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1.
J Am Acad Dermatol ; 91(3): 421-430, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38588817

RESUMO

Extramammary Paget disease is a rare cutaneous malignancy that most commonly affects the genitals, perianal area, and axilla of elderly patients. Delays in care often lead to high levels of disease burden for patients. Thus, evidence-based recommendations are paramount in mitigating morbidity and mortality for this unique patient population. This 2-part continuing medical education series provides a complete picture of extramammary Paget disease. Part 2 of this continuing medical education series focuses on the complex management of extramammary Paget disease including surgical and noninvasive therapies, as well as novel approaches for advanced disease.


Assuntos
Medicina Baseada em Evidências , Doença de Paget Extramamária , Doença de Paget Extramamária/terapia , Doença de Paget Extramamária/patologia , Doença de Paget Extramamária/diagnóstico , Humanos , Neoplasias Cutâneas/terapia , Neoplasias Cutâneas/patologia , Masculino , Feminino
2.
J Am Acad Dermatol ; 91(3): 409-418, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38704032

RESUMO

Extramammary Paget disease (EMPD) is a rare skin cancer of apocrine-rich skin that mimics common inflammatory and infectious dermatoses, leading to delays in diagnosis and increased patient morbidity. Better clinical recognition of this entity, multidisciplinary patient assessment, and deeper understanding of the underlying pathophysiology are essential to improve patient care and disease outcomes. It is important to distinguish primary intraepithelial/micro-invasive EMPD from invasive EMPD or cases with adenocarcinoma arising within EMPD. This 2-part continuing medical education series provides a complete picture of EMPD. Part 1 of this continuing medical education series reviews the epidemiology, oncogenesis, clinical and histopathologic presentation, workup, and prognosis of this rare cancer.


Assuntos
Doença de Paget Extramamária , Neoplasias Cutâneas , Doença de Paget Extramamária/epidemiologia , Doença de Paget Extramamária/diagnóstico , Doença de Paget Extramamária/patologia , Humanos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Prognóstico , Masculino , Feminino , Diagnóstico Diferencial
3.
Oncologist ; 28(3): 268-275, 2023 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-36302223

RESUMO

BACKGROUND: Widespread implementation of immune checkpoint inhibitors (ICI) and targeted therapies for metastatic melanoma has led to a decline in melanoma-related mortality but increased healthcare costs. We aimed to determine how healthcare utilization varied by systemic, non-adjuvant melanoma treatment from 2016 to 2020. PATIENTS AND METHODS: Adults with presumed stage IV metastatic melanoma receiving systemic therapy from 2016 to 2020 were identified in Optum, a nationwide commercial claims database. Treatment groups were nivolumab, pembrolizumab, ipilimumab+nivolumab (combination-ICI), or BRAF+MEK inhibitor (BRAFi+MEKi) therapy. Outcomes included hospitalizations, days hospitalized, emergency room (ER) visits, outpatient visits, and healthcare costs per patient per month (pppm). Multivariable regression models were used to analyze whether cost and utilization outcomes varied by treatment group, with nivolumab as reference. RESULTS: Among 2018 adult patients with metastatic melanoma identified, mean (SD) age was 67 (15) years. From 2016 to 2020, nivolumab surpassed pembrolizumab as the most prescribed systemic melanoma therapy while combination-ICI and BRAFi+MEKi therapies remained stable. Relative to nivolumab, all other therapies were associated with increased total healthcare costs (combination-ICI: ß = $47 600 pppm, 95%CI $42 200-$53 100; BRAFi+MEKi: ß = $3810, 95%CI $365-$7260; pembrolizumab: ß = $6450, 95%CI $4420-$8480). Combination-ICI and BRAFi+MEKi therapies were associated with more inpatient hospital days. CONCLUSIONS: Amid the evolving landscape of systemic therapy for advanced melanoma, nivolumab monotherapy emerged as the most used and least costly systemic treatment from 2016 to 2020. Its sharp increase in use in 2018 and lower costs relative to pembrolizumab may in part be due to earlier adoption of less frequent dosing intervals.


Assuntos
Melanoma , Nivolumabe , Idoso , Humanos , Atenção à Saúde , Custos de Cuidados de Saúde , Ipilimumab/uso terapêutico , Melanoma/patologia , Nivolumabe/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde , Pessoa de Meia-Idade
4.
Pediatr Dermatol ; 40(5): 829-834, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37439382

RESUMO

BACKGROUND: Dermatologists and other providers play essential roles in managing the dermatologic care of pediatric patients. This study aims to identify patterns and elucidate factors associated with receiving dermatologic care in the United States. METHODS: The National Ambulatory Medical Care Survey (NAMCS) was used to identify pediatric patients with dermatologic diagnoses from 2009 to 2015. Clinical and demographic information were evaluated, and visit diagnoses were stratified based on provider type (dermatologists vs. non-dermatologists). Multivariate logistic regression analysis was used to identify key predictors of outpatient dermatology care for pediatric patients. National estimates of diagnoses were procured using weights provided within the NAMCS database to project disease incidence. RESULTS: A total of 85,217,557 pediatric patients (survey-weighted) were observed during the study period. Of the sampled patients, 29.3% were evaluated by dermatologists, while 70.7% were seen by non-dermatology providers. Atopic dermatitis was the most common diagnosis encountered by dermatologists in ages 0-3 years, while unspecified contact dermatitis was the most common diagnosis reported by non-dermatologists in all age groups. On multivariable logistic regression, ≥1 year of age, Caucasian race, private insurance versus Medicaid, residence in a metropolitan area, referral from another provider, and longer appointment wait time were associated with an increased likelihood of being evaluated by a dermatologist compared to a non-dermatologist. CONCLUSIONS: Non-dermatologists are responsible for the majority of pediatric dermatologic care. For pediatric patients, health disparities by race, insurance status, and rurality present significant challenges to being evaluated by a dermatologist.


Assuntos
Dermatite Atópica , Dermatite de Contato , Dermatologia , Dermatopatias , Humanos , Criança , Estados Unidos/epidemiologia , Assistência Ambulatorial , Pesquisas sobre Atenção à Saúde , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapia , Brancos
5.
World J Urol ; 39(8): 2995-3003, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33471163

RESUMO

PURPOSE: To assess the incidence, risk factors, and clinical outcomes associated with (Clostridioides difficile infection) CDI following urological surgery, which is the leading cause of nosocomial diarrhea and a growing public health burden. METHODS: We queried the National Surgical Quality Improvement Program (NSQIP) to identify patients undergoing urological surgery in 2015-2016. We evaluated the 30-day incidence and factors associated with postoperative CDI and 30-day hospital readmission and length of stay as secondary outcomes. Among the subset of patients undergoing radical cystectomy with urinary diversion (surgery with highest CDI incidence) we used multivariable logistic regression analysis to evaluate independent clinical and demographic factors associated with postoperative CDI. RESULTS: We identified 98,463 patients during the study period. The overall 30-day incidence of CDI was 0.31%, but varied considerably across surgery type. The risk of CDI was greatest following radical cystectomy with urinary diversion (2.72%) compared to all other urologic procedures (0.19%) and was associated with increased risk of hospital readmission (p < 0.0001), re-operation (p < 0.0001), and longer mean length of stay (p < 0.0001) in this cohort. Among patients undergoing radical cystectomy with urinary diversion, multivariable logistic regression revealed that preoperative renal failure (OR: 5.30, 95% CI 1.13-24.9, p = 0.035) and blood loss requiring transfusion (OR: 1.67, 95% CI 1.15-2.44, p = 0.0075) were independently associated with CDI. CONCLUSIONS: In a nationally representative cohort, the incidence of CDI was low but varied substantially across surgery types. CDI was most common following radical cystectomy and associated with potentially modifiable factors such as blood transfusion and significantly longer length of stay.


Assuntos
Infecções por Clostridium , Infecção Hospitalar , Cistectomia , Complicações Pós-Operatórias , Derivação Urinária , Procedimentos Cirúrgicos Urológicos , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/etiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Cistectomia/efeitos adversos , Cistectomia/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Reoperação/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Estados Unidos/epidemiologia , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/classificação , Procedimentos Cirúrgicos Urológicos/métodos
6.
World J Urol ; 39(4): 1141-1151, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32562045

RESUMO

PURPOSE: To evaluate practice patterns of planned post-operative radiation therapy (RT) among men with positive surgical margins (PSM) at radical prostatectomy. METHODS: We identified 43,806 men within the National Cancer Database with pathologic node-negative prostate cancer diagnosed in 2010 through 2014 with PSM. The primary endpoint was receipt of planned (RT) within a patient's initial course of treatment. We examined post-RP androgen deprivation therapy (ADT) with RT as a secondary endpoint. We evaluated patterns of post-operative management and characteristics associated with planned post-prostatectomy RT. RESULTS: Within 12 months of RP, 87.0% received no planned RT, 8.5% RT alone, 1.3% ADT alone, and 3.1% RT with ADT. In a multivariable logistic regression model, planned RT use was associated with clinical and pathologic characteristics as estimated by surgical Cancer of the Prostate Risk Assessment (CAPRA-S) category (intermediate versus low, OR = 2.87, 95% CI 2.19-3.75, P < 0.001; high versus low, OR = 10.23, 95% CI 7.79-13.43, P < 0.001), treatment at community versus academic centers (OR = 1.24, 95% CI 1.15-1.34, P < 0.001), shorter distance to a treatment facility (OR = 0.97 for each 10-mile, 95% CI 0.96-0.98, P < 0.001), and uninsured status (OR = 1.39, 95% CI 1.10-1.77, P = 0.005). The odds of receiving planned RT were lower in 2014 versus 2010 (OR = 0.76, 95% CI 0.68-0.85, P < 0.001). There was no significant change in the use of ADT with RT. High versus low CAPRA-S category was associated with the use of ADT in addition to RT (OR = 5.13, 95% CI 1.57-16.80, P = 0.007). CONCLUSION: The use of planned post-prostatectomy RT remained stable among patients with PSM and appears driven primarily by the presence of other adverse pathologic features.


Assuntos
Margens de Excisão , Padrões de Prática Médica , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Estados Unidos
7.
Dermatol Ther ; 34(1): e14461, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33112465

RESUMO

Tyrosine kinase inhibitors are a class of targeted anticancer drugs that inhibit cancer cell proliferation by inactivating proteins involved in signal transduction cascades. Various cutaneous adverse events have been observed after tyrosine kinase inhibitor administration, including Sweet syndrome. We queried the PubMed database to identify 14 cases of Sweet syndrome thought to be secondary to tyrosine kinase inhibitors. Tyrosine kinase inhibitor-induced Sweet syndrome had a median of 2 months latency following drug administration. All cases but one had morphologic features classic for Sweet syndrome (erythematous and tender papules, plaques, or nodules). All cases also had classic histopathologic findings (dermal neutrophilic infiltrate without vasculitis or necrosis). Using diagnostic criteria for drug-induced Sweet syndrome and the Naranjo Drug Reaction Probability Scale for a drug-induced cutaneous eruption, we found that six cases favored a drug-induced etiology over malignancy, two cases favored a malignancy-associated Sweet syndrome, and the remaining eight met drug-induced Sweet syndrome criteria but had low Naranjo scores. Nine cases resulted in medication discontinuation, while five cases continued anticancer therapy and were treated only with corticosteroids with quick resolution of skin lesions. Dermatologists should be aware of this adverse cutaneous reaction to tyrosine kinase inhibitors and should treat on a case-by-case basis, though limited evidence in this review suggests that oncologic therapy may safely be continued with prompt corticosteroid treatment.


Assuntos
Toxidermias , Neoplasias , Síndrome de Sweet , Toxidermias/diagnóstico , Toxidermias/etiologia , Humanos , Neoplasias/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Pele , Síndrome de Sweet/induzido quimicamente , Síndrome de Sweet/diagnóstico
8.
Dermatol Online J ; 27(8)2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34755954

RESUMO

BACKGROUND: Although hematogenous malignancy is a risk factor for poorer prognosis in Merkel cell carcinoma (MCC), current guidelines make no specific recommendations for surveillance. OBJECTIVE: We aim to characterize MCC-specific mortality compared to other causes of death for patients with hematologic malignancy in MCC, which will guide workup and surveillance strategies. METHODS: The Surveillance, Epidemiology, and End Results-18 registry was queried for MCC patients with chronic lymphocytic leukemia (CLL) or non-Hodgkin lymphoma (NHL). RESULTS: Of 8519 patients with MCC, 146 (1.7%) had CLL and 234 (2.8%) had NHL. Chronic lymphocytic leukemia patients had 5-year cumulative incidence of MCC-specific mortality of 38.4% versus 28.4% in patients without CLL/NHL. For both cohorts, oncologic risk was highest within the first three years of diagnosis with competing risks favored thereafter. On competing risk regression, a history of CLL trended toward statistical significance with poorer MCC-specific mortality (subdistribution hazard ratio: 1.33, 95% CI: 0.963-1.834, P=0.084), while NHL was not prognostic. CONCLUSIONS: Merkel cell carcinoma patients with CLL may benefit from more aggressive initial management. Surveillance for similar length in CLL patients with MCC may be appropriate; this co-morbidity did not affect the timeframe by which the risk of competing causes of death exceeded oncologic risks.


Assuntos
Carcinoma de Célula de Merkel/complicações , Leucemia Linfocítica Crônica de Células B/complicações , Linfoma não Hodgkin/complicações , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Carcinoma de Célula de Merkel/terapia , Feminino , Humanos , Masculino , Análise de Regressão , Medição de Risco , Programa de SEER , Análise de Sobrevida
9.
Plant Dis ; 104(12): 3159-3165, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33079630

RESUMO

Oxathiapiprolin is highly effective in the management of Phytophthora root rot of citrus; however, its uptake into plants after soil application is not known. This was investigated and compared with mefenoxam using potted citrus seedlings sampled 7, 10, 13, and 16 days after soil treatments. Bioassays and high-performance liquid chromatography tandem mass spectroscopy (HPLC-MS/MS) were used to quantify fungicide amounts in plant extracts. Distinct inhibition zones of mycelial growth of Phytophthora citrophthora were observed in bioassays when root, stem, or leaf extracts were added to filter paper disks on agar plates. Based on the two quantification methods, concentrations of both fungicides in the three tissue types and at all sampling times were above the mean effective concentration that provides 50% growth reduction values of the baseline sensitivities. Relative concentrations at the four sampling times sometimes varied between the two methods but, for both methods, concentrations of oxathiapiprolin were significantly higher in roots and leaves as compared with stems 10 days after treatment and statistically similar in the three tissues after 7 days. For mefenoxam, concentrations significantly increased in roots between 7 and 16 days after treatment and were significantly the highest in roots as compared with stems or leaves 16 days after treatment. Regressions of oxathiapiprolin and mefenoxam concentrations using HPLC-MS/MS on those calculated from bioassay standard curves indicated that the bioassays overestimated fungicide amounts in the extracts. The bioassay, however, can be considered an alternative option comparable with costly residue analyses in fungicide mobility studies in plants. Uptake of oxathiapiprolin at sufficient but low concentrations into plant roots provides an explanation for its long-lasting high activity in the management of Phytophthora root rot.


Assuntos
Citrus , Phytophthora , Alanina/análogos & derivados , Hidrocarbonetos Fluorados , Pirazóis , Plântula , Espectrometria de Massas em Tandem
10.
J Biol Chem ; 293(44): 17061-17069, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30224356

RESUMO

The repair of DNA double-strand breaks (DSBs) by homologous recombination (HR) is initiated by nucleolytic resection of the DNA break ends. The current model, being based primarily on genetic analyses in Saccharomyces cerevisiae and companion biochemical reconstitution studies, posits that end resection proceeds in two distinct stages. Specifically, the initiation of resection is mediated by the nuclease activity of the Mre11-Rad50-Xrs2 (MRX) complex in conjunction with its cofactor Sae2, and long-range resection is carried out by exonuclease 1 (Exo1) or the Sgs1-Top3-Rmi1-Dna2 ensemble. Using fully reconstituted systems, we show here that DNA with ends occluded by the DNA end-joining factor Ku70-Ku80 becomes a suitable substrate for long-range 5'-3' resection when a nick is introduced at a locale proximal to one of the Ku-bound DNA ends. We also show that Sgs1 can unwind duplex DNA harboring a nick, in a manner dependent on a species-specific interaction with the ssDNA-binding factor replication protein A (RPA). These biochemical systems and results will be valuable for guiding future endeavors directed at delineating the mechanistic intricacy of DNA end resection in eukaryotes.


Assuntos
Quebras de DNA de Cadeia Dupla , DNA Helicases/metabolismo , Proteínas de Ligação a DNA/metabolismo , Exodesoxirribonucleases/metabolismo , RecQ Helicases/metabolismo , Proteína de Replicação A/metabolismo , Proteínas de Saccharomyces cerevisiae/metabolismo , Saccharomyces cerevisiae/genética , DNA Helicases/genética , Reparo do DNA , Proteínas de Ligação a DNA/genética , Exodesoxirribonucleases/genética , Recombinação Homóloga , RecQ Helicases/genética , Proteína de Replicação A/genética , Saccharomyces cerevisiae/enzimologia , Saccharomyces cerevisiae/metabolismo , Proteínas de Saccharomyces cerevisiae/genética
11.
Cancer ; 125(2): 232-238, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30561791

RESUMO

BACKGROUND: Patients treated for renal cell carcinoma (RCC) may be diagnosed with a metachronous, contralateral tumor. We evaluated the risks of contralateral tumor development using the Surveillance, Epidemiology, and End Results database. METHODS: Among RCC patients, we identified those with a metachronous, contralateral RCC diagnosed ≥1 year after primary diagnosis. We performed a competing risks analysis to evaluate associations between clinicopathologic factors and metachronous, bilateral RCC. Cumulative incidence and standardized incidence ratios (SIRs) were calculated. RESULTS: There were 80,403 cases of RCC identified, with a median follow-up of 8.3 years; of these, 1063 (1.3%) developed metachronous, contralateral RCC (median of 6 years after diagnosis). The cumulative incidence at 10, 20, and 30 years of follow-up was 1.5%, 3.1%, and 4.7%, respectively. An increased risk was observed among men (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.20-1.55), blacks (HR, 2.00; 95% CI, 1.71-2.33), and those with papillary histology (HR, 1.72; 95% CI, 1.41-2.10). Risk of metachronous disease decreased with increasing age at primary diagnosis (HR per 1-year increase, 0.97; 95% CI, 0.96-0.97). The SIRs were highest among those diagnosed at a younger age and remained elevated even after extended follow-up (>10 years). CONCLUSIONS: Our findings suggest that the cumulative incidence of metachronous, contralateral RCC may be higher than previously reported. Younger age, black race, papillary histology, and male sex increase the risk of metachronous, contralateral RCC development. The high SIRs seen in all demographic groups may support a rationale for lifelong surveillance, especially in high-risk subgroups with early disease onset.


Assuntos
Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Idoso , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Incidência , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Segunda Neoplasia Primária/epidemiologia , Fatores de Risco , Programa de SEER
12.
Dermatol Surg ; 45(9): 1125-1135, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30829780

RESUMO

BACKGROUND: It remains controversial if Mohs surgery is superior to surgical excision in treating localized sebaceous carcinoma. OBJECTIVE: To compare Mohs surgery and surgical excision for treating patients with localized sebaceous carcinoma. MATERIALS AND METHODS: The US National Cancer Database was used to identify patients with histologically confirmed Stage 0 to 2 sebaceous carcinoma from 2004 to 2014. Clinicopathologic and socioeconomic factors were compared between treatment groups using the chi-square test. Overall survival (OS) was evaluated by log-rank test, multivariable Cox proportional hazard regression, and propensity score-matched analysis. Relative survival analyses compared with age- and sex-matched US population were performed. RESULTS: Of 1,265 patients, 234 received Mohs surgery and 1,031 received surgical excision. Mohs surgery had a higher rate of negative margin (p = .004). On multivariate Cox regression analysis, Mohs surgery was associated with longer OS than surgical excision (HR: 0.703, 95% CI: 0.496-0.995, p = .047). The survival benefit of Mohs surgery persisted on relative survival analysis and propensity score-matched analysis (p = .0385), after matching the 2 groups on patient and disease characteristics. CONCLUSION: Patients who received Mohs surgery had significantly longer OS when compared with those who received surgical excision. Prospective clinical trials comparing these treatment paradigms are warranted.


Assuntos
Adenocarcinoma Sebáceo/cirurgia , Procedimentos Cirúrgicos Dermatológicos , Cirurgia de Mohs , Neoplasias das Glândulas Sebáceas/cirurgia , Adenocarcinoma Sebáceo/patologia , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pontuação de Propensão , Modelos de Riscos Proporcionais , Neoplasias das Glândulas Sebáceas/patologia , Fatores Socioeconômicos
13.
Can J Urol ; 26(2): 9699-9707, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31012833

RESUMO

INTRODUCTION: Approximately 7% of patients with localized upper tract urothelial cancer (UTUC) are treated without definitive therapy. Understanding outcomes and alternative therapy would aid in counseling older patients with comorbidities. MATERIALS AND METHODS: We utilized the National Cancer Database to identify patients with localized UTUC managed non-surgically between 2004 and 2013. Patient demographics, comorbidity, tumor grade, and chemotherapy and radiation utilization were recorded. Survival analyses were performed with the Kaplan-Meier method and a cox proportional hazard regression model. RESULTS: We identified 3157 (10.9%) patients with localized UTUC who did not receive definitive surgery. Median age was 79 years, 55% were males, 79% had government health insurance, and 68% had a Charlson-Deyo Score (CDS) of 0. Tumor grade was low (grade 1 or 2) in 632 (36.4%) and high (grade 3 or 4) in 1104 (63.6%). Median overall survival (OS) for the cohort was 2.2 years, significantly shorter for patients with greater comorbidities. Chemotherapy or radiation was performed in 294 (9.3%) and 197 (6.3%) patients respectively. There were no OS differences for individuals receiving chemotherapy. Of patients who received radiation therapy, the median OS was 1.4 versus 2.0 years, (p < 0.001) favoring no radiation. Those with high grade tumors had worse survival (1.9 versus 3.8 years (p < 0.001). Significant predictors of shorter OS included older age, male gender, higher CDS, and government insurance. CONCLUSIONS: In this population-based cohort, 10.9% of patients with localized UTUC were managed non-surgically. There was no OS advantage noted in cohorts receiving chemotherapy and radiation therapy. Median OS was significantly shorter for those with higher grade disease, increasing comorbidity profile, male gender, and those with government insurance status.


Assuntos
Antineoplásicos/uso terapêutico , Doença Crônica/epidemiologia , Tratamento Conservador , Neoplasias Renais , Radioterapia , Neoplasias Ureterais , Idoso , Estudos de Coortes , Comorbidade , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Fatores de Risco , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/patologia , Neoplasias Ureterais/terapia
14.
Br J Haematol ; 181(2): 196-204, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29602182

RESUMO

Systemic anaplastic lymphoma kinase positive (ALK+) anaplastic large cell lymphoma with extranodal involvement (ALCL-E) is a rare form of non-Hodgkin lymphoma. No large study in the literature has compared the survival outcomes among different primary extranodal sites of involvement in ALK+ ALCL-E. We identified 1306 patients with ALK+ ALCL-E diagnosed between 2004 and 2014 in the US National Cancer Database, among whom 387 had primary extranodal site in the chest/abdomen/pelvis, 103 in the bone, 62 in the central nervous system, 134 in the head and neck and 620 in the cutaneous/soft tissue. Younger age, lower Charlson-Deyo score, lower clinical stage, receipt of chemotherapy and receipt of radiotherapy were predictors of longer overall survival. Patients with extranodal involvement of central nervous system and chest/abdomen/pelvis had shorter overall survival than those with involvement of head and neck, bone, and cutaneous/subcutaneous tissue after adjusting for confounding variables. We recommend treating these patients upfront with more aggressive therapy.


Assuntos
Quinase do Linfoma Anaplásico , Bases de Dados Factuais , Adulto , Fatores Etários , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Linfoma Anaplásico de Células Grandes/enzimologia , Linfoma Anaplásico de Células Grandes/mortalidade , Linfoma Anaplásico de Células Grandes/patologia , Linfoma Anaplásico de Células Grandes/terapia , Masculino , Pessoa de Meia-Idade , Especificidade de Órgãos , Taxa de Sobrevida , Estados Unidos/epidemiologia
15.
Br J Haematol ; 181(6): 752-759, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29676444

RESUMO

Primary cutaneous CD30+ T cell lymphoproliferative disorders (PCLPD), the second most common type of primary cutaneous T cell lymphomas, accounts for approximately 25-30% of cutaneous T-cell lymphoma cases. However, only small retrospective studies have been reported. We aimed to identify prognostic factors and evaluate the overall survival (OS) of patients with PCLPD stratified by ethnicity. We identified 1496 patients diagnosed with PCLPD between 2004 and 2014 in the US National Cancer Database. Chi-square test and anova were used to evaluate differences in demographic and disease characteristics, socioeconomic factors and treatments received. OS was evaluated with the log-rank test, Cox proportional hazard regression analysis, and propensity score matching. The study included 1267 Caucasians, 153 African Americans (AA), 43 Asians, and 33 of other/unknown ethnicity. Older age, higher Charlson-Deyo score, higher clinical stage and receipt of chemotherapy were predictors of shorter OS. Primary disease site on a lower extremity was associated with shorter OS, while a head and neck location was associated with longer OS. AA patients had shorter OS when compared to Caucasian patients on multivariate analysis. This ethnic disparity persisted on propensity-score matched analysis and after matching Caucasian and AA patients on demographic and disease characteristics, socioeconomic factors and treatments received, and age and gender-matched relative survival analyses.


Assuntos
Bases de Dados Factuais , Neoplasias de Cabeça e Pescoço , Transtornos Linfoproliferativos , Neoplasias Cutâneas , Adulto , Fatores Etários , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/etnologia , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Antígeno Ki-1 , Transtornos Linfoproliferativos/etnologia , Transtornos Linfoproliferativos/mortalidade , Transtornos Linfoproliferativos/terapia , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias , Estudos Retrospectivos , Fatores Sexuais , Neoplasias Cutâneas/etnologia , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/terapia , Fatores Socioeconômicos , Taxa de Sobrevida , Linfócitos T , Estados Unidos/epidemiologia , Estados Unidos/etnologia
16.
BJU Int ; 121(1): 124-129, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28972702

RESUMO

OBJECTIVE: To investigate the outcomes of patients with upper tract urothelial carcinoma (UTUC) with non-definitive therapy, which currently remains unknown. PATIENTS AND METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify individuals with a localised, histologically confirmed kidney/renal pelvis and ureteric UC. Survival analysis using the Kaplan-Meier method was performed. A competing risk model evaluated the cumulative incidence and predictors of cancer-specific mortality (CSM). RESULTS: We identified 633 (7.6%) individuals who did not receive surgery. These individuals were significantly older (median age 81 vs 71 years, P < 0.001) than surgically managed patients. The median overall survival (OS) was significantly shorter compared to the surgical cohort (1.9 vs 7.8 years, P < 0.001). The 3-year disease-specific survival (DSS) for patients without surgery was significantly lower compared to those with surgery, at 73.7% vs 92.4%, respectively (P < 0.001). The 3-year DSS for patients with high-grade tumours was worse when compared to patients with low-grade tumours, at 65.1% vs 82.9%, respectively (P < 0.001). The 3-year cumulative CSM was 26.3%. On multivariable analysis, older age (hazard ratio [HR] 1.05, P < 0.001) and high tumour grade (HR 1.88, P < 0.001) were predictors of worse outcomes. CONCLUSIONS: In this population-based cohort, 7.6% of patients with UTUC were managed with a non-definitive approach. The median OS for the untreated cohort was significantly shorter compared to the surgical cohort (1.9 vs 7.8 years, respectively). These data may be helpful in counselling patients who are poor surgical candidates, as non-definitive therapy may provide reasonable oncological outcomes.


Assuntos
Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/terapia , Tratamento Conservador/métodos , Neoplasias Renais/terapia , Neoplasias Ureterais/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/mortalidade , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Avaliação Geriátrica/métodos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Seleção de Pacientes , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Programa de SEER , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/patologia
18.
Cancer ; 123(22): 4363-4371, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-28787086

RESUMO

BACKGROUND: Panel testing has been recently introduced to evaluate hereditary cancer; however, limited information is available regarding its use in kidney cancer. METHODS: The authors retrospectively reviewed test results and clinical data from patients who underwent targeted multigene panel testing of up to 19 genes associated with hereditary kidney cancer from 2013 to 2016. The frequency of positive (mutation/variant likely pathogenic), inconclusive (variant of unknown significance), and negative results was evaluated. A logistic regression analysis evaluated predictive factors for a positive test. RESULTS: Patients (n = 1235) had a median age at diagnosis of 46 years, which was significantly younger than the US population of individuals with kidney cancer (P < .0001). Overall, 6.1%, 75.5%, and 18.4% of individuals had positive, negative, and inconclusive results, respectively. The most commonly altered genes included folliculin (FLCN) and fumarate hydratase (FH), which were altered in 1.8% and 1.3% of patients, respectively. Tuberous Sclerosis Complex 2 (TSC2), mesenchymal epithelial transition factor proto-oncogene (MET), and PMS1 homolog 2 (PMS2) had the highest rates of variants of unknown significance, which were identified in 2.7%, 2.2%, and 1.7% of patients, respectively. Early age of onset was the only factor that was identified as predictive of a positive test on multivariate analysis (odds ratio, 0.975; P = .0052) and may be the only identifying characteristic of low-penetrant syndromes, such as those associated with MITF (melanogenesis-associated transcription factor) mutations, which do not have singular histology or a family history of kidney cancer. CONCLUSIONS: Panel tests may be particularly useful for patients who lack distinguishing clinical characteristics of known hereditary kidney cancer syndromes. The current results support the use of early age of onset for genetic counseling and/or testing. Cancer 2017;123:4363-71. © 2017 American Cancer Society.


Assuntos
Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/tendências , Testes Genéticos/tendências , Neoplasias Renais/diagnóstico , Síndromes Neoplásicas Hereditárias/diagnóstico , Transcriptoma , Adulto , Análise Mutacional de DNA/métodos , Feminino , Predisposição Genética para Doença , Humanos , Neoplasias Renais/genética , Masculino , Pessoa de Meia-Idade , Síndromes Neoplásicas Hereditárias/genética , Proto-Oncogene Mas , Proteínas Proto-Oncogênicas/genética , Estudos Retrospectivos , Proteínas Supressoras de Tumor/genética
19.
Nephrol Dial Transplant ; 32(10): 1767-1773, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28967967

RESUMO

BACKGROUND: For potential transplant recipients with a prior history of renal malignancy, no evidence-based recommendations currently exist with regard to waiting duration on dialysis. We aim to improve decision making by evaluating the impact of waiting duration on the outcomes of kidney cancer patients awaiting renal transplantation. METHODS: The United States Renal Data System was used to identify patients with a known cause of end-stage renal disease (ESRD) from 1983 to 2007. Evaluation of overall survival (OS) was performed with Kaplan-Meier estimates and Cox proportional hazards models. Fine-Gray competing risk models were used to assess cancer-specific mortality (CSM) and non-cancer-specific mortality (NCSM). RESULTS: Of 1 374 175 patients with ESRD, 228 984 (16.7%) received transplantation. Transplant recipients with renal malignancy-associated ESRD (RM-ESRD) had longer waiting durations than those with other known causes of ESRD (2.4 versus 1.3 years; P < 0.0001). RM-ESRD patients who had shorter waiting durations (0-2 years) had better OS than those who waited longer (2+ years) (10-year OS 69.0 versus 46.7%, respectively; P < 0.0001), with similar CSM (10-year CSM 10.3 versus 10.2%, respectively; P = 0.883), whereas NCSM was worse for those with longer waiting durations (10-year NCSM 20.7 versus 44.3%, respectively; P < 0.0001). On Cox modeling, the status of RM-ESRD was not a significant predictor (P = 0.07), while longer waiting duration remained significant (P < 0.0001). CONCLUSION: We found that CSM was not affected by waiting duration, while NCSM significantly improved with shorter wait times. These findings suggest that the OS of potential transplant recipients with RM-ESRD may be improved by reducing waiting duration.


Assuntos
Neoplasias Renais/mortalidade , Transplante de Rim , Diálise Renal/mortalidade , Listas de Espera/mortalidade , Adulto , Idoso , Feminino , Humanos , Neoplasias Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Fatores de Tempo , Tempo para o Tratamento , Transplantados , Estados Unidos
20.
Pediatr Blood Cancer ; 64(5)2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27805307

RESUMO

PURPOSE: Renal cell carcinoma (RCC) represents a small proportion of renal malignancies early in life. Distinguishing RCC from other malignancies is important as treatment strategies may differ. We analyze the Surveillance Epidemiology, and End Results (SEER) database to identify predictive factors of RCC in the pediatric population with renal tumors. METHODS: We queried SEER to identify patients from ages 0 to 19 diagnosed with a renal malignancy between 1973 and 2013. Cases were sorted using histology and site codes. Age-adjusted standardized incidence rates (SIR) were calculated. We compared differences in characteristics between cancer types. A logistic regression model and a nomogram were created to identify predictors of RCC. RESULTS: A total of 3,670 patients were identified, of which 281 (7.7%) were diagnosed with RCC. The SIR of RCC increased with age. After age 12, RCC was found in >50% of all newly diagnosed cases. On multivariate analysis, RCC was associated with smaller tumor size (P < 0.001), increasing age (P < 0.001), black race (P < 0.001), and localized stage (P < 0.001). The nomogram predicted RCC pathology with a concordance index of 0.965. CONCLUSIONS: RCC in childhood and adolescence is relatively uncommon; however, it accounts for >50% of renal malignancies after age 12. For every year of increasing age, the odds of having an RCC diagnosis are increased by 50%. The odds of a renal tumor being RCC are increased in black children, those with localized disease, and those with smaller tumors. In these specific populations, RCC should be favored in the differential diagnosis of the renal mass.


Assuntos
Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/terapia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Tratamentos com Preservação do Órgão/métodos , Adolescente , Adulto , Carcinoma de Células Renais/patologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Neoplasias Renais/patologia , Masculino , Análise Multivariada , Programa de SEER/estatística & dados numéricos , Adulto Jovem
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