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PubMed1998

Prognosis of 2,800 patients with epithelial ovarian cancer diagnosed during 1975-94 and treated at the Norwegian Radium Hospital.

BACKGROUND: Ovarian cancer patients have a poor prognosis. In Norway, however, the prognosis has improved steadily since the 1950s, the age-adjusted 5-year relative survival reaching 37% in 1989 93. The aim of the present study was to explore the prognosis of patients with epithelial ovarian cancer diagnosed during 1975-94 (the prepaclitaxel period) and treated at The Norwegian Radium Hospital. METHOD: Relative risks (RR) of dying and 95% confidence intervals (95% CI) were derived from multivariate Cox proportional hazards regression models. RESULTS: A total of 2,769 patients with epithelial ovarian cancer were included in the present study. Altogether 54% of the patients were diagnosed with advanced stage disease (stages III and IV), whereas 32% were diagnosed with stage I disease. The prognosis of the patients improved from the 1970s to the 1990s, mainly due to increased short-term survival. In multivariate survival analysis, the RR of dying decreased with period of diagnosis. An RR of 0.77 (95% CI=0.66-0.89) was seen in 1990-94 compared with 1975-79. CONCLUSION: The short-term survival of patients with epithelial ovarian cancer improved from the late 1970s to the early 1990s. However, no major improvement in the long-term survival was seen.

Adolescent↗
PubMed2001

Prognosis after lymph node recurrence in papillary thyroid carcinoma depends on age.

Papillary thyroid carcinoma (PTC) is a malignancy that has good prognosis especially among patients up to 45 years of age; about half of the patients are female and of childbearing age. Lymph node recurrence (LNR) occurs in 10%-14% of patients but is considered to be associated with relatively good prognosis. The purpose of this study was to estimate the association between patient age at primary operation, and the behavior of the disease after LNR. Between 1967 and 1994, 495 patients underwent surgery for primary PTC at the Department of Surgery, Helsinki University Central Hospital. There were 391 (79.0%) women and 104 (21.0%) men with a mean age of 44.5 years (range, 10.8-85.4 years). Fifty-eight patients in whom LNR was the first clinical sign of persistent disease after complete clinical response to primary treatment were included in this series. At the time of primary operation, 37 (64.3%) of the 58 patients who developed LNR were younger than 45 years of age and 21 patients were older. The mean times to LNR in these groups were 42.0 months (range, 3.0-194.5 months) and 49.0 months (range, 3.6-209.0 months) respectively. Carcinoma-specific 5-year survival after LNR was 100% (95% confidence interval [CI] 88.8%-100.0%) in patients ages up to 45 years and 61.1% (40.5%-82.8%) in older patients; 10-year survival rates were 100%, and 41.3% (p < 0.0001), respectively. Relative survival at 10 years was 98.6% for patients ages up to 45 years and 42.6% for older patients (p = 0.0014). Using the Cox model it was shown that development of LNR after primary treatment has an independent highly significant negative effect on survival (p < 0.001) in patients over 45 years of age. Prognosis of PTC even after LNR on patients ages up to 45 years at the time of the primary operation is almost parallel to the normal reference population, but in patients over 45 years of age the prognosis is relatively poor.

Adolescent↗
PubMed2006

Diagnosis and prognosis disclosure among cancer patients. Results from an Italian mortality follow-back survey.

BACKGROUND: The observed cultural changes in truth-telling attitudes suggest a radical change in the practice of delivering information to cancer patients, but limited research is available from countries known for their policy of non-disclosure. This study estimates the proportion of Italian who died of cancer who had received information about diagnosis and prognosis, and explores the variables associated with disclosure. MATERIALS AND METHODS: This is a mortality follow-back survey of 1271 non-professional caregivers of Italians who died of cancer in 2002, representative of the approximate 160 000 Italian annual cancer deaths. Caregivers were interviewed after the patient's death about the process of diagnosis and prognosis disclosure. RESULTS: It was estimated that 37% of people who died of cancer had received information about diagnosis and 13% about poor prognosis. A consistent proportion, although non-informed, knew the diagnosis (29%) and the poor prognosis (50%). The probability to be informed was higher for patients living in the north of Italy, young, well educated, with longer survival, and with breast or head and neck tumor. CONCLUSIONS: These findings suggest that not necessarily the observed cultural changes towards a less paternalistic approach in medical care translate into an effective change in the quantity of information delivered to the patients.

Adolescent↗
PubMed2006

Improved breast cancer prognosis through the combination of clinical and genetic markers.

MOTIVATION: Accurate prognosis of breast cancer can spare a significant number of breast cancer patients from receiving unnecessary adjuvant systemic treatment and its related expensive medical costs. Recent studies have demonstrated the potential value of gene expression signatures in assessing the risk of post-surgical disease recurrence. However, these studies all attempt to develop genetic marker-based prognostic systems to replace the existing clinical criteria, while ignoring the rich information contained in established clinical markers. Given the complexity of breast cancer prognosis, a more practical strategy would be to utilize both clinical and genetic marker information that may be complementary. METHODS: A computational study is performed on publicly available microarray data, which has spawned a 70-gene prognostic signature. The recently proposed I-RELIEF algorithm is used to identify a hybrid signature through the combination of both genetic and clinical markers. A rigorous experimental protocol is used to estimate the prognostic performance of the hybrid signature and other prognostic approaches. Survival data analyses is performed to compare different prognostic approaches. RESULTS: The hybrid signature performs significantly better than other methods, including the 70-gene signature, clinical makers alone and the St. Gallen consensus criterion. At the 90% sensitivity level, the hybrid signature achieves 67% specificity, as compared to 47% for the 70-gene signature and 48% for the clinical makers. The odds ratio of the hybrid signature for developing distant metastases within five years between the patients with a good prognosis signature and the patients with a bad prognosis is 21.0 (95% CI:6.5-68.3), far higher than either genetic or clinical markers alone. AVAILABILITY: The breast cancer dataset is available at www.nature.com and Matlab codes are available upon request.

Algorithms↗
PubMed1997

Prognosis of intraoperative brachial plexus injury: a review of 22 cases.

A retrospective review over 6 yr of patients presenting to the hand clinic was performed to identify cases of postoperative brachial plexopathy (PBP) and to assess both prognosis and early indices of prognosis. Over this period (1989-1995), 22 patients were referred by the hospital's surgical departments to the hand clinic because of PBP. Eight cases followed open heart surgery (OHS) and 14 followed non-cardiac surgery (NCS). Median full recovery took 10 (range 4-16) weeks and 20 (8-50) weeks, respectively. Long-term follow-up revealed one OHS patient with residual tingling and three NCS patients with residual weakness. Brachial plexopathy after median sternotomy was characterized by a predominance of sensory complaint in the lower roots of the plexus. Injury after non-cardiac surgery was reflected by a predominance of motor deficit in the upper and middle roots. Brachial plexus injury after cardiac surgery carries an excellent prognosis for full functional recovery. Although the limited number of cases precludes statistical substantiation, the data suggest that the prognosis of PBP after non-cardiac surgery may be worse in males, diabetics, those with injury to all roots of the plexus and, when in addition to the motor deficit there is sensory loss and pain or dysaesthesia. At a 1 week "prognostic milestone", 79% of NCS patients with significant symptomatology enjoyed complete recovery although this took as long as 5 months to 1 yr in 50% of patients. At a 6-8 week "prognostic milestone", 50% of those who had not yet had improvement in the motor deficit suffered residual neurological deficit. All patients recovered to a significant extent even when recovery was not complete and none suffered from late deterioration or chronic pain.

Aged↗
PubMed1999

Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study.

OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general practice in Denmark. The patients were those aged 18-60 years consulting their GP due to an episode of LBP lasting less than 2 weeks. The GPs collected data regarding 34 exposure variables, including their global assessment of the likelihood of chronic LBP. Outcome variables were collected from the patients after 1, 6 and 12 months. The outcome measures were days on sick leave, and functional or complete recovery from LBP. RESULTS: In total, 503 (96%) patients were followed during the whole study period. Fifty per cent of the patients on sick leave returned to work within 8 days; after 1 year, only 2% remained on sick leave. At the 1-year follow-up, 45% of the patients continued to complain of LBP. Logistic regression analyses showed that the factors most significantly associated with poor long-term LBP outcome were (i) severity of LBP at inclusion, (ii) assessments by the GP of susceptibility to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict the prognosis of the individual LBP patient. The overall assessment by the GPs seems to be the most important predictor associated with the long-term outcome.

Acute Disease↗
PubMed2005

The prognosis of different fatigue diagnostic labels: a longitudinal survey.

BACKGROUND: Several different diagnostic labels exist for the fatigue syndromes, including chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME) and postviral fatigue syndrome (PVFS). An allied condition is fibromyalgia. No study has examined prognostic differences across these different labels. OBJECTIVE: To compare the prognoses of patients labelled with different fatigue syndromes in primary care. METHODS: We performed a longitudinal survey, using electronic records from the General Practice Research Database. All 18,122 patients diagnosed by their GP with a fatigue syndrome from 1988-2001 with a minimum of one year of records after diagnosis were collated into four groups: CFS, ME, PVFS and fibromyalgia. CFS and ME were combined for the main analysis as no code for CFS was available until 1995. The length of illness was calculated as the interval between the diagnosis and the last recorded fatigue symptom, expressed as days per year, to account for differing lengths of record after diagnosis. RESULTS: Patients with CFS/ME combined had a worse prognosis (median length of illness 80 days per year; interquartile range 0-242) than fibromyalgia (51; 0-244) or PVFS 0 (0-108), a significant difference, P < 0.001. In a subgroup analysis, ME had a worse prognosis (median length of illness in days per year 106; interquartile range 0-259) than CFS (33; 0-170), P < 0.001, in spite of a better course before diagnosis. Secondary outcome measures were consistent with these results. CONCLUSION: There were important differences in outcome between the various fatigue labels, with ME having the worst prognosis and PVFS the best. This could be an adverse effect of the label ME itself. Alternatively, patients who are destined to have a worse prognosis may preferentially attract the ME label. Our data support the first interpretation.

Adult↗
PubMed1999

Impact of the treating institution on survival of patients with "poor-prognosis" metastatic nonseminoma. European Organization for Research and Treatment of Cancer Genito-Urinary Tract Cancer Collaborative Group and the Medical Research Council Testicular Cancer Working Party.

BACKGROUND: Because metastatic nonseminomatous germ cell cancer is a rare but treatable cancer, we have explored whether there is an association between the experience of the treating institution with this disease and the long-term clinical outcome of the patients, particularly patients with a poor prognosis. METHODS: We analyzed data on 380 patients treated in one of 49 institutions participating in the European Organization for Research and Treatment of Cancer/ Medical Research Council randomized trial of four cycles of bleomycin-etoposide-cisplatin followed by two cycles of etoposide-cisplatin versus three cycles of bleomycin-vincristine-cisplatin followed by three cycles of etoposide-ifosfamide-cisplatin-bleomycin, both treatment regimens given with or without filgrastim (granulocyte colony-stimulating factor). Institutions were divided into four groups based on the total number of patients entered in the trial. The groups were compared by use of the Cox proportional hazards model stratified for treatment with filgrastim and for patient prognosis as defined by the International Germ Cell Consensus Classification Group. With the use of this classification, only 65 % of the patients had a poor prognosis. RESULTS: Patients treated in the 26 institutions that entered fewer than five patients into the trial had an overall survival that was statistically significantly worse (two-sided P = .010; hazard ratio = 1.85; 95% confidence interval = 1.16-3.03) than that of patients treated in the 23 institutions that entered five patients or more. Overall survival and failure-free survival were similar among institutions that entered at least five patients. The observed effect may be related to differences in adherence to the chemotherapy protocol and in the frequency and extent of surgery for residual masses, although only the differences in dose intensity achieved statistical significance. CONCLUSIONS: Patients treated in institutions that entered fewer than five patients into the trial appeared to have poorer survival than those treated in institutions that entered a larger number of patients with "poor-prognosis" nonseminoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Expression of p73 and its relation to histopathology and prognosis in hepatocellular carcinoma.

BACKGROUND: The protein p73, the first identified homologue of the tumor suppressor gene p53 (also known as TP53), has been shown to induce apoptosis (programmed cell death), but its function in tumor development has not been established. This study was undertaken to investigate the expression of p73 in liver tissue of patients with hepatocellular carcinoma (HCC) and to determine whether this expression has any impact on prognosis. METHODS: In situ hybridization and immunohistochemistry for the detection of p73 RNA transcripts and protein, respectively, were performed in tissues from 193 patients with curatively (R0-) resected HCC. Patients receiving liver transplantation were excluded. The results obtained were analyzed with respect to their association with pathohistologic stage, Edmondson grade, p53 expression status and several histopathologic factors of possible prognostic value, and, finally, with patient survival. RESULTS: RNA transcripts encoding p73 were detected by in situ hybridization in tumor cells but not in stromal, endothelial, or inflammatory cells or in cholangiocytes. Transcripts were also found occasionally in non-neoplastic hepatocytes. By immunohistochemistry, we detected p73 protein in 61 (32%) of the 193 carcinomas examined. Positive immunohistochemical staining was confined to the cell nucleus. Univariate survival analysis showed that p73 expression status was statistically significantly related to prognosis (two-sided P<.0001). Patients with p73-positive tumors had a poorer prognosis than those with p73-negative carcinomas. Multivariate Cox survival analysis identified the age of the patient, p73 expression status, co-existing cirrhosis, and Edmondson grade as independent prognostic factors. CONCLUSION: The protein p73 is overexpressed by a subset of HCCs and could serve as a useful indicator of prognosis in patients with this disease.

Apoptosis↗
PubMed2005

A systematic review describing the prognosis of chronic fatigue syndrome.

AIM: To perform a systematic review of studies describing the prognosis of chronic fatigue (CF) and chronic fatigue syndrome (CFS) and to identify occupational outcomes from such studies. METHOD: A literature search was used to identify all studies describing the clinical follow-up of patients following a diagnosis of CF or CFS. The prognosis is described in terms of the proportion of individuals improved during the period of follow-up. Return to work, other medical illnesses and death as outcomes are also considered, as are variables which may influence prognosis. RESULTS: Twenty-eight articles met the inclusion criteria and, for the 14 studies of subjects meeting operational criteria for CFS, the median full recovery rate was 5% (range 0-31%) and the median proportion of patients who improved during follow-up was 39.5% (range 8-63%). Less fatigue severity at baseline, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a good outcome. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome. CONCLUSIONS: Full recovery from untreated CFS is rare. The prognosis for an improvement in symptoms is less gloomy. This review looks at the course of CF/CFS without systematic intervention. However, there is increasing evidence for the effectiveness of cognitive behavioural and graded exercise therapies. Medical retirement should be postponed until a trial of such treatment has been given.

Fatigue↗
PubMed1997

The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review.

The prognosis of chronic fatigue syndrome and chronic fatigue has been studied in numerous small case series. We performed a systematic review of all studies to determine the proportion of individuals with the conditions who recovered at follow-up, the risk of developing alternative physical diagnoses, and the risk factors for poor prognosis. A literature search of all published studies which included a follow-up of patients with chronic fatigue syndrome or chronic fatigue were performed. Of 26 studies identified, four studied fatigue in children, and found that 54-94% of children recovered over the periods of follow-up. Another five studies operationally defined chronic fatigue syndrome in adults and found that < 10% of subjects return to pre-morbid levels of functioning, and the majority remain significantly impaired. The remaining studies used less stringent criteria to define their cohorts. Among patients in primary care with fatigue lasting < 6 months, at least 40% of patients improved. As the definition becomes more stringent the prognosis appears to worsen. Consistently reported risk factors for poor prognosis are older age, more chronic illness, having a comorbid psychiatric disorder and holding a belief that the illness is due to physical causes.

Adult↗
PubMed1998

Prognosis of osteosarcoma with pulmonary metastases at initial presentation is not dismal.

Prognosis of osteosarcoma has been improved markedly with the introduction of effective, intensive chemotherapy. However, there are many reports that indicate that the prognosis of osteosarcoma with pulmonary metastases at the initial presentation is poor. One hundred seventeen patients with osteosarcoma involving the extremities were treated at the Chiba Cancer Center from 1976 to 1995. Of these, nine (7.6%) patients had pulmonary metastases at initial presentation; these nine patients are the subjects of this article. There was an average of 0.9 pulmonary metastatic lesions at initial presentation seen on plain chest radiographs, an average 2.9 lesions seen on computed tomograms of the chest, and an average 12.7 lesions found at thoracotomy in these nine patients. The pulmonary metastatic lesions that could not be detected by computed tomography of the chest were resected by thoracotomy. Three patients died, and six patients are alive, with the 5-year survival being 64.8%. Intensive chemotherapy and aggressive surgical therapy were done for these patients with osteosarcoma with pulmonary metastases at initial presentation, and it is thought that this improved the prognosis of these patients. Pulmonary metastases of osteosarcoma at initial presentation do not always indicate a hopeless prognosis.

Adolescent↗
PubMed2002

Prognosis of symptomatic versus asymptomatic autoimmune hepatitis: a study of 68 patients.

BACKGROUND: Autoimmune hepatitis (AIH) is a chronic liver disorder of unknown etiology. Disease presentation ranges from asymptomatic to symptomatic onset, fulminant, acute, or chronic. GOALS: To evaluate the prognosis of patients with asymptomatic versus symptomatic AIH and to determine the role of early treatment and prognostic factors in this subgroup of patients. METHODS: Sixty-eight patients with AIH were retrospectively evaluated for clinical presentation, liver function tests, autoantibody profile, liver biopsy, treatment, and long-term prognosis. RESULTS: Twenty-three patients were classified as having asymptomatic AIH. They were compared with the 45 AIH patients with symptomatic onset. Patients with symptomatic and asymptomatic presentations were indistinguishable by age, but there was a relative male predominance in the asymptomatic group. Aminotransferase and immunoglobulin levels were lower in the asymptomatic group. In contrast, the histopathologic picture was indistinguishable between the two groups. Lobular hepatitis of a moderate to severe degree, portal fibrosis, and bridging fibrosis were detected in similar frequencies in both groups. Asymptomatic onset led to a delay in diagnosis and, consequently, in the initiation of treatment and was associated with use of relatively lower doses of corticosteroids. Response to treatment and long-term prognosis of asymptomatic patients was better than that observed in the symptomatic group. CONCLUSIONS: Asymptomatic onset of AIH is relatively common. The clinical presentation appears in correlation with liver functions tests but not with liver histology. This subgroup of AIH carries a better response to treatment and a favorable prognosis.

Adult↗
PubMed1983

Physician prognosis in relationship to drug and placebo response in anxious and depressed psychiatric outpatients.

The relationship between treating physician's prognosis and treatment response to active drug or placebo in samples of 517 anxious and 569 depressed outpatients who had participated in 4-week double-blind drug trials was examined. Log-linear analyses employing diagnosis, prognosis, treatment (active drug or placebo), and treatment response were conducted. Anxious patients had been treated with either chlordiazepoxide or placebo, and depressed patients had received either amitriptyline or placebo. Significant differences were found, suggesting that physician prognosis is related to pharmacologically induced symptom relief in anxious but not in depressed patients. In the depressed patient sample, prognosis and improvement were found to be significantly related in placebo but not drug-treated patients.

Adult↗
PubMed2006

Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients.

OBJECTIVES: To identify whether differences exist in the outcomes between patients undergoing hemodialysis and elderly nonhemodialysis patients with a femoral neck fracture. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/INTERVENTIONS: A total of 71 femoral neck fractures in 62 patients undergoing hemodialysis treated nonoperatively or operatively. MAIN OUTCOME MEASUREMENTS: Clinical outcomes were analyzed to identify factors that may be correlated with life expectancy and functional prognosis. RESULTS: The overall survival rates in this study at 1-year and 5-years postfracture were found to be 89.8% and 51.5%, respectively. There were significant correlations among the survival rate, patients' age, type of treatment, prefracture ambulation status, and prefracture activities of daily living status. However, using multivariate analysis, the only significant predictor of life expectancy was prefracture ambulation status. As for functional prognosis, the rates of total ambulation recovery and total activities of daily living recovery at 1-year postfracture were 50.0% and 71.2%, respectively. Both patients' age and age at the onset of hemodialysis may contribute considerably to functional prognosis in patients undergoing hemodialysis after femoral neck fracture. CONCLUSIONS: The present study suggests that the clinical outcomes of patients with femoral neck fractures who undergo hemodialysis are considerably superior to those of previous studies. In addition, when those fractures are treated surgically with specific management in patients undergoing hemodialysis, it may be possible to expect a life expectancy and functional prognosis similar to elderly nonhemodialysis patients with hip fractures.

Adult↗
PubMed1999

Comparison of parameters of 123I-MIBG scintigraphy for predicting prognosis in patients with dilated cardiomyopathy.

123I-metaiodobenzylguanidine (MIBG) scintigraphy has been used to predict prognosis of patients with dilated cardiomyopathy (DCM), although it is unknown which parameter of MIBG is the most useful clinically. We studied MIBG in 59 patients with DCM, and followed them up to evaluate the prognosis of DCM. Single photon emission tomography (SPET) and planar imaging were performed, both early (e) and 4 h (delayed, d) post-injection. 201Tl (TL) SPET and radionuclide-ventriculography were also investigated. The total defect score of early and delayed MIBG and 201 Tl (MIBGeDS, MIBGdDS, TLDS) was analysed visually for each SPET image. The heart to mediastinum ratio (H/M) for both the early and delayed MIBG planar images and myocardial washout rate at 4 h were analysed quantitatively. Sixteen patients died during follow-up. Cox Hazards univariate analysis selected washout rate (P < 0.0001), H/Me (P = 0.0012), H/Md (P = 0.0001) and left ventricular ejection fraction (P = 0.0004) as indices for the prediction of cardiac death. Multivariate analysis selected washout rate as the most powerful independent predictor of prognosis (P < 0.0001). Survival curves with a threshold value of 52% for washout rate were able to differentiate a negative outcome from survival (P < 0.0001). TLDS, MIBGeDS and MIBGdDS were not useful in the prediction of prognosis. The washout rate of MIBG is the most potent predictor of cardiac death and is considered clinically useful.

3-Iodobenzylguanidine↗
PubMed2003

Hypoxia-inducible factors 1alpha and 2alpha are related to vascular endothelial growth factor expression and a poorer prognosis in nodular malignant melanomas of the skin.

Hypoxia is a key regulatory factor in tumour growth, activating angiogenesis, glycolysis and cell migration. It is readily recognized by the intracellular accumulation of hypoxia-inducible factor 1alpha (HIF1alpha) and HIF2alpha. Accumulation of HIF1alpha and HIF2alpha was detected immunohistochemically in a series of 46 nodular malignant melanomas of the skin (epithelioid cell variant), treated with wide local excision. The results were correlated with vascular density (VD) and expression of the angiogenesis-stimulating factors vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP). Further associations were sought with patient prognosis and the important histopathological features of Breslow's thickness, Clark's level of invasion, mitotic rate, inflammatory cell infiltrates and tumour ulceration. HIF1alpha and HIF2alpha accumulation in malignant melanomas was directly correlated with VEGF expression. Tumours with high VEGF or HIF2alpha expression were associated with a poorer prognosis on both univariate and multivariate analyses. Tumours displaying high VD were also associated with a poor prognosis, but only on univariate analysis. Such vascularized malignant melanomas had only a limited inflammatory cell response. TP and VEGF were frequently co-expressed. The value of Breslow's thickness and Clark's level in prognosis was reaffirmed, although only on univariate analysis. Overexpression of the transcription factors HIF1alpha and HIF2alpha are linked to VEGF expression in nodular malignant melanomas. Loss of immune surveillance, as indicated by a limited inflammatory cell response, was also associated with high angiogenic activity. HIF2alpha, VEGF and, to a lesser extent, VD are important prognostic factors in these cutaneous tumours.

Adult↗
PubMed2005

Effect of primary site on prognosis in patients with cutaneous malignant melanoma. A study using a new model to analyse anatomical locations.

The prognostic impact of different anatomical sites in patients with cutaneous malignant melanoma (CMM) has been widely debated and requires further elucidation. Therefore, we developed EssDoll, a new computerized method to address the question of site in relation to prognosis. A population-based cohort of 1891 patients, diagnosed between 1976 and 1987 with invasive CMM without evidence of metastasis, was identified. The body surface was divided into 24 areas. Hazard ratios (HRs) for CMM death were calculated and areas were compared in both the whole model and in pairs. Cox's proportional hazard regression model was used and adjustments were made for established prognostic factors. Furthermore, the overall effect of site was calculated using the likelihood ratio test. Overall, the tumour site was of prognostic importance (P=0.0036). There was a significantly increased risk of CMM-specific death in patients with a primary tumour site in the middle and lower back (HR=1.8, P=0.04) and in the supramammary and mammary area (HR=1.8, P=0.05). When all areas were analysed in pairs, the dorsal shoulder, superior back and clavicular area also showed a worse prognosis. CMM diagnosed in other anatomical regions, including the calves, Achilles, upper arms, forehead, temples, cheeks and face, seemed to be related to a better prognosis. It can be concluded that the tumour site is of prognostic importance, and that the middle and lower back and supramammary and mammary areas are independent factors related to a poor prognosis.

Aged↗