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Xia Q, Ma Q, Zhu J, Gu L, Zhou F. Prognostic factors in postoperative patients with cutaneous melanoma: a systematic review and meta-analysis. Am J Cancer Res 2024; 14:1947-1956. [PMID: 38859868 PMCID: PMC11162687 DOI: 10.62347/sqzt7285] [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: 02/19/2024] [Accepted: 04/18/2024] [Indexed: 06/12/2024] Open
Abstract
Cutaneous melanoma is a prevalent tumor associated with a poor prognosis. This systematic review and meta-analysis aimed to identify and evaluate prognostic factors for patients with cutaneous melanoma following surgery, thereby providing crucial insights for enhancing patient outcomes. We searched PubMed, Embase, Cochrane Library, CINAHL, and Web of Science for studies on postoperative prognostic factors of cutaneous melanoma up to March 2024. Literature screening, data extraction, and quality assessment were performed, followed by meta-analysis using RevMan 5.3 software. Trial Sequential Analysis (TSA) was conducted with Stata 17 software to verify the robustness of the findings. Eleven studies encompassing 27,352 patients were included. The meta-analysis identified several prognostic factors impacting disease-specific survival post-surgery: age over 50 years (HR=1.05, 95% CI: 1.02-1.08), female gender (HR=0.71, 95% CI: 0.57-0.87), Breslow thickness greater than 2 mm (HR=1.11, 95% CI: 1.06-1.17), presence of ulceration (HR=2.06, 95% CI: 1.63-2.60), and positive sentinel lymph node (HR=3.03, 95% CI: 2.50-3.66). TSA confirmed the adequacy of the sample size. Aggressive treatment strategies are recommended for patients exhibiting these characteristics to improve prognosis and extend 5-year survival rates.
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Affiliation(s)
- Qi Xia
- Department of PICC, Day Chemotherapy Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Qinghua Ma
- Department of Nursing, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Jiuqun Zhu
- Department of Pharmacy, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Lu Gu
- Department of Radiation, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
| | - Fengling Zhou
- Department of Pediatrics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of ChinaChengdu 610072, Sichuan, China
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Choi ME, Jung JM, Kim DH, Won CH, Chang SE, Lee MW, Lee WJ. Baseline Serum neutrophil-to-lymphocyte ratio in acral melanoma compared with nonacral melanoma and its prognostic significance. J Am Acad Dermatol 2024; 90:977-985. [PMID: 38272394 DOI: 10.1016/j.jaad.2023.12.064] [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: 09/24/2023] [Revised: 11/21/2023] [Accepted: 12/16/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM), a cutaneous melanoma subtype, exhibits a poorer prognosis than nonacral cutaneous melanoma (NACM). The neutrophil-to-lymphocyte ratio (NLR) is emerging as a prognostic indicator across diverse cancers. OBJECTIVE We explored the baseline NLR disparities between ALM and NACM, and the NLR's prognostic significance in patients with ALM. METHODS We reviewed records of patients with ALM and NACM diagnosed between 1997 and 2022, analyzing medical data. RESULTS Among 327 and 159 patients with ALM and NACM, respectively, baseline NLR varied based on distinct clinicopathologic factors between ALM and NACM. In stage 3 to 4 melanomas, the median NLR for ALM (2.18; IQR, 1.70-3.08) significantly surpassed NACM (1.74; IQR, 1.33-2.53) (P = .029). In patients with ALM, high NLR (hazard ratio, 1.64; 95% CI, 1.02-2.66; P = .043) was independently correlated with poor progression-free survival when adjusting for ulceration, Breslow thickness of ≥2 mm, and nodal invasion. LIMITATIONS Single-center, retrospective design. CONCLUSION Advanced-stage ALM exhibited a significantly higher baseline NLR compared with that of NACM. Evaluating baseline NLR could provide valuable prognostic insights for patients with ALM.
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Affiliation(s)
- Myoung Eun Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do Hyung Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Vița O, Jurescu A, Văduva A, Cornea R, Cornianu M, Tăban S, Szilagyi D, Micșescu C, Natarâș B, Dema A. Invasive Cutaneous Melanoma: Evaluating the Prognostic Significance of Some Parameters Associated with Lymph Node Metastases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1241. [PMID: 37512052 PMCID: PMC10385614 DOI: 10.3390/medicina59071241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: This study aimed to assess the clinical-pathological profile of patients with invasive cutaneous melanomas and to identify the parameters with a prognostic role in the lymph nodal spread of this malignant tumor. Materials and Methods: We performed a retrospective study on patients with invasive cutaneous melanomas who underwent surgery in the "Pius Brînzeu" County Clinical Emergency Hospital from Timișoara, Romania, and were evaluated for the status of loco-regional lymph nodes. We selected and analyzed some parameters searching for their relationship with lymph node metastases. Results: We identified 79 patients with invasive cutaneous melanomas (29 men and 50 women, mean age 59.36 years). A percentage of 58.3% of melanomas had Breslow tumor thickness >2 mm; 69.6% of melanomas showed a Clark level IV-V. Tumor ulceration was present in 59.5% of melanomas. A mitotic rate of ≥5 mitoses/mm2 was observed in 48.1% of melanomas. Tumor-infiltrating lymphocytes (TILs), non-brisk, were present in 59.5% of cases and 22.8% of patients had satellite/in-transit metastasis (SINTM). Tumor regression was identified in 44.3% of cases. Lymph nodes metastases were found in 43.1% of patients. Statistical analysis showed that lymph node metastases were more frequent in melanomas with Breslow thickness >2 mm (p = 0.0002), high Clark level (p = 0.0026), mitotic rate >5 mitoses/mm2 (p = 0.0044), ulceration (p = 0.0107), lymphovascular invasion (p = 0.0182), SINTM (p = 0.0302), and non-brisk TILs (p = 0.0302). Conclusions: The Breslow thickness >2 mm, high Clark level, high mitotic rate and ulceration are the most important prognostic factors for lymph nodal spread in cutaneous melanomas. However, some melanomas without these clinical-pathological features can have an unexpected, aggressive evolution, which entails the necessity of close and prolonged clinical follow-up of patients, including those with lesions considered without risk.
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Affiliation(s)
- Octavia Vița
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Aura Jurescu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adrian Văduva
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Remus Cornea
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Marioara Cornianu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Sorina Tăban
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Diana Szilagyi
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Cristian Micșescu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Bianca Natarâș
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Alis Dema
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
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Lapkina EZ, Esimbekova AR, Ruksha TG. [Vasculogenic mimicry]. Arkh Patol 2023; 85:62-69. [PMID: 38010640 DOI: 10.17116/patol20238506162] [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] [Indexed: 11/29/2023]
Abstract
Anti-angiogenic drugs are used as an established approach of malignant neoplasms therapy. It has been established that the development of the phenomenon of vasculogenic mimicry - a specific variant of tumor neoangiogenesis, which is formed in highly aggressive solid tumors, is associated with a decrease in the effectiveness of antitumor therapy. This review highlights the mechanisms of development of vasculogenic mimicry in malignant neoplasms, which is one of the alternative options for tumor blood supply. In the formation of vasculogenic mimicry, an important role is assigned to the tumor microenvironment, primarily tumor-associated macrophages and fibroblasts. The signaling pathways that regulate the formation of vasculogenic mimicry channels in tumors have been characterized. The prospects for a targeted impact on molecular targets that initiate and promote vasculogenic mimicry, the impact on which can increase the effectiveness of antitumor therapy, are shown. The review discusses experimental studies of the mechanisms of vasculogenic mimicry formation in malignant neoplasms and the prospects for targeted action on molecules that are components of signaling cascades involved in the development of this model of neoangiogenesis.
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Affiliation(s)
- E Z Lapkina
- Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - A R Esimbekova
- Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - T G Ruksha
- Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Li X, Li Z, Yi X, Gao X, Yang Z, Huang X, Ma S, Ma T, Deng Z, Shang L, Jian Z. A population-based cohort study for presence of ulceration among cutaneous malignant melanoma subgroups of patients. Front Oncol 2022; 12:929600. [PMID: 36408152 PMCID: PMC9666370 DOI: 10.3389/fonc.2022.929600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Observational studies suggest that ulceration is considered to be a negative prognostic factor for cutaneous melanoma. However, the impact of ulceration over different subgroups (e.g. AJCC Stage, thickness level) are controversial and its true causal effect on survival is lack of studies in the view of treating ulceration as an exposure. OBJECTIVE To explore the true causal effect of ulceration on melanoma's survival by adopting a combination of methods to discover proper adjustment set and confirming its correctness through a variety of means. METHODS A minimal sufficient adjustment set (MSAS) was found using directed acyclic graphs (DAG) to adjust the effect of causality. Sensitivity analysis was conducted to diagnose potential confounders in addition to MSAS. Cox models were built to analyze the causality in-depth and the model was validated using a novel method. Lastly, stratified effects of ulceration were examined to illustrate its impact within subgroups. RESULTS Hazard ratio (HR) of ulceration after adjustment by MSAS variables was 1.99 (95% CI=1.88-2.09). The sensitivity analysis of propensity score matching and E-value both demonstrated that variables other than MSAS do not have great influence on ulceration and MSS relationship. The HR of ulceration in AJCC Stage, thickness level, invasion level and tumor extension were all monotonically decreased from 5.76 to 1.57, 4.03 to 1.78, 2.75 to 1.78 and 2.65 to 1.71 respectively. CONCLUSION Ulceration in all subgroups were shown to have a significantly negative impact on MSS and its magnitude of effect was monotonically decreased as the disease progressed. The true effect of ulceration can be adjusted by MSAS and its correctness was validated through a variety of approaches.
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Affiliation(s)
- Xinrui Li
- School of Medicine, Northwest University, Xi’an, Shaanxi, China,Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zichao Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xiaowei Yi
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xianchun Gao
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhe Yang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xingning Huang
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Sijie Ma
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Tianyuan Ma
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Ziyi Deng
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Lei Shang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China,*Correspondence: Lei Shang, ; Zhe Jian,
| | - Zhe Jian
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China,*Correspondence: Lei Shang, ; Zhe Jian,
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