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Sousa CS, Coelho DB, Amorim P, Viana P, Cruz-Martins N, Drummond M. Differences between FEV6, FVC and VC at the diagnosis of obstructive ventilatory defect. Pulmonology 2024; 30:170-173. [PMID: 34987020 DOI: 10.1016/j.pulmoe.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The diagnosis of airway obstruction can be made through FEV1/FVC ratio <0.7 or FEV1/VC ratio < lower limit of normality (LLN). Several authors advocate that FEV1/FEV6 ratio is an alternative to diagnosing obstructive ventilatory defect, while others have determined that the best cut-off for this ratio (best combined sensitivity and specificity) is 0.73. OBJECTIVE To evaluate the non-inferiority of FEV1/FEV6 ratio < 0.73 when compared to FEV1/FVC ratio < 0.7 and FEV1/VC < LLN in diagnosing airway obstruction. METHODS A retrospective analysis of the medical records from patients who underwent spirometry or plethysmography in a university central hospital from June 1st to December 31st, 2018 was carried out. Only medical records which included FEV1/FVC < 0.7 or FEV1/VC < LLN were selected, and these results were compared to FEV1/FEV6 ratio. RESULTS A total of 526 patients with obstructive ventilatory defect were identified by one of the two ratios described. Of these, 95.1%, 87.4% and 88.6% were obstructive by FEV1/FVC, FEV1/VC, and FEV1/FEV6 ratio, respectively. The positive predictive value (PPV) of FEV1/FEV6 in relation to FEV1/FVC ratio was 99.6% (p < 0.001) with a diagnostic efficacy of 92.8%, whereas the PPV of FEV1/FEV6 in relation to FEV1/VC was 91.0% (p < 0.001) and diagnostic efficacy was 85.2%. Most false negatives, comparing FEV6 with the other two tests, were found in patients with FEV1 > 70% (mild obstruction) and in individuals aged >50 years. CONCLUSIONS FEV1/FEV6 < 0.73 may be a good alternative ratio, as it is non-inferior to FEV1/VC and FEV1/FVC in diagnosing obstructive ventilatory defect.
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Affiliation(s)
- C S Sousa
- Hospital Central do Funchal, Portugal.
| | - D B Coelho
- Centro Hospitalar Universitário de São João - Porto, Portugal
| | - P Amorim
- Centro Hospitalar Universitário de São João - Porto, Portugal
| | - P Viana
- Centro Hospitalar Universitário de São João - Porto, Portugal
| | - N Cruz-Martins
- Faculdade de Medicina da Universidade do Porto, Portugal; Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Portugal; Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde (CESPU), Portugal
| | - M Drummond
- Centro Hospitalar Universitário de São João - Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal
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Brierley CK, Yip BH, Orlando G, Goyal H, Wen S, Wen J, Levine MF, Jakobsdottir GM, Rodriguez-Meira A, Adamo A, Bashton M, Hamblin A, Clark SA, O'Sullivan J, Murphy L, Olijnik AA, Cotton A, Narina S, Pruett-Miller SM, Enshaei A, Harrison C, Drummond M, Knapper S, Tefferi A, Antony-Debré I, Thongjuea S, Wedge DC, Constantinescu S, Papaemmanuil E, Psaila B, Crispino JD, Mead AJ. Chromothripsis orchestrates leukemic transformation in blast phase MPN through targetable amplification of DYRK1A. bioRxiv 2023:2023.12.08.570880. [PMID: 38106192 PMCID: PMC10723394 DOI: 10.1101/2023.12.08.570880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Chromothripsis, the process of catastrophic shattering and haphazard repair of chromosomes, is a common event in cancer. Whether chromothripsis might constitute an actionable molecular event amenable to therapeutic targeting remains an open question. We describe recurrent chromothripsis of chromosome 21 in a subset of patients in blast phase of a myeloproliferative neoplasm (BP-MPN), which alongside other structural variants leads to amplification of a region of chromosome 21 in ∼25% of patients ('chr21amp'). We report that chr21amp BP-MPN has a particularly aggressive and treatment-resistant phenotype. The chr21amp event is highly clonal and present throughout the hematopoietic hierarchy. DYRK1A , a serine threonine kinase and transcription factor, is the only gene in the 2.7Mb minimally amplified region which showed both increased expression and chromatin accessibility compared to non-chr21amp BP-MPN controls. We demonstrate that DYRK1A is a central node at the nexus of multiple cellular functions critical for BP-MPN development, including DNA repair, STAT signalling and BCL2 overexpression. DYRK1A is essential for BP-MPN cell proliferation in vitro and in vivo , and DYRK1A inhibition synergises with BCL2 targeting to induce BP-MPN cell apoptosis. Collectively, these findings define the chr21amp event as a prognostic biomarker in BP-MPN and link chromothripsis to a druggable target.
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Correia S, Sousa S, Drummond M, Pinto P, Staats R, Brito D, Lousada N, Cardoso JS, Moita J. Diagnostic and therapeutic approach of central sleep apnea in heart failure - the role of adaptive servo-ventilation. A statement of the Portuguese society of pulmonology and the Portuguese sleep association. Pulmonology 2023; 29:138-143. [PMID: 35501278 DOI: 10.1016/j.pulmoe.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 10/18/2022] Open
Abstract
It is known that patients with heart failure (HF) have an increased risk of developing central sleep apnoea (CSA), with Cheyne-Stokes respiration. The development of servo-ventilation aimed to treat CSA and improve the quality of life (QoL) of these patients. A large randomized clinical study, SERVE-HF, was conducted in order to test this theory in patients with HF and reduced ejection fraction (HFrEF). The results from this trial seemed to indicate that, in these patients, there was no beneficial effect of the assisted ventilation in CSA treatment. More surprisingly, an increased rate of all-cause or cardiovascular mortality was observed. This has led to dramatic changes in clinical practice, with decreased frequency of servo-ventilation prescription across Europe, including Portugal, due to changes in the guidelines. However, SERVE-HF was conducted only in severe systolic HF patients with CSA, and caution must be taken when extrapolating these results to HF patients with preserved ejection fraction or CSA patients without HF. The study also showed poor adherence, methodological and statistical gaps, including study design, patient selection, data collection and analysis, treatment adherence, and group crossovers, which have not been discussed in the trial as potential confounding factors and raise several concerns. Moreover, the adaptive servo-ventilation (ASV) device used in SERVE-HF was unable to lower the minimum support pressure below 3 mm H20, and this has been suggested as one of the probable contributing reasons to the excess mortality observed in this study. This limitation has since been solved, and this ASV device is no longer used. This paper describes the results of a Portuguese Task Force on the treatment of central sleep apnoea in patients with chronic HF.
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Affiliation(s)
- S Correia
- Hospital Pedro Hispano, Porto, Portugal.
| | - S Sousa
- Centro Hospitalar de Setubal, Portugal
| | - M Drummond
- Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - P Pinto
- Centro Hospitalar Universitario Lisboa Norte, Lisboa, Portugal
| | - R Staats
- Centro Hospitalar Universitario Lisboa Norte, Lisboa, Portugal
| | - D Brito
- Centro Hospitalar Universitario Lisboa Norte, Lisboa, Portugal
| | - N Lousada
- Centro Hospitalar Universitario Lisboa Norte, Lisboa, Portugal
| | - J S Cardoso
- Centro Hospitalar Universitário de São João, Portugal
| | - J Moita
- Centro Hospitalar e Universitario de Coimbra, Portugal
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Holtkamp LHJ, Lo S, Drummond M, Thompson JF, Nieweg OE, Hong AM. Hypofractionated or Conventionally Fractionated Adjuvant Radiotherapy After Regional Lymph Node Dissection for High-Risk Stage III Melanoma. Clin Oncol (R Coll Radiol) 2023; 35:e85-e93. [PMID: 35851490 DOI: 10.1016/j.clon.2022.06.012] [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: 11/22/2021] [Revised: 06/04/2022] [Accepted: 06/30/2022] [Indexed: 01/04/2023]
Abstract
AIMS Adjuvant radiotherapy can be beneficial after regional lymph node dissection for high-risk stage III melanoma, as it has been shown to reduce the risk of recurrence in the node field. However, the optimal fractionation schedule is unknown and both hypofractionated and conventionally fractionated adjuvant radiotherapy are used. The present study examined the oncological outcomes of these two approaches in patients treated in an era before effective systemic immunotherapy became available. MATERIALS AND METHODS This retrospective cohort study involved 335 patients with stage III melanoma who received adjuvant radiotherapy after therapeutic regional lymph node dissection for metastatic melanoma between 1990 and 2011. Information on tumour characteristics, radiotherapy doses and fractionation schedules and patient outcomes was retrieved from the institution's database and patients' medical records. RESULTS Hypofractionated radiotherapy (median dose 33 Gy in six fractions over 3 weeks) was given to 95 patients (28%) and conventionally fractionated radiotherapy (median dose 48 Gy in 20 fractions over 4 weeks) to 240 patients (72%). Five-year lymph node field control rates were 86.0% (95% confidence interval 78.4-94.4%) for the hypofractionated group and 85.5% (95% confidence interval 80.5-90.7%) for the conventional fractionation group (P = 0.87). There were no significant differences in recurrence-free survival (RFS) (41.7%, 95% confidence interval 32.5-53.5 versus 31.9%, 95% confidence interval 26.1-38.9; P = 0.18) or overall survival (41.2%, 95% confidence interval 32.1-52.8 versus 45.0%, 95% confidence interval 38.7-52.4; P = 0.77). On multivariate analysis, extranodal spread was associated with decreased RFS (P = 0.04) and the number of resected lymph nodes containing metastatic melanoma was associated with decreased RFS (P = 0.0006) and overall survival (P = 0.01). CONCLUSION Lymph node field control rates, RFS and overall survival were similar after hypofractionated and conventionally fractionated adjuvant radiotherapy. The presence of extranodal spread and an increasing number of positive lymph nodes were predictive of an unfavourable outcome.
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Affiliation(s)
- L H J Holtkamp
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Surgical Oncology, University Medical Centre Groningen, Groningen, the Netherlands.
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - M Drummond
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - O E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A M Hong
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia; GenesisCare, Radiation Oncology, Mater Sydney Hospital, Sydney, NSW, Australia
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Holtkamp L, Lo S, Drummond M, Thompson J, Nieweg O, Hong A. MO-0152 Hypofractionated versus conventional adjuvant radiotherapy for lymph node metastases of melanoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02312-x] [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: 10/18/2022]
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Eime R, Harvey J, Charity M, Elliott S, Drummond M, Pankowiak A, Westerbeek H. The impact of COVID-19 restrictions on perceived health and wellbeing of adult Australian sport and physical activity participants. BMC Public Health 2022; 22:848. [PMID: 35484616 PMCID: PMC9046706 DOI: 10.1186/s12889-022-13195-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals’ access to sport and physical activity has been hampered due to COVID-19 lockdown restrictions. In Australia participation in community sport was cancelled during lockdowns. There is limited research on the impact of sport participation restrictions on the health and wellbeing of adults. Aim The aim of this study was to investigate the perceived health and wellbeing of a sample of predominantly active Australian adults, both during COVID-19 and in comparison with one year earlier (pre COVID-19). Methods A survey was conducted during the first COVID-19 restrictions and lockdowns in Australia in May–June 2020. It was distributed by national and state sporting organisations and through researchers’ social media accounts. This particular paper focuses on adults aged 18–59 years. The survey collected information on participant demographics, the sport and physical activity patterns pre- COVID-19, and health and wellbeing outcomes during COVID-19 lockdown and compared to one year earlier. The health measures were cross-tabulated against the demographic and sport and physical activity variables, and group profiles compared with chi-square tests. Scales were derived from three wellbeing questions, and group differences were analysed by t-tests and F-tests. Results The survey sample included 1279 men and 868 women aged 18–59 years. Most (67%) resided in metropolitan cities. The great majority (83%) were sport participants. During COVID-19 lockdown men were significantly more likely than women to report worse or much worse general (p = 0.014), physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction (p = 0.016). The inactive adults were significantly more likely to report poorer general health (p = 0.001) and physical health (p = 0.001) compared to active adults. The younger age cohort (18–29 years) were significantly more likely to report poorer general wellbeing (p < 0.001), and lower life satisfaction (p < 0.001) compared to the older age groups. Conclusion It seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted males and younger adults in particular. Sports clubs provide an important setting for individuals’ health and wellbeing which is why clubs require the capacity to deliver sport and individuals may need to regain the motivation to return.
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Affiliation(s)
- R Eime
- School of Science, Psychology and Sport, Federation University, Ballarat, Australia. .,Institute for Health and Sport, Victoria University, Footscray, Australia.
| | - J Harvey
- School of Science, Psychology and Sport, Federation University, Ballarat, Australia.,Institute for Health and Sport, Victoria University, Footscray, Australia
| | - M Charity
- School of Science, Psychology and Sport, Federation University, Ballarat, Australia
| | - S Elliott
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - M Drummond
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - A Pankowiak
- Institute for Health and Sport, Victoria University, Footscray, Australia
| | - H Westerbeek
- Institute for Health and Sport, Victoria University, Footscray, Australia
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Husereau D, Drummond M, Augustovski F, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, de Bekker-Grob E, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu RF, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BJOG 2022; 129:336-344. [PMID: 35014160 DOI: 10.1111/1471-0528.17012] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
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Affiliation(s)
- D Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Institute of Health Economics, Edmonton, AB, Canada
| | - M Drummond
- Centre for Health Economics, University of York, York, UK
| | - F Augustovski
- Health Technology Assessment and Health Economics Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.,University of Buenos Aires, Buenos Aires, Argentina.,CONICET (National Scientific and Technical Research Council), Buenos Aires, Argentina
| | - A H Briggs
- London School of Hygiene and Tropical Medicine, London, UK
| | - C Carswell
- Adis Journals, Springer Nature, Auckland, New Zealand
| | - L Caulley
- Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program and Center for Journalology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - N Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - E de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - D Greenberg
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, School of Public Health, Israel
| | - E Loder
- Harvard Medical School, Boston, MA, USA.,The BMJ, London, UK
| | - J Mauskopf
- RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - C D Mullins
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | - S Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R-F Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei City, Taiwan
| | - S Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
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Drummond C, Drummond M, Fennell M, Hart J, Kamaludin M, Keith C, Lange B, Paparella L, Ramos J, Wallen M, Williams H. The relationship between cardiorespiratory fitness and chronic pelvic pain in women with endometriosis: a preliminary cross-sectional analysis. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.097] [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: 11/30/2022]
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Serino M, Cardoso C, Carneiro RJ, Ferra J, Aguiar F, Rodrigues D, Redondo M, van Zeller M, Drummond M. OSA patients not treated with PAP - Evolution over 5 years according to the Baveno classification and cardiovascular outcomes. Sleep Med 2021; 88:1-6. [PMID: 34710706 DOI: 10.1016/j.sleep.2021.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The evolution of patients with obstructive sleep apnea (OSA) non-eligible for PAP-therapy at diagnosis is unknown. Currently, the severity of OSA is based on the apnea-hypopnea index (AHI), but its prognostic relevance has raised concerns. The Baveno classification may allow a better stratification of severity and therapeutic guidance in OSA. METHODS Patients with AHI≥5/h in 2015, classified into Baveno groups A and B and non-eligible for PAP therapy at diagnosis and over 5 years, were analyzed. Patients were reclassified into Baveno groups (A-D) and changes in groups over 5 years were explored. Patients in Baveno groups C and D, who developed major cardiovascular comorbidities (CVC) or end-organ damage (EOD group), were compared with patients in Baveno groups A and B (non-EOD group). To identify predictors of the development of major CVC or EOD, a logistic regression analysis was performed. RESULTS There were 76 patients, 58% male, mean age 51.9 ± 10.1 years, mean body mass index (BMI) of 30.3 ± 5.0 kg/m2 and median AHI of 8.9 (5.9-12.0) events/h. At diagnosis, 46% and 54% of patients were classified into Baveno group A and group B, respectively. In total, 21% of patients developed major CVC or EOD (Baveno group C or D); higher age (p = 0.011) and BMI (p = 0.004) and a higher percentage of central apneas (p = 0.012) at diagnosis significantly predicted it, while sex, sleepiness, insomnia, AHI, ODI and T90 were not. CONCLUSIONS A significant percentage of patients non-eligible for PAP-therapy at diagnosis of OSA developed CVC or EOD; higher age and BMI and a higher percentage of central apneas were significant predictors.
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Affiliation(s)
- M Serino
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.
| | - C Cardoso
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal
| | - R J Carneiro
- Department of Pneumology, Centro Hospitalar Oeste, Hospital Torres Vedras, Torres Vedras, Portugal
| | - J Ferra
- Department of Pneumology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, LisboaVedras, Portugal
| | - F Aguiar
- Department of Pneumology, Hospital de Braga, Braga, Portugal
| | - D Rodrigues
- Pulmonology Department, Centro Hospitalar Universitário São João, Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M Redondo
- Pulmonology Department, Centro Hospitalar Universitário São João, Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Porto, Portugal
| | - M van Zeller
- Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - M Drummond
- Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
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Rocha LKFL, Vilain RE, Scolyer RA, Lo SN, Drummond M, Star P, Fogarty GB, Hong AM, Guitera P. Confocal microscopy, dermoscopy, and histopathology features of atypical intraepidermal melanocytic proliferations associated with evolution to melanoma in situ. Int J Dermatol 2021; 61:167-174. [PMID: 34351639 DOI: 10.1111/ijd.15815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/17/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atypical intraepidermal melanocytic proliferations (AIMP) is a descriptive term sometimes applied to biopsies that do not fulfill diagnostic criteria of melanoma. They are common on sun-damaged skin, but their definition and management are controversial. OBJECTIVE To describe dermoscopic (DS), reflectance confocal microscopic (RCM) and histopathological features of AIMP and identify features associated with subsequent melanoma in situ (MIS). METHODS A retrospective analysis of AIMP lesions correlated with patient outcome at two melanoma tertiary centers between 2005 and 2015. RESULTS Thirty-four patients were included. Nine (26%) patients had MIS in subsequent biopsies. Predictors of later MIS were target-like pattern (OR:12.0 [CI: 1.23, 117.41]; P = 0.032) and high-density vascular network (OR:12 [CI: 1.23-117.41], P: 0.032) on DS, and presence of dendritic cells touching each other (OR:9.1 [CI: 1.54, 54.59], P = 0.014) on RCM. Clinical predictors of worse outcome included a previous history of MIS at the same site. Radiotherapy for AIMP had a high failure rate (all patients presented with recurrent disease, three as AIMP and two as MIS). CONCLUSIONS Considering that most cases in this series received non-surgical treatment at baseline, we recommend close monitoring for lesions with target-like pattern and density vascular network on DS and treatment for lesions with progression of atypia and/or with "confluent" dendritic cells on RCM. Although the number of patients in this series is very low, early surgery is recommended for MIS cases that recur as AIMP.
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Affiliation(s)
- Lilian K F L Rocha
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Dermatology, Hospital das Clínicas of São Paulo University, São Paulo, Brazil
| | - Ricardo E Vilain
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Anatomical Pathology, John Hunter, University of Newcastle, Newcastle, Australia
| | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Drummond
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Phoebe Star
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Gerald B Fogarty
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Genesis Cancer Care, Radiation Oncology, St Vincents Hospital, Darlinghurst, NSW, Australia
| | - Angela M Hong
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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11
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Star P, Rawson RV, Drummond M, Lo S, Scolyer RA, Guitera P. Lentigo maligna: defining margins and predictors of recurrence utilizing clinical, dermoscopic, confocal microscopy and histopathology features. J Eur Acad Dermatol Venereol 2021; 35:1811-1820. [PMID: 33998703 DOI: 10.1111/jdv.17349] [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: 01/09/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lentigo maligna (LM) is a subtype of melanoma in situ with poorly defined margins and a high recurrence rate. The biological behaviour of LM appears to differ widely between cases, from biologically indolent to biologically active variants, with some patients experiencing multiple recurrences. It is not known whether this is secondary to inadequate margins, field cancerization or the innate biology of the lesion itself. OBJECTIVES (a) Describe the margins of LM in detail by analysing LM in three zones, that is centre, edge and surround using reflectance confocal microscopy (RCM) and histopathology; (b) ascertain association of histological distance of LM and atypical melanocytic hyperplasia from the surgical margin with multi-recurrent (MR) disease and (c) identify features (clinical, dermoscopy, RCM and histopathology) associated with MR LM. METHODS (1) Descriptive observational study comparing the centre, edge and surround of LM on histopathology and RCM; (2) retrospective cohort study comparing parameters associated with MR and non-recurrent (NR) LM. RESULTS 30 patients (median follow-up time 6.2 years) were included. On histopathology, confluent or near confluent lentiginous proliferation, melanocyte density >15 per 0.5 mm and adnexal spread were best for distinguishing surround from edge of LM. On RCM, predominant melanocytes, lentiginous proliferation and pleomorphism distinguished surround from centre/edge. MR patients had a median histological distance of LM from the surgical margin of 2mm (versus NR patients with an average distance of 4mm). MR patients had a greater proportion of more florid features, compared with NR on histopathology at both the centre and the edge but were similar in the surround. CONCLUSION These data may help pathologists and confocalists better define margins of LM. More florid features in MR patients, despite a similar background of sun-damaged skin, suggest the innate biology of the lesion rather than the field of cancerization may explain MR LM.
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Affiliation(s)
- P Star
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - R V Rawson
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, Sydney, NSW, Australia
| | - M Drummond
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - S Lo
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, Sydney, NSW, Australia
| | - P Guitera
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre (SMDC), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Serino M, Pinto J, van Zeller M, Drummond M. Phone medical appointments for sleep-disordered breathing in Covid-19 pandemic - were they useful? Sleep Med 2021; 86:123. [PMID: 34127389 PMCID: PMC8168330 DOI: 10.1016/j.sleep.2021.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Affiliation(s)
- M Serino
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - J Pinto
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - M van Zeller
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal.
| | - M Drummond
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Sleep and Non-Invasive Ventilation Unit, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal.
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Gunduz C, Basoglu OK, Kvamme JA, Verbraecken J, Anttalainen U, Marrone O, Steiropoulos P, Roisman G, Joppa P, Hein H, Trakada G, Hedner J, Grote L, Steiropoulos P, Verbraecken J, Petiet E, Trakada G, Montserrat J, Fietze I, Penzel T, Ondrej L, Rodenstein D, Masa J, Bouloukaki I, Schiza S, Kent B, McNicholas W, Ryan S, Riha R, Kvamme J, Hein H, Schulz R, Grote L, Hedner J, Zou D, Pépin J, Levy P, Bailly S, Lavie L, Lavie P, Basoglu O, Tasbakan M, Varoneckas G, Joppa P, Tkacova R, Staats R, Barbé F, Lombardi C, Parati G, Drummond M, van Zeller M, Bonsignore M, Marrone O, Petitjean M, Roisman G, Pretl M, Vitols A, Dogas Z, Galic T, Pataka A, Anttalainen U, Saaresranta T, Plywaczewski R, Sliwinski P, Bielicki P. Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA). Sleep Med 2020; 75:201-209. [DOI: 10.1016/j.sleep.2020.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
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Holland EA, Lo S, Kelly B, Schmid H, Cust AE, Palmer JM, Drummond M, Hayward NK, Pritchard AL, Mann GJ. FRAMe: Familial Risk Assessment of Melanoma-a risk prediction tool to guide CDKN2A germline mutation testing in Australian familial melanoma. Fam Cancer 2020; 20:231-239. [PMID: 32989607 DOI: 10.1007/s10689-020-00209-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/19/2020] [Indexed: 11/30/2022]
Abstract
Germline mutations in CDKN2A greatly increase risk of developing cutaneous melanoma. We have constructed a risk prediction model, Familial Risk Assessment of Melanoma (FRAMe), for estimating the likelihood of carrying a heritable CDKN2A mutation among Australian families, where the prevalence of these mutations is low. Using logistic regression, we analysed characteristics of 299 Australian families recruited through the Sydney site of GenoMEL (international melanoma genetics consortium) with at least three cases of cutaneous melanoma (in situ and invasive) among first-degree blood relatives, for predictors of the presence of a pathogenic CDKN2A mutation. The final multivariable prediction model was externally validated in an independent cohort of 61 melanoma kindreds recruited through GenoMEL Queensland. Family variables independently associated with the presence of a CDKN2A mutation in a multivariable model were number of individuals diagnosed with melanoma under 40 years of age, number of individuals diagnosed with more than one primary melanoma, and number of individuals blood related to a melanoma case in the first degree diagnosed with any cancer excluding melanoma and non-melanoma skin cancer. The number of individuals diagnosed with pancreatic cancer was not independently associated with mutation status. The risk prediction model had an area under the receiver operating characteristic curve (AUC) of 0.851 (95% CI 0.793, 0.909) in the training dataset, and 0.745 (95%CI 0.612, 0.877) in the validation dataset. This model is the first to be developed and validated using only Australian data, which is important given the higher rate of melanoma in the population. This model will help to effectively identify families suitable for genetic counselling and testing in areas of high ambient ultraviolet radiation. A user-friendly electronic nomogram is available at www.melanomarisk.org.au .
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Affiliation(s)
- Elizabeth A Holland
- Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia.
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, 2065, Australia
| | - Blake Kelly
- Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia
| | - Helen Schmid
- Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, 2065, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Jane M Palmer
- Oncogenomics Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4005, Australia
| | - Martin Drummond
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, 2065, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Nicholas K Hayward
- Oncogenomics Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4005, Australia
| | - Antonia L Pritchard
- Oncogenomics Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4005, Australia.,Genetics and Immunology, An L`ochran, University of the Highlands and Islands, Inverness, UK
| | - Graham J Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia.,Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, 2065, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia
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Serino M, van Zeller M, Martins N, Drummond M. Severe asthma intervention in adult obese patients. Pulmonology 2020; 26:325-327. [PMID: 32553823 DOI: 10.1016/j.pulmoe.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- M Serino
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - M van Zeller
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - N Martins
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Portugal
| | - M Drummond
- Pulmonology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Freitas C, Amorim P, Queiroga H, Drummond M. WHAT CAN REAL WORLD DATA TELL US ABOUT OBSTRUCTIVE SLEEP APNEA AND LUNG CANCER? Chest 2020. [DOI: 10.1016/j.chest.2020.05.490] [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: 10/24/2022] Open
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17
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Corbacho B, Drummond M, Santos R, Jones E, Borràs JM, Mestre-Ferrandiz J, Espín J, Henry N, Prat A. Does the use of health technology assessment have an impact on the utilisation of health care resources? Evidence from two European countries. Eur J Health Econ 2020; 21:621-634. [PMID: 32026155 PMCID: PMC7214388 DOI: 10.1007/s10198-020-01160-5] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES A centralised approach to health technology assessment (HTA) may facilitate optimal use of HTA resources. A regional approach may increase the chances of local implementation of recommendations. This study aimed to compare assessment procedures in England (centralised HTA approach) with Spain (regional HTA approach) discussing key challenges and opportunities from both approaches. METHODS We compared technology assessments of anticancer medicines in the two jurisdictions from 2008 to 2015. To assess the implementation of HTA recommendations, we assessed trends in medicine usage using regression methods. We used IQVIA data, from 2011 to 2016, for a sample of 11 medicines. We used CatSalut data from Catalonia to assess the implementation of local recommendations. RESULTS In England, 66 assessments were undertaken by the National Institute for Health and Care Excellence (NICE), using a standardised methodology. In Spain, there were 79 reports undertaken by a range of bodies using a shared process and coordinated through the GENESIS collaboration; the assessment methods used varied substantially. Overall, the recommendations in the two jurisdictions were similar. Regression analyses indicate that where there is a positive recommendation by HTA bodies, the usage of the medicine responds most strongly (p < 0.001) in Catalonia (4.892), followed by England (3.120) and Spain (1.693). CONCLUSIONS This study suggests that medicine utilisation does respond to the positive recommendations of HTA bodies. However, if HTA capacity is organised primarily regionally, considerable effort may be required in coordination, to ensure consistent and rigorous assessments and adequate implementation of HTA findings.
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Affiliation(s)
- B Corbacho
- York Trials Unit, ARRC Building, Department of Health Sciences, University of York, York, UK.
| | - M Drummond
- Centre for Health Economics, University of York, York, UK
| | - R Santos
- Centre for Health Economics, University of York, York, UK
| | | | - J M Borràs
- Department Clinical Sciences, Universidad de Barcelona, Barcelona, Spain
| | | | - J Espín
- Escuela Andaluza de Salud Publica, Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - N Henry
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- IQVIA, London, UK
| | - A Prat
- Pharmacy and Medicines Department, Servei Catala` de la Salut (CatSalut), Barcelona, Spain
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18
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Vuong K, Armstrong B, Drummond M, Hopper J, Barrett J, Davies J, Bishop D, Newton‐Bishop J, Aitken J, Giles G, Schmid H, Jenkins M, Mann G, McGeechan K, Cust A. Development of a new method to calculate individuals’ melanoma risk. Br J Dermatol 2020. [DOI: 10.1111/bjd.18992] [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: 11/29/2022]
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19
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Vuong K, Armstrong B, Drummond M, Hopper J, Barrett J, Davies J, Bishop D, Newton‐Bishop J, Aitken J, Giles G, Schmid H, Jenkins M, Mann G, McGeechan K, Cust A. 开发一种新方法来计算个体的黑色素瘤风险. Br J Dermatol 2020. [DOI: 10.1111/bjd.19003] [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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Vuong K, Armstrong BK, Drummond M, Hopper JL, Barrett JH, Davies JR, Bishop DT, Newton-Bishop J, Aitken JF, Giles GG, Schmid H, Jenkins MA, Mann GJ, McGeechan K, Cust AE. Development and external validation study of a melanoma risk prediction model incorporating clinically assessed naevi and solar lentigines. Br J Dermatol 2020; 182:1262-1268. [PMID: 31378928 PMCID: PMC6997040 DOI: 10.1111/bjd.18411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Melanoma risk prediction models could be useful for matching preventive interventions to patients' risk. OBJECTIVES To develop and validate a model for incident first-primary cutaneous melanoma using clinically assessed risk factors. METHODS We used unconditional logistic regression with backward selection from the Australian Melanoma Family Study (461 cases and 329 controls) in which age, sex and city of recruitment were kept in each step, and we externally validated it using the Leeds Melanoma Case-Control Study (960 cases and 513 controls). Candidate predictors included clinically assessed whole-body naevi and solar lentigines, and self-assessed pigmentation phenotype, sun exposure, family history and history of keratinocyte cancer. We evaluated the predictive strength and discrimination of the model risk factors using odds per age- and sex-adjusted SD (OPERA) and the area under curve (AUC), and calibration using the Hosmer-Lemeshow test. RESULTS The final model included the number of naevi ≥ 2 mm in diameter on the whole body, solar lentigines on the upper back (a six-level scale), hair colour at age 18 years and personal history of keratinocyte cancer. Naevi was the strongest risk factor; the OPERA was 3·51 [95% confidence interval (CI) 2·71-4·54] in the Australian study and 2·56 (95% CI 2·23-2·95) in the Leeds study. The AUC was 0·79 (95% CI 0·76-0·83) in the Australian study and 0·73 (95% CI 0·70-0·75) in the Leeds study. The Hosmer-Lemeshow test P-value was 0·30 in the Australian study and < 0·001 in the Leeds study. CONCLUSIONS This model had good discrimination and could be used by clinicians to stratify patients by melanoma risk for the targeting of preventive interventions. What's already known about this topic? Melanoma risk prediction models may be useful in prevention by tailoring interventions to personalized risk levels. For reasons of feasibility, time and cost many melanoma prediction models use self-assessed risk factors. However, individuals tend to underestimate their naevus numbers. What does this study add? We present a melanoma risk prediction model, which includes clinically-assessed whole-body naevi and solar lentigines, and self-assessed risk factors including pigmentation phenotype and history of keratinocyte cancer. This model performs well on discrimination, the model's ability to distinguish between individuals with and without melanoma, and may assist clinicians to stratify patients by melanoma risk for targeted preventive interventions.
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Affiliation(s)
- K Vuong
- School of Public Health and Community Medicine, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - B K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M Drummond
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - J L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - J H Barrett
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J R Davies
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - D T Bishop
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J Newton-Bishop
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J F Aitken
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
| | - G G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - H Schmid
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
| | - M A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - G J Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - K McGeechan
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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Machado F, Aguiar T, Valente R, Ferraz T, Amorim P, Pimentel A, Teles P, Montenegro N, Drummond M. Evaluation of obstructive sleep apnea screening questionnaires in obese women in the first trimester of pregnancy. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.663] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moreira AA, Martins N, Drummond M. Impact of non-invasive ventilatory support in an obstructive sleep apnea cohort of patients: a 10-years follow-up study on cardiovascular events incidence. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Viana Machado F, van Zeller M, Pinto T, Saganha S, Drummond M. Predictive symptoms of early adherence to autotitrating positive airway pressure in patients with obstructive sleep apnea. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1128] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Cust A, Drummond M, Bishop D, Azizi L, Schmid H, Jenkins M, Hopper J, Armstrong B, Aitken J, Kefford R, Giles G, Demenais F, Goldstein A, Barrett J, Kanetsky P, Elder D, Mann G, Newton‐Bishop J. Associations of pigmentary and naevus phenotype with melanoma risk in two populations with comparable ancestry but contrasting levels of ambient sun exposure. J Eur Acad Dermatol Venereol 2019; 33:1874-1885. [PMID: 31087403 PMCID: PMC6800761 DOI: 10.1111/jdv.15680] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/10/2018] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND People at high risk of developing melanoma are usually identified by pigmentary and naevus phenotypes. OBJECTIVE We examined whether associations of these phenotypes with melanoma risk differed by ambient sun exposure or participant characteristics in two population-based, case-control studies with comparable ancestry but different ambient sun exposure. METHODS Data were analysed from 616 cases and 496 controls from the Australian Melanoma Family Study and 2012 cases and 504 controls from the Leeds (UK) case-control study. Questionnaire, interview and dermatological skin examination data were collected using the same measurement protocols. Relative risks were estimated as odds ratios using unconditional logistic regression, adjusted for potential confounders. RESULTS Hair and skin colour were the strongest pigmentary phenotype risk factors. All associations of pigmentary phenotype with melanoma risk were similar across countries. The median number of clinically assessed naevi was approximately three times higher in Australia than Leeds, but the relative risks for melanoma associated with each additional common or dysplastic naevus were higher for Leeds than Australia, especially for naevi on the upper and lower limbs. Higher naevus counts on the head and neck were associated with a stronger relative risk for melanoma for women than men. The two countries had similar relative risks for melanoma based on self-reported naevus density categories, but personal perceptions of naevus number differed by country. There was no consistent evidence of interactions between phenotypes on risk. CONCLUSIONS Classifying people at high risk of melanoma based on their number of naevi should ideally take into account their country of residence, type of counts (clinical or self-reported), body site on which the naevus counts are measured and sex. The presence of naevi may be a stronger indicator of a genetic predisposition in the UK than in Australia based on less opportunity for sun exposure to influence naevus development.
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Affiliation(s)
- A.E. Cust
- Cancer Epidemiology and Prevention ResearchSydney School of Public HealthThe University of SydneySydneyAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
| | - M. Drummond
- Cancer Epidemiology and Prevention ResearchSydney School of Public HealthThe University of SydneySydneyAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
| | - D.T. Bishop
- Section of Epidemiology and BiostatisticsLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
| | - L. Azizi
- School of Mathematics and StatisticsThe University of SydneySydneyAustralia
| | - H. Schmid
- Centre for Cancer ResearchWestmead Institute for Medical ResearchThe University of SydneySydneyAustralia
| | - M.A. Jenkins
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - J.L. Hopper
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - B.K. Armstrong
- Cancer Epidemiology and Prevention ResearchSydney School of Public HealthThe University of SydneySydneyAustralia
| | - J.F. Aitken
- Viertel Centre for Research in Cancer ControlCancer Council QueenslandBrisbaneAustralia
| | - R.F. Kefford
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
- Macquarie University Health Sciences CentreMacquarie UniversitySydneyAustralia
| | - G.G. Giles
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
- Cancer Epidemiology CentreCancer Council VictoriaMelbourneAustralia
| | - F. Demenais
- Genetic Variation and Human Diseases UnitUMR‐946INSERMUniversité Paris DiderotUniversité Sorbonne Paris CitéParisFrance
| | - A.M. Goldstein
- Human Genetics ProgramDivision of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMDUSA
| | - J.H. Barrett
- Section of Epidemiology and BiostatisticsLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
| | - P.A. Kanetsky
- Cancer Epidemiology ProgramMoffitt Cancer CenterTampaFLUSA
| | - D.E. Elder
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - G.J. Mann
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
- Centre for Cancer ResearchWestmead Institute for Medical ResearchThe University of SydneySydneyAustralia
| | - J.A. Newton‐Bishop
- Section of Epidemiology and BiostatisticsLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
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Watts CG, Drummond M, Goumas C, Schmid H, Armstrong BK, Aitken JF, Jenkins MA, Giles GG, Hopper JL, Mann GJ, Cust AE. Sunscreen Use and Melanoma Risk Among Young Australian Adults. JAMA Dermatol 2019; 154:1001-1009. [PMID: 30027280 DOI: 10.1001/jamadermatol.2018.1774] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance There are limited data among young adults on sunscreen use during childhood and adulthood and on the association of sunscreen use with melanoma risk. Objective To assess correlates of early-life sunscreen use and the association between sunscreen use and risk of cutaneous melanoma before age 40 years. Design, Setting, and Participants This population-based, case-control family study analyzed Australian Melanoma Family Study data for persons with questionnaire data on sunscreen use collected by interview from 2001 to 2005 across 3 states in Australia, representing two-thirds of the country's population. Case participants (aged 18-39 years) had confirmed first primary melanoma. Siblings of case participants were included, and case participants without a sibling control were excluded. Unrelated controls (aged 18-44 years) were recruited from the electoral roll or were a spouse, partner, or friend nominated by case participants. Data analyses were conducted from October 2017 to February 2018. Exposures Self- and parent-reported sunscreen use, sun exposure, and other candidate risk factors during childhood and adulthood. Main Outcomes and Measures Logistic regression analyses adjusted for potential confounders were used to estimate odds ratios (ORs) for melanoma and for correlates of sunscreen use. Results Participation was 629 of 830 contactable cases (76%) (629 of 1197 overall [53%]), 240 of 570 contactable controls (42%) from the electoral roll (240 of 1068 overall [23%]), and 295 of 371 nominated spouse or friend controls (80%); analysis incuded 603 cases and 1088 controls. The median (interquartile range) age was 32 (28-36) years for 603 cases, 35 (30-38) years for 478 unrelated controls, and 34 (29-38) years for 610 sibling controls. There were more women than men (range, 57%-62%) in all groups, approximately 40% (range, 39%-43%) of participants had a university education, and most participants (range, 58%-73%) had British/northern European ethnicity. Risk of melanoma was less with higher use of sunscreen in childhood (OR for highest vs lowest tertiles, 0.60; 95% CI, 0.42-0.87; P = .02 for trend) and across the lifetime (OR, 0.65; 95% CI, 0.45-0.93; P = .07 for trend). Subgroup analyses suggested that the protective association of sunscreen with melanoma was stronger for people reporting blistering sunburn, receiving a diagnosis of melanoma at a younger age, or having some or many nevi. Total lifetime sun exposure was unrelated to melanoma risk (OR for highest vs lowest tertile, 0.97; 95% CI, 0.66-1.43; P = .94 for trend). By contrast, total sun exposure inversely weighted by sunscreen use (as a measure of sun exposure unprotected by sunscreen) was significantly associated with melanoma risk (OR, 1.80; 95% CI, 1.22-2.65; P = .007 for trend) and appeared stronger for people having lighter pigmentation or some or many nevi or using sunscreen to stay longer in the sun. Regular users of sunscreen were more likely to be female, younger, and of British or northern European ancestry and to have higher educational levels, lighter skin pigmentation, and a stronger history of blistering sunburn. Conclusions and Relevance Our findings provided evidence that regular sunscreen use is significantly associated with reduced risk of cutaneous melanoma among young adults and identified several characteristics associated with less sunscreen use.
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Affiliation(s)
- Caroline G Watts
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia.,Melanoma Institute Australia, Sydney, New South Wales, Australia.,Now with The Kirby Institute, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin Drummond
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia.,Melanoma Institute Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Goumas
- Melanoma Institute Australia, Sydney, New South Wales, Australia
| | - Helen Schmid
- Melanoma Research Group, Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Bruce K Armstrong
- The School of Population Health, The University of Western Australia, Perth, Australia
| | - Joanne F Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Graham J Mann
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,Melanoma Research Group, Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia.,Melanoma Institute Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Pereira N, Cardoso A, Mota P, Santos A, Melo N, Morais A, Drummond M. Predictive factors of obstructive sleep apnoea in patients with fibrotic lung diseases. Sleep Med 2019; 56:123-127. [DOI: 10.1016/j.sleep.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/06/2018] [Accepted: 01/14/2019] [Indexed: 01/09/2023]
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Chakera AH, Quinn MJ, Lo S, Drummond M, Haydu LE, Bond JS, Stretch JR, Saw RPM, Lee KJ, McCarthy WH, Scolyer RA, Thompson JF. Subungual Melanoma of the Hand. Ann Surg Oncol 2018; 26:1035-1043. [DOI: 10.1245/s10434-018-07094-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 01/06/2023]
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Cust AE, Drummond M, Kanetsky PA, Goldstein AM, Barrett JH, MacGregor S, Law MH, Iles MM, Bui M, Hopper JL, Brossard M, Demenais F, Taylor JC, Hoggart C, Brown KM, Landi MT, Newton-Bishop JA, Mann GJ, Bishop DT. Assessing the Incremental Contribution of Common Genomic Variants to Melanoma Risk Prediction in Two Population-Based Studies. J Invest Dermatol 2018; 138:2617-2624. [PMID: 29890168 PMCID: PMC6249137 DOI: 10.1016/j.jid.2018.05.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 01/02/2023]
Abstract
It is unclear to what degree genomic and traditional (phenotypic and environmental) risk factors overlap in their prediction of melanoma risk. We evaluated the incremental contribution of common genomic variants (in pigmentation, nevus, and other pathways) and their overlap with traditional risk factors, using data from two population-based case-control studies from Australia (n = 1,035) and the United Kingdom (n = 1,460) that used the same questionnaires. Polygenic risk scores were derived from 21 gene regions associated with melanoma and odds ratios from published meta-analyses. Logistic regression models were adjusted for age, sex, center, and ancestry. Adding the polygenic risk score to a model with traditional risk factors increased the area under the receiver operating characteristic curve (AUC) by 2.3% (P = 0.003) for Australia and by 2.8% (P = 0.002) for Leeds. Gene variants in the pigmentation pathway, particularly MC1R, were responsible for most of the incremental improvement. In a cross-tabulation of polygenic by traditional tertile risk scores, 59% (Australia) and 49% (Leeds) of participants were categorized in the same (concordant) tertile. Of participants with low traditional risk, 9% (Australia) and 21% (Leeds) had high polygenic risk. Testing of genomic variants can identify people who are susceptible to melanoma despite not having a traditional phenotypic risk profile.
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Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
| | - Martin Drummond
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Alisa M Goldstein
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jennifer H Barrett
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Stuart MacGregor
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Matthew H Law
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Mark M Iles
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, University of Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, University of Melbourne, Australia
| | - Myriam Brossard
- INSERM, UMR 946, Genetic Variation and Human Diseases Unit, Paris, France; Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Florence Demenais
- INSERM, UMR 946, Genetic Variation and Human Diseases Unit, Paris, France; Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - John C Taylor
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Clive Hoggart
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Kevin M Brown
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Maria Teresa Landi
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Julia A Newton-Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - D Timothy Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
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Reis A, Alves C, Furtado S, Ferreira J, Drummond M, Robalo-Cordeiro C. COPD exacerbations: management and hospital discharge. Pulmonology 2018; 24:345-350. [DOI: 10.1016/j.pulmoe.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022] Open
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31
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Guitera P, Collgros H, Madronio CM, Goumas C, Mann GJ, Watts CG, Pereira AR, Armstrong BK, Drummond M, Morton RL, Scolyer RA, Menzies SW, Thompson JF, Cust AE. The steadily growing problem of lentigo maligna and lentigo maligna melanoma in Australia: Population-based data on diagnosis and management. Australas J Dermatol 2018; 60:118-125. [PMID: 30302753 DOI: 10.1111/ajd.12928] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES There are limited population-based data documenting the incidence and management of lentigo maligna (LM) and invasive lentigo maligna melanoma (LMM). We report the data on occurrence and management of LM and LMM in an Australian population. METHODS Prospective collection of incidence and clinician-reported management of melanoma in situ (MIS; n = 450, capped) and localised invasive melanoma (n = 3251) notified to the New South Wales Cancer Registry over 12-months in 2006-2007. RESULTS The estimated annual incidence of all MIS was 27.0 per 100 000 (LM 12.2, non-LM MIS 5.9 and unclassified MIS 9.0). Patients with LM or LMM were on average approximately 10 years older than those with other melanoma subtypes (P < 0.001). The head and neck was the location of 59% of LM, 44% of LMM and <20% of other melanoma subtypes (P < 0.001). The majority of LM and LMM were treated only by specialists. Diagnostic partial biopsies were more frequent for LM and LMM than for other melanoma subtypes, and primary care physicians were more likely than specialists to do a punch partial biopsy than a shave biopsy. The reported median definitive excision margin for LM was 5.0 mm compared with 7.2 mm for non-LM MIS (P = 0.001). CONCLUSIONS In this Australian population, LM was twice as frequent as other types of MIS. Improved strategies for diagnosis and management are required.
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Affiliation(s)
- Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Helena Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christine M Madronio
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Goumas
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Caroline G Watts
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surveillance, Evaluation & Research Program, Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda R Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Dermatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Bruce K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin Drummond
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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32
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Drummond M, Wang S, MacLean A, Gutierrez G, Nie Q, Atwood S. 1337 Single cell transcriptome profiling of human interfollicular epidermis reveals robust heterogeneity and divergent differentiation lineages. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1354] [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: 11/30/2022]
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Winck JC, Moreira S, Bugalho A, Drummond M, Ferreira AJ, Guimarães M, Reis-Ferreira JM. What exactly Portuguese respiratory professionals aim for their scientific Society: Findings from the VOICE online survey. Rev Port Pneumol (2006) 2017; 23:225-226. [PMID: 28392156 DOI: 10.1016/j.rppnen.2017.02.008] [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: 01/11/2017] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- J C Winck
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - S Moreira
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - A Bugalho
- Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - M Drummond
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - A J Ferreira
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Guimarães
- Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
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Fernández ME, Loaiza Echeverri AM, Henry M, Drummond M, Andrade de Oliveira DA, Demyda Peyrás S, Cunha Cardoso D, Giovambattista G, Liron JP. Bovine thyroglobulin gene polymorphisms and their association with sexual precocity in Guzerat bulls. Reprod Domest Anim 2017; 52:911-913. [DOI: 10.1111/rda.12989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- ME Fernández
- IGEVET - Instituto de Genética Veterinaria “Ing. Fernando N. Dulout” (UNLP-CONICET LA PLATA); Facultad de Ciencias Veterinarias; Universidad Nacional de La Plata; La Plata Argentina
| | - AM Loaiza Echeverri
- Departamento de Clínica e Cirurgia Veterinarias; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - M Henry
- Departamento de Clínica e Cirurgia Veterinarias; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - M Drummond
- Departamento de Clínica e Cirurgia Veterinarias; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - DA Andrade de Oliveira
- Departamento de Zootecnia; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - S Demyda Peyrás
- IGEVET - Instituto de Genética Veterinaria “Ing. Fernando N. Dulout” (UNLP-CONICET LA PLATA); Facultad de Ciencias Veterinarias; Universidad Nacional de La Plata; La Plata Argentina
| | - D Cunha Cardoso
- Departamento de Zootecnia; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | - G Giovambattista
- IGEVET - Instituto de Genética Veterinaria “Ing. Fernando N. Dulout” (UNLP-CONICET LA PLATA); Facultad de Ciencias Veterinarias; Universidad Nacional de La Plata; La Plata Argentina
| | - JP Liron
- IGEVET - Instituto de Genética Veterinaria “Ing. Fernando N. Dulout” (UNLP-CONICET LA PLATA); Facultad de Ciencias Veterinarias; Universidad Nacional de La Plata; La Plata Argentina
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Parakh S, Park JJ, Mendis S, Rai R, Xu W, Lo S, Drummond M, Rowe C, Wong A, McArthur G, Haydon A, Andrews MC, Cebon J, Guminski A, Kefford RF, Long GV, Menzies AM, Klein O, Carlino MS. Efficacy of anti-PD-1 therapy in patients with melanoma brain metastases. Br J Cancer 2017; 116:1558-1563. [PMID: 28524161 PMCID: PMC5518864 DOI: 10.1038/bjc.2017.142] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 01/09/2023] Open
Abstract
Background: There is limited data on the efficacy of anti-programmed death 1 (PD-1) antibodies in patients (pts) with melanoma brain metastasis (BM), particularly those which are symptomatic. Method: We retrospectively assessed pts with melanoma BM treated with PD-1 antibodies, nivolumab and pembrolizumab. Clinicopathologic and treatment parameters were collected and outcomes determined for intracranial (IC) response rate (RR) using a modified RECIST criteria, with up to five IC target lesions used to determine IC response, disease control rate (DCR) and progression-free survival (PFS). Results: A total of 66 pts were identified with a median follow up of 7.0 months (range 0.8–24.5 months). A total of 68% were male and 45% BRAF V600 mutation positive. At PD-1 antibody commencement, 50% had an elevated LDH; 64% had local therapy to BM prior to commencing anti-PD1, of which 5% had surgical resection, 14% stereotactic radiosurgery (SRS), 18% whole-brain radiotherapy (WBRT), 27% had surgery and radiotherapy. Twenty-one per cent started anti-PD-1 as first line systemic therapy. No pt had prior anti-PD-1 treatment. The IC overall RR was 21 and DCR 56%. Responses occurred in 21% of pts with symptomatic BM. The median OS was 9.9 months (95% CI 6.93–17.74). Pts with symptomatic BM had shorter PFS than those without symptoms (2.7 vs 7.4 months, P=0.035) and numerically shorter OS (5.7 vs 13.0 months, P=0.068). Pts requiring corticosteroids also had a numerically shorter PFS (3.2 vs 7.4 months, P=0.081) and OS (4.8 vs 13.1 months, P=0.039). Conclusions: IC responses to anti-PD-1 antibodies occur in pts with BM, including those with symptomatic BM requiring corticosteroids. Prospective trials evaluating anti-PD-1 therapy in pts with BM are underway.
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Affiliation(s)
- Sagun Parakh
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia.,La Trobe University School of Cancer Medicine, Melbourne, Victoria 3086, Australia
| | - John J Park
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales 2145, Australia.,The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Shehara Mendis
- Medical Oncology Unit, Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Rajat Rai
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
| | - Wen Xu
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Serigne Lo
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
| | - Martin Drummond
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
| | - Catherine Rowe
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Annie Wong
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Grant McArthur
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Andrew Haydon
- Medical Oncology Unit, Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Miles C Andrews
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia
| | - Jonathan Cebon
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia
| | - Alex Guminski
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales 2065, Australia
| | - Richard F Kefford
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales 2145, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Department of Clinical Medicine, Macquarie University, New South Wales 2109, Australia
| | - Georgina V Long
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales 2065, Australia
| | - Alexander M Menzies
- The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales 2065, Australia
| | - Oliver Klein
- Medical Oncology Unit, Austin Health, Melbourne, Victoria 3084, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Victoria 3084, Australia
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales 2145, Australia.,The University of Sydney, Sydney, New South Wales 2006, Australia.,Melanoma Institute Australia, Sydney, New South Wales 2060, Australia
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Choong ES, Lo S, Drummond M, Fogarty GB, Menzies AM, Guminski A, Shivalingam B, Clarke K, Long GV, Hong AM. Survival of patients with melanoma brain metastasis treated with stereotactic radiosurgery and active systemic drug therapies. Eur J Cancer 2017; 75:169-178. [PMID: 28236768 DOI: 10.1016/j.ejca.2017.01.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [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: 10/18/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION With new systemic therapies demonstrating activity in melanoma brain metastasis, most of the previously reported stereotactic radiosurgery (SRS) data are superseded. In this study, we report the outcomes (overall survival [OS] and brain control [BC]) and identify factors that associate with such outcomes in the era of modern systemic therapy. METHOD A total of 108 patients treated with SRS from 2010 to 2015 were included. Systemic treatment use within 6 weeks of SRS was noted. OS was defined as time from SRS to death or last follow-up, and BC was defined as absence of any active intracranial disease during follow-up. Univariate and multivariate Cox proportional hazard analyses were performed on clinico-pathological prognostic features associated with OS and BC. RESULTS The median age was 64.3 years, and the median follow-up was 8.6 months. Seventy-nine (73.1%) patients received systemic treatment. The median OS were as follows: anti-CTLA4 - 7.5 months (95% CI: 4.4-15.6), anti-PD1 - 20.4 months (95% CI: 8.8 - N/A) and BRAF inhibitor (BRAFi) ± MEK inhibitor (MEKi) - 17.8 months (95% CI: 11.8 - N/A). Median BC was as follows: anti-CTLA4 - 7.5 months (95% CI: 4.0-15.6), anti-PD1 - 12.7 months (95% CI: 5.5 - N/A) and BRAFi ± MEKi - 12.7 months (95% CI: 8.3-18.5). In multivariate analysis, age and type of systemic therapy were strongly associated with OS. Age, Eastern Cooperative Oncology Group performance status, Graded Prognostic Assessment (GPA) score, and presence of symptoms were associated with BC. CONCLUSIONS Favourable outcomes are seen in patients treated with SRS and with the best survival seen in patients treated with anti-PD1. Known independent prognostic factors for survival such as age and performance status and GPA score remain relevant in this setting.
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Affiliation(s)
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, NSW, Australia
| | - Martin Drummond
- Melanoma Institute Australia, The University of Sydney, NSW, Australia
| | - Gerald B Fogarty
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Genesis Cancer Care, Mater Radiation Oncology, North Sydney, Australia; Mater Hospital, North Sydney NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Mater Hospital, North Sydney NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Alexander Guminski
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Mater Hospital, North Sydney NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Brindha Shivalingam
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Camperdown, NSW Australia; Mater Hospital, North Sydney NSW, Australia
| | - Kathryn Clarke
- Genesis Cancer Care, Mater Radiation Oncology, North Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Mater Hospital, North Sydney NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Angela M Hong
- Melanoma Institute Australia, The University of Sydney, NSW, Australia; Genesis Cancer Care, Mater Radiation Oncology, North Sydney, Australia; Mater Hospital, North Sydney NSW, Australia.
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Crookes TR, Scolyer RA, Lo S, Drummond M, Spillane AJ. Extranodal Spread is Associated with Recurrence and Poor Survival in Stage III Cutaneous Melanoma Patients. Ann Surg Oncol 2017; 24:1378-1385. [PMID: 28130620 DOI: 10.1245/s10434-016-5723-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inconsistent data suggests extranodal spread (ENS) is an adverse prognostic factor in Stage III melanoma patients but it remains contentious. By rigorously matching cohorts, this study sought to clarify associations with recurrence and survival. METHODS Melanoma patients with lymph node metastases (AJCC Stage III), with or without ENS, sub-classified on the basis of known (MKP) or unknown primary (MUP), were identified from a single institution prospective database. Of 725 ENS patients identified, 567 were able to be precisely matched 1:1 with a non-ENS cohort. Clinicopathologic factors were analyzed for associations with outcome. RESULTS There were 481 MKP and 86 MUP patients in each cohort. ENS, compared to non-ENS, was an independent predictor of worse melanoma specific survival (MSS) (HR = 1.71, 95% CI = 1.39-2.11, P < 0.0001) with median MSS 56.4 versus 175.2 months, P < 0.001; worse disease free survival (DFS) (HR = 1.16, 95%CI = 1.00-1.34, P = 0.044) with median DFS 15.6 versus 21.5 months, P = 0.009; and worse post-recurrence survival (PRS) (HR = 1.66, 95%CI = 1.37-2.02, P < 0.0001) with median PRS 20.1 versus 51.1 months, P < 0.001. ENS was also associated with reduced time to distant recurrence (Distant Disease Free Survival [DDFS]) (HR = 2.00, 95% CI = 1.24-3.24, P = 0.0047), however median time to distant recurrence not reached within the study time period. CONCLUSIONS ENS represents a significant independent predictor of worse MSS, DFS, PRS and DDFS in Stage III melanoma patients. ENS should be considered in the stratification of patients in adjuvant therapy trials.
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Affiliation(s)
- Thomas R Crookes
- Melanoma Institute Australia, 40 Rockland Roads, North Sydney, NSW, 2060, Australia.,School of Medicine Sydney, The University of Notre Dame, Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, 40 Rockland Roads, North Sydney, NSW, 2060, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Serigne Lo
- Melanoma Institute Australia, 40 Rockland Roads, North Sydney, NSW, 2060, Australia
| | - Martin Drummond
- Melanoma Institute Australia, 40 Rockland Roads, North Sydney, NSW, 2060, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, 40 Rockland Roads, North Sydney, NSW, 2060, Australia. .,Sydney Medical School, The University of Sydney, Sydney, Australia.
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Drummond M, Houwing N, Slothuus U, Giangrande P. Making economic evaluations more helpful for treatment choices in haemophilia. Haemophilia 2017; 23:e58-e66. [DOI: 10.1111/hae.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 01/25/2023]
Affiliation(s)
- M. Drummond
- Centre for Health Economics; University of York; York UK
| | - N. Houwing
- Pharmerit Europe; Rotterdam The Netherlands
| | | | - P. Giangrande
- University of Oxford, Green Templeton College; Oxford UK
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Winck JC, Bugalho A, Drummond M, Ferreira AJ, Moreira S. Portuguese Pulmonology footprint in Europe: From abstracts to papers and grants. Rev Port Pneumol (2006) 2016; 22:360-362. [PMID: 26897096 DOI: 10.1016/j.rppnen.2015.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023] Open
Affiliation(s)
- J C Winck
- Faculdade de Medicina da Universidade do Porto, Portugal.
| | - A Bugalho
- Faculdade Ciências Médicas da Universidade Nova de Lisboa, Portugal
| | - M Drummond
- Faculdade de Medicina da Universidade do Porto, Portugal
| | - A J Ferreira
- Faculdade de Medicina da Universidade de Coimbra, Portugal
| | - S Moreira
- Faculdade de Medicina da Universidade de Lisboa, Portugal
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Guitera P, Menzies SW, Argenziano G, Longo C, Losi A, Drummond M, Scolyer RA, Pellacani G. Dermoscopy and in vivo confocal microscopy are complementary techniques for diagnosis of difficult amelanotic and light-coloured skin lesions. Br J Dermatol 2016; 175:1311-1319. [PMID: 27177158 DOI: 10.1111/bjd.14749] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Amelanotic melanomas are often difficult to diagnose. OBJECTIVES To find and test the best methods of diagnosis using dermoscopy and reflectance confocal microscopy (RCM) tools. METHODS We selected consecutive, difficult-to-diagnose, light-coloured and amelanotic skin lesions from three centres (in Australia and Italy). Dermoscopy and RCM diagnostic utility were evaluated under blinded conditions utilizing 45 melanomas (16 in situ, 29 invasive), 68 naevi, 48 basal cell carcinomas (BCCs), 10 actinic keratoses, 10 squamous cell carcinomas (SCCs) and 13 other benign lesions. RESULTS Sensitivity and specificity for melanoma with dermoscopy pattern analysis by two blinded observers and their 'confidence in diagnosis' were low. The amelanotic dermoscopy method had the highest sensitivity (83%) for a diagnosis of malignancy (melanoma, BCC or SCC), but specificity was only 18%. Multivariate analysis confirmed the utility of RCM features previously identified for the diagnosis of BCC and melanoma (highest odds ratio for melanoma: epidermal disarray, dark and/or round pagetoid cells). RCM sensitivity was 67% and 73% for melanoma and BCC diagnosis, respectively, and its specificity for nonmalignant lesion diagnosis was 56%. RCM reader confidence was higher than for dermoscopy; 84% of melanomas would have been biopsied and biopsy avoided in 47% of benign lesions. All melanomas misclassified by either dermoscopy or RCM were detected by the other tool. CONCLUSIONS Dermoscopy and RCM represent complementary/synergistic methods for diagnosis of amelanotic/light-coloured skin lesions.
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Affiliation(s)
- P Guitera
- Sydney Melanoma Diagnostic Centre and Dermatology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW, Australia
| | - S W Menzies
- Sydney Melanoma Diagnostic Centre and Dermatology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - G Argenziano
- Dermatology Unit, Second University of Naples, Naples, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, University of Modena and Reggio Emilia, Modena, Italy
| | - A Losi
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Drummond
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Liron JP, Echeveri AML, Fernandez ME, Drummond M, Goszczynski D, Cardoso DC, García PP, Henry MRJM, Giovambattista G, Andrade de Oliveira DA. P4044 Search for polymorphisms through next-generation sequencing of genes involved in reproductive development in Guzerat bulls. J Anim Sci 2016. [DOI: 10.2527/jas2016.94supplement4100x] [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: 11/13/2022] Open
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Winck M, Drummond M, Viana P, Pinho JC, Winck JC. Sleep bruxism associated with obstructive sleep apnoea syndrome - A pilot study using a new portable device. Rev Port Pneumol (2006) 2016; 23:22-26. [PMID: 27567051 DOI: 10.1016/j.rppnen.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/08/2016] [Revised: 05/08/2016] [Accepted: 07/06/2016] [Indexed: 11/25/2022] Open
Abstract
Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways. We aimed to study the presence and relationship of SB in a OSAS population. Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles. From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3±11.3 years, and apnea hypopnea index of 11.1±5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index>2/h). Mean SB index was 5.12±3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7±9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (R=0.755, p=0.019 and R=0.737, p=0.023 respectively, Pearson correlation). Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (R=-0.632 and R=-0.611, p>0.05, Pearson correlation). This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting.
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Affiliation(s)
- M Winck
- Faculdade de Medicina Dentária da Universidade do Porto, Porto, Portugal.
| | - M Drummond
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - P Viana
- Centro Hospitalar São João, Porto, Portugal
| | - J C Pinho
- Faculdade de Medicina Dentária da Universidade do Porto, Porto, Portugal
| | - J C Winck
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Quintas-Neves M, Preto J, Drummond M. Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA). Rev Port Pneumol (2006) 2016; 22:331-336. [PMID: 27339391 DOI: 10.1016/j.rppnen.2016.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 07/31/2015] [Revised: 03/31/2016] [Accepted: 05/06/2016] [Indexed: 01/23/2023] Open
Abstract
A worldwide rise in weight and obesity is taking place, associated with an increase in several comorbid conditions, such as Obstructive Sleep Apnea (OSA). Bariatric surgery is an effective treatment approach for obesity, with resultant improvement in obesity-related comorbidities. However, the relationship between this type of treatment and OSA is not well established. This systematic review aims to assess and characterize the impact that different types of bariatric surgery have on obese OSA patients. 22 articles with stated preoperative apnea-hypopnea index (AHI), apnea index (AI) or respiratory disturbance index (RDI) were analyzed in this review. A significant improvement in AHI/AI/RDI occurred after surgery, in addition to the foreseeable reduction in body mass index (BMI). Moreover, almost every study stated a postoperative reduction of the AHI to < 20/h and/or a >50% postoperative reduction of AHI, with few exceptions. The interventions with a combined malabsorptive and restrictive mechanism, like roux-en-Y gastric bypass (RYGB), were more efficacious in resolving and improving OSA than purely restrictive ones, like laparoscopic adjustable gastric banding (LAGB). In conclusion, bariatric surgery has a significant effect on OSA, leading to its resolution or improvement, in the majority of cases, at least in the short/medium term (1-2 years). However, the different results must be interpreted with caution as there are many potential biases resulting from heterogeneous inclusion criteria, duration of follow-up, diagnostic methodology and assessed variables.
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Affiliation(s)
| | - J Preto
- Faculty of Medicine, University of Porto, Porto, Portugal; Surgery Department of São João Medical Center, Porto, Portugal.
| | - M Drummond
- Faculty of Medicine, University of Porto, Porto, Portugal; Pulmonology Department of São João Medical Center, Porto, Portugal.
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Ferreira J, Drummond M, Pires N, Reis G, Alves C, Robalo-Cordeiro C. Optimal treatment sequence in COPD: Can a consensus be found? Rev Port Pneumol (2006) 2015; 22:39-49. [PMID: 26655798 DOI: 10.1016/j.rppnen.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/14/2015] [Accepted: 10/20/2015] [Indexed: 12/26/2022] Open
Abstract
There is currently no consensus on the treatment sequence in chronic obstructive pulmonary disease (COPD), although it is recognized that early diagnosis is of paramount importance to start treatment in the early stages of the disease. Although it is fairly consensual that initial treatment should be with an inhaled short-acting beta agonist, a short-acting muscarinic antagonist, a long-acting beta-agonist or a long-acting muscarinic antagonist. As the disease progresses, several therapeutic options are available, and which to choose at each disease stage remains controversial. When and in which patients to use dual bronchodilation? When to use inhaled corticosteroids? And triple therapy? Are the existing non-inhaled therapies, such as mucolytic agents, antibiotics, phosphodiesterase-4 inhibitors, methylxanthines and immunostimulating agents, useful? If so, which patients would benefit? Should co-morbidities be taken into account when choosing COPD therapy for a patient? This paper reviews current guidelines and available evidence and proposes a therapeutic scheme for COPD patients. We also propose a treatment algorithm in the hope that it will help physicians to decide the best approach for their patients. The authors conclude that, at present, a full consensus on optimal treatment sequence in COPD cannot be found, mainly due to disease heterogeneity and lack of biomarkers to guide treatment. For the time being, and although some therapeutic approaches are consensual, treatment of COPD should be patient-oriented.
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Affiliation(s)
- J Ferreira
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, Portugal
| | - M Drummond
- Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal; Porto Medical School, Porto University, Portugal
| | - N Pires
- Pulmonology Department, Hospital Santa Maria Maior, Barcelos, Portugal
| | - G Reis
- Pulmonology Department, Hospital Distrital de Santarém, Portugal
| | - C Alves
- Pulmonology Department, Hospital de Nossa Senhora do Rosário, Barreiro, Portugal
| | - C Robalo-Cordeiro
- Pulmonology Department, University Hospital, Coimbra, Portugal; Coimbra Medical School, Coimbra University, Portugal.
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Lambert A, Neptune E, Brown R, Diette G, Drummond M, Hansel N, Liu M, Shade D, Wise R. Angiotensin Receptor Blockade Treatment for COPD: Phase II Trial. Chest 2015. [DOI: 10.1378/chest.2233371] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Sousa AS, Pereira AM, Fonseca JA, Azevedo LF, Abreu C, Arrobas A, Calvo T, Silvestre MJ, Cunha L, Falcão H, Drummond M, Geraldes L, Loureiro C. Asthma control and exacerbations in patients with severe asthma treated with omalizumab in Portugal. Rev Port Pneumol (2006) 2015; 21:S2173-5115(15)00080-9. [PMID: 25926263 DOI: 10.1016/j.rppnen.2015.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/13/2015] [Accepted: 03/08/2015] [Indexed: 01/31/2023] Open
Abstract
The analysis of outcomes from patients with severe asthma treated with omalizumab, using real-life prospective data, should contribute to future informed decisions about this treatment in Portugal. The aim of this study was to assess the clinical effect of omalizumab in Portuguese patients with severe persistent allergic asthma, considering specifically asthma control and exacerbations. This was an observational, prospective, multicentre study. Data were collected at routine care over a 12-month period. Disease control was defined by Control of Allergic Rhinitis and Asthma Test (CARAT) global score >24. All asthma patients already under treatment with omalizumab in 7 departments from 6 Portuguese hospitals were included (n=48). Most (77%) patients were female and the mean (SD) age was 51.9 (10.2) years old. During the study period, asthma was controlled in 34% of the visits and the 12-month exacerbation rate was 1.7 per patient (0.6 with unscheduled medical care). One-third of the patients needed unscheduled medical care because of asthma and 29% had to start or increase oral corticosteroid. There was still a 41% reduction in the total sum of oral corticosteroids usage from the first to the last trimester of the study. During routine treatment with omalizumab, Portuguese patients with severe asthma achieved asthma control in 1/3 of the visits and only 1/3 needed unscheduled or Emergency Room care because of asthma exacerbations. These outcomes support the maintenance of the clinical effect during treatment with omalizumab in routine care in Portugal.
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Affiliation(s)
- A S Sousa
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - A M Pereira
- Allergy Department, Centro Hospitalar de São João, EPE, Porto, Portugal; Allergy Unit, CUF Porto Instituto e CUF Porto Hospital, Portugal; Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - J A Fonseca
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Allergy Unit, CUF Porto Instituto e CUF Porto Hospital, Portugal; Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - L F Azevedo
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - C Abreu
- Allergy Department, Hospital Pedro Hispano Unidade Local de Saúde de Matosinhos, EPE, Matosinhos, Portugal.
| | - A Arrobas
- Pulmonology Department, Hospital Geral de Coimbra Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.
| | - T Calvo
- Pulmonology Department, Centro Hospitalar de Trás os Montes e Alto Douro, EPE, Vila Real, Portugal.
| | - M J Silvestre
- Pulmonology Department, Centro Hospitalar de Trás os Montes e Alto Douro, EPE, Vila Real, Portugal.
| | - L Cunha
- Allergy Department, Centro Hospitalar do Porto, EPE, Porto, Portugal.
| | - H Falcão
- Allergy Department, Centro Hospitalar do Porto, EPE, Porto, Portugal.
| | - M Drummond
- Pulmonology Department, Centro Hospitalar de São João, EPE, Porto, Portugal.
| | - L Geraldes
- Allergy Department, Centro Hospitalar do Alto Ave, EPE, Guimarães, Portugal.
| | - C Loureiro
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.
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Pang TC, Spiro C, Ramacciotti T, Choi J, Drummond M, Sweeney E, Samra JS, Hugh TJ. Complications following liver resection for colorectal metastases do not impact on longterm outcome. HPB (Oxford) 2015; 17:185-93. [PMID: 25158227 PMCID: PMC4299393 DOI: 10.1111/hpb.12327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND It has been suggested that adverse postoperative outcomes may have a negative impact on longterm survival in patients with colorectal liver metastases. OBJECTIVES This study was conducted to evaluate the prognostic impact of postoperative complications in patients submitted to a potentially curative resection of colorectal liver metastases. METHODS A retrospective analysis of outcomes in 199 patients submitted to hepatic resection with curative intent for metastatic colorectal cancer during 1999-2008 was conducted. RESULTS The overall complication rate was 38% (n = 75). Of all complications, 79% were minor (Grades I or II). There were five deaths (3%). The median length of follow-up was 39 months. Rates of 5-year overall and disease-free survival were 44% and 27%, respectively. Univariate analysis demonstrated that an elevated preoperative level of carcinoembryonic antigen (CEA), intraoperative blood loss of > 300 ml, multiple metastases, large (≥ 35 mm) metastases and resection margins of < 1 mm were associated with poor overall and disease-free survival. In addition, male sex and synchronous metastases were associated with poor disease-free survival. Postoperative complications did not have an impact on either survival measure. The multivariate model did not include complications as a predictive factor. CONCLUSIONS Postoperative complications were not found to influence overall or disease-free survival in the present series. The number and size of liver metastases were confirmed as significant prognostic factors.
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Affiliation(s)
- Tony C Pang
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, North Shore Private HospitalSt Leonards, NSW, Australia,Discipline of Surgery, University of SydneySydney, NSW, Australia
| | - Calista Spiro
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, North Shore Private HospitalSt Leonards, NSW, Australia
| | - Tim Ramacciotti
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, North Shore Private HospitalSt Leonards, NSW, Australia
| | - Julian Choi
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, North Shore Private HospitalSt Leonards, NSW, Australia
| | - Martin Drummond
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, North Shore Private HospitalSt Leonards, NSW, Australia
| | - Edmund Sweeney
- Department of Anaesthesia, North Shore Private Hospital, University of SydneySt Leonards, NSW, Australia
| | - Jaswinder S Samra
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, North Shore Private HospitalSt Leonards, NSW, Australia,Discipline of Surgery, University of SydneySydney, NSW, Australia
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, North Shore Private HospitalSt Leonards, NSW, Australia,Discipline of Surgery, University of SydneySydney, NSW, Australia,Correspondence, Thomas J. Hugh, Department of GIT Surgery, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. Tel: + 61 2 9463 2899. Fax: + 61 2 9463 2080. E-mail:
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Pang T, Kaufman A, Choi J, Gill A, Drummond M, Hugh T, Samra J. Peroxisome proliferator-activated receptor-α staining is associated with worse outcome in colorectal liver metastases. Mol Clin Oncol 2014; 3:308-316. [PMID: 25798259 DOI: 10.3892/mco.2014.482] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/09/2014] [Indexed: 01/01/2023] Open
Abstract
Peroxisome proliferator-activated receptors (PPARs) are a family of nuclear receptors involved in lipid metabolism and liver response to injury. We hypothesised that differences in the expression of PPARs may reflect differences in the cellular microenvironment of the liver and, consequently, in the behaviour of colorectal liver metastases. Of the 145 patients who underwent hepatectomy for colorectal liver metastases between 1998 and 2007, 103 had adequate tissue for PPAR staining and histological re-evaluation. The histological characteristics evaluated included sinusoidal dilatation, perisinusoidal fibrosis, ballooning and steatosis. PPAR- α and-γ staining was performed and the results were correlated with clinical and survival data. Lobular inflammation and sinusoidal dilatation were the most common histopathological abnormalities. A total of 50% of the patients were PPAR- α-negative and 34% were PPAR- γ-negative. More patients exhibited lobular inflammation in the PPAR- α -positive group (P=0.023) compared to patients with negative PPAR- α staining, as seen on the multivariate analysis. PPAR- γpositivity was associated with oxaliplatin use, surgical margins ≥1 mm and a trend towards a lesser degree of fibrosis. The median follow-up in this cohort of patients was 48 months. Patients with PPAR- α staining had a worse overall survival (median, 36 vs. 79 months, P=0.037) compared to those with no PPAR- α staining. There was no correlation between PPAR- α or-γpositivity and disease-free survival. In conclusion, PPAR- α staining is associated with lobular inflammation and worse overall survival in patients with colorectal liver metastases. The exact mechanism underlying this finding remains unclear and further research into the diagnostic and therapeutic implications is required.
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Affiliation(s)
- Tony Pang
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital ; Northern Clinical School, University of Sydney
| | - Antony Kaufman
- Department of Anatomical Pathology, Royal North Shore Hospital
| | - Julian Choi
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital
| | - Anthony Gill
- Northern Clinical School, University of Sydney ; Cancer Diagnosis and Pathology Group, Kolling Institute of Medicine, Royal North Shore Hospital, St. Leonards, NSW 2065
| | - Martin Drummond
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital
| | - Thomas Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital ; Northern Clinical School, University of Sydney
| | - Jaswinder Samra
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital ; Northern Clinical School, University of Sydney ; Australian School of Advanced Medicine, Macquarie University, Macquarie Park, NSW 2109, Australia
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Wilkinson G, Drummond M. Going Beyond The Qaly In Assessing The Benefits of Medical Devices. Value Health 2014; 17:A440. [PMID: 27201179 DOI: 10.1016/j.jval.2014.08.1153] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- G Wilkinson
- London School of Economics and Political Science, London, UK
| | - M Drummond
- University of York, Heslington, York, UK
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Ricciardi GW, Toumi M, Weil-Olivier C, Ruitenberg EJ, Dankó D, Duru G, Picazo J, Zöllner Y, Poland G, Drummond M. Comparison of NITAG policies and working processes in selected developed countries. Vaccine 2014; 33:3-11. [PMID: 25258100 DOI: 10.1016/j.vaccine.2014.09.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vaccines are specific medicines characterized by two country-specific market access processes: (1) a recommendation by National Immunization Technical Advisory Group (NITAG), and (2) a funding policy decision. OBJECTIVES The objective of this study was to compare and analyze NITAGs of 13 developed countries by describing vaccination committees' bodies and working processes. METHODS Information about NITAGs bodies and working processes was searched from official sources from June 2011 to November 2012. Retrieved information was completed from relevant articles identified through a systematic literature review and by information provided by direct contact with NITAGs or parent organizations. An expert panel was also conducted to discuss, validate, and provide additional input on obtained results. RESULTS While complete information, defined as 100%, was retrieved only for the UK, at least 80% of data was retrieved for 9 countries out of the 13 selected countries. Terms of references were identified in 7 countries, and the main mission for all NITAGs was to provide advice for National immunization programs. However, these terms of references did not fully encompass all the actual missions of the NITAGs. Decision analysis frameworks were identified for 10 out of the 13, and all NITAGs considered at least four criteria for decision-making: disease burden, efficacy/effectiveness, safety and cost-effectiveness. Advices were published by most NITAGs, but few NITAGs published meeting agendas and minutes. Only the United States had open meetings. CONCLUSIONS This study supports previous findings about the disparities in NITAGs processes which could potentially explain the disparity in access to vaccinations and immunization programs across Europe. With NITAGs recommendations being used by policy decision makers for implementation and funding of vaccine programs, guidances should be well-informed and transparent to ensure National Immunization Programs' (NIP) credibility among the public and health care professionals.
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Affiliation(s)
- G W Ricciardi
- European Public Health Association and Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - M Toumi
- University Aix-Marseille, Faculty of Medicine - Public Health, Marseilles, France.
| | | | - E J Ruitenberg
- Health Council of the Netherlands, The Hague, VU University Amsterdam, Amsterdam, The Netherlands
| | - D Dankó
- Corvinus University of Budapest, Budapest, Hungary
| | - G Duru
- CYKLAD Group, Rillieux Pape, France
| | - J Picazo
- Hospital Clinico, Universidad Complutense, Madrid, Spain
| | - Y Zöllner
- Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - G Poland
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - M Drummond
- Centre for Health Economics, University of York, York, UK
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