Results from 1 578 482 adults diagnosed during 2000-2014 in 59 countries (CONCORD-3). Br J Dermatol 2022; 187:364-380. [PMID: 35347700 PMCID: PMC9542891 DOI: 10.1111/bjd.21274] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND CONCORD-3 highlighted wide disparities in population-based 5-year net survival for cutaneous melanoma during 2000-2014. Clinical evidence suggests marked international differences in the proportion of lethal acral and nodular subtypes of cutaneous melanoma. OBJECTIVES We aimed to assess whether the differences in morphology may explain global variation in survival. METHODS Patients with melanoma were grouped into the following seven morphological categories: malignant melanoma, not otherwise specified (International Classification of Diseases for Oncology, third revision morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722-8723, 8726-8727, 8730, 8740-8741, 8746, 8761, 8770-8774, 8780). We estimated net survival using the nonparametric Pohar Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All-ages survival estimates were standardized using the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death. RESULTS Worldwide, the proportion of nodular melanoma ranged between 7% and 13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). Overall, 36% of tumours were classified as superficial spreading melanoma. During 2010-2014, age-standardized 5-year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but was only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66% and 95%. Nodular melanoma had the poorest prognosis in all countries. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes. CONCLUSIONS This study provides the broadest picture of distribution and population-based survival trends for the main morphological subtypes of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment. What is already known about this topic? The histopathological features of cutaneous melanoma vary markedly worldwide. The proportion of melanomas with the more aggressive acral lentiginous or nodular histological subtypes is higher in populations with predominantly dark skin than in populations with predominantly fair skin. What does this study add? We aimed to assess the extent to which these differences in morphology may explain international variation in survival when all histological subtypes are combined. This study provides, for the first time, international comparisons of population-based survival at 5 years for the main histological subtypes of melanoma for over 1.5 million adults diagnosed during 2000-2014. This study highlights the less favourable distribution of histological subtypes in Asia and Central and South America, and the poorer prognosis for nodular and acral lentiginous melanomas. We found that later stage at diagnosis does not fully explain the higher excess risk of death for nodular and acral lentiginous melanoma compared with superficial spreading melanoma.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | | | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of LübeckRatzeburger Allee160 23538LübeckGermany
| | - Andrea Bordoni
- Ticino Cancer Registry, Dipartimento Sanità e SocialitàDivisione della Salute PubblicaVia Ciseri10 6600LocarnoSwitzerland
| | - Melissa Matz
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | - Maria P. Curado
- Goiânia Cancer Registry, Group of Epidemiology and Statistics on CancerAC Camargo Cancer CenterRua Tamandaré 753 ‐ LiberdadeSP01525‐001São PauloBrazil
| | - Laetitia Daubisse‐Marliac
- Tarn Cancer RegistryInstitut Universitaire du Cancer Toulouse – Oncopole Institut C. Regaud1 Avenue Irène Joliot‐Curie31059ToulouseFrance
| | - Mikhail Valkov
- Northern State Medical UniversityProspekt Troitskiy51 163000ArkhangelskRussian Federation
| | - Jean‐Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
- Neuchâtel and Jura Tumour RegistryNeuchâtelSwitzerland
| | - David Morrison
- Scottish Cancer RegistryGyle Square, 1 South Gyle CrescentEH12 9EBEdinburghUK
| | - Chris Johnson
- Cancer Data Registry of Idaho, 615 North 7th StreetID83701‐1278BoiseUSA
| | - Fabio Girardi
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
- Division of Medical Oncology 2Veneto Institute of Oncology IOV‐IRCCSVia Gattamelata64 35128PadovaItaly
| | - Rafael Marcos‐Gragera
- Epidemiology Unit and Girona Cancer RegistryCatalan Institute of Oncology (ICO), IDIBGI, Oncology Coordination Plan, Department of Health Government of Catalonia17004GironaSpain
- University of Girona (UdG)17004GironaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Mario Šekerija
- Croatian National Cancer RegistryCroatian Institute of Public HealthRockefeller Street7 10000ZagrebCroatia
| | | | - Eunice Sirri
- Epidemiological Cancer Registry of Lower SaxonyOffis Caree GmbHIndustriestr92 6121OldenburgGermany
| | - Michel P. Coleman
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
| | - Claudia Allemani
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
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16
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Podlipnik S, Boada A, López-Estebaranz JL, Martín-González MM, Redondo P, Martin B, Quick AP, Bailey CN, Kurley SJ, Cook RW, Puig S. Using a 31-Gene Expression Profile Test to Stratify Patients with Stage I-II Cutaneous Melanoma According to Recurrence Risk: Update to a Prospective, Multicenter Study. Cancers (Basel) 2022; 14:cancers14041060. [PMID: 35205808 PMCID: PMC8870692 DOI: 10.3390/cancers14041060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Many people with skin cancer will have their cancer come back. The 31-gene expression profile (31-GEP) test can help predict if a cancer has a low (Class 1) or high (Class 2) chance of returning. This study looked at 86 patients with early skin cancer to see how well the 31-GEP test predicted if their cancer would return. None of the patients with a Class 1 GEP result had their cancer return within 3 years, but one-fourth of patients with a Class 2 result did. This study showed that the 31-GEP test can help predict if a patient’s skin cancer will return. Accurate risk prediction can help doctors make better treatment plans for patients with skin cancer. Abstract Background: Fifteen to forty percent of patients with localized cutaneous melanoma (CM) (stages I–II) will experience disease relapse. The 31-gene expression profile (31-GEP) uses gene expression data from the primary tumor in conjunction with clinicopathologic features to refine patient prognosis. The study’s objective was to evaluate 31-GEP risk stratification for disease-free survival (DFS) in a previously published cohort with longer follow-up. Methods: Patients with stage IB–II CM (n = 86) were prospectively tested with the 31-GEP. Follow-up time increased from 2.2 to 3.9 years. Patient outcomes were compared using Kaplan-Meier and Cox regression analysis. Results: A Class 2B result was a significant predictor of 3-year DFS (hazard ratio (HR) 8.4, p = 0.008) in univariate analysis. The 31-GEP significantly stratified patients by risk of relapse (p = 0.005). A Class 2B result was associated with a lower 3-year DFS (75.0%) than a Class 1A result (100%). The 31-GEP had a high sensitivity (77.8%) and negative predictive value (95.0%). Conclusions: The 31-GEP is a significant predictor of disease relapse in patients with stage IB–II melanoma and accurately stratified patients by risk of relapse.
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Affiliation(s)
- Sebastian Podlipnik
- Department of Dermatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (S.P.); (S.P.)
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Institut d’investigació Germans Trias Badalona, 08916 Barcelona, Spain;
| | - Jose L. López-Estebaranz
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Alcorcón, 28922 Madrid, Spain;
| | | | - Pedro Redondo
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain;
| | - Brian Martin
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Ann P. Quick
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Christine N. Bailey
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Sarah J. Kurley
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Robert W. Cook
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
- Correspondence:
| | - Susana Puig
- Department of Dermatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (S.P.); (S.P.)
- Department of Dermatology, University of Barcelona, IDIBAPS, 08007 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Instituto de Salud Carlos III, 46010 Barcelona, Spain
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17
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Zheng G, Chattopadhyay S, Sundquist K, Sundquist J, Försti A, Hemminki A, Hemminki K. Types of second primary cancer influence overall survival in cutaneous melanoma. BMC Cancer 2021; 21:1123. [PMID: 34663263 PMCID: PMC8524825 DOI: 10.1186/s12885-021-08845-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Favorable survival in malignant cutaneous melanoma (melanoma) has increased the likelihood of second primary cancer (SPC). We assess the influence of patient characteristics at diagnosis of first melanoma and the type of SPC (second melanoma and other SPC) on overall survival. METHODS We used the Swedish Cancer Registry data to assess overall survival in melanoma for the period 1990 to 2015. Kaplan-Meier curves were plotted and hazard ratios (HRs) were estimated with Cox regression models by considering SPC diagnosis as a time-dependent variable. RESULTS A total of 46,726 patients were diagnosed with melanoma, and 15.3% of them developed SPC, among which, two thirds were other SPCs. Second melanomas were diagnosed early (31% during the first year) compared to non-melanoma SPCs (9.5%). Survival for women with second melanoma or other SPC (56 and 21% alive after 25 years of follow-up, respectively) exceeded the male rates (21 and 10%, respectively) but all these figures were lower than for females (60% alive) or males (48%) without SPC. Time dependent analysis showed vastly increased HRs for cancer types that are fatal also as first cancers, but SPC-specific HRs remained relatively uniform, irrespective of SPC diagnosed soon or late after first melanoma. In early-onset melanoma, SPC diagnosis after 10 years may not negatively influence overall survival. CONCLUSIONS As the overall survival of patients with many types of SPCs is unfavorable, advice about health lifestyle should benefit smoking patients and early detection methods may be recommended for SPCs of the breast, prostate and colorectum.
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Affiliation(s)
- Guoqiao Zheng
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
| | - Subhayan Chattopadhyay
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Hopp Children's Cancer Center (KiTZ), 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic.
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
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El-Qushayri AE, Benmelouka AY, Salman S, Nardone B. Melanoma and hypertension, is there an association? A U.S. population based study. Ital J Dermatol Venerol 2021; 157:270-274. [PMID: 34545727 DOI: 10.23736/s2784-8671.21.07089-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Melanoma is one of the three major types of skin cancer. In this study we aimed to investigate the association between melanoma and hypertension comorbidity. METHODS We performed a population based study using NHANES database during the period 1999-2004. Data were analyzed using SPSS version 24. RESULTS Data for 12446 individuals of which 146 had a diagnosis for melanoma were extracted. Melanoma group were older than the no melanoma group as 51% of the melanoma group were 60 years or elder; however 53.6% of the no melanoma group falls below 30 years old. Melanoma group had higher frequency of hypertension (37%) compared to the no melanoma group (22.5%). Logistic regression revealed that melanoma patients had higher odds of hypertension prevalence using the unadjusted model (odds ratio (OR): 2.03, 95% confidence interval (CI): 1.45-2.84, p <0.001). However, after controlling of all potential confounding factors the significance was lost (OR: 0.89, 95% CI: 0.61-1.3, p = 0.54). CONCLUSIONS There may be a possible association of melanoma with hypertension comorbidity. With the limitations we faced, we encourage further research to confirm the association of melanoma and hypertension comorbidity.
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Affiliation(s)
| | | | - Samar Salman
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University Hospital, Tanta University, Tanta, Egypt
| | - Beatrice Nardone
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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19
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Subramanian S, Han G, Olson N, Leong SP, Kashani-Sabet M, White RL, Zager JS, Sondak VK, Messina JL, Pockaj B, Kosiorek HE, Vetto J, Fowler G, Schneebaum S, Han D. Regression in melanoma is significantly associated with a lower regional recurrence rate and better recurrence-free survival. J Surg Oncol 2021; 125:229-238. [PMID: 34535899 DOI: 10.1002/jso.26678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The prognostic significance of regression in predicting melanoma recurrences is unknown. We present a large multicenter study correlating regression with recurrence. METHODS The Sentinel Lymph Node Working Group database was queried from 1993 to 2018 for cases with regression data. Clinicopathologic factors were correlated with overall and first-site of recurrence and with recurrence-free survival (RFS). RESULTS There were 4790 patients and the median follow-up was 39.6 months. Regression and recurrences were seen in 1081 (22.6%) and 773 (16.1%) cases, respectively. First-site locoregional and distant recurrences were seen in 412 (8.6%) and 352 (7.3%) patients, respectively. Regression was seen in 15.8% and 24.7% of all cases with and without recurrences (p < 0.0001), respectively, while regression was seen in 14.3% and 17.9% of first-site locoregional and distant recurrent cases, respectively, compared with 23.3% and 22.9% of patients with regression and without first-site locoregional and distant recurrences, respectively (p = 0.29). On multivariable analysis, after controlling for age, gender, thickness, ulceration, lymphovascular invasion, and sentinel lymph node status, regression significantly predicted improved RFS (p = 0.004) and fewer first-site regional recurrences (p = 0.017). CONCLUSION Our data suggest that regression is a favorable prognostic marker in melanoma and predicts significantly better RFS and decreased first-site regional recurrences.
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Affiliation(s)
- Sarayu Subramanian
- Division of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Natalie Olson
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Stanley P Leong
- Division of Cutaneous Oncology, Center for Melanoma Research and Treatment, California Pacific Medical Center and Research Institute, San Francisco, California, USA
| | - Mohammed Kashani-Sabet
- Division of Cutaneous Oncology, Center for Melanoma Research and Treatment, California Pacific Medical Center and Research Institute, San Francisco, California, USA
| | - Richard L White
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncologic Sciences, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
| | - Barbara Pockaj
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Heidi E Kosiorek
- Division of Surgical Oncology and Endocrine Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - John Vetto
- Division of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Graham Fowler
- Division of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Schlomo Schneebaum
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Dale Han
- Division of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
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20
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Primary Melanoma Characteristics of Metastatic Disease: A Nationwide Cancer Registry Study. Cancers (Basel) 2021; 13:cancers13174431. [PMID: 34503242 PMCID: PMC8431672 DOI: 10.3390/cancers13174431] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Melanoma of the skin is the most lethal form of skin cancer. Almost 40% of the patients who die of metastatic melanoma did not have metastases at first diagnosis. More knowledge about patient and tumour characteristics as well as patterns of disease progression is needed. We described the characteristics and disease patterns of early-stage melanomas that progress into metastatic disease. We observed that more than half of the patients with metastases were initially diagnosed with early-stage disease. Additionally, we found that melanomas in some specific body sites were likely to metastasize to certain organs. Our finding that a substantial proportion of patients with metastases were initially diagnosed with early-stage disease highlights the need to investigate who these high-risk patients are. Abstract The characteristics and disease patterns of primary stage I and II cutaneous melanomas that progress to stage III or IV disease were investigated based on data from the Netherlands Cancer Registry (NCR). Data on stage III or IV melanomas at first diagnosis or during follow-up between 2017 and 2019 were retrieved. Patient and primary tumour characteristics were investigated in relation to time to disease progression and the number of organ sites with metastatic disease using regression models. In total, 2763 patients were included, of whom 1613 were diagnosed with stage IV disease. Among the patients with stage IV disease, 60% (n = 963) were initially diagnosed with stage I or II disease. The proportion of patients who received a sentinel lymph node biopsy increased after the introduction of adjuvant therapy in 2019 from 61% to 87%. Among all patients with stage III disease who were eligible for adjuvant systemic therapy (n = 453) after 2019, 37% were not treated with this therapy. Among patients with stage IV disease, lung metastases were most often detected as the first metastatic site and females presented with more metastatic sites than males. Most patient and primary tumour characteristics were not associated with the distant metastatic organ site, except melanoma localisation in the lower extremities and the head or neck. Our observation that most stage IV patients were initially diagnosed with early-stage disease highlights the need for more accurate risk prediction models.
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21
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m5C-Related Signatures for Predicting Prognosis in Cutaneous Melanoma with Machine Learning. JOURNAL OF ONCOLOGY 2021; 2021:6173206. [PMID: 34394351 PMCID: PMC8360728 DOI: 10.1155/2021/6173206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 12/21/2022]
Abstract
Background Cutaneous melanoma (CM) is one of the most life-threatening primary skin cancers and is prone to distant metastases. A widespread presence of posttranscriptional modification of RNA, 5-methylcytosine (m5C), has been observed in human cancers. However, the potential mechanism of the tumorigenesis and prognosis in CM by dysregulated m5C-related regulators is obscure. Methods We use comprehensive bioinformatics analyses to explore the expression of m5C regulators in CM, the prognostic implications of the m5C regulators, the frequency of the copy number variant (CNV), and somatic mutations in m5C regulators. Additionally, the CM patients were divided into three clusters for better predicting clinical features and outcomes via consensus clustering of m5C regulators. Then, the risk score was established via Lasso Cox regression analysis. Next, the prognosis value and clinical characteristics of m5C-related signatures were further explored. Then, machine learning was used to recognize the outstanding m5C regulators to risk score. Finally, the expression level and clinical value of USUN6 were analyzed via the tissue microarray (TMA) cohort. Results We found that m5C regulators were dysregulated in CM, with a high frequency of somatic mutations and CNV alterations of the m5C regulatory gene in CM. Furthermore, 16 m5C-related proteins interacted with each other frequently, and we divided CM patients into three clusters to better predicting clinical features and outcomes. Then, five m5C regulators were selected as a risk score based on the LASSO model. The XGBoost algorithm recognized that NOP2 and NSUN6 were the most significant risk score contributors. Immunohistochemistry has verified that low expression of USUN6 was closely correlated with CM progression. Conclusion The m5C-related signatures can be used as new prognostic biomarkers and therapeutic targets for CM, and NSUN6 might play a vital role in tumorigenesis and malignant progression.
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22
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Majem M, Manzano JL, Marquez-Rodas I, Mujika K, Muñoz-Couselo E, Pérez-Ruiz E, de la Cruz-Merino L, Espinosa E, Gonzalez-Cao M, Berrocal A. SEOM clinical guideline for the management of cutaneous melanoma (2020). Clin Transl Oncol 2021; 23:948-960. [PMID: 33651321 PMCID: PMC8057998 DOI: 10.1007/s12094-020-02539-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
Melanoma affects about 6000 patients a year in Spain. A group of medical oncologists from Spanish Society of Medical Oncology (SEOM) and Spanish Multidisciplinary Melanoma Group (GEM) has designed these guidelines to homogenize the management of these patients. The diagnosis must be histological and determination of BRAF status has to be performed in patients with stage ≥ III. Stage I–III resectable melanomas will be treated surgically. In patients with stage III melanoma, adjuvant treatment with immunotherapy or targeted therapy is also recommended. Patients with unresectable or metastatic melanoma will receive treatment with immunotherapy or targeted therapy, the optimal sequence of these treatments remains unclear. Brain metastases require a separate consideration, since, in addition to systemic treatment, they may require local treatment. Patients must be followed up closely to receive or change treatment as soon as their previous clinical condition changes, since multiple therapeutic options are available.
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Affiliation(s)
- M Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, c/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain.
| | - J L Manzano
- Department of Medical Oncology, H. Germans Trias i Pujol, Catalan Institute of Oncology, ICO-Badalona, Badalona, Spain
| | - I Marquez-Rodas
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERONC, Madrid, Spain
| | - K Mujika
- Department of Medical Oncology, UGC de Oncología de Gipuzkoa, OSI Donostialdea-Onkologikoa, Guipúzcoa, Spain
| | - E Muñoz-Couselo
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Hospital Vall d'Hebron Barcelona, Barcelona, Spain
| | - E Pérez-Ruiz
- Department of Medical Oncology, Hospital Costa del Sol and UGC Oncol, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Regional Virgen Victoria, Málaga, Spain
| | - L de la Cruz-Merino
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain.,Medicine Department, Universidad de Sevilla, Seville, Spain
| | - E Espinosa
- Department of Medical Oncology, Hospital Universitario La Paz, CIBERONC, Madrid, Spain
| | - M Gonzalez-Cao
- Oncology Department (IOR), Hospital Dexeus, Barcelona, Spain
| | - A Berrocal
- Department of Medical Oncology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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23
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Wang Y, Ren S, Gong X, Wang J, Zhu N, Cai D, Ruan J. Prognostic factors for postoperative survival in melanoma patients with bone metastasis. Medicine (Baltimore) 2021; 100:e24558. [PMID: 33530285 PMCID: PMC7850704 DOI: 10.1097/md.0000000000024558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Melanoma can spread to the bone by metastasis and is relevant to a poor outcome. However, because of the rarity of melanoma patients with bone metastasis, the prognostic postoperative survival factors of them have not been elucidated. The aim of this special population-based cohort was to elucidate the prognostic factors associated with postoperative survival. The Surveillance, Epidemiology, and End Results database was used to extract postoperative survival data relating to patients with melanoma and bone metastasis at diagnosis between 2010 and 2016, along with data on a range of potential postoperative prognostic factors. We then investigated the potential postoperative prognostic roles of these factors using a Cox regression model and the Kaplan-Meier analysis. In all, the Surveillance, Epidemiology, and End Results database included 186 cases. Regarding overall survival, the 1-, 3-, and 5-year overall survival rates for the entire cohort were 36.2%, 15.4%, and 9.5%, respectively. Regarding cancer-specific survival, the 1-, 3-, and 5-year cancer-specific survival rates were 42.0%, 23.2%, and 16.6%, respectively. Within a cohort of melanoma patients with bone metastasis after surgery, our analysis showed that a smaller tumor size and the lack of metastases at other sites were predictors of survival.
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Affiliation(s)
- Yucheng Wang
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
- Hebei North University, Zhangjiakou, Hebei
| | - Shihong Ren
- Department of Orthopedics, The First People's Hospital of Wenling, Taizhou, Zhejiang, China
| | - Xiaokang Gong
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
| | - Jiacheng Wang
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
| | - Ning Zhu
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
| | | | - Jianwei Ruan
- Department of Orthopedics, Taizhou University Affiliated Municipal Hospital, Taizhou, Zhejiang
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24
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Ma Q, Yang L, Gu F. Immunotherapy-related pneumonitis and bacterial pneumonia after the successful treatment of metastatic malignant melanoma with pembrolizumab: A case report. Medicine (Baltimore) 2021; 100:e24018. [PMID: 33429766 PMCID: PMC7793440 DOI: 10.1097/md.0000000000024018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pembrolizumab, a monoclonal antibody targeting programmed cell death-1 (PD-1), is approved as a therapy for unresectable or metastatic melanoma. Immunotherapy-associated pneumonitis is an uncommon event. PATIENT CONCERNS A 73-year-old man was admitted to our hospital with a history of melanoma on the left side of the face (resected in December 2012) and metastasis to the left lung upper lobe (resected in November 2016). Recurrence of metastasis to the bilateral lungs and left pleura was detected in April 2018. A complete response was achieved following treatment with pembrolizumab, with lower limb rashes the only adverse events occurring during therapy. The patient was readmitted in March 2019 with a productive cough, shortness of breath, and mild fever, and sputum culture identified Escherichia coli. DIAGNOSIS A diagnosis of pneumonia was made, and although cough and shortness of breath responded to ceftazidime and levofloxacin, but fever and poor appetite persisted. Computed tomography showed no improvement in the bilateral lower lobe lesions. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis. The response to prednisone confirmed the diagnosis. INTERVENTIONS The patient first received ceftazidime and levofloxacin, but the symptoms persisted. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis. OUTCOME Complete resolution of the bilateral lung lesions occurred after 45 days of prednisone therapy. CONCLUSION This case report highlights that both pneumonitis and bacterial pneumonia can occur as complications of anti-PD-1 immunotherapy.
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25
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Di Carlo V, Estève J, Johnson C, Girardi F, Weir HK, Wilson RJ, Minicozzi P, Cress RD, Lynch CF, Pawlish KS, Rees JR, Coleman MP, Allemani C. Trends in short-term survival from distant-stage cutaneous melanoma in the United States, 2001-2013 (CONCORD-3). JNCI Cancer Spectr 2021; 4:pkaa078. [PMID: 33409455 PMCID: PMC7771008 DOI: 10.1093/jncics/pkaa078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/13/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Survival from metastatic cutaneous melanoma is substantially lower than for localized disease. Treatments for metastatic melanoma have been limited, but remarkable clinical improvements have been reported in clinical trials in the last decade. We described the characteristics of US patients diagnosed with cutaneous melanoma during 2001-2013 and assessed trends in short-term survival for distant-stage disease. Methods Trends in 1-year net survival were estimated using the Pohar Perme estimator, controlling for background mortality with life tables of all-cause mortality rates by county of residence, single year of age, sex, and race for each year 2001-2013. We fitted a flexible parametric survival model on the log-hazard scale to estimate the effect of race on the hazard of death because of melanoma and estimated 1-year net survival by race. Results Only 4.4% of the 425 915 melanomas were diagnosed at a distant stage, cases diagnosed at a distant stage are more commonly men, older patients, and African Americans. Age-standardized, 1-year net survival for distant-stage disease was stable at approximately 43% during 2001-2010. From 2010 onward, survival improved rapidly, reaching 58.9% (95% confidence interval = 56.6% to 61.2%) for patients diagnosed in 2013. Younger patients experienced the largest improvement. Survival for distant-stage disease increased in both Blacks and Whites but was consistently lower in Blacks. Conclusions One-year survival for distant-stage melanoma improved during 2001-2013, particularly in younger patients and those diagnosed since 2010. This improvement may be a consequence of the introduction of immune-checkpoint-inhibitors and other targeted treatments for metastatic and unresectable disease. Persistent survival inequalities exist between Blacks and Whites, suggesting differential access to treatment.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacques Estève
- Université Claude Bernard, Hospices Civils de Lyon, Service de Biostatistique, Lyon Cedex 03, France
| | | | - Fabio Girardi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reda J Wilson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pamela Minicozzi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosemary D Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | | | - Judith R Rees
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Gambichler T, Tsagoudis K, Kiecker F, Reinhold U, Stockfleth E, Hamscho R, Egberts F, Hauschild A, Amaral T, Garbe C. Prognostic significance of an 11-gene RNA assay in archival tissue of cutaneous melanoma stage I-III patients. Eur J Cancer 2021; 143:11-18. [PMID: 33278769 DOI: 10.1016/j.ejca.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to validate the results of an 11-gene expression profiling (GEP) assay which aims to improve the precision of individual prognosis beyond conventional American Joint Committee on Cancer staging for patients with cutaneous melanoma. METHODS The reverse transcriptase polymerase chain reaction test of 11 prospectively selected genes was performed on 291 formalin-fixed, paraffin-embedded primary tumours of patients with stage I-III cutaneous melanoma. The expression levels of eight prognostic and three reference genes were used in a predefined algorithm to calculate a numerical score (-0.84 to 3.53) and then assign each patient to a preselected risk group (low versus high score) for melanoma-specific survival (MSS). RESULTS One hundred twenty-seven patients were allocated to the low-score group, with a corresponding five-year disease-free survival (DFS) and MSS of 95% and 99%, respectively. 164 patients were allocated to the high-score group, with a corresponding five-year DFS and MSS of 78% and 88%. Continuous regression analysis demonstrated decreasing MSS probabilities with increasing scores. In a multivariate cox regression, only the 11-GEP, tumour thickness and age were statistically associated with MSS (p = 0.0068, 0.002 and 0.0159). CONCLUSIONS The 11-GEP has been validated as an independent predictor of outcome for melanoma patients. More specifically, using an 11-GEP score cut-off of ≤0, the assay can identify patient cohorts with 10-year survival probabilities well above 90%. This information may be used in the decision-making for a potential adjuvant therapy.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | | | - Felix Kiecker
- Skin Cancer Center, Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Reinhold
- Dermatological Centre Bonn Friedensplatz, Bonn, Germany
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Rami Hamscho
- Department of Dermatology and Allergology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Friederike Egberts
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Axel Hauschild
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
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Moreno M, Schmidt JC, Grosbelli L, Dassi M, Mierzwa RV. Análise de prevalência e mortalidade associada ao melanoma cutâneo em pacientes atendidos em centro de referência no Oeste do estado de Santa Catarina, Brasil, de 2002 a 2016. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i4.1018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: determinar a epidemiologia e as características clínicas do melanoma cutâneo (MC) na região Oeste do estado de Santa Catarina, Brasil. Métodos: este estudo transversal e descritivo avaliou o comportamento clínico e o perfil epidemiológico do MC em pacientes de 78 municípios do Oeste do Estado de Santa Catarina, Brasil, no período de 2002 a 2016, tratados no Sistema Único de Saúde. Para a análise dos dados foi utilizado o teste do Qui-quadrado. Para elaborar as curvas de sobrevida, foi considerado um período de 10 anos (teste Log Rank). Resultados: dados de 1.146 pacientes foram avaliados, e houve uma média de 20 casos/100.000 habitantes/ano. Encontravam-se nos estágios I e II 63,5% dos pacientes. A sobrevida global em 10 anos de acompanhamento foi de 89%(IC95% 87,7% - 91,5%). Pacientes do sexo feminino apresentaram maior sobrevida (94,5%; IC95% 92,7% - 96,4% vs. 82,6%; IC95% 78,9% - 86,3%; p < 0,001) e variáveis de melhor prognóstico. Conclusões: o Oeste do estado de Santa Catarina apresentou uma alta prevalência de MC. As características clínicas e epidemiológicas encontradas concordam com as descritas nas populações que residem em regiões geográficas equivalentes; mas diferem de outras regiões do Brasil. Essas diferenças, associadas à organização do sistema público de saúde de referência e contra-referência, podem explicar aos resultados de sobrevida encontrados.
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Real-world clinical outcomes of anticancer treatments and prognostic
factors in patients with advanced melanoma in China. INTERNATIONAL JOURNAL OF SURGERY: ONCOLOGY 2020. [DOI: 10.1097/ij9.0000000000000097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center. Cornea 2020; 40:554-563. [PMID: 32740010 DOI: 10.1097/ico.0000000000002449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the clinical features and outcomes for conjunctival melanoma based on patient age. METHODS A retrospective review of patients with conjunctival melanoma managed at a single tertiary referral center from April 18, 1974, to September 9, 2019. Clinical features and outcomes were compared by patient age category at presentation (young ≤45 years, middle-aged 46-69 years, and older ≥70 years), with Kaplan-Meier and Cox proportional hazard analysis [hazard ratio (95% confidence interval)]. RESULTS There were 629 patients categorized as young in 130 (21%), middle-aged in 278 (44%), and older in 221 (35%). A comparison by age category (young vs. middle-aged vs. older) revealed that older patients had melanoma with greater number of affected quadrants (1.7 vs. 1.8 vs. 2.0, P = 0.001) and clock hours (3.9 vs. 4.2 vs. 5.2, P = 0.001). All patients were treated with surgical excision, with no difference in requirement for additional medical or radiation therapy. By 10-year Kaplan-Meier outcomes, older patients had more frequent visual acuity loss ≥3 lines (11% vs. 28% vs. 64%, P < 0.001) and local tumor recurrence (38% vs. 46% vs. 70%, P < 0.001). Hazard ratio for the oldest age group (age ≥70) revealed a 7.76-fold (3.33-18.09) increased risk for visual acuity loss (P < 0.001), and a 2.08-fold (1.32-3.28) increased risk of local tumor recurrence (P = 0.002). There was no difference by age in risk for enucleation, exenteration, locoregional lymph node involvement, distant systemic metastasis, or death. CONCLUSIONS Older patients with conjunctival melanoma present with more extensive disease and have increased risk for visual acuity loss and local tumor recurrence.
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Strömberg U, Parkes BL, Holmén A, Peterson S, Holmberg E, Baigi A, Piel FB. Disease mapping of early- and late-stage cancer to monitor inequalities in early detection: a study of cutaneous malignant melanoma. Eur J Epidemiol 2020; 35:537-547. [PMID: 32350689 PMCID: PMC7320924 DOI: 10.1007/s10654-020-00637-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/21/2020] [Indexed: 01/23/2023]
Abstract
We consider disease mapping of early- and late-stage cancer, in order to identify and monitor inequalities in early detection. Our method is demonstrated by mapping cancer incidence at high geographical resolution using data on 10,302 cutaneous malignant melanoma (CMM) cases within the 3.7 million population of South-West Sweden. The cases were geocoded into small-areas, each with a population size between 600 and 2600 and accessible socio-demographic data. Using the disease mapping application Rapid Inquiry Facility (RIF) 4.0, we produced regional maps to visualise spatial variations in stage I, II and III-IV CMM incidences, complemented by local maps to explore the variations within two urban areas. Pronounced spatial disparities in stage I CMM incidence were revealed by the regional and local maps. Stage I CMM incidence was markedly higher in wealthier small-areas, in particular within each urban area. A twofold higher stage I incidence was observed, on average, in the wealthiest small-areas (upper quintile) than in the poorest small-areas (lower quintile). We identified in the regional map of stage III-IV CMM two clusters of higher or lower than expected late-stage incidences which were quite distinct from those identified for stage I. In conclusion, our analysis of CMM incidences supported the use of this method of cancer stage incidence mapping for revealing geographical and socio-demographic disparities in cancer detection.
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Affiliation(s)
- Ulf Strömberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy At University of Gothenburg, PO Box 463, 405 30, Gothenburg, Sweden.
- Department of Research and Development, Region Halland, Halmstad, Sweden.
| | - Brandon L Parkes
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Anders Holmén
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | | | | | - Amir Baigi
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Frédéric B Piel
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Imperial College London, London, UK
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31
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Miller R, Walker S, Shui I, Brandtmüller A, Cadwell K, Scherrer E. Epidemiology and survival outcomes in stages II and III cutaneous melanoma: a systematic review. Melanoma Manag 2020; 7:MMT39. [PMID: 32399177 PMCID: PMC7212505 DOI: 10.2217/mmt-2019-0022] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim Management of cutaneous melanoma (CM) is continually evolving with adjuvant treatment of earlier stage disease. The aim of this review was to identify published epidemiological data for stages II-III CM. Materials & methods Systematic searches of Medline and Embase were conducted to identify literature reporting country/region-specific incidence, prevalence, survival or mortality outcomes in stage II and/or III CM. Screening was carried out by two independent reviewers. Results & conclusion Of 41 publications, 14 described incidence outcomes (incidence rates per stage were only reported for US and Swedish studies), 33 reported survival or mortality outcomes and none reported prevalence data. This review summarizes relevant data from published literature and highlights an overall paucity of epidemiological data in stages II and III CM.
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Affiliation(s)
- Rachael Miller
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Sophie Walker
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Irene Shui
- Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | | | - Kevin Cadwell
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
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32
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Moody R, Wilson K, Jaworowski A, Plebanski M. Natural Compounds with Potential to Modulate Cancer Therapies and Self-Reactive Immune Cells. Cancers (Basel) 2020; 12:cancers12030673. [PMID: 32183059 PMCID: PMC7139800 DOI: 10.3390/cancers12030673] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 12/24/2022] Open
Abstract
Cancer-related deaths are approaching 10 million each year. Survival statistics for some cancers, such as ovarian cancer, have remained unchanged for decades, with women diagnosed at stage III or IV having over 80% chance of a lethal cancer recurrence after standard first-line treatment (reductive surgery and chemotherapy). New treatments and adjunct therapies are needed. In ovarian cancer, as in other cancers, the immune response, particularly cytotoxic (CD8+) T cells are correlated with a decreased risk of recurrence. As well as completely new antigen targets resulting from DNA mutations (neo-antigens), these T cells recognize cancer-associated overexpressed, re-expressed or modified self-proteins. However, there is concern that activation of self-reactive responses may also promote off-target pathology. This review considers the complex interplay between cancer-reactive and self-reactive immune cells and discusses the potential uses for various leading immunomodulatory compounds, derived from plant-based sources, as a cancer therapy option or to modulate potential autoimmune pathology. Along with reviewing well-studied compounds such as curcumin (from turmeric), epigallocatechin gallate (EGCG, from green tea) and resveratrol (from grapes and certain berries), it is proposed that compounds from novel sources, for example, native Australian plants, will provide a useful source for the fine modulation of cancer immunity in patients.
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33
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Zheng G, Chattopadhyay S, Sundquist K, Sundquist J, Försti A, Hemminki A, Hemminki K. Association between tumor characteristics and second primary cancers with cutaneous melanoma survival: A nationwide cohort study. Pigment Cell Melanoma Res 2020; 33:625-632. [PMID: 32012479 DOI: 10.1111/pcmr.12868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/11/2020] [Accepted: 01/29/2020] [Indexed: 12/17/2022]
Abstract
The increased survival in malignant cutaneous melanoma (melanoma) is probably due to early diagnosis combined with improved treatment most recently. National health campaigns and screening programs for melanoma detection were started in Sweden several decades ago. We want to assess the influence of tumor characteristics, based on the TNM classification, and of second primary cancers on overall survival in melanoma. We used the Swedish Cancer Registry to assess all-cause survival in melanoma from 2003 to 2015. Hazard ratios (HRs) were estimated using multivariable Cox regression models. A total of 19,773 melanoma patients were diagnosed with TNM data. Survival showed a strong improving trend over time (p-trend <.001). T1a was the most common classification (48.0% of all), while higher T class was associated systematically with worse survival (p-trend <.001). For distant metastases, the HR was 3.17, accounting for 0.9% of the patients. Any types of second primary cancers, other than melanoma, were associated with an HR of 2.00, accounted for 6.7% of all cases. Even if melanoma survival in Sweden ranks among the best national rates, the large percentage of patients with advanced tumors (T3b, T4a, and T4b, 17%) and 21% of deaths with T1a call for improved preventive and follow-up strategies.
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Affiliation(s)
- Guoqiao Zheng
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Subhayan Chattopadhyay
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA.,Department of Functional Pathology, Center for Community-based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Izumo, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA.,Department of Functional Pathology, Center for Community-based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Izumo, Japan
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic
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34
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Lim Y, Lee J, Lee DY. Is the survival rate for acral melanoma actually worse than other cutaneous melanomas? J Dermatol 2019; 47:251-256. [PMID: 31889335 DOI: 10.1111/1346-8138.15201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022]
Abstract
It is still not clear whether the survival rate for acral melanoma (AM) is better or worse than that of cutaneous melanoma developed at other sites. We sought to evaluate the difference in survival depending on the primary tumor site of cutaneous melanoma. We retrospectively reviewed primary cutaneous melanoma cases diagnosed at Samsung Medical Center, a tertiary institution in Korea, from January 1995 to July 2017. The cohort consisted of 642 patients, with 389 non-acral cutaneous melanoma (NACM) patients and 253 AM patients. The AM patients had a higher percentage of stage 0 diagnoses than the NACM patients (31.6% vs 6.9%, respectively). The factors associated with overall survival were primary tumor site, sex, age, American Joint Committee on Cancer stage, surgery and medical treatment (P < 0.05). Non-acral sites showed worse survival in multivariable analysis (hazard ratio [HR], 1.457; 95% confidence interval [CI], 1.051-2.020; P = 0.0240). Among the NACM, melanomas on the trunk were associated with a higher risk of mortality compared with AM (HR, 1.883; 95% CI, 1.142-3.107; P = 0.0131). Acral melanoma was associated with a better prognosis than non-acral melanoma, specifically when located on the trunk, in Korean patients.
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Affiliation(s)
- Youngkyoung Lim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongeun Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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35
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Poklepovic AS, Luke JJ. Considering adjuvant therapy for stage II melanoma. Cancer 2019; 126:1166-1174. [PMID: 31869447 PMCID: PMC7065103 DOI: 10.1002/cncr.32585] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/09/2019] [Accepted: 08/18/2019] [Indexed: 12/21/2022]
Abstract
Melanoma is among the few cancers that demonstrate an increasing incidence over time. Simultaneously, this trend has been marked by an epidemiologic shift to earlier stage at diagnosis. Before 2011, treatment options were limited for patients with metastatic disease, and the median overall survival was less than 1 year. Since then, the field of melanoma therapeutics has undergone major changes. The use of anti–CTLA‐4 and anti‐PD1 immune checkpoint inhibitors and combination BRAF/MEK inhibitors for patients with BRAF V600 mutations has significantly extended survival and allowed some patients to remain in durable disease remission off therapy. It has now been confirmed that these classes of agents have a benefit for patients with stage III melanoma after surgical resection, and anti‐PD1 and BRAF/MEK inhibitors are standards of care in this setting. Some patients with stage II disease (lymph node‐negative; American Joint Committee on Cancer stage IIB and IIC) have worse melanoma‐specific survival relative to some patients with stage III disease. Given these results, expanding the population of patients who are considered for adjuvant therapy to include those with stage II melanoma has become a priority, and randomized phase 3 clinical trials are underway. Moving into the future, the validation of patient risk‐stratification and treatment‐benefit prediction models will be important to improve the number needed to treat and limit exposure to toxicity in the large population of patients with early stage melanoma. Adjuvant therapy has improved outcomes in patients with stage III melanoma and is being explored in those with stage II melanoma. Stage III data as well as risk‐stratification tools and clinical considerations for the lymph node‐negative population are reviewed.
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Affiliation(s)
- Andrew S Poklepovic
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia.,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jason J Luke
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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36
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Risk factors for post-operative complications after sentinel lymph node biopsy for cutaneous melanoma: Results from a large cohort study. J Plast Reconstr Aesthet Surg 2019; 72:1956-1962. [DOI: 10.1016/j.bjps.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 08/03/2019] [Accepted: 08/18/2019] [Indexed: 11/18/2022]
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37
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Verver D, van der Veldt AAM, van Akkooi ACJ, Verhoef K, Grünhagen DJ, Louwman MWJ. Author's reply to: The real-world outcome of metastatic melanoma: Unknown primary vs. known cutaneous. Int J Cancer 2019; 145:3175-3176. [PMID: 31423580 DOI: 10.1002/ijc.32630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Danielle Verver
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Kees Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
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38
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Mohr P, Kiecker F, Soriano V, Dereure O, Mujika K, Saiag P, Utikal J, Koneru R, Robert C, Cuadros F, Chacón M, Villarroel RU, Najjar YG, Kottschade L, Couselo EM, Koruth R, Guérin A, Burne R, Ionescu-Ittu R, Perrinjaquet M, Zager JS. Adjuvant therapy versus watch-and-wait post surgery for stage III melanoma: a multicountry retrospective chart review. Melanoma Manag 2019; 6:MMT33. [PMID: 31871622 PMCID: PMC6923782 DOI: 10.2217/mmt-2019-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/11/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To describe treatment patterns among patients with stage III melanoma who underwent surgical excision in years 2011-2016, and assess outcomes among patients who subsequently received systemic adjuvant therapy versus watch-and-wait. METHODS Chart review of 380 patients from 17 melanoma centers in North America, South America and Europe. RESULTS Of 129 (34%) patients treated with adjuvant therapy, 85% received interferon α-2b and 56% discontinued treatment (mostly due to adverse events). Relapse-free survival was significantly longer for patients treated with adjuvant therapy versus watch-and-wait (hazard ratio = 0.63; p < 0.05). There was considerable heterogeneity in adjuvant treatment schedules and doses. Similar results were found in patients who received interferon-based adjuvant therapy. CONCLUSION Adjuvant therapies with better safety/efficacy profiles will improve clinical outcomes in patients with stage III melanoma.
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Affiliation(s)
- Peter Mohr
- Department of Dermatology, Elbe Kliniken, Stade, Germany
| | - Felix Kiecker
- Department of Dermatology and Allergy, Skin Cancer Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Virtudes Soriano
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Olivier Dereure
- Department of Dermatology and INSERM U1058 ‘pathogenesis and control of chronic infections’, University of Montpellier, Montpellier, France
| | - Karmele Mujika
- Department of Medical Oncology, Onkologikoa-Oncology Institute Gipuzkoa, Gipuzkoa, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology Ambroise Paré Hospital, APHP; EA 4340 ‘Biomarkers in cancerology and hemato-oncology’, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany and Department of Dermatology, Venereology and Allergology; University Medical Center, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Rama Koneru
- RS McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Oshawa, Ontario, Canada
| | - Caroline Robert
- Dermatology Unit, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - Florencia Cuadros
- Medical Oncology, Instituto de Oncologia de Rosario, Rosario, Santa Fe, Argentina
| | - Matias Chacón
- Departments of Medical and Surgical Oncology, Instituto Alexander Fleming, Buenos Aires, Argentina
| | | | - Yana G Najjar
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lisa Kottschade
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Eva M Couselo
- Department of Medical Oncology, Vall d'Hebron Hospital and VHIO (Vall d'Hebron Institute of Oncology), Barcelona, Spain
| | - Roy Koruth
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | | | | | | | | | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL 33612, USA
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Lim WH, Au E, Krishnan A, Wong G. Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink? Transpl Int 2019; 32:1223-1240. [PMID: 31385629 PMCID: PMC6900036 DOI: 10.1111/tri.13486] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
Abstract
Kidney transplant recipients have up to a 100-fold greater risk of incident cancer compared with the age/sex-matched general population, attributed largely to chronic immunosuppression. In patients with a prior history of treated cancers, the type, stage and the potential for cancer recurrence post-transplant of prior cancers are important factors when determining transplant suitability. Consequently, one of the predicaments facing transplant clinicians is to determine whether patients with prior cancers are eligible for transplantation, balancing between the accelerated risk of death on dialysis, the projected survival benefit and quality of life gains with transplantation, and the premature mortality associated with the potential risk of cancer recurrence post-transplant. The guidelines informing transplant eligibility or screening and preventive strategies against cancer recurrence for patients with prior cancers are inconsistent, underpinned by uncertain evidence on the estimates of the incidence of cancer recurrence and the lack of stage-specific outcomes data, particularly among those with multiple myeloma or immune-driven malignancies such as melanomas. With the advent of newer anti-cancer treatment options, it is unclear whether the current guidelines for those with prior cancers remain appropriate. This review will summarize the uncertainties of evidence informing the current recommendations regarding transplant eligibility of patients with prior cancers.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Eric Au
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anoushka Krishnan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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40
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Zhou M, Yu X, Jing Z, Wu W, Lu C. Overexpression of microRNA‑21 inhibits the growth and metastasis of melanoma cells by targeting MKK3. Mol Med Rep 2019; 20:1797-1807. [PMID: 31257538 PMCID: PMC6625455 DOI: 10.3892/mmr.2019.10408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/21/2019] [Indexed: 12/17/2022] Open
Abstract
Melanoma is an aggressive skin carcinoma with poor prognosis, and is prevalent worldwide. It was demonstrated that microRNA (miR)‑21 and mitogen‑activated protein kinase kinase 3 (MKK3) both participated in the occurrence and development of various tumors; however, their detailed roles in the progression of melanoma remain unclear. Reverse transcription‑quantitative PCR (RT‑qPCR) and western blot analyses were conducted to examine the expression levels of miR‑21 and MKK3 in clinical specimens of patients with melanoma and melanoma cell lines. A dual‑luciferase reporter assay was performed to verify the target interaction between miR‑21 and MKK3. The mRNA and protein expressions of MKK3 were measured using RT‑qPCR and western blot analysis, respectively, following transfection with miR‑21 mimics and inhibitor. Subsequently, Cell Counting Kit‑8 and colony formation assays, and flow cytometry were conducted to assess the effects of miR‑21 and MKK3 on the cell growth of melanoma. Cell migration and invasion experiments were performed to evaluate the effects of miR‑21 and MKK3 on the cell metastasis of melanoma. It was revealed that MKK3 was upregulated, and miR‑21 was downregulated in patients with melanoma and melanoma cell lines. MKK3 was demonstrated to be a direct target of miR‑21. Furthermore, it was demonstrated that upregulated miR‑21 expression and downregulated MKK3 expression suppressed cell proliferation and colony formation, promoted apoptosis, delayed the cell cycle, and inhibited cell migration and invasion. The present findings suggested that miR‑21 could inhibit the cell growth and metastasis of melanoma by negatively regulating MKK3.
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Affiliation(s)
- Meng Zhou
- Department of Dermatology, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China
| | - Xiaoqian Yu
- Department of Dermatology, Qingdao Hiser Medical Group, Qingdao Hospital of Traditional Chinese Medicine, Qingdao, Shandong 266032, P.R. China
| | - Zhenhai Jing
- Department of Oncology, Qingdao Hiser Medical Group, Qingdao Hospital of Traditional Chinese Medicine, Qingdao, Shandong 266032, P.R. China
| | - Wei Wu
- College of Food Science and Technology, Qingdao Agricultural University, Qingdao, Shandong 266179, P.R. China
| | - Chenglong Lu
- Department of Emergency, Qilu Hospital of Shandong University, Qingdao, Shandong 266000, P.R. China
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41
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Feigelson HS, Powers JD, Kumar M, Carroll NM, Pathy A, Ritzwoller DP. Melanoma incidence, recurrence, and mortality in an integrated healthcare system: A retrospective cohort study. Cancer Med 2019; 8:4508-4516. [PMID: 31215776 PMCID: PMC6675720 DOI: 10.1002/cam4.2252] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 01/13/2023] Open
Abstract
Background Numerous studies have examined melanoma incidence and survival, but studies on melanoma recurrence are limited. We examined melanoma incidence, recurrence, and mortality among members of Kaiser Permanente Colorado (KPCO) between January 1, 2000 and December 31, 2015. Methods Age‐adjusted incidence rates were computed to examine trends among KPCO members aged 21 years and older. Cox proportional hazards models were used to examine factors associated with recurrence and mortality. Results Our cohort included 1931 cases of invasive melanoma. Incidence rates increased over time and were higher than SEER rates; however, the increase was limited to early stage disease. In multivariable models, stage at initial diagnosis, gender, and age were associated with melanoma recurrence. Men were more likely to have a recurrence than women (adjusted hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.19‐2.43), and for each decade of increasing age, the adjusted HR = 1.20 (95% CI: 1.06‐1.37). Factors associated with all‐cause mortality included stage (HR = 12.87, 95% CI: 6.63‐24.99, for stage IV vs stage I), male gender (HR = 1.42, 95% CI: 1.12‐1.79), older age at diagnosis, lower socioeconomic status, and comorbidity index. For melanoma‐specific mortality, results were similar, with one exception: age was not associated with melanoma‐specific death (HR = 1.09, 95% CI: 0.94‐1.25, P = 0.253). Conclusions Data derived from an insured patient population, such as KPCO, have the potential to enhance our understanding of emerging trends in melanoma. This is the first population‐based study in the United States to examine patient characteristics associated with risk of recurrence. Men have an increased risk of both recurrence and death, and thus may benefit from more intensive follow‐up than women.
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Affiliation(s)
| | - John D Powers
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Mayanka Kumar
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Arun Pathy
- Department of Dermatology, Kaiser Permanente Colorado, Aurora, Colorado
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
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42
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Leeneman B, Franken MG, Coupé VM, Hendriks MP, Kruit W, Plaisier PW, van Ruth S, Verstijnen JA, Wouters MW, Blommestein HM, Uyl – de Groot CA. Stage-specific disease recurrence and survival in localized and regionally advanced cutaneous melanoma. Eur J Surg Oncol 2019; 45:825-831. [DOI: 10.1016/j.ejso.2019.01.225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/20/2018] [Accepted: 01/31/2019] [Indexed: 10/27/2022] Open
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43
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Pérez-Aldrete BM, Matildes-Mariscal JB, Gómez-Padilla F, Guevara-Gutiérrez E, Barrientos-García JG, Hernández-Peralta SL, Tlacuilo-Parra A. Cutaneous melanoma in patients from western Mexico: Clinical pathology characteristics and their relationship to prognosis. Australas J Dermatol 2019; 60:e298-e303. [PMID: 31016713 DOI: 10.1111/ajd.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE Melanoma is the third most frequent malignant neoplasm in skin. The majority of information available comes from studies performed in Caucasian populations. Our objective was to investigate the clinico-pathological characteristics in Mexican patients with cutaneous melanoma and the relationship these characteristics had to prognosis. METHODS A retrospective study included patients with a histopathological diagnosis of melanoma who were attended at a tertiary level Dermatology Institute over a 10-year period. Age, gender, anatomical location; histopathological subtype, Breslow thickness, Clark level; presence of ulceration, metastasis, anatomical-pathological stage and survival were investigated. To assess the data, descriptive statistics, chi-squared or the Fisher exact test and Kaplan-Meier curves were used. RESULTS There were 323 patients included. The overall survival rate was 77% with an average follow-up of 7 years. The lowest survival was statistically related to the following: higher age (>65 years), localisation in palms/soles, histopathological nodular subtype, presence of ulceration, Breslow thickness >4.0 mm, Clark level V, the presence of metastasis and stage IV disease. CONCLUSIONS Our results relay the characteristics and prognosis of patients with the diagnosis of cutaneous melanoma in western Mexico.
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Affiliation(s)
| | | | | | - Elizabeth Guevara-Gutiérrez
- Instituto Dermatologico de Jalisco "Dr. José Barba Rubio", Secretaria de Salud Jalisco, Zapopan, Jalisco, Mexico
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44
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Rotaru M, Jitian CR, Iancu GM. A 10-year retrospective study of melanoma stage at diagnosis in the academic emergency hospital of Sibiu county. Oncol Lett 2019; 17:4145-4148. [PMID: 30944608 DOI: 10.3892/ol.2019.10098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/28/2019] [Indexed: 01/18/2023] Open
Abstract
Melanoma is considered to be the most aggressive skin cancer, with an increasing incidence worldwide. An accurate staging of melanoma is crucial in describing the cancer status, estimating prognosis and deciding the optimal treatment solution. In the present study, melanoma staging highlights the importance of early detection, most of the patients having been diagnosed with advanced stages of this skin cancer. A retrospective study was conducted among 117 patients of the Academic Emergency County Hospital of Sibiu, diagnosed with melanoma between 2007 and 2016. The staging of the patients with melanoma was made using the American Joint Committee on Cancer (AJCC) 7th edition, and reconsidered in the light of the AJCC 8th edition. The results showed that the majority of the cases had distant metastases, 40.17% were diagnosed with stage IV melanoma. 25.65% of the patients were diagnosed with stage III melanoma, having a regional disease. The rest of the cases had localized melanoma (stages I and II, 30.76%), while only 3.42% of them were diagnosed with melanoma in situ, the melanoma type with the greatest chances of survival. Analyzing the Breslow index, it was observed that the most common tumor thickness was 2.1 to 4 mm (34.19%). In conclusion, as the incidence of melanoma increases in Romania, further efforts are needed to improve the early detection of melanoma. There are hopes that with the correct and early diagnosis of melanoma, the mortality rate of this neoplasm will decrease in the future.
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Affiliation(s)
- Maria Rotaru
- Department of Dermatology, Faculty of Medicine, 'Lucian Blaga' University of Sibiu, 550245 Sibiu, Romania.,Clinic of Dermatology, Clinical Hospital of Sibiu, 550245 Sibiu, Romania
| | | | - Gabriela Mariana Iancu
- Department of Dermatology, Faculty of Medicine, 'Lucian Blaga' University of Sibiu, 550245 Sibiu, Romania.,Clinic of Dermatology, Clinical Hospital of Sibiu, 550245 Sibiu, Romania
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45
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Freeman M, Laks S. Surveillance imaging for metastasis in high-risk melanoma: importance in individualized patient care and survivorship. Melanoma Manag 2019; 6:MMT12. [PMID: 31236204 PMCID: PMC6582455 DOI: 10.2217/mmt-2019-0003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/01/2019] [Indexed: 12/29/2022] Open
Abstract
Most patients newly diagnosed with melanoma have early-stage disease considered of good prognosis. However, with a risk of recurrence, appropriate follow-up may include surveillance imaging for early relapse detection. Previously, surveillance imaging to detect recurrences was considered unjustified, given the lack of effective treatments. Now, systemic therapies have improved, and patients with low tumor burden may derive benefit from surveillance imaging. Despite this, controversy exists regarding the role of surveillance imaging in early-stage melanoma survivorship, in part reflected by the lack of consensus on specific imaging protocols and broad guidelines. This review discusses published evidence on surveillance imaging to detect metastasis in high-risk melanoma, the need for early recurrence detection and implications for value-based clinical decision-making, survivorship care and multidisciplinary patient management.
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Affiliation(s)
- Morganna Freeman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
| | - Shachar Laks
- Department of Surgery, East Carolina University, Greenville, NC 27834, USA
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46
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Lyth J. Conditional recurrence-free survival in patients with primary stage I-II cutaneous malignant melanoma - a population-based study. Melanoma Res 2018; 28:637-640. [PMID: 29994850 DOI: 10.1097/cmr.0000000000000479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Conditional survival in patients with localized primary cutaneous malignant melanoma (CMM) is well described. However, conditional recurrence-free survival (RFS) has not been investigated before. The aim of this study was to determine conditional RFS and test for time dependency in prognostic factors in patients with localized stage I-II CMM. This study included 1437 CMM patients registered in one region of Sweden during 1999-2012 followed up through 31 December 2012. To identify first recurrence of CMM disease, data from a care data warehouse, the pathology and radiology department registries were used. Patients were also followed through a Census Register and the National Cause of Death Register. The time-dependent risk of recurrence was analysed in a Cox's proportional hazard regression. The 5-year conditional RFS increased from 86% (95% confidence interval: 84-88) at diagnosis to 96% (95% confidence interval: 94-98) at 5 years after diagnosis. Women showed a 60% lower risk of recurrence than men and this effect was stable over time (P=0.39). Patients aged greater than or equal to 65 years had a 40% higher risk of recurrence than patients aged less than 65 years, and this effect was stable over time (P=0.65). Patients with tumour ulceration showed a 70% higher risk of recurrence than nonulcerated patients, but this effect disappeared after 2 years (P=0.04). For patients with T3-T4 CMM, the hazard ratios decreased over time and were similar to hazard ratio of patients with T2 CMM after 2 years and later. The decreasing impact of tumour thickness and ulceration over time could have important implications for CMM patients in terms of counselling and follow-up.
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Affiliation(s)
- Johan Lyth
- Research and Development Unit in Region Östergötland, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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47
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Veierød MB, Page CM, Aaserud S, Bassarova A, Jacobsen KD, Helsing P, Robsahm TE. Melanoma staging: Varying precision and terminal digit clustering in Breslow thickness data is evident in a population-based study. J Am Acad Dermatol 2018; 79:118-125.e1. [PMID: 29580861 DOI: 10.1016/j.jaad.2018.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/07/2018] [Accepted: 03/20/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Errors in Breslow thickness reporting can give misclassification of T category, an important classifier in melanoma staging. OBJECTIVE We sought to investigate precision (number of digits) and terminal digit clustering in Breslow thickness and potential consequences for T category. METHODS All first primary and morphologically verified invasive melanomas in Norway between 2008 and 2015 were included. A smoothing model was fitted to estimate the underlying Breslow thickness distribution without digit clustering. RESULTS Thickness was reported for 13,057 (97.5%) patients; the median was 1.0 mm (range, 0.09-85). It was reported as whole numbers (15.6%), to 1 decimal (78.2%) and 2 decimal places (6.2%)-thin tumors with more precision than thick tumors. Terminal digit clustering was found with marked peaks in the observed frequency distribution for terminal digits 0 and 5, and with drops around these peaks. Terminal digit clustering increased proportions of patients classified with T1 and T4 tumors and decreased proportions classified with T2 and T3. LIMITATIONS Breslow thickness was not reported in 2.5% of cases. CONCLUSIONS The Norwegian recommendation of measurement to the nearest 0.1 mm was not followed. Terminal digit clustering was marked, with consequences for T category. Pathologists, clinicians, and epidemiologists should know that clustering of thickness data around T category cut points can impact melanoma staging with consequent effect on patient management and prognosis.
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Affiliation(s)
- Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Christian M Page
- Oslo Centre for Biostatistics and Epidemiology, Division for Research Support, Oslo University Hospital, Oslo, Norway; Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Stein Aaserud
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Assia Bassarova
- Department of Pathology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Kari D Jacobsen
- Department of Oncology, Oslo University Hospital-Radium Hospitalet, Oslo, Norway
| | | | - Trude E Robsahm
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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48
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Lyth J, Falk M, Maroti M, Eriksson H, Ingvar C. Prognostic risk factors of first recurrence in patients with primary stages I-II cutaneous malignant melanoma - from the population-based Swedish melanoma register. J Eur Acad Dermatol Venereol 2017; 31:1468-1474. [DOI: 10.1111/jdv.14280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/27/2017] [Indexed: 02/06/2023]
Affiliation(s)
- J. Lyth
- Local Health Care Research and Development Unit; County of Östergötland Linköping Sweden
| | - M. Falk
- Department of Medical and Health Sciences; Division of Community Medicine; Primary Care; Linköping University; Linköping Sweden
| | - M. Maroti
- Department of Oncology; County Hospital Ryhov; Jönköping Sweden
| | - H. Eriksson
- Department of Oncology and Pathology; Karolinska Institutet; Stockholm Sweden
- Department of Oncology; Karolinska University Hospital; Stockholm Sweden
| | - C. Ingvar
- Department of Surgery; Skåne University Hospital, Clinical Sciences; Lund University; Lund Sweden
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