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Moreira AG, Freitas AVDS, Pires CAA. Prognostic factors and survival of patients with melanoma treated at a reference hospital in the Brazilian Amazon region. An Bras Dermatol 2024; 99:594-597. [PMID: 38697885 PMCID: PMC11221155 DOI: 10.1016/j.abd.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 05/05/2024] Open
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2
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Ma C, Qin R, Cao Y, Dai Y, Hua M, Wang L, Cao L, Fan L, Li K. Nomogram Predicts Prognostic Factors for Head and Neck Cutaneous Melanoma: A Population-Based Analysis. World Neurosurg 2024; 187:e839-e851. [PMID: 38729520 DOI: 10.1016/j.wneu.2024.04.176] [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: 03/17/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The head and neck cutaneous melanoma (HNCM) accounts for 20% of newly diagnosed melanoma. Research on prognostic models for their survival yet remains largely unexplored. This study employed a nomogram approach to develop and validate a predictive model for both overall survival (OS) and disease-specific survival (DSS) in patients with HNCM. METHODS This study analyzed the HNCM patients diagnosed between 2004 and 2014 from Surveillance, Epidemiology, and End Results database. To identify independent prognostic factors for HNCM, we integrated results from univariate Cox regression analysis, random survival forests, and LASSO regression with cross-validation. A nomogram was designed and validated based on the identified characteristics to predict the 3-, 5-, and 8-year OS and DSS of patients with HNCM. RESULTS Age, Stage, Ulceration, Thickness, Chemotherapy, lymph node metastasis, and Radiation were identified as independent prognostic factors. The nomogram achieved a satisfactory performance with C-indices of 0.824(DSS) and 0.757(OS) in the training cohort and 0.827(DSS) and 0.749(OS) in the validation cohort, respectively. The area under the curves for the OS at 3, 5, and 8 years were 0.789, 0.788, and 0.794 for the training cohort, and 0.778, 0.776, and 0.795 for the validation cohort, respectively. For DSS, the area under the curves at 3, 5, and 8 years were 0.859, 0.842, and 0.828 in the training cohort, and 0.864, 0.844, and 0.834 in the validation cohort, respectively. The calibration curve showed that there was a strong correlation between the observed outcomes and the predicted survival probability. CONCLUSIONS This study established and validated predictive nomograms for HNCM patients with robust predictive performance.
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Affiliation(s)
- Chenjing Ma
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Ruihao Qin
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Yong Cao
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Yanyan Dai
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Menglei Hua
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Liuying Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Lei Cao
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Lijun Fan
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Kang Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China.
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Taylor MA, Thomas SI, Ituarte BE, Sharma D, Wei EX. Racial and ethnic differences in presentation and disease-specific survival in female melanoma patients. Int J Dermatol 2024. [PMID: 38876461 DOI: 10.1111/ijd.17322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Mitchell A Taylor
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
- School of Medicine, Creighton University, Omaha, NE, USA
| | - Sierra I Thomas
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
- School of Medicine, University of Utah, Salt Lake City, MO, USA
| | - Bianca E Ituarte
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Divya Sharma
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Erin X Wei
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
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4
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Yan J, Wang H, Lu X, Li F. Development and validation of a nomogram for elderly patients with ulcerative melanoma. Melanoma Res 2024; 34:207-214. [PMID: 38092017 DOI: 10.1097/cmr.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The current state of survival prediction models for elderly patients with ulcerative melanoma (uCM) is limited. We sought to develop a nomogram model that can predict overall survival of geriatric patients with uCM. The Surveillance, Epidemiology, and End Results (SEER) database served as a source for patients diagnosed with uCM between 2004 and 2015. Statistical analyses were conducted to determine the significant prognostic elements affecting overall survival using multivariate and univariate Cox proportional risk regression models. Subsequently, an independent forecasting nomogram was developed on the basis of these identified predictors. The predictive model was then assessed and validated through the utilization of receiver operating characteristic curves, calibration curves as well as decision curves. The study included a total of 5019 participants. Univariate and multivariate analyses revealed age, sex, marital status, primary site, tumor size, N stage, M stage, histological type, and surgery were independent prognostic factors. A nomogram was developed using the findings from both univariate and multivariate Cox analyses ( P < 0.05). The receiver operating characteristic curves, which vary over time, and the area under the curve (AUC) for the training and validation cohorts, demonstrated the nomogram's strong discriminatory ability. Additionally, the calibration curves indicated satisfactory agreement between the predicted values from the nomogram and the practical outcomes observed in both cohorts. Furthermore, the decision curve analysis curves displayed favorable positive net gains at all times, when the critical value is most likely to occur. In this study, age, sex, marital status, primary site, tumor size, N stage, M stage, histologic type and surgery were determined as independent predictors for elderly patients with uCM. Then, a predictive model with good discriminatory ability was constructed to predict 12-, 24-, and 36-month overall survival in geriatric patients with uCM, which facilitates patients' counseling and individualized medical decision.
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Affiliation(s)
- Jie Yan
- Department of Dermatology, the Affiliated Hospital of QingDao University, Qingdao, Shandong
- Department of Dermatology, Contemporary Plastic Surgery Hospital of Chongqing, Chongqing
| | - Haiyan Wang
- Department of Dermatology, Weilin Medical Hospital of Beijing, Beijing, China
| | - Xiaoou Lu
- Department of Dermatology, the Affiliated Hospital of QingDao University, Qingdao, Shandong
| | - Fengjuan Li
- Department of Dermatology, the Affiliated Hospital of QingDao University, Qingdao, Shandong
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5
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Greene AC, Matzelle-Zywicki M, Ziegler O, El-Mallah JC, Stack MJ, Pameijer CR, Shen C. Characteristics and variations in young adults with cutaneous melanoma: A national cancer database analysis. J Surg Oncol 2024; 129:1554-1565. [PMID: 38764307 DOI: 10.1002/jso.27685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/29/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Many cancers in young adulthood differ in terms of biology, histologic variation, and prognosis compared to cancer in other older age groups. Differences in cutaneous melanoma among young adults compared to other older age groups, as well as between sexes in young adults are not well studied. METHODS The National Cancer Database was queried for patients diagnosed with cutaneous melanoma between 2004 and 2017. Patient characteristics, disease factors, and treatment were stratified by age-based cohorts and compared using standard univariate statistics. The Kaplan-Meier method and log-rank tests were used to evaluate overall survival (OS) between age-based cohorts and young adult sexes. RESULTS Of the 329 765 patients identified, 10.5% were between 18 and 39 years of age at diagnosis. Compared with other older age groups, young adult patients were more likely to be female and uninsured with higher proportions of superficial spreading melanoma, melanoma of the trunk and extremities, and earlier-stage disease. Young adults had improved OS compared to other older age groups. Young male patients had a greater proportion of no insurance, nodular melanoma, higher-stage disease, and decreased OS compared to young female patients. Additionally, while the 5-year OS difference was statistically significant across all stages of disease between young males and females, the clinical significance is likely limited to later stages. CONCLUSIONS Age and sex-specific differences in cutaneous melanoma highlight distinct patterns and characteristics, emphasizing the need for tailored approaches to screening, diagnosis, and treatment.
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Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | | | - Olivia Ziegler
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessica C El-Mallah
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Michael J Stack
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Colette R Pameijer
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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6
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Fernandez JM, Mata EM, Plampton K, Whitley MJ, Sutton AV, Wysong A. Melanoma characteristics and overall survival predictors in American Indians and Alaska Natives: An analysis of the national cancer database from 2004 to 2018. J Am Acad Dermatol 2024; 90:836-837. [PMID: 38043590 DOI: 10.1016/j.jaad.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth M Mata
- Department of Medicine, University of Arizona, College of Medicine - Tucson, Tucson, Arizona
| | - Katherine Plampton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; University of Minnesota Medical School, Minneapolis, Minnesota
| | - Melodi Javid Whitley
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Adam V Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska.
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Afshar N, Dashti SG, Mar V, Te Marvelde L, Evans S, Milne RL, English DR. Do age at diagnosis, tumour thickness and tumour site explain sex differences in melanoma survival? A causal mediation analysis using cancer registry data. Int J Cancer 2024; 154:793-800. [PMID: 37823184 DOI: 10.1002/ijc.34752] [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: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
Women diagnosed with melanoma have better survival than men, but little is known about potential intervention targets to reduce this survival gap by sex. We conducted a population-based study using Victorian Cancer Registry data including 5833 women and 6780 men aged 15 to 70 years when diagnosed with first primary melanoma between 2007 and 2015. Deaths to the end of 2020 were identified through linkage to the Victorian and national death registries. We estimated the effect of age at diagnosis, tumour thickness and tumour site on reducing the melanoma-specific survival gap by sex (ie, interventional indirect effects [IIEs]) on risk difference (RD) scale. Compared to women, there were 211 (95% CI: 145-278) additional deaths per 10 000 in men within 5 years following diagnosis. We estimated that 44% of this gap would be reduced by a hypothetical intervention shifting the distribution of melanoma thickness in men to be the same as that observed for women (IIEthickness RD 93 [95% CI: 75-118] per 10 000) and 20% by an intervention on tumour site (head and neck/trunk vs upper limb/lower limb; IIEsite RD 42 [95% CI: 15-72] per 10 000), while an intervention on age at diagnosis would have a negligible effect. Tumour thickness, tumour site and age at diagnosis mediated 65% of the effect of sex on 5-year melanoma survival in Victoria. Of these factors, tumour thickness had the most considerable mediating effect, suggesting that effective promotion of earlier detection of melanoma in men could potentially nearly halve the gap in melanoma-specific survival by sex.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - S Ghazaleh Dashti
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Luc Te Marvelde
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sue Evans
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Fernandez JM, Koblinski JE, Dahak S, Curiel-Lewandrowski C, Thiede R. Gender differences in pediatric and adolescent melanoma: A retrospective analysis of 4645 cases. J Am Acad Dermatol 2024; 90:280-287. [PMID: 37802183 DOI: 10.1016/j.jaad.2023.09.049] [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: 04/12/2023] [Revised: 07/28/2023] [Accepted: 09/02/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND There is paucity of data on how gender impacts melanoma prognosis in pediatric and adolescent patients. OBJECTIVES This study explores gender differences in presentation and survival among pediatric and adolescent patients with melanoma. METHODS The National Cancer Database 2004-2018 was queried for cases of primary invasive cutaneous melanoma in pediatric and adolescent patients (birth to 21 years) for a retrospective cohort study. RESULTS Of the 4645 cases, 63.4% were female. Median Breslow depth was 1.05 mm for males (interquartile range 0.50-2.31) and 0.80 mm for females (interquartile range 0.40-1.67; P < .001). Trunk was the most common primary site for females (34.3%) and males (32.9%). More females than males were diagnosed with stage I disease (67.8% vs 53.6%). Males had higher rates of regional lymph node positivity (27.9% vs 18.1%; P < .001) and ulceration (17.1% vs 11.4%; P < .001). Five-year overall survival was 95.9% for females and 92.0% for males (P < .001). After adjusting for confounders, male gender independently increased mortality risk (reference: females; adjusted hazard ratio 1.57; 95% confidence interval 1.32-1.86). LIMITATIONS Retrospective study. CONCLUSION Males exhibited more aggressive pathologic features including greater Breslow thickness and higher ulceration and lymph node positivity rates. Male gender independently increased mortality risk.
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Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jenna E Koblinski
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Sabrina Dahak
- Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, Department of Medicine, University of Arizona College of Medicine - Tucson, Tucson, Arizona
| | - Rebecca Thiede
- Division of Dermatology, Department of Medicine, University of Arizona College of Medicine - Tucson, Tucson, Arizona.
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9
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Fernandez JM, Mata EM, Erdrich J, Fazel M. Retrospective Cohort Analysis of Sex Differences in American Indians and Alaska Natives With Invasive Melanoma From the National Cancer Database. Dermatol Surg 2023; 49:1039-1041. [PMID: 37602949 DOI: 10.1097/dss.0000000000003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth M Mata
- University of Arizona, College of Medicine-Tucson, Tucson, Arizona
| | - Jennifer Erdrich
- Department of Surgery, University of Arizona, College of Medicine-Tucson, Tucson, Arizona
| | - Mohammad Fazel
- Division of Dermatology, Department of Medicine, University of Arizona, College of Medicine-Tucson, Tucson, Arizona
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10
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Fernandez JM, Mata EM, Bubic BN, Kwan KR, Whitley MJ, Wysong A. Racial and ethnic differences in males with melanoma: A retrospective cohort study of 205,125 cases from the National Cancer Database. J Am Acad Dermatol 2023; 89:828-832. [PMID: 37436331 DOI: 10.1016/j.jaad.2023.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/20/2023] [Accepted: 05/10/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth M Mata
- University of Arizona, College of Medicine - Tucson, Tucson, Arizona
| | - Bianka N Bubic
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kevin R Kwan
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Melodi Javid Whitley
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; Department of Dermatology, Duke University School of Medicine, Durham, Nebraska
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska.
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11
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Wang S, Chen Y, Sun J, Mo R, Tan Q. Development and validation of two online dynamic nomograms for patients with non-distant metastatic cutaneous melanoma based on surgical approaches. Cancer Med 2023; 12:18479-18490. [PMID: 37592896 PMCID: PMC10557963 DOI: 10.1002/cam4.6448] [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: 04/02/2023] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Surgery is an essential treatment for non-distant metastatic cutaneous melanoma (NMCM). We aim to construct and validate prognostic nomograms based on surgical approaches and the clinicopathological characteristics of NMCM patients. METHODS Data of patients diagnosed with cutaneous melanoma from 2004 to 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Two online nomograms were constructed to predict the 3, 5-year melanoma-specific survival (MSS) for NMCM patients based on the surgical approaches. These nomograms were evaluated by the dynamic Harrell's concordance index (C-index), decision curve analysis and clinical impact curve. Both internal and external data verification were conducted. RESULTS A total of 14,091 NMCM cases were included in this study. The C-index of the nomograms for the excisional surgery group and amputation group were 0.818 and 0.806, respectively, and 0.763 and 0.731, respectively, in our hospital data validation. After internal and bootstrap verification, our two nomograms showed good accuracy and practicality. CONCLUSION NMCM patients exhibited equal survival rates independent of resection margin size, while those who needed amputation had worse survival rates. We generated two online nomograms distinguished by surgical approach to predict NMCM patient survival based on clinicopathological characteristics.
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Affiliation(s)
- Shiqi Wang
- Department of Burns and Plastic SurgeryAffiliated Drum Tower Hospital, Medical School of Nanjing UniversityNanjingPeople's Republic of China
- Department of Burns and Plastic SurgeryAffiliated Jinling Hospital, Medical School of Nanjing UniversityNanjingPeople's Republic of China
| | - Yuedong Chen
- Diabetic Foot CenterNanjing Junxie HospitalNanjingPeople's Republic of China
| | - Jiawei Sun
- Department of Burns and Plastic SurgeryAffiliated Drum Tower Hospital, Medical School of Nanjing UniversityNanjingPeople's Republic of China
| | - Ran Mo
- Department of Burns and Plastic SurgeryAffiliated Drum Tower Hospital, Medical School of Nanjing UniversityNanjingPeople's Republic of China
| | - Qian Tan
- Department of Burns and Plastic SurgeryAffiliated Drum Tower Hospital, Medical School of Nanjing UniversityNanjingPeople's Republic of China
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12
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Nevola R, Tortorella G, Rosato V, Rinaldi L, Imbriani S, Perillo P, Mastrocinque D, La Montagna M, Russo A, Di Lorenzo G, Alfano M, Rocco M, Ricozzi C, Gjeloshi K, Sasso FC, Marfella R, Marrone A, Kondili LA, Esposito N, Claar E, Cozzolino D. Gender Differences in the Pathogenesis and Risk Factors of Hepatocellular Carcinoma. BIOLOGY 2023; 12:984. [PMID: 37508414 PMCID: PMC10376683 DOI: 10.3390/biology12070984] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
Several chronic liver diseases are characterized by a clear gender disparity. Among them, hepatocellular carcinoma (HCC) shows significantly higher incidence rates in men than in women. The different epidemiological distribution of risk factors for liver disease and HCC only partially accounts for these gender differences. In fact, the liver is an organ with recognized sexual dysmorphism and is extremely sensitive to the action of androgens and estrogens. Sex hormones act by modulating the risk of developing HCC and influencing its aggressiveness, response to treatments, and prognosis. Furthermore, androgens and estrogens are able to modulate the action of other factors and cofactors of liver damage (e.g., chronic HBV infection, obesity), significantly influencing their carcinogenic power. The purpose of this review is to examine the factors related to the different gender distribution in the incidence of HCC as well as the pathophysiological mechanisms involved, with particular reference to the central role played by sex hormones.
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Affiliation(s)
- Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Giovanni Tortorella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Valerio Rosato
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Simona Imbriani
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | | | | | - Marco La Montagna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Antonio Russo
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Giovanni Di Lorenzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maria Rocco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Carmen Ricozzi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Klodian Gjeloshi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Aldo Marrone
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | | | | | - Ernesto Claar
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Domenico Cozzolino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
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13
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [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: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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14
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Liszkay G, Benedek A, Polgár C, Oláh J, Holló P, Emri G, Csejtei A, Kenessey I, Polányi Z, Knollmajer K, Várnai M, Vokó Z, Nagy B, Rokszin G, Fábián I, Barcza Z, Gyulai R, Kiss Z. Significant improvement in melanoma survival over the last decade: A Hungarian nationwide study between 2011 and 2019. J Eur Acad Dermatol Venereol 2023; 37:932-940. [PMID: 36785988 DOI: 10.1111/jdv.18960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Recent real-world studies have reported significant improvements in the survival of malignant melanoma in the past few years, mainly as a result of modern therapies. However, long-term survival data from Central Eastern European countries such as Hungary are currently lacking. METHODS This nationwide, retrospective study examined melanoma survival in Hungary between 2011-2019 using the databases of the National Health Insurance Fund (NHIF) and Central Statistical Office (CSO) of Hungary. Crude overall survival and age-standardized 5-year net survival as well as the association between age, sex and survival were calculated. RESULTS Between 2011 and 2019, 22,948 newly diagnosed malignant melanoma cases were recorded in the NHIF database (47.89% male, mean age: 60.75 years (SD: ±16.39)). Five-year overall survival was 75.40% (women: 80.78%; men: 69.52%). Patients diagnosed between 2017-2019 had a 20% lower risk of mortality compared to patients diagnosed between 2011-2012 (HR 0.80, 95% CI 0.73-0.89; p < 0.0001). Age-standardized 5-year net survival rates in 2011-2014 and 2015-2019 were 90.6% and 95.8%, respectively (women: 93.1% and 98.4%, men: 87.8% and 92.7%, respectively). The highest age-standardized 5-year net survival rates were found in the 0-39 age cohort (94.6% in the 2015-2019 period). CONCLUSION Hungary has similar melanoma survival rates to Western European countries. Based on net survival, the risk of dying of melanoma within 5 years was cut by more than half (55%) during the study period, which coincides with the successful implementation of awareness campaigns and the wide availability of modern therapies.
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Affiliation(s)
- Gabriella Liszkay
- Department of Molecular Immunology and Toxicology and the National Tumorbiology Laboratory, National Institute of Oncology, Budapest, Hungary
| | | | - Csaba Polgár
- Department of Molecular Immunology and Toxicology and the National Tumorbiology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Judit Oláh
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Gabriella Emri
- Department of Dermatology, University of Debrecen, Debrecen, Hungary
| | - András Csejtei
- Department of Oncoradiology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - István Kenessey
- Department of Molecular Immunology and Toxicology and the National Tumorbiology Laboratory, National Institute of Oncology, Budapest, Hungary
| | | | | | - Máté Várnai
- MSD Pharma Hungary Ltd., Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Balázs Nagy
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | | | - Ibolya Fábián
- RxTarget Ltd., Szolnok, Hungary
- University of Veterinary Medicine, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - Rolland Gyulai
- Department of Dermatology, Venereology and Oncodermatology, Faculty of Medicine, University of Pécs, Pécs, Hungary
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15
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Fernandez JM, Bubic BN, Dahak S, Mata EM, Kwan KR, Sutton A, Whitley MJ, Wysong A. Racial and ethnic differences in tumor characteristics and overall survival of women with melanoma: A national cancer database retrospective cohort study. J Am Acad Dermatol 2023; 88:694-696. [PMID: 35933068 DOI: 10.1016/j.jaad.2022.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bianka N Bubic
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sabrina Dahak
- University of Arizona, College of Medicine - Phoenix, Phoenix, Arizona
| | - Elizabeth M Mata
- University of Arizona, College of Medicine - Tucson, Tucson, Arizona
| | - Kevin R Kwan
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Adam Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Melodi Javid Whitley
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska.
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16
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Fernandez JM, Dahak S, Wysong A, Whitley MJ. Gender differences in black patients with melanoma: a retrospective cohort analysis of 2464 cases from the National Cancer Database. Int J Dermatol 2023; 62:e105-e108. [PMID: 36371764 DOI: 10.1111/ijd.16498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sabrina Dahak
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melodi Javid Whitley
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
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17
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Anatomic Region of Cutaneous Melanoma Impacts Survival and Clinical Outcomes: A Population-Based Analysis. Cancers (Basel) 2023; 15:cancers15041229. [PMID: 36831571 PMCID: PMC9954057 DOI: 10.3390/cancers15041229] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE The objective was to determine the effects of the anatomic site of a cutaneous melanoma on the survival outcomes of diagnosed individuals. METHODS We conducted a cross-sectional study using data from the Surveillance, Epidemiology, and End Results Program (SEER) Database from 2004-2014 and included 178,892 cases of individuals diagnosed with cutaneous melanoma. Overall survival (OS) for each anatomic site as well as associated demographics, primary site, stage, and pathologic prognostic factors (Breslow's depth of invasion (DOI), level of mitoses, and ulceration), were analyzed. RESULTS Lower extremity melanoma (LEM) was the most likely to have locoregional nodal spread, yet head and neck melanoma (HNM) was the most likely to present at the most advanced stage of disease (IV). Independent of other factors, HNM was associated with the greatest risk of death (HR 1.90 [95% CI, 1.85-1.96]) compared to other sites, and males experienced worse overall survival (OS) (HR 1.74 [95% CI, 1.70-1.78]) compared to females. The last and greatest risk of death is associated with LEM and HNM, respectively. CONCLUSION Given these survival differences, consideration should be given to incorporating the primary site of melanoma into staging to ensure treatment is efficacious as possible.
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18
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Fernandez JM, Poling KL, Desai AD, Koblinski JE, Borgstrom M, Abraham I, Behbahani S. Primary cutaneous melanoma in Black patients: An analysis of 2464 cases from the National Cancer Database 2004-2018. Pigment Cell Melanoma Res 2023; 36:42-52. [PMID: 36112089 DOI: 10.1111/pcmr.13065] [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: 06/06/2022] [Accepted: 08/12/2022] [Indexed: 12/31/2022]
Abstract
Melanoma in Black patients carries a poor prognosis. Due to its rarity, melanoma in this population has not been well characterized. This study evaluates survival predictors in Black patients with melanoma. This was a retrospective cohort study of Black patients with cutaneous melanoma from the National Cancer Database 2004-2018. Of the 2464 cases, melanoma was more common among females than males (57.1% vs. 42.9%, p < .001). Median Breslow depth was 1.8 mm (interquartile range 0.4-4.4). Lower extremities were the most common location (52.8%), followed by upper extremities (13.1%) along with otherwise specified/overlapping/other (13.1%), then by trunk (11.8%), and lastly head and neck (9.2%). Stage at diagnosis was I (30.7%), II (27.5%), III (24.1%), and IV (17.7%). Ulceration was observed in 41.4% of lesions. Acral lentiginous melanoma (ALM) was the most common specific histologic subtype (20.3%), followed by superficial spreading melanoma (9.4%). After adjusting for confounders, higher stages and primary site on the head and neck were the strongest independent predictors of worse overall survival. Melanoma in Black patients is most likely to appear on the lower extremities. A large portion (41.8%) presented with stage III or IV disease. ALM was the most common specific histologic subtype.
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Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristi L Poling
- College of Medicine - Tucson, University of Arizona, Tucson, Arizona, USA
| | - Amar D Desai
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jenna E Koblinski
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mark Borgstrom
- University Information Technology Services, University of Arizona, Tucson, Arizona, USA
| | - Ivo Abraham
- Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Sara Behbahani
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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19
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Bainvoll L, Mandelbaum RS, Worswick SD, Matsuo K. Anatomical location of melanoma: A gender-specific analysis. J Surg Oncol 2023; 127:203-206. [PMID: 36173039 DOI: 10.1002/jso.27111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Liat Bainvoll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rachel S Mandelbaum
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Scott D Worswick
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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20
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Jeremić J, Suđecki B, Radenović K, Mihaljević J, Radosavljević I, Jovanović M, Milić N, Pavlović V, Brašanac D, Jović M. Impact of the COVID-19 Pandemic on Melanoma Diagnosis: Increased Breslow Thickness in Primary Melanomas-A Single Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16806. [PMID: 36554683 PMCID: PMC9779520 DOI: 10.3390/ijerph192416806] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Early melanoma diagnosis plays a key role in ensuring best prognosis with good survival rates. The ongoing global COVID-19 pandemic has greatly impacted global and national healthcare systems, thus making it a real challenge. The aim of this study was to evaluate the impact of the pandemic on diagnostic delay in melanoma patients in Serbia. In this retrospective study, we included patients treated at the university hospital in Serbia's capitol over a period of five years and three months. We compared the prepandemic (01/JAN/17-14/MAR/20) and pandemic periods (15/MAR/20-31/MAR/22) by evaluating patient demographic data, melanoma subtype, Breslow thickness, Clark level, ulceration status, mitotic index rate and pT staging. We observed a significant reduction in the number of diagnosed patients (86.3 vs. 13.7%; p = 0.036), with melanomas having an increased median Breslow thickness (1.80 vs. 3.00; p = 0.010), a higher percentage of Clark IV-V level lesions (44.0% vs. 63.0%; p = 0.009), an increase in median mitotic index rate (2 vs. 5; p < 0.001) and a trend of increase in lesions thicker than 2 mm (37.8% vs. 53.7%; p = 0.026). We believe that this study can be a useful scenario guide for future similar events, highlighting the importance of preventive measures and timely diagnosis for the best patient outcomes.
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Affiliation(s)
- Jelena Jeremić
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Kristina Radenović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovan Mihaljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivan Radosavljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nataša Milić
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vedrana Pavlović
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dimitrije Brašanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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21
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Ke X, Lin W, Li D, Zhao S, Chen M, Xiao Y, Chen X, Shen M, Su J. Spending and Hospital Stay for Melanoma in Hunan, China. Front Public Health 2022; 10:917119. [PMID: 35928495 PMCID: PMC9343693 DOI: 10.3389/fpubh.2022.917119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to describe the economic burden of Chinese patients with melanoma in Hunan province of China, and to investigate the factors for hospitalization spending and length of stay (LOS) in patients undergoing melanoma surgery. Methods Data was extracted from the Chinese National Health Statistics Network Reporting System database in Hunan province during 2017–2019. Population and individual statistics were presented, and nonparametric tests and quantile regression were used to analyze the factors for spending and LOS. Result A total of 2,644 hospitalized patients with melanoma in Hunan were identified. During 2017–2019, the total hospitalization spending was $5,247,972, and out-of-pocket payment (OOP) was $1,817,869, accounting for 34.6% of the total expenditure. The median spending was $1,123 [interquartile range (IQR): $555–2,411] per capita, and the median LOS was 10 days (IQR: 5–18). A total of 1,104 patients who underwent surgery were further analyzed. The non-parametric tests and quantile regression showed that women were associated with less spending and LOS than men. In general, patients aged 46–65 and those with lesions on the limbs had higher hospitalization costs and LOS than other subgroups. Conclusion Melanoma causes heavy economic burdens on patients in Hunan, such that the median spending is close to 60% of the averagely annual disposable income. Middle-aged men patients with melanoma on the limbs present the highest financial burden of melanoma.
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Affiliation(s)
- Xinchen Ke
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wenrui Lin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Daishi Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- *Correspondence: Juan Su
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Minxue Shen
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22
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Buja A, Rugge M, Damiani G, Zorzi M, De Toni C, Vecchiato A, Del Fiore P, Spina R, Baldo V, Brazzale AR, Rossi CR, Mocellin S. Sex Differences in Cutaneous Melanoma: Incidence, Clinicopathological Profile, Survival, and Costs. J Womens Health (Larchmt) 2022; 31:1012-1019. [PMID: 35076310 PMCID: PMC9299528 DOI: 10.1089/jwh.2021.0223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: This study aims to provide a comprehensive overview of sex-related characteristics of cutaneous malignant melanoma (CMM), with special reference to its incidence, clinicopathological profile, overall survival, and treatment-related costs. Methods: This retrospective cohort study included all 1,279 CMM patients who were registered in 2015 in the Veneto Cancer Registry (a population-based registry including all 4,900,000 regional residents). The by-sex comparisons included tumor stage and site, histological subtype, and other clinical-pathological variables. A Cox regression analysis was used to test the association between sex and survival, adjusting for the main covariates. Treatment costs were calculated by linking patients with several administrative regional databases. Results: Age-specific incidence rates were significantly higher for men among people >50 years old. For men, the trunk was the most common primary site (59.3%), whereas for women the lower limbs (32.1%) were the most common primary site, followed by the trunk (31.8%), which was lower than for men (p < 0.001). At presentation, the frequency of early stage CMM was higher among women, who also featured a significantly lower risk of death (p = 0.016), after adjusting for covariates. Men also incurred higher costs for melanoma treatment in the first year after their diagnosis. Conclusions: Among younger adults, CMM was more common in women, whereas among older adults, it was more common in men. Sex also influences patients' histopathological characteristics at diagnosis. Women had better overall survival after adjusting for demographic, pathological, and clinical profiles. The costs of treatment were also lower for women with CMM.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, Health Care Services and Health Promotion Evaluation, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
- Department of Medicine-DIMED, Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- PhD Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - Chiara De Toni
- Departament of Statistical Sciences, University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
| | - Romina Spina
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, Health Care Services and Health Promotion Evaluation, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | | | - Carlo Riccardo Rossi
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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23
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Agirgol S, Ozkok Akbulut T, Topaloglu Demir F, Cakir E, Gumus A, Agirgol M, Turkoglu Z, Caytemel C. Investigation of Cardiovascular Disease and Metabolic Syndrome Risk with Copeptin in Psoriasis Patients: A Case-Control Study. HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2022.7694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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24
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Bayerl C. Männer- und Frauenhaut – Genderaspekte. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1844-8977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungMänner- und Frauenhaut sind unterschiedlich. Männerhaut ist dicker, hat mehr Talgdrüsen und Oberflächenlipide, eine höhere, nicht so divergente Keimzahl wie Frauen, niedrigere transepidermale Wasserverlust (TEWL)-Werte und einen niedrigeren pH-Wert. Die Wundheilung und das Niveau von Antioxidantien ist bei Frauenhaut besser. Männerhaut hat mehr Kollagen, altert an anderer Lokalisation, bei Männern finden sich mehr Falten an der Stirn, bei Frauen mehr Falten perioral. Studien sollten die Auswertung der Daten nach Geschlechtern mit beachten.
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Affiliation(s)
- Christiane Bayerl
- Klinik für Dermatologie und Allergologie, Helios Dr. Horst Schmidt Kliniken, Hauttumorzentrum Wiesbaden
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Nemes S, Gustavsson A, Jauhiainen A. Focused Information Criterion for Restricted Mean Survival Times: Non-Parametric or Parametric Estimators. ENTROPY 2022; 24:e24050713. [PMID: 35626596 PMCID: PMC9141018 DOI: 10.3390/e24050713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023]
Abstract
Restricted Mean Survival Time (RMST), the average time without an event of interest until a specific time point, is a model-free, easy to interpret statistic. The heavy reliance on non-parametric or semi-parametric methods in the survival analysis has drawn criticism, due to the loss of efficacy compared to parametric methods. This assumes that the parametric family used is the true one, otherwise the gain in efficacy might be lost to interpretability problems due to bias. The Focused Information Criterion (FIC) considers the trade-off between bias and variance and offers an objective framework for the selection of the optimal non-parametric or parametric estimator for scalar statistics. Herein, we present the FIC framework for the selection of the RMST estimator with the best bias-variance trade-off. The aim is not to identify the true underling distribution that generated the data, but to identify families of distributions that best approximate this process. Through simulation studies and theoretical reasoning, we highlight the effect of censoring on the performance of FIC. Applicability is illustrated with a real life example. Censoring has a non-linear effect on FICs performance that can be traced back to the asymptotic relative efficiency of the estimators. FICs performance is sample size dependent; however, with censoring percentages common in practical applications FIC selects the true model at a nominal probability (0.843) even with small or moderate sample sizes.
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Effects of COVID-19 Lockdown on Melanoma Diagnosis in Switzerland: Increased Tumor Thickness in Elderly Females and Shift towards Stage IV Melanoma during Lockdown. Cancers (Basel) 2022; 14:cancers14102360. [PMID: 35625961 PMCID: PMC9139530 DOI: 10.3390/cancers14102360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 01/09/2023] Open
Abstract
At the early stages of the COVID-19 outbreak in 2020, Switzerland was among the countries with the highest number of SARS-CoV2-infections per capita in the world. Lockdowns had a remarkable impact on primary care access and resulted in postponed cancer screenings. The aim of this study was to investigate the effects of the COVID-19 lockdown on the diagnosis of melanomas and stage of melanomas at diagnosis. In this retrospective, exploratory cohort study, 1240 patients with a new diagnosis of melanoma were analyzed at five tertiary care hospitals in German-speaking Switzerland over a period of two years and three months. We compared the pre-lockdown (01/FEB/19-15/MAR/20, n = 655) with the lockdown (16/MAR/20-22/JUN/20, n = 148) and post-lockdown period (23/JUN/20-30/APR/21, n = 437) by evaluating patients' demographics and prognostic features using Breslow thickness, ulceration, subtype, and stages. We observed a short-term, two-week rise in melanoma diagnoses after the major lift of social lockdown restrictions. The difference of mean Breslow thicknesses was significantly greater in older females during the lockdown compared to the pre-lockdown (1.9 ± 1.3 mm, p = 0.03) and post-lockdown period (1.9 ± 1.3 mm, p = 0.048). Thickness increase was driven by nodular melanomas (2.9 ± 1.3 mm, p = 0.0021; resp. 2.6 ± 1.3 mm, p = 0.008). A proportional rise of advanced melanomas was observed during lockdown (p = 0.047). The findings provide clinically relevant insights into lockdown-related gender- and age-dependent effects on melanoma diagnosis. Our data highlight a stable course in new melanomas with a lower-than-expected increase in the post-lockdown period. The lockdown period led to a greater thickness in elderly women driven by nodular melanomas and a proportional shift towards stage IV melanoma. We intend to raise awareness for individual cancer care in future pandemic management strategies.
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Khan J, Ullah A, Matolo N, Waheed A, Nama N, Sharma N, Ballur K, Gilstrap L, Singh SG, Ghleilib I, White J, Cason FD. Prognostic Value of Lymph Node Ratio in Cutaneous Melanoma: A Systematic Review. Cureus 2021; 13:e19117. [PMID: 34868763 PMCID: PMC8627641 DOI: 10.7759/cureus.19117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
The prognosis of cutaneous melanoma (CM) is based on the histological characteristics of the primary tumor, such as Breslow depth, ulceration, and mitotic rate. The lymph node ratio (LNR) is the ratio of the involved lymph nodes (LNs) divided by the total number of LNs removed during regional LN dissection. LNR is a prognostic factor for many solid tumors; however, controversies exist regarding CM. This study sought to analyze the role of LNR as a prognostic factor in CM. An extensive literature search was conducted using PubMed, Google Scholar, Medline, and the Cochrane Central Registry of Controlled Trials from January 1966 to July 2015. The keywords included in the search were CM and inclusion of the ratio of positive to the total number of LNs as a prognostic factor. The outcomes analyzed included the number of patients with positive LNs, type of survival analysis, and results from the multivariate analysis. A total of 11 studies involving 12,011 patients with positive LNs were evaluated. No previous randomized controlled trials, meta-analyses, or systematic reviews were identified in the Cochrane database on the prognostic value of LNR in CM. The primary electronic database search resulted in 333 full-text articles. The LN location examined was the cervical, axillary, and inguinal regions in all studies except for one that examined only the inguinal region. All studies except three studied the prognostic value of the LNR as a categorical variable rather than a continuous variable. LNR was categorized as A (≤0.1), B (0.11-0.25), and C (>0.25). All studies identified LNR as an independent predictor of overall survival (OS), disease-free survival (DFS), or disease-specific survival (DSS). The hazard ratio (HR) and confidence interval (CI) associated with either DFS or OS were available only in a few studies. Moreover, pooled HR for OS was 2.08 (95% CI: 1.48 2.92), for DFS was 1.364 (95% CI: 0.92-2.02), and for DSS was 1.643 (95% CI: 0.89-3.0). The LNR provides superior prognostic stratification among patients with CM. Additional adequately powered prospective studies are needed to further define the role of LNR and be included in the staging system of CM and direct adjuvant therapy.
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Affiliation(s)
- Jaffar Khan
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Asad Ullah
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Nathaniel Matolo
- Surgical Oncology, San Joaquin General Hospital, French Camp, USA
| | - Abdul Waheed
- Surgery, San Joaquin General Hospital, French Camp, USA
| | - Noor Nama
- Obstetrics and Gynaecology, Bolan Medical College Complex Hospital Quetta, Quetta, PAK
| | | | - Kalyani Ballur
- Pathology and Laboratory Medicine, Medical College of Georgia - Augusta University, Augusta, USA
| | - Lauren Gilstrap
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Sohni G Singh
- Surgery, San Joaquin General Hospital, French Camp, USA
| | - Intisar Ghleilib
- Pathology and Laboratory Medicine, Medical College of Georgia - Augusta University, Augusta, USA
| | - Joseph White
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
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Cesati M, Scatozza F, D’Arcangelo D, Antonini-Cappellini GC, Rossi S, Tabolacci C, Nudo M, Palese E, Lembo L, Di Lella G, Facchiano F, Facchiano A. Investigating Serum and Tissue Expression Identified a Cytokine/Chemokine Signature as a Highly Effective Melanoma Marker. Cancers (Basel) 2020; 12:cancers12123680. [PMID: 33302400 PMCID: PMC7762568 DOI: 10.3390/cancers12123680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary In this study, we investigated the expression of 27 cytokines/chemokines in the serum of 232 individuals (136 melanoma patients vs. 96 controls). It identified several cytokines/chemokines differently expressed in melanoma patients as compared to the healthy controls, as a function of the presence of the melanoma, age, tumor thickness, and gender, indicating different systemic responses to the melanoma presence. We also analyzed the gene expression of the same 27 molecules at the tissue level in 511 individuals (melanoma patients vs. controls). From the gene expression analysis, we identified several cytokines/chemokines showing strongly different expression in melanoma as compared to the controls, and the 4-gene signature “IL-1Ra, IL-7, MIP-1a, and MIP-1b” as the best combination to discriminate melanoma samples from the controls, with an extremely high accuracy (AUC = 0.98). These data indicate the molecular mechanisms underlying melanoma setup and the relevant markers potentially useful to help the diagnosis of biopsy samples. Abstract The identification of reliable and quantitative melanoma biomarkers may help an early diagnosis and may directly affect melanoma mortality and morbidity. The aim of the present study was to identify effective biomarkers by investigating the expression of 27 cytokines/chemokines in melanoma compared to healthy controls, both in serum and in tissue samples. Serum samples were from 232 patients recruited at the IDI-IRCCS hospital. Expression was quantified by xMAP technology, on 27 cytokines/chemokines, compared to the control sera. RNA expression data of the same 27 molecules were obtained from 511 melanoma- and healthy-tissue samples, from the GENT2 database. Statistical analysis involved a 3-step approach: analysis of the single-molecules by Mann–Whitney analysis; analysis of paired-molecules by Pearson correlation; and profile analysis by the machine learning algorithm Support Vector Machine (SVM). Single-molecule analysis of serum expression identified IL-1b, IL-6, IP-10, PDGF-BB, and RANTES differently expressed in melanoma (p < 0.05). Expression of IL-8, GM-CSF, MCP-1, and TNF-α was found to be significantly correlated with Breslow thickness. Eotaxin and MCP-1 were found differentially expressed in male vs. female patients. Tissue expression analysis identified very effective marker/predictor genes, namely, IL-1Ra, IL-7, MIP-1a, and MIP-1b, with individual AUC values of 0.88, 0.86, 0.93, 0.87, respectively. SVM analysis of the tissue expression data identified the combination of these four molecules as the most effective signature to discriminate melanoma patients (AUC = 0.98). Validation, using the GEPIA2 database on an additional 1019 independent samples, fully confirmed these observations. The present study demonstrates, for the first time, that the IL-1Ra, IL-7, MIP-1a, and MIP-1b gene signature discriminates melanoma from control tissues with extremely high efficacy. We therefore propose this 4-molecule combination as an effective melanoma marker.
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Affiliation(s)
- Marco Cesati
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Francesca Scatozza
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
| | - Daniela D’Arcangelo
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
| | - Gian Carlo Antonini-Cappellini
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
| | - Stefania Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.R.); (C.T.)
| | - Claudio Tabolacci
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.R.); (C.T.)
| | - Maurizio Nudo
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
| | - Enzo Palese
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
| | - Luigi Lembo
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
| | - Giovanni Di Lella
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
| | - Francesco Facchiano
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; (S.R.); (C.T.)
- Correspondence: (F.F.); (A.F.)
| | - Antonio Facchiano
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, via Monti di Creta 104, 00167 Rome, Italy; (F.S.); (D.D.); (G.C.A.-C.); (M.N.); (E.P.); (L.L.); (G.D.L.)
- Correspondence: (F.F.); (A.F.)
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