Objective. To evaluate how the independent predictors of recurrence f or stage IB2 cervical cancers treated with up-front radical hysterectomy apply to establ ished risk models. Methods. Patients with IB2 cervical can...Objective. To evaluate how the independent predictors of recurrence f or stage IB2 cervical cancers treated with up-front radical hysterectomy apply to establ ished risk models. Methods. Patients with IB2 cervical cancers diagnosed from 19 90 to 2000 were identified from tumor registries of two institutions. Patients w ere classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (L VSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle-CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease free survival ( DFS) was estimated by Kaplan-Meier method and comparisons between subgroups wer e studied by log rank. A Cox proportional hazards model was used to determine in dependent predictors of recurrence. Results. We identified 86 patientswith stage IB2 tumors treated by RH.We found 34%of patients to be HR, 60%IR, and 6%LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperat ive adjuvant radiation (PRT) was used in 52%of the 86 patients, including 0/5 L R, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pel vic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not asso ciated with recurrence. Multivariate analysis identified LVSI as the only indepe ndent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100%, 83%, and 60%, respectively. Only 4/24 (17%) IR patient s with (-) LVSI got PRT compared with 12/28 (43%) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96%. IR (+) pa tients recurred more frequently with a 2-year DFS of 71%. Conclusions. Overall , 66%of patients with IB2 disease were classified as having low or intermediate -risk disease. IR patients with (-) LVSI and all LR patients did well with sur gery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.展开更多
Self-detection of suspicious pigmented skin lesion combined with rapid referr al to dermatologie centres is the key strategy in the fight against melanoma. Th e investigation of factors associated with pattern of dete...Self-detection of suspicious pigmented skin lesion combined with rapid referr al to dermatologie centres is the key strategy in the fight against melanoma. Th e investigation of factors associated with pattern of detection of melanoma (sel f-vs. nonself-detection) may be useful to refine educational strategies for th e future. We investigated the frequency of melanoma self-detection in a Mediter ranean populat ionatintermediatemelanoma risk. A multicentric survey identified 816 consecutive cases of cutaneous melanoma in the period January to December 20 01 in 11 Italian clinical centres belonging to the Italian Multidisciplinary Group on M elanoma. All patients filled a standardized questionnaire and were clinically ex amined by expert dermatologists. Self-detected melanomas were 40.6%, while the remaining lesions were detected by a dermatologist (18.5%), the family physici an (15.2%), other specialists (5%), the spouse (12.5%), a friend or someone e lse (8.2%). Variablesassociated with self-detected melanomas were female sex, young age, absence of atypical nevi, knowledge of the ABCD rule, habit of perfor ming skin self-examination. Self-detected melanomas did not differ from nonsel f-detected tumours in term of lesion thickness; however, patients with self-de tected melanomas waited a longer period before having a diagnostic confirmation (patient’s delay) (>3 months:odds ratio, 3.89; 95%confidence interval, 2.74- 5.53). In order to reduce the patients’delays, educational messages should adeq uately stress the need for a prompt referral to a physician once a suspicious pi gmented lesion is self-detected.展开更多
In this study,we assessed the role of melanocortin 1 receptor(MC1R)variants and of two patched(PTCH)polymorphisms(c.3944C > T(P1315L),insertion 18 bp IVS1-83)as risk factors for basal cell carcinoma(BCC)in the Fren...In this study,we assessed the role of melanocortin 1 receptor(MC1R)variants and of two patched(PTCH)polymorphisms(c.3944C > T(P1315L),insertion 18 bp IVS1-83)as risk factors for basal cell carcinoma(BCC)in the French population.The population investigated comprised 126 BCC patients who were enrolled on the basis of specific criteria(multiple and/or familial BCC and/or onset before the age of 40 years and/or association with another tumor)-and 151 controls matched for ethnicity,age,and sex.MC1R variants appeared as a moderate risk factor for BCC(odds ratio(OR)for one and two variants,2.17 [1.28-3.68] and 7.72 [3.42-17.38],respectively),independently of pigmentation characteristics(OR=2.53 [1.34-4.8]).Interestingly,in addition to the predictable red hair color(RHC)alleles,two non-RHCalleles(V60L and V92M)were also closely associated with BCC risk(OR 3.21 [1.91-5.38] and 2.87 [1.5-5.48],respectively),which differs from the situation in the Celtic population.In addition,the PTCH c.3944C/C genotype was also associated with BCC risk(OR 1.94 [1.2-3.1]),especially in the subgroup of patients with multiple tumors(OR 2.16 [1.3-3.6]).Thus,our data show that MC1R and PTCH variants are associated with BCC risk in the French population.We further suggest that assessing MC1R and PTCH status could be useful,combined with the assessment of clinical risk factors,in identifying high-risk patients to be targeted for prevention or morerigorous surveillance.展开更多
文摘Objective. To evaluate how the independent predictors of recurrence f or stage IB2 cervical cancers treated with up-front radical hysterectomy apply to establ ished risk models. Methods. Patients with IB2 cervical cancers diagnosed from 19 90 to 2000 were identified from tumor registries of two institutions. Patients w ere classified into risk groups: high-risk (HR) (positive nodes, parametria, or margins), intermediate-risk (IR) (positive lymph vascular space involvement (L VSI) with any cervical stromal invasion (CSI), or (-) LVSI and > middle-CSI), or low-risk (LR) (absence of HR or IR characteristics). Disease free survival ( DFS) was estimated by Kaplan-Meier method and comparisons between subgroups wer e studied by log rank. A Cox proportional hazards model was used to determine in dependent predictors of recurrence. Results. We identified 86 patientswith stage IB2 tumors treated by RH.We found 34%of patients to be HR, 60%IR, and 6%LR. Of the 52 IR patients, 28 had (+) LVSI with superficial, middle, and outer 1/3 CSI, and 24 had (-) LVSI with middle or outer 1/3 invasion. Overall, postoperat ive adjuvant radiation (PRT) was used in 52%of the 86 patients, including 0/5 L R, 16/52 IR, and 29/29 HR patients. Univariate predictors of recurrence were pel vic nodal disease, (+) LVSI, (+) parametria, outer 1/3 CSI, and tumor size > 6 cm. Age, grade, histology, and the use of postoperative radiation were not asso ciated with recurrence. Multivariate analysis identified LVSI as the only indepe ndent predictor of recurrence (RR 5.2, P = 0.03). Two-year DFS for LR, IR, and HR patients was 100%, 83%, and 60%, respectively. Only 4/24 (17%) IR patient s with (-) LVSI got PRT compared with 12/28 (43%) of IR patients with (+) LVSI. The 2-year DFS for IR patients with (-) LVSI was 96%. IR (+) pa tients recurred more frequently with a 2-year DFS of 71%. Conclusions. Overall , 66%of patients with IB2 disease were classified as having low or intermediate -risk disease. IR patients with (-) LVSI and all LR patients did well with sur gery alone. This study defines the independent importance of LVSI and questions the utility of published IR models when applied to stage IB2 cervical cancer.
文摘Self-detection of suspicious pigmented skin lesion combined with rapid referr al to dermatologie centres is the key strategy in the fight against melanoma. Th e investigation of factors associated with pattern of detection of melanoma (sel f-vs. nonself-detection) may be useful to refine educational strategies for th e future. We investigated the frequency of melanoma self-detection in a Mediter ranean populat ionatintermediatemelanoma risk. A multicentric survey identified 816 consecutive cases of cutaneous melanoma in the period January to December 20 01 in 11 Italian clinical centres belonging to the Italian Multidisciplinary Group on M elanoma. All patients filled a standardized questionnaire and were clinically ex amined by expert dermatologists. Self-detected melanomas were 40.6%, while the remaining lesions were detected by a dermatologist (18.5%), the family physici an (15.2%), other specialists (5%), the spouse (12.5%), a friend or someone e lse (8.2%). Variablesassociated with self-detected melanomas were female sex, young age, absence of atypical nevi, knowledge of the ABCD rule, habit of perfor ming skin self-examination. Self-detected melanomas did not differ from nonsel f-detected tumours in term of lesion thickness; however, patients with self-de tected melanomas waited a longer period before having a diagnostic confirmation (patient’s delay) (>3 months:odds ratio, 3.89; 95%confidence interval, 2.74- 5.53). In order to reduce the patients’delays, educational messages should adeq uately stress the need for a prompt referral to a physician once a suspicious pi gmented lesion is self-detected.
文摘In this study,we assessed the role of melanocortin 1 receptor(MC1R)variants and of two patched(PTCH)polymorphisms(c.3944C > T(P1315L),insertion 18 bp IVS1-83)as risk factors for basal cell carcinoma(BCC)in the French population.The population investigated comprised 126 BCC patients who were enrolled on the basis of specific criteria(multiple and/or familial BCC and/or onset before the age of 40 years and/or association with another tumor)-and 151 controls matched for ethnicity,age,and sex.MC1R variants appeared as a moderate risk factor for BCC(odds ratio(OR)for one and two variants,2.17 [1.28-3.68] and 7.72 [3.42-17.38],respectively),independently of pigmentation characteristics(OR=2.53 [1.34-4.8]).Interestingly,in addition to the predictable red hair color(RHC)alleles,two non-RHCalleles(V60L and V92M)were also closely associated with BCC risk(OR 3.21 [1.91-5.38] and 2.87 [1.5-5.48],respectively),which differs from the situation in the Celtic population.In addition,the PTCH c.3944C/C genotype was also associated with BCC risk(OR 1.94 [1.2-3.1]),especially in the subgroup of patients with multiple tumors(OR 2.16 [1.3-3.6]).Thus,our data show that MC1R and PTCH variants are associated with BCC risk in the French population.We further suggest that assessing MC1R and PTCH status could be useful,combined with the assessment of clinical risk factors,in identifying high-risk patients to be targeted for prevention or morerigorous surveillance.
