1
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Cook S, Pethick J, Kibbi N, Hollestein L, Lavelle K, de Vere Hunt I, Turnbull C, Rous B, Husain A, Burn J, Lüchtenborg M, Santaniello F, McRonald F, Hardy S, Linos E, Venables Z, Rajan N. Sebaceous carcinoma epidemiology, associated malignancies and Lynch/Muir-Torre syndrome screening in England from 2008 to 2018. J Am Acad Dermatol 2023; 89:1129-1135. [PMID: 37031776 DOI: 10.1016/j.jaad.2023.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/02/2023] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Sebaceous carcinomas (SC) may be associated with the cancer predisposition syndrome Muir-Torre/Lynch syndrome (MTS/LS), identifiable by SC mismatch repair (MMR) screening; however, there is limited data on MMR status of SC. OBJECTIVE To describe the epidemiology of SC, copresentation of other cancers, and population level frequency of MMR screening in SC. METHODS A population-based retrospective cohort study of SC patients in the National Cancer Registration and Analysis Service in England. RESULTS This study included 1077 SC cases (739 extraocular, 338 periocular). Age-standardized incidence rates (ASIR) were higher in men compared with women, 2.74 (95% CI, 2.52-9.69) per 1,000,000 person-years for men versus 1.47 person-years (95% CI, 1.4-1.62) for women. Of the patients, 19% (210/1077) developed at least one MTS/LS-associated malignancy. MMR immunohistochemical screening was performed in only 20% (220/1077) of SC tumors; of these, 32% (70/219) of tumors were MMR deficient. LIMITATIONS Retrospective design. CONCLUSIONS Incorporation of MMR screening into clinical practice guidelines for the management of SC will increase the opportunity for MTS/LS diagnoses, with implications for cancer surveillance, chemoprevention with aspirin, and immunotherapy treatment targeted to MTS/LS cancers.
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Affiliation(s)
- Sam Cook
- Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Joanna Pethick
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands
| | - Katrina Lavelle
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Isabella de Vere Hunt
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Clare Turnbull
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Brian Rous
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Akhtar Husain
- Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - John Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Margreet Lüchtenborg
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom; Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King's College London, London, United Kingdom
| | - Francesco Santaniello
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom; Health Data Insight, Cambridge, United Kingdom
| | - Fiona McRonald
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Steven Hardy
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Zoe Venables
- National Disease Registration Service (NDRS), NHS Digital, London, United Kingdom; Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Neil Rajan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
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2
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Kerkour T, Zhou C, Hollestein L, Mooyaart A. Genetic Concordance in Primary Cutaneous Melanoma and Matched Metastasis: A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:16281. [PMID: 38003476 PMCID: PMC10671327 DOI: 10.3390/ijms242216281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Studying primary melanoma and its corresponding metastasis has twofold benefits. Firstly, to better understand tumor biology, and secondly, to determine which sample should be examined in assessing drug targets. This study systematically analyzed all the literature on primary melanoma and its matched metastasis. Following PRISMA guidelines, we searched multiple medical databases for relevant publications from January 2000 to December 2022, assessed the quality of the primary-level studies using the QUIPS tool, and summarized the concordance rate of the most reported genes using the random-effects model. Finally, we evaluated the inter-study heterogeneity using the subgroup analysis. Thirty-one studies investigated the concordance of BRAF and NRAS in 1220 and 629 patients, respectively. The pooled concordance rate was 89.4% [95% CI: 84.5; 93.5] for BRAF and 97.8% [95% CI: 95.8; 99.4] for NRAS. When high-quality studies were considered, only BRAF mutation status consistency increased. Five studies reported the concordance status of c-KIT (93%, 44 patients) and TERT promoter (64%, 53 patients). Lastly, three studies analyzed the concordance of cancer genes involved in the signaling pathways, apoptosis, and proliferation, such as CDKN2A (25%, four patients), TP53 (44%, nine patients), and PIK3CA (20%, five patients). Our study found that the concordance of known drug targets (mainly BRAF) during melanoma progression is higher than in previous meta-analyses, likely due to advances in molecular techniques. Furthermore, significant heterogeneity exists in the genes involved in the melanoma genetic makeup; although our results are based on small patient samples, more research is necessary for validation.
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Affiliation(s)
- Thamila Kerkour
- Department of Dermatology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (T.K.); (C.Z.); (L.H.)
| | - Catherine Zhou
- Department of Dermatology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (T.K.); (C.Z.); (L.H.)
| | - Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (T.K.); (C.Z.); (L.H.)
| | - Antien Mooyaart
- Department of Pathology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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3
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George CD, Tokez S, Hollestein L, Pardo LM, Keurentjes AJ, Wakkee M, Nijsten T. Longitudinal Assessment of the Prevalence of Actinic Keratosis and Extensive Risk Factor Evaluation: An Update from the Rotterdam Study. J Invest Dermatol 2023; 143:2193-2203.e12. [PMID: 37169068 DOI: 10.1016/j.jid.2023.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 05/13/2023]
Abstract
Population-based studies available to analyze the prevalence, risk factors, and longitudinal outlook of actinic keratoses (AKs) are limited. These features mentioned earlier were assessed using Rotterdam study participants aged ≥40 years who underwent a full-body skin examination by a dermatology-trained physician. ORs with 95% confidence intervals were calculated for the associations between risk factors and the presence of AK. Among 8,239 eligible participants, the prevalence of one or more AKs was 21.1% (95% confidence interval = 20.2-22.0) and was higher in men. Male sex, age, lighter hair and eye color, baldness, genetic risk score, and digital photoaging measures (digitally assessed pigmented spots, telangiectasias, and global facial wrinkling) had a positive association with AK. Cigarette smokers had reduced odds of having AK, with current smokers having the lowest risk. Among patients with two AK assessments, there was no difference in the presence of AK during follow-up between treated and untreated participants. In conclusion, genetic risk score and digital photoaging measures showed associations with increased lesion count. At the individual level, patients were most likely to decrease in AK severity group over time, possibly regardless of whether or not participants were treated.
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Affiliation(s)
- Christopher D George
- Departmentof Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Selin Tokez
- Departmentof Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Loes Hollestein
- Departmentof Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Luba M Pardo
- Departmentof Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne J Keurentjes
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marlies Wakkee
- Departmentof Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamar Nijsten
- Departmentof Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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4
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Smak Gregoor AM, Sangers TE, Bakker LJ, Hollestein L, Uyl-de Groot CA, Nijsten T, Wakkee M. An artificial intelligence based app for skin cancer detection evaluated in a population based setting. NPJ Digit Med 2023; 6:90. [PMID: 37210466 DOI: 10.1038/s41746-023-00831-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/28/2023] [Indexed: 05/22/2023] Open
Abstract
Artificial intelligence (AI) based algorithms for classification of suspicious skin lesions have been implemented in mobile phone apps (mHealth), but their effect on healthcare systems is undocumented. In 2019, a large Dutch health insurance company offered 2.2 million adults free access to an mHealth app for skin cancer detection. To study the impact on dermatological healthcare consumption, we conducted a retrospective population-based pragmatic study. We matched 18,960 mHealth-users who completed at least one successful assessment with the app to 56,880 controls who did not use the app and calculated odds ratios (OR) to compare dermatological claims between both groups in the first year after granting free access. A short-term cost-effectiveness analysis was performed to determine the cost per additional detected (pre)malignancy. Here we report that mHealth-users had more claims for (pre)malignant skin lesions than controls (6.0% vs 4.6%, OR 1.3 (95% CI 1.2-1.4)) and also a more than threefold higher risk of claims for benign skin tumors and nevi (5.9% vs 1.7%, OR 3.7 (95% CI 3.4-4.1)). The costs of detecting one additional (pre)malignant skin lesion with the app compared to the current standard of care were €2567. Based on these results, AI in mHealth appears to have a positive impact on detecting more cutaneous (pre)malignancies, but this should be balanced against the for now stronger increase in care consumption for benign skin tumors and nevi.
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Affiliation(s)
- Anna M Smak Gregoor
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tobias E Sangers
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lytske J Bakker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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5
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Neale RE, Lucas RM, Byrne SN, Hollestein L, Rhodes LE, Yazar S, Young AR, Berwick M, Ireland RA, Olsen CM. The effects of exposure to solar radiation on human health. Photochem Photobiol Sci 2023:10.1007/s43630-023-00375-8. [PMID: 36856971 PMCID: PMC9976694 DOI: 10.1007/s43630-023-00375-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.
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Affiliation(s)
- R. E. Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,School of Public Health, University of Queensland, Brisbane, QLD Australia
| | - R. M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT Australia
| | - S. N. Byrne
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - L. Hollestein
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands ,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - L. E. Rhodes
- Dermatology Research Centre, School of Biological Sciences, University of Manchester, Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| | - S. Yazar
- Garvan Medical Research Institute, Sydney, NSW Australia
| | | | - M. Berwick
- University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - R. A. Ireland
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - C. M. Olsen
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,Frazer Institute, University of Queensland, Brisbane, QLD Australia
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6
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Mistry K, Levell NJ, Hollestein L, Wakkee M, Nijsten T, Knott CS, Steven NM, Craig PJ, Venables ZC. Trends in incidence, treatment and survival of Merkel cell carcinoma in England 2004-2018: a cohort study. Br J Dermatol 2023; 188:228-236. [PMID: 36763882 DOI: 10.1093/bjd/ljac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare tumour with neuroendocrine differentiation and high associated mortality. Studies that describe the epidemiology of MCC are often limited by small sample size, short duration of follow-up, absence of nationwide data and paucity of data on different risk factors. OBJECTIVES To determine the incidence, demographics and survival for MCC in England between 2004 and 2018. METHODS This national retrospective cohort study identified all cases of MCC in England from 2004 to 2018 using national population-based data from the National Disease Registration Service. Crude counts, European age-standardized incidence rates (EASRs) and joinpoint analysis were conducted. Patient demographics and treatments received were described. Multivariable Cox regression analysis was used to study risk factors for MCC-specific mortality, by including a priori defined demographic factors, tumour characteristics and immunosuppression. Treatment data were not included in the Cox regression analysis. RESULTS A total of 3775 MCC tumours were registered. The median age at diagnosis was 81 years (interquartile range 74-87). Overall, 96·6% of patients identified as White ethnicity, and 8·3% of patients were immunosuppressed. The most common site was the face (27·4%). Patients most often presented with stage one disease (22·8%); however, stage was unknown in 31·0%. In total, 80·7% of patients underwent surgical excision, 43·5% radiotherapy and 9·2% systemic therapy. The EASR increased from 0·43 per 100 000 person-years (PYs) to 0·65 per 100 000 person-years between 2004 and 2018, representing a significant annual percentage change of 3·9%. The EASR was greater in men than in women for all years, with an overall male-to-female ratio of 1·41 : 1. The highest EASR was in South West England. Five-year disease-specific survival was 65·6% [95% confidence interval (CI) 63·8-67·4], with a median follow-up of 767 days. MCC-specific mortality increased with age [hazard ratio (HR) 1·02, 95% CI 1·02-1·03], deprivation (HR 1·43, 95% CI 1·16-1·76), immunosuppression (HR 2·80, 95% CI 2·34-3·34) and stage at diagnosis (HR 8·24, 95% CI 5·84-11·6). CONCLUSIONS This study presents the largest national MCC dataset in Europe, and the most complete reporting of MCC incidence and survival ever published. With the EASR of MCC increasing and high associated mortality, this study encourages further research into the pathology, diagnosis and therapeutic options for MCC to support management guidelines.
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Affiliation(s)
- Khaylen Mistry
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nick J Levell
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Loes Hollestein
- Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Tamar Nijsten
- Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Craig S Knott
- National Disease Registration Service, NHS Digital, Leeds, UK.,Health Data Insight CIC, Cambridge, UK
| | - Neil M Steven
- Cancer Research UK Centre, University of Birmingham, Birmingham, UK
| | - Paul J Craig
- Cellular Pathology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Zoe C Venables
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK.,National Disease Registration Service, NHS Digital, Leeds, UK
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7
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Eggermont C, Wakkee M, Bruggink A, Voorham Q, Schreuder K, Louwman M, Mooyaart A, Hollestein L. Development and Validation of an Algorithm to Identify Patients with Advanced Cutaneous Squamous Cell Carcinoma from Pathology Reports. J Invest Dermatol 2023; 143:98-104.e5. [PMID: 35926654 DOI: 10.1016/j.jid.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
To facilitate nationwide epidemiological research on advanced cutaneous squamous cell carcinoma (cSCC), that is, locally advanced, recurrent, or metastatic cSCC, we sought to develop and validate a rule-based algorithm that identifies advanced cSCC from pathology reports. The algorithm was based on both hierarchical histopathological codes and free text from pathology reports recorded in the National Pathology Registry. Medical files from the Erasmus Medical Center of 186 patients with stage III/IV/recurrent cSCC and 184 patients with stage I/II cSCC were selected and served as the gold standard to assess the performance of the algorithm. The rule-based algorithm showed a sensitivity of 91.9% (95% confidence interval = 88.0‒95.9), a specificity of 96.7% (95% confidence interval = 94‒2-99.3), and a positive predictive value of 78.5% (95% confidence interval = 74.2‒82.8) for all advanced cSCC combined. The sensitivity was lower per subgroup: locally advanced (52.3‒86.2%), recurrent cSCC (23.3%), and metastatic cSCC (70.0%). The specificity per subgroup was above 97%, and the positive predictive value was above 78%, with the exception of metastatic cSCC, which had a positive predictive value of 62%. This algorithm can be used to identify advanced patients with cSCC from pathology reports and will facilitate large-scale epidemiological studies of advanced cSCC in the Netherlands and internationally after external validation.
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Affiliation(s)
- Celeste Eggermont
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Annette Bruggink
- Nationwide Network and Registry of Histo- and Cytopathology (PALGA), Houten, The Netherlands
| | - Quirinus Voorham
- Nationwide Network and Registry of Histo- and Cytopathology (PALGA), Houten, The Netherlands
| | - Kay Schreuder
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Marieke Louwman
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Antien Mooyaart
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
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8
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George C, Tokez S, Hollestein L, Wakkee M, Pardo-Cortes L, Nijsten T. 212 Prevalence and risk factors of actinic keratosis: Results from the rotterdam study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Slotman E, Schreuder K, Nijsten T, Wakkee M, Hollestein L, Mooyaart A, Siesling S, Louwman M. The impact of the COVID‐19 pandemic on keratinocyte carcinoma in the Netherlands: trends in diagnoses and magnitude of diagnostic delays. J Eur Acad Dermatol Venereol 2022; 36:680-687. [DOI: 10.1111/jdv.17976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/22/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- E. Slotman
- Dept. Health Technology and Services Research Technical Medical Centre University of Twente Enschede
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - K. Schreuder
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - T.E.C. Nijsten
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - M. Wakkee
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - L. Hollestein
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - A. Mooyaart
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - S. Siesling
- Dept. Health Technology and Services Research Technical Medical Centre University of Twente Enschede
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - M.W.J. Louwman
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
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10
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Schreuder K, Hollestein L, Nijsten TEC, Wakkee M, Louwman MWJ. A nationwide study of the incidence and trends of first and multiple basal cell carcinoma in the Netherlands and prediction of future incidence. Br J Dermatol 2021; 186:476-484. [PMID: 34726263 DOI: 10.1111/bjd.20871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most frequently diagnosed malignancy worldwide and an ever increasing annual incidence is observed. However, nationwide registries of BCCs are very rare and often extrapolation of the data was necessary to estimate the absolute number of diagnoses. Since September 2016, all histopathologically confirmed BCCs are registered in the Netherlands, due to developments in automatic notification and import in the Netherlands cancer registry. This offers the unique possibility to assess the nationwide population-based incidence of first and multiple BCC. OBJECTIVES The current study aims to assess nationwide incidence and trends of first and multiple BCC in the Netherlands and to predict incidence rates up to 2029. METHODS All patients with histopathologically confirmed BCC between 2001 and 2019 were selected from the population-based Netherlands Cancer Registry. Age-standardized incidence rates were calculated and trends were analyzed with use of the estimated annual percentage change. Prediction of BCC incidence rates up to 2029 was based on a regression model. RESULTS In total, 601,806 patients were diagnosed with a first BCC over the period 2001-2019. The age-standardized incidence rates for both men and women with a first BCC increased over these years from 158 to 304 and 124 to 274 per 100,000 person-years, respectively. For male and female patients aged between 30-39 years, decreases in annual incidences of -3.6% and -3.0% were found in recent years, respectively. For patients aged 50 years or older an ever increasing trend was found. A quarter of the patients with a first primary BCC developed one or more subsequent BCCs within three years. Increases in incidence of 30.4% (male) and 25.3% (female) is expected in the next 10 years. CONCLUSIONS BCC incidence doubled over the past decades. Trends seemed to stabilize in recent years for patients aged below 50 years. This might be a first sign of a decreasing trend. The incidence keeps rising in patients aged 50 years and older. In the next decade a further increase in BCC incidence is expected.
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Affiliation(s)
- K Schreuder
- Department of Research and Development, Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - L Hollestein
- Department of Research and Development, Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - T E C Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M W J Louwman
- Department of Research and Development, Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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11
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Cook S, Bajwa D, Hollestein L, Husain A, Rajan N. A 5-year retrospective review of skin adnexal tumours received at a tertiary dermatopathology service: Implications for linked genetic diagnoses. Br J Dermatol 2021; 186:167-173. [PMID: 34388263 DOI: 10.1111/bjd.20701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin adnexal tumours (SATs) comprise a diverse range of neoplasms, which are difficult to diagnose clinically. They present in paediatric and adult populations, and may be indicative of an underlying genetic syndrome. There is a lack of recent data on the presentation of these tumours in clinical practice in European populations. OBJECTIVE To characterise the clinical and pathological features of SATs received at a single tertiary centre over a 5-year period. METHODS A retrospective health record audit of SATs received at the Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, during the period November 2012 to October 2017. RESULTS 107144 skin cases were received during the audit period. 1615 cases of SATs from 1359 patients were included; 1570 (97.2%) were benign and 45 (2.8%) were malignant. Overall, the average age at presentation was 55 years (range 11 months - 97 years) and the male to female ratio was 0.77:1. Sweat gland and hair follicle SATs were most frequently excised; in adults the most frequent tumour was hidrocystoma, and in children, pilomatrixoma. Pre-biopsy diagnosis was correct 28% of the time. Benign SATs are often markers of an associated genetic condition, warranting improved discrimination of sporadic from genetically related SATs. CONCLUSIONS SATs are difficult to diagnose clinically, and clinicopathological correlation may help enhance selection of genetically related SATs from sporadic cases. These data have implications for clinical and dermatopathological training provision, the development of reporting standards, and genetic assessment of selected patients.
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Affiliation(s)
- S Cook
- Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - D Bajwa
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - L Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - A Husain
- Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - N Rajan
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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12
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Nijsten T, Silverberg J, Gisondi P, Vestergaard C, Hollestein L, Wakkee M. Considerations in association studies in dermatoepidemiology. Br J Dermatol 2021; 185:1-2. [PMID: 34216012 DOI: 10.1111/bjd.20393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- T Nijsten
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - J Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - P Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Italy
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - L Hollestein
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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13
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Sbidian E, Mezzarobba M, Shourick J, Billionnet C, Coste J, Weill A, Rudant J, Chosidow O, Hollestein L, Nijsten T. Choice of Systemic Drugs for the Management of Moderate-to-severe Psoriasis: A Cross-country Comparison Based on National Health Insurance Data. Acta Derm Venereol 2021; 101:adv00473. [PMID: 33585948 PMCID: PMC9380268 DOI: 10.2340/00015555-3765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Current management of moderate-to-severe psoriasis may be heterogeneous between European countries, probably due to differences in the organization of care. The aim of this study was to compare the utilization of systemic treatments for psoriasis between 2 countries. All adults with psoriasis who were registered in the French (SNDS) and the Dutch (VEKTIS) national health insurance databases between 2012 and 2016 were eligible for inclusion. In France, 105,035 (15%) of 684,156 patients and, in the Netherlands, 37,405 (28.6%) of 130,822 patients received at least a systemic agent. In France, the proportion of patients treated with systemic agents was constant, while the type of drugs dispensed shifted from non-biological to biological agents. In the Netherlands, the first systemic treatment was methotrexate and, in France, acitretin. In France, the choice of the first biologic was much more variable than it was in the Netherlands, where a large proportion of patients were dispensed ustekinumab. This study highlights discrepancies between France and the Netherlands concerning the choice of first non-biologic agent and first biologic agent for patients with psoriasis. These discrepancies may be due to differences in the healthcare systems between the 2 countries.
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Affiliation(s)
- Emilie Sbidian
- Department of Dermatology, Hôpital Henri-Mondor, 51, av du Maréchal de Lattre de Tassigny, FR-94010 Créteil Cedex, France. E-mail:
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14
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Drucker AM, Hollestein L, Na Y, Weinstock MA, Li WQ, Abdel-Qadir H, Chan AW. Association between antihypertensive medications and risk of skin cancer in people older than 65 years: a population-based study. CMAJ 2021; 193:E508-E516. [PMID: 33846199 PMCID: PMC8087333 DOI: 10.1503/cmaj.201971] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: The risk of skin cancer associated with antihypertensive medication use is unclear, although thiazides have been implicated in regulatory safety warnings. We aimed to assess whether use of thiazides and other antihypertensives is associated with increased rates of keratinocyte carcinoma and melanoma. METHODS: We conducted a population-based inception cohort study using linked administrative health data from Ontario, 1998–2017. We matched adults aged ≥ 66 years with a first prescription for an antihypertensive medication (thiazides, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, β-blockers) by age and sex to 2 unexposed adults who were prescribed a non-antihypertensive medication within 30 days of the index date. We evaluated each antihypertensive class in a separate cohort study. Our primary exposure was the cumulative dose within each class, standardized according to the World Health Organization’s Defined Daily Dose. Outcomes were time to first keratinocyte carcinoma, advanced keratinocyte carcinoma and melanoma. RESULTS: The inception cohorts included a total of 302 634 adults prescribed an antihypertensive medication and 605 268 unexposed adults. Increasing thiazide exposure was associated with an increased rate of incident keratinocyte carcinoma (adjusted hazard ratios [HRs] per 1 Defined Annual Dose unit 1.08, 95% confidence interval [CI] 1.03–1.14), advanced keratinocyte carcinoma (adjusted HR 1.07, 95% CI 0.93–1.23) and melanoma (adjusted HR 1.34, 95% CI 1.01–1.78). We found no consistent evidence of association between other antihypertensive classes and keratinocyte carcinoma or melanoma. INTERPRETATION: Higher cumulative exposure to thiazides was associated with increased rates of incident skin cancer in people aged 66 years and older. Consideration of other antihypertensive treatments in patients at high risk of skin cancer may be warranted.
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Affiliation(s)
- Aaron M Drucker
- Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China
| | - Loes Hollestein
- Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China
| | - Yingbo Na
- Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China
| | - Martin A Weinstock
- Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China
| | - Wen-Qing Li
- Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China
| | - Husam Abdel-Qadir
- Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China
| | - An-Wen Chan
- Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China
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15
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van Egmond S, de Vries E, Hollestein L, Bastiaens M, de Roos KP, Kuijpers D, Steyerberg E, Wakkee M, Mosterd K, Nijsten T, de Bekker-Grob EW. What do patients and dermatologists prefer regarding low-risk basal cell carcinoma follow-up care? A discrete choice experiment. PLoS One 2021; 16:e0249298. [PMID: 33780499 PMCID: PMC8007023 DOI: 10.1371/journal.pone.0249298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Follow-up after low-risk basal cell carcinoma (BCC) is being provided more frequently than recommended by guidelines. To design an acceptable strategy to successfully reduce this 'low-value' care, it is important to obtain insights into the preferences of patients and dermatologists. OBJECTIVE To determine the preferences and needs of patients and dermatologists to reduce low-risk BCC follow-up care, and the trade-offs they are willing to make. METHODS A questionnaire including a discrete choice experiment was created, containing attributes regarding amount of follow-up, continuity of care, method of providing addition information, type of healthcare provider, duration of follow-up visits and skin examination. In total, 371 BCC patients and all Dutch dermatologists and dermatology residents (n = 620) were invited to complete the questionnaire. A panel latent class model was used for analysis. RESULTS Eighty-four dermatologists and 266 BCC patients (21% and 72% response rates respectively) completed the discrete choice experiment. If the post-treatment visit was performed by the same person as treatment provider and a hand-out was provided to patients containing personalised information, the acceptance of having no additional follow-up visits (i.e. following the guidelines) would increase from 55% to 77% by patients. Female patients and older dermatologists, however, are less willing to accept the guidelines and prefer additional follow-up visits. LIMITATIONS The low response rate of dermatologists. CONCLUSION This discrete choice experiment revealed a feasible strategy to substantially reduce costs, while maintaining quality of care, based on the preferences and needs of BCC patients, which is supported by dermatologists.
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Affiliation(s)
- Sven van Egmond
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- * E-mail:
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Hospital San Ignacio, Bogota, Colombia
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maarten Bastiaens
- Department of Dermatology, TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | | | - Daniëlle Kuijpers
- Department of Dermatology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment & Erasmus Choice Modelling Centre, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
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16
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Tokez S, Hollestein L, Louwman M, Nijsten T, Wakkee M. Incidence of Multiple vs First Cutaneous Squamous Cell Carcinoma on a Nationwide Scale and Estimation of Future Incidences of Cutaneous Squamous Cell Carcinoma. JAMA Dermatol 2021; 156:1300-1306. [PMID: 33112377 DOI: 10.1001/jamadermatol.2020.3677] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Until now, most studies on cutaneous squamous cell carcinoma (cSCC) incidence rates concerned only the first cSCC per patient. Given the increase in incidence rates and the frequent occurrence of subsequent cSCCs per patient, population-based data on the incidence rates of both first and multiple cSCCs are needed. Objectives To calculate annual age-standardized incidence rates for histopathologically confirmed first and multiple cSCCs per patient and to estimate future cSCC incidence rates up to 2027. Design, Setting, and Participants A nationwide population-based epidemiologic cohort study used cancer registry data on 145 618 patients with a first histopathologically confirmed cSCC diagnosed between January 1, 1989, and December 31, 2017, from the Netherlands Cancer Registry and all patients with multiple cSCCs diagnosed in 2017. Main Outcomes and Measures Age-standardized incidence rates for cSCC-standardized to the European Standard Population 2013 and United States Standard Population 2000-were calculated per sex, age group, body site, and disease stage. A regression model with positive slope was fitted to estimate cSCC incidence rates up to 2027. Results A total of 145 618 patients in the Dutch population (84 572 male patients [58.1%]; mean [SD] age, 74.5 [11.5] years) received a diagnosis of a first cSCC between 1989 and 2017. Based on incident data, European Standardized Rates (ESRs) increased substantially, with the highest increase found among female patients from 2002 to 2017, at 8.2% (95% CI, 7.6%-8.8%) per year. The ESRs for first cSCC per patient in 2017 were 107.6 per 100 000 person-years (PY) for male patients, an increase from 40.0 per 100 000 PY in 1989, and 68.7 per 100 000 PY for female patients, an increase from 13.9 per 100 000 PY in 1989, which corresponds with a US Standardized Rate of 71.4 per 100 000 PY in 2017 for men and 46.4 per 100 000 PY in 2017 for women. Considering multiple cSCCs per patient, ESRs increased by 58.4% for men (from 107.6 per 100 000 PY to 170.4 per 100 000 PY) and 34.8% for women (from 68.7 per 100 000 PY to 92.6 per 100 000 PY). Estimation of ESRs for the next decade show a further increase of 23.0% for male patients (ESR up to 132.4 per 100 000 PY [95% prediction interval, 125.8-139.0 per 100 000 PY]) and 29.4% for female patients (ESR up to 88.9 per 100 000 PY [95% prediction interval, 84.3-93.5 per 100 000 PY]). Conclusions and Relevance This nationwide epidemiologic cohort study suggests that incidence rates of cSCC keep increasing, especially among female patients, and that the occurrence of multiple cSCCs per patient significantly adds to the current and future burden on dermatologic health care. Revision of skin cancer policies are needed to halt this increasing trend.
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Affiliation(s)
- Selin Tokez
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Loes Hollestein
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Marieke Louwman
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
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17
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Tokez S, Wakkee M, Louwman M, Noels E, Nijsten T, Hollestein L. Assessment of Cutaneous Squamous Cell Carcinoma (cSCC) In situ Incidence and the Risk of Developing Invasive cSCC in Patients With Prior cSCC In situ vs the General Population in the Netherlands, 1989-2017. JAMA Dermatol 2021; 156:973-981. [PMID: 32609322 DOI: 10.1001/jamadermatol.2020.1988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The incidence rates of keratinocyte cancer are increasing globally; however, the incidence rates of cutaneous squamous cell carcinoma (cSCC) in situ and the risk of developing subsequent invasive cSCC remain unknown. Objective To estimate annual population-based age-standardized incidence rates of histopathologically confirmed cSCC in situ stratified by sex, age, and body site and to assess the risk of developing invasive cSCC among patients with cSCC in situ compared with the general population. Design, Setting, and Participants This nationwide epidemiological population-based cohort study used cancer registry data to identify all patients with a first incident of histopathologically confirmed cSCC in situ between January 1, 1989, and December 31, 2017. In addition, all patients with cSCC in situ who subsequently had a first incident of invasive cSCC were identified up to June 11, 2019. Data were analyzed between March 18 and November 12, 2019. Main Outcomes and Measures Age-standardized incidence rates per year for cSCC in situ, standardized to the 2013 edition of the European Standard Population, were calculated by sex, age, and body site. Cumulative risks, standardized incidence ratios, and absolute excess risks were calculated to assess the risk of invasive cSCC in patients with cSCC in situ compared with the general population. Results In this population-based cohort study of 88 754 patients with a first incident of cSCC in situ between January 1, 1989, and December 31, 2017, 58.8% were women; the median age was 75 years (interquartile range [IQR], 67-82 years) for women and 73 years (IQR, 65-80 years) for men. Increasing incidence rates were observed, with the highest incidence rates in 2017 among women in general (71.7 cases per 100 000 person-years) and among men 80 years and older (540.9 cases per 100 000 person-years). The most common body site among women was the face (15.9 cases per 100 000 person-years) and among men was the scalp and/or neck (12.3 cases per 100 000 person-years). After 5 years of follow-up, among patients with cSCC in situ, the cumulative risk of developing an invasive cSCC at any anatomic location was 11.7% (95% CI, 11.6%-11.9%) in men and 6.9% (95% CI, 6.8%-7.0%) in women (P < .001). The standardized incidence ratio was highest in the first year of follow-up among both men (16.6; 95% CI, 15.7-17.5) and women (15.1; 95% CI, 14.2-16.1). Conclusions and Relevance This study reports the first nationwide incidence rates of cSCC in situ to date. The increasing incidence rates of cSCC in situ and the high risk of developing invasive cSCC among patients with cSCC in situ may increase the health care burden associated with precursors of keratinocyte cancer and highlight the need to include cutaneous skin cancer precursor lesions when exploring policies to address skin cancer care.
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Affiliation(s)
- Selin Tokez
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marieke Louwman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Eline Noels
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Loes Hollestein
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
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18
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Noels E, Hollestein L, Luijkx K, Louwman M, de Uyl-de Groot C, van den Bos R, van der Veldt A, Grünhagen D, Wakkee M. Increasing Costs of Skin Cancer due to Increasing Incidence and Introduction of Pharmaceuticals, 2007-2017. Acta Derm Venereol 2020; 100:adv00147. [PMID: 32189004 PMCID: PMC9137355 DOI: 10.2340/00015555-3463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin cancer is the most common type of cancer and its incidence is increasing. The objective of this study was to describe the trends in reimbursed drug and hospital costs of benign and (pre)malignant skin tumours, and to present future projections. Therefore, nationwide hospital and drug reimbursement data (for the period 2007-17) were used. In 2017, malignant skin tumours were the 4th most costly cancer in the Netherlands (after breast, colorectal, and lung cancer). The total costs for skin tumours increased from €278 million for 384,390 patients (in 2007) to €465 million for 578,355 patients (in 2017). Drug costs increased from €0.7 million to €121 million (over the period 2007-17), resulting in a 26% share of overall costs in 2017. Future costs are projected to reach €1.35 billion in 2030. In conclusion, the increasing costs of skin cancer are strongly affected by the increasing incidence and introduction of expensive drugs, and future projections are for an alarming increase.
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Affiliation(s)
- Eline Noels
- Department of Dermatology , Erasmus Medical Center Cancer Institute, Dr. Molewaterplein 40, NL-3015 GD Rotterdam, The Netherlands. E-mail:
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Nijsten T, Hollestein L. [Incidence of melanoma among young people: likely to be lower than reported]. Ned Tijdschr Geneeskd 2020; 164:D4834. [PMID: 32395958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A recent study has concluded that the incidence rate of head and neck melanomas in children and young people in Canada and the United States has increased over the last 20 years.However, other studies have shown that in the Netherlands and North America, the incidence of all melanomas among teenagers and young adults is falling, and certainly not rising.What is the reason for these contradictory results?Although the Canadian-American study saw an increase in melanoma of the head and neck region in people < 40 years-old, melanomas in the head and neck region represent only 12% of all melanomas in this age group.Other North American researchers have investigated the incidence of melanomas on all parts of the body and have come to the conclusion that the incidence rates among young people fell between 2001-2015. An analysis of data from the Netherlands Cancer Registry (NCR) shows that the incidence of melanoma in young children has not risen in 25 years. The Canadian-American study into the incidence of melanomas in children and young adults only included 12% of all melanomas and the age group studied was too broad (ages 15-39). It is highly likely that it is for this reason that the falling trend among teenagers and young adults did not come to light.
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Affiliation(s)
- Tamar Nijsten
- Erasmus MC Kankerinstituut, afd. Dermatologie, Rotterdam
- Contact: Tamar Nijsten
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20
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Wakkee M, van Egmond S, Louwman M, Bindels P, van der Lei J, Nijsten T, Hollestein L. Opportunities for improving the efficiency of keratinocyte carcinoma care in primary and specialist care: Results from population-based Dutch cohort studies. Eur J Cancer 2019; 117:32-40. [PMID: 31229947 DOI: 10.1016/j.ejca.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND High incidence rates of keratinocyte carcinoma (KC) in Western countries put pressure on healthcare systems. The aim of this study was to describe clinical practice in order to identify areas for improvement. METHODS A random selection of patients from the Integrated Primary Care Information database who consulted their general practitioner (GP) for suspicious or confirmed KC (n = 1597) was made in the analysis. For secondary care, 1569 patients with histologically confirmed KC were randomly selected from the Netherlands Cancer Registry. All patients were diagnosed between 2009 and 2013 and followed up until 2016. Details on diagnosis, treatment and care during follow-up were described. RESULTS Among 942 patients who consulted their GP, KC was included in the working or differential diagnosis, but two-thirds (629) were not KC. If the GP suspected KC, the GP directly referred to a medical specialist in most cases (548 of 942). In half (470 of 967) of all confirmed KCs, a skin malignancy was not described in the initial working or differential diagnosis of the GP. The medical specialist treated the first primary KC in 86% (1369 of 1596) by excision, 4% (69 of 1596) by Mohs surgery and 10% (158 of 1596) by another treatment. Although follow-up is not recommended for low-risk basal cell carcinoma, 83% (29 of 35) received follow-up care. In contrast, 82% (60 of 73) patients with squamous cell carcinoma received less follow-up than recommended. CONCLUSIONS Strengthening the diagnostic pathway for KC in primary care and reduction of low-value follow-up visits in secondary care seem potential areas for improving the efficiency of KC care.
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Affiliation(s)
- M Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - S van Egmond
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M Louwman
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - P Bindels
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - J van der Lei
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - L Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
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Hollestein L, Leonardi-Bee J, Lo S, Rosset S, Shomron N. The ABC of reporting statistical analyses in the BJD: Always Be Clear. Br J Dermatol 2018; 179:3-5. [PMID: 30156280 DOI: 10.1111/bjd.16742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- L Hollestein
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Center (IKNL), Utrecht, the Netherlands
| | - J Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, U.K
| | - S Lo
- Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | - S Rosset
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - N Shomron
- Faculty of Medicine and Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
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Wakkee M, van Egmond S, Ramdas K, Bindels P, van der Lei J, Louwman M, Nijsten T, Hollestein L. 324 Opportunities for improving keratinocyte cancer care in primary and specialist care in the Netherlands: A retrospective descriptive cohort study. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hollestein L, Weinstock M, Le Roux E, Olsen C. More Than Many: How to Manage the Most Frequent Cancer? J Invest Dermatol 2017; 137:1823-1826. [PMID: 28843292 DOI: 10.1016/j.jid.2017.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
Leiter et al. report on the increasing incidence of keratinocyte cancers in Germany. The true population burden is even larger then reported, because many of these new patients will develop multiple keratinocyte cancers. Keratinocyte cancer puts a large burden on health care systems worldwide. Prevention and management strategies are needed to maintain high quality of care for all patients.
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Affiliation(s)
- Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands.
| | - Martin Weinstock
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Emma Le Roux
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Catherine Olsen
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia; School of Public Health, University of Queensland, Queensland, Australia
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Greveling K, Wakkee M, Nijsten T, van den Bos R, Hollestein L. 046 Epidemiology of lentigo maligna and lentigo maligna melanoma in the Netherlands, 1989 – 2013. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Van der Velden SK, Lawaetz M, De Maeseneer MGR, Hollestein L, Nijsten T, van den Bos RR. Predictors of Recanalization of the Great Saphenous Vein in Randomized Controlled Trials 1 Year After Endovenous Thermal Ablation. Eur J Vasc Endovasc Surg 2016; 52:234-41. [PMID: 26994834 DOI: 10.1016/j.ejvs.2016.01.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE/BACKGROUND The objective was to identify predictors to develop and validate a prognostic model of recanalization of the great saphenous vein (GSV) in patients treated with endovenous thermal ablation (EVTA). METHODS The search strategy of Siribumrungwong was updated between August 2011 and August 2014 using MEDLINE, Embase, and the Cochrane register to identify randomized controlled trials (RCTs), in which patients presenting with GSV reflux were treated with radiofrequency or endovenous laser ablation. Leg level data (n = 1226) of 15/23 selected RCTs were pooled. The primary outcome was recanalization of the GSV; the secondary outcome was change in health related quality of life (HRQoL) measured by the Chronic Venous Insufficiency quality of life Questionnaire or Aberdeen Varicose Vein Questionnaire 1 year post-procedure. Candidate predictors were age, sex, body mass index, clinical class, GSV diameter, saphenofemoral junction reflux, type of device, energy, and length of treated vein. RESULTS At 1 year, 130 GSVs were recanalized (11%). Clinical class (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.4-3.3) and diameter (OR 1.8, 95% CI 1.2-2.7) of the GSV were the strongest predictors of recanalization. Other predictors included in the final model were sex, type of device, and length of treated vein. The performance of the recanalization model was moderate, with an area under the curve above 0.717. GSV diameter, type of device, and amount of energy delivered were the only predictors of the change of HRQoL. None of the candidate predictors were included in the final HRQoL model (R(2) = .027). CONCLUSION There are several important prognostic factors for GSV recanalization and change of HRQoL after EVTA. However, the performance of each model was unsatisfactory to allow use in clinical practice yet.
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Affiliation(s)
| | - M Lawaetz
- Danish Vein Centers, Åreknudeklinikken, and Surgical Center Roskilde, Naestved, Denmark
| | | | - L Hollestein
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - R R van den Bos
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
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Hollestein L, Baser Ö, Stricker BHC, Nijsten T. The healthy user and healthy adherer bias: a nested case-control study among statin users in the Rotterdam Study. Arch Public Health 2015. [PMCID: PMC4582295 DOI: 10.1186/2049-3258-73-s1-o6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sprecher E, Ingram J, Lovat P, Brown S, Nijsten T, Burden D, Hollestein L. News and Notices. Br J Dermatol 2015. [DOI: 10.1111/bjd.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eli Sprecher
- Department of Dermatology and Laboratory of Molecular Medicine; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - John Ingram
- Department of Dermatology & Wound Healing; University Hospital of Wales; Cardiff University; Cardiff U.K
| | - Penny Lovat
- Institute of Cellular Medicine; The Medical School; Newcastle University; Framlington Place Newcastle upon Tyne NE2 4HH U.K
| | - Sara Brown
- Dermatology & Genetic Medicine, Division of Cancer Research; Medical Research Institute; Ninewells Hospital and Medical School; University of Dundee; Dundee DD1 9SY U.K
| | - Tamar Nijsten
- Department of Dermatology; Erasmus Medical Center; Rotterdam The Netherlands
| | - David Burden
- Department of Deermatology; Western Infirmary; Glasgow U.K
| | - Loes Hollestein
- Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
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Hajdarbegovic E, Nijsten T, Westgeest A, Habraken F, Hollestein L, Thio B. Decreased prevalence of atopic features in patients with psoriatic arthritis, but not in psoriasis vulgaris. J Am Acad Dermatol 2012; 68:270-7. [PMID: 22921106 DOI: 10.1016/j.jaad.2012.07.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/10/2012] [Accepted: 07/16/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of atopic disorders is reduced in patients with various autoinflammatory diseases but, to our knowledge, this association has not been studied in psoriasis vulgaris or psoriatic arthritis (PSA). OBJECTIVE Prevalence of hay fever, asthma, and sensitization to common aeroallergens was compared in patients with psoriasis vulgaris to patients with PSA and control subjects; we also investigated whether atopy influences the arthritis activity and severity scores in patients with PSA. METHODS In a cross-sectional cohort study design, the differences in patient-reported lifetime prevalence of atopic disorders and serum IgE directed against common aeroallergens were compared. The effect of atopy on arthritis severity was assessed using the 28-joint Disease Activity Score and Health Assessment Questionnaire. Logistic regression models were used to calculate crude and adjusted odds ratios with 95% confidence intervals (CI) for presence of atopy. RESULTS A total of 168 patients with PSA, 133 patients with psoriasis vulgaris, and 147 control subjects were included. The lifetime prevalence of hay fever did not differ across groups. Patients with PSA were less likely to have had asthma than control subjects (adjusted odds ratio 0.20; 95% CI 0.04-0.92) and they were less likely to be sensitized (adjusted odds ratio 0.50; 95% CI 0.25-0.99). Health Assessment Questionnaire-visual analog scales for pain and for patient global score were significantly reduced by sensitization to common aeroallergens (beta-coefficients -0.54 [95% CI -0.84 to -0.25] and -18.4 [95% CI -28.5 to -8.25], respectively.) LIMITATIONS This was a cross-sectional, small-numbered study. CONCLUSION Atopy may protect against development of PSA and diminish its severity.
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Affiliation(s)
- Enes Hajdarbegovic
- Department of Dermatology and Venerology, Erasmus Medical Center, Rotterdam, The Netherlands.
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