Predictors of time to definitive surgery and survival in Merkel cell carcinoma: analysis of the US National Cancer Database.

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cancer, and it has been suggested that earlier treatment would allow for better patient outcomes. However, the causes of delays in the initiation of treatment and the effects of delayed treatment on survival of patients have not fully been explored, and the effects of treatment delays for MCC are not yet fully understood. AIM: To determine the effect of time to treatment initiation (TTI) on mortality in MCC and to determine the predictors of TTI itself. METHODS: This was a retrospective cohort analysis of the US National Cancer Database (NCDB) for cases of MCC from 2004 to 2016, excluding individuals with Stage IV MCC, as surgery is not the preferred treatment for this group. The time difference between initial biopsy of MCC and definitive surgery (TTI) was stratified into five groups by 30-day intervals. RESULTS: In total, 12 157 patients [7491 (61.6%) men, 4666 (38.4%) women; mean ± SD age 74.4 ± 10.9 years] were included in the study. A risk for longer TTI was seen in black individuals (OR = 1.7, 95% CI 1.2-2.6) and in elderly individuals aged > 70 years (OR = 1.7, 95% CI 1.2-2.5). Kaplan-Meier survival analysis showed that individuals with TTI < 30 days had a significantly longer overall survival than those with TTI > 120 days (6.1 vs. 4.8 years, P < 0.001). However, after controlling for clinical and tumour factors in Cox multivariable analysis, no difference in survival was noted for TTI < 30 days and TTI > 120 days [hazard ratio (HR) = 0.9, 95% CI 0.8-1.1). Worse outcomes were also associated with increasing age (HR = 2.0, 95% CI 1.7-2.5), male sex (HR = 1.2, 95% CI 1.2-1.3), higher Charlson-Deyo comorbidity score (HR = 1.4, 95% CI 1.3-1.5), lack of radiation therapy (HR = 0.8, 95% CI 0.8-0.9), lack of private insurance (HR = 0.7, 95% CI 0.6-1.0), and use of surgical technique other than Mohs micrographic surgery or wide local excision (HR = 1.2, 95% CI 1.2-1.3). CONCLUSION: Although TTI is a useful prognostic metric in isolated survival analysis, its utility declines when other factors are controlled for in the analysis. Age, radiotherapy, type of surgery performed, comorbidities, tumour size and lymph node involvement may be important predictors of survival.

Microcystic adnexal carcinoma of the head and neck: Characteristics, treatment, and survival statistics.

Studies on microcystic adnexal carcinoma (MAC) survival rates have been limited. This effort examines the association of patient demographics, treatment modalities, and tumor stage with overall survival (OS) in patients with MAC of the head and neck. All cases of MAC with primary sites of the skin of the head and neck, confirmed histologically, and diagnosed from 2004 to 2016 in the National Cancer Database, were analyzed. We utilized Kaplan-Meier and Cox proportional-hazard models to analyze the characteristics and survival outcomes of the 415 cases that met the criteria. The mean age of diagnosis was 63.8 years (SD ±15.8). Mean OS was 10.8 years with 5- and 10-year OS being 81.0% and 68.0%, respectively. Women were more frequently affected (59.0%; P < .001). Stand-alone primary site surgery was the most common treatment (81.4%): 15.9% of patients were treated with postexcision radiation therapy (RT). 18.3% were treated with RT with or without surgery and/or chemotherapy. RT was independently associated with a decreased hazard of death (HR = 0.23; P = .044). MAC of the head and neck disproportionately affects whites, is more common in women, and has the potential to metastasize. Surgical excision is the commonest treatment; our study shows benefit from judicious RT.

Analysis of Head and Neck Primary Cutaneous Mucinous Carcinoma: An Indolent Tumor of the Eccrine Sweat Glands.

BACKGROUND/OBJECTIVES: Primary cutaneous mucinous carcinoma (PCMC) of the head and neck is a rare pathologic entity that is an adenocarcinoma of the eccrine sweat glands. Though it has low metastatic potential, it does have a significant recurrence rate. Due to its rarity, its clinical features are not well-known. METHODS: The authors searched the National Cancer Database (NCDB) for all cases of PCMC with primary sites of the skin of the head and neck confirmed histologically diagnosed from 2004 to 2016. Those with missing survival information were excluded. Kaplan-Meier (KM) and Cox proportional-hazards models were used to analyze the epidemiology and survival outcomes of PCMC. RESULTS: The authors analyzed 289 cases. Females were more commonly affected (58.8%; P < 0.05) with the most common primary sites being the eyelid (41.9%) and scalp/neck (25.3%). The average age of diagnosis was 63.8 years (± SD 12.5). Almost all patients received surgery as standalone treatment (92.7%) with wide local excision being the common surgery performed (36.3%). Mohs surgery represented 15.2% of surgically treated cases. Mean overall survival (OS) was 11.4 years with 5-year and 10-year OS being 85.0% and 78.0%, respectively. Most cases were localized at diagnosis with only 2% metastatic at presentation. KM analysis indicated that surgical procedure type, age, tumor diameter, Charlson-Deyo Comorbidity Score, facility type, and stage were significant predictors of OS (P < 0.05). Cox proportional-hazards analysis did not reveal independent association of the aforementioned factors with OS. CONCLUSION: Primary cutaneous mucinous carcinoma has an excellent prognosis with 98% of cases being diagnosed in Stage I and Stage II. As most cases present in the eyelid, special attention should be given to surgical treatment to ensure optimal aesthetic outcomes in this sensitive region. This study represents the largest cohort of head and neck PCMC studied to date.

Localized sebaceous carcinoma treatment: Wide local excision verses Mohs micrographic surgery.

The optimal surgical management of sebaceous carcinoma (SC) has yet to be determined between Mohs micrographic surgery (MMS) and wide local excision (WLE). To investigate overall survival (OS) differences for SC undergoing WLE or MMS, The National Cancer Database (NCDB) was queried for all SC from 2004 to 2015 (n = 2863). Cases missing staging data, undergoing palliative care, showing lymph node extension, or of AJCC Stage III/IV were omitted. Chi-squared tests were used to analyze patient demographics, cancer characteristics, and treatment modalities. Kaplan-Meier and Cox proportional hazards regression modeling analyzed OS outcomes. A total of 554 cases met inclusion criteria (WLE [n = 243], MMS [n = 311]). Multivariate analysis revealed that cases treated in academic facilities (ref: non-acad; OR = 2.273; CI95% [1.448-3.568]; P < .001] were independently associated with greater MMS rates, whereas those with primaries on the trunk (ref: head/neck OR = 0.359; CI95%[0.203-0.634]; P < .001) and extremities (ref: head/neck OR = 0.399; CI95% [0.182-0.877]; P = .022) held lower MMS rates. Between surgical modalities, Kaplan-Meier survival showed no significant difference in outcomes (P = .611), with WLE and MMS demonstrating 5-year OS rates of 65.8% and 61.4%, respectively. On Cox proportional hazard regression, the survival outcomes of MMS and WLE did not show any significant differences in OS (HR = 0.832; CI95% [0.996-3.662]; P = .334). MMS and WLE of localized SC demonstrate similar overall survival outcomes. MMS may be preferred for margin control, tissue conservation, and cosmesis.

Gender differences in cutaneous melanoma: Demographics, prognostic factors, and survival outcomes.

Several recent studies have reported a considerably higher overall survival (OS) rate in females in various geographic regions This study further investigates the characteristics of melanoma that contribute to OS of women residing in the United States. Chi-square, Kaplan-Meier, and Cox regression models were used to analyze differences in demographics, treatment, and survival of invasive cutaneous melanoma in men and women diagnosed from 2004 to 2016 in the National cancer database. In 316 966 patients met inclusion criteria. Men had a significantly higher median age of diagnosis at 61 years (interquartile range or IQR: 51-72) in comparison to women where the median age of diagnosis was 55 years (IQR: 43-68) (P < .0001). The most common primary site for men was the trunk (35.5%), whereas the lower extremities were the most common primary site for women (30.3%). Women had a higher 5 year (82.6%) and 10 year (73.1%) OS compared to 5 year and 10 year OS of 72.2% and 58.7%, respectively, in men (P < .0001). When adjusting for confounders, female gender was independently associated with improved OS (ref: male HR = 0.791; 95% confidence interval 0.773-0.809; P < .0001). Overall, we conclude that female gender is an independent favorable prognostic factor for melanoma survival.

Impact of partnership status on clinical outcomes of patients with vulvar squamous cell carcinoma and performance of sentinel lymph node biopsy.

OBJECTIVES: Vulvar squamous cell carcinoma is a rare malignancy and lymph node involvement is the most significant prognostic factor. We aimed to evaluate the association between partnership status and mortality from vulvar squamous cell carcinoma, cancer stage at the time of presentation, and the decision for sentinel lymph node biopsy. METHODS: The US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database was queried and different parameters were evaluated relative to partnership status. A total of 4851 patients with vulvar squamous cell carcinoma, >18 years of age, who presented between January 2010 to December 2015, were analyzed. Kaplan-Meier and Cox regression analyses were used to assess survival and hazard ratio. Multinomial regression analysis and χ2 were utilized to evaluate odd ratios and significance of variables. RESULTS: Most patients were unpartnered (58.5%), including never married (17.7%), divorced (13.8%), or widowed (27%). Partnered patients were mostly Caucasian (88.4%), insured (74%), and presented with stage I disease (57.2%), compared with unpartnered patients (79.1%), (61.7%), and (51.7%), respectively (p<0.01). The mean survival time (months) in partnered patients was longer, compared with unpartnered (p<0.001), and the difference between both groups increased from 9 months at stage I to 24 months at stage IV, which remained independently significant after adjusting the different variables. Cox regression showed that partnered patients had a lower hazard ratio than unpartnered patients (p<0.01). Mortality from vulvar squamous cell carcinoma increased with age at diagnosis, no surgery, and unemployment (p<0.01). Unpartnered patients were the least likely to undergo sentinel lymph node biopsy in early stages, compared with partnered (p<0.01). Univariate Cox regression analysis showed that not performing sentinel lymph node biopsy almost doubled the hazard ratio of vulvar squamous cell carcinoma (p<0.01). CONCLUSIONS: Partnership status should be considered when counseling patients for vulvar squamous cell carcinoma therapy and when recommending screening and follow-up to optimize patient care.

The Utilization of YouTube as a Resource on Hair Loss Treatments.

INTRODUCTION: To the best of our knowledge, no previous studies have evaluated the quality of videos discussing hair loss treatments METHODS: YouTube was searched on December 10, 2019, using the relevance and view count filters for the following search terms: hair loss treatment, baldness, alopecia, male pattern baldness, and female pattern baldness. The DISCERN criterion for assessing consumer health information was used to evaluate each video. A score of 1 indicates a low overall video quality, whereas a 5 indicates a high-quality source of information for patients. The DISCERN treatment assessment is a validated tool to assess the quality of patient information about treatment choices. Two-sample t tests and Mann-Whitney U tests were used to determine significance. RESULTS: We analyzed 90 videos receiving a total of 108,240,496 views with a mean view count of 1,202,672 views per video (Table 1). Pharmaceuticals including minoxidil and finasteride were the most commonly mentioned treatment (30% of videos) followed by nutraceuticals (20%). YouTube influencers (Table 2) represented 37.8% of authors followed by companies/advertisers (15.6%). Seventeen videos (18.9%) included board-certified dermatologists. The mean DS overall was 2.66, and the mean DS for bias was 2.98. DISCUSSION: Our data demonstrate the extensive use of YouTube for hair loss treatment information. While YouTube can be a valuable resource for patients, videos are often biased and can misinform patients. Moreover, the lack of a central review process or governing body to validate claims made in videos can be a safety concern. EBM LEVEL V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Primary cutaneous melanoma in Black patients: An analysis of 2464 cases from the National Cancer Database 2004-2018.

Melanoma in Black patients carries a poor prognosis. Due to its rarity, melanoma in this population has not been well characterized. This study evaluates survival predictors in Black patients with melanoma. This was a retrospective cohort study of Black patients with cutaneous melanoma from the National Cancer Database 2004-2018. Of the 2464 cases, melanoma was more common among females than males (57.1% vs. 42.9%, p < .001). Median Breslow depth was 1.8 mm (interquartile range 0.4-4.4). Lower extremities were the most common location (52.8%), followed by upper extremities (13.1%) along with otherwise specified/overlapping/other (13.1%), then by trunk (11.8%), and lastly head and neck (9.2%). Stage at diagnosis was I (30.7%), II (27.5%), III (24.1%), and IV (17.7%). Ulceration was observed in 41.4% of lesions. Acral lentiginous melanoma (ALM) was the most common specific histologic subtype (20.3%), followed by superficial spreading melanoma (9.4%). After adjusting for confounders, higher stages and primary site on the head and neck were the strongest independent predictors of worse overall survival. Melanoma in Black patients is most likely to appear on the lower extremities. A large portion (41.8%) presented with stage III or IV disease. ALM was the most common specific histologic subtype.

Patterns of Care and Outcomes of Primary Adenoid Cystic Carcinoma of the Trachea.

OBJECTIVE: Primary tracheal malignancies are relatively rare cancers, representing 0.1% to 0.4% of all malignancies. Adenoid cystic carcinoma (ACC) is the second most common histology of primary tracheal malignancy, after squamous cell carcinoma. This study aims to analyze demographic characteristics and potential influencing factors on survival of tracheal ACC (TACC). METHODS: This was a retrospective cohort study utilizing the National Cancer Database (NCDB). The NCDB was queried for all cases of TACC diagnosed from 2004 to 2016 (n = 394). Kaplan-Meier (KM) and Cox proportional-hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes. RESULTS: Median age of diagnosis was 56 (IQR: 44.75-66.00). Females were affected slightly more than males (53.8% vs 46.2%). The most prevalent tumor diameter range was 20 to 39 mm (34.8%) followed by greater than 40 mm in diameter (17.8%). Median overall survival (OS) was 9.72 years with a 5- and 10-year OS of 70% and 47.5%, respectively. Localized disease was not associated with a survival benefit over invasive disease (P = .388). The most common intervention was surgery combined with radiation therapy (RT) at 46.2%, followed by surgery alone (16.8%), and standalone RT (8.9%). When adjusting for confounders, surgical resection was independently associated with improved OS (HR 0.461, 95% CI 0.225-0.946). Tumor size greater than 40 mm was independently associated with worse OS (HR 2.808; 95% CI 1.096-7.194). CONCLUSION: Our data suggests that surgical resection, possibly in conjunction with radiation therapy, is associated with improved survival, and tumor larger than 40 mm are associated with worse survival.

Application of mobile health to support the elderly during the COVID-19 outbreak: A systematic review.

BACKGROUND: : The COVID-19 outbreak has affected the elderly's physical and mental health. The application of information and communication technology, such as mobile health (m-health), can help control this pandemic by changing the behavior and lifestyle of the elderly during this time of crisis. OBJECTIVE: : This review aimed to synthesize the capabilities of m-health in providing health services to the elderly during the COVID-19 pandemic, and to identify the factors contributing to the success of these tools. METHODS: : To find the relevant studies, a search was conducted in PubMed, Web of Science, Scopus, ProQuest, and Google Scholar. The inclusion criteria were: studies in English that used m-health intervention in all aspects of elderly healthcare during the COVID-19 outbreak, were published in peer-reviewed journals from 31 December 2019, and had any research design and methodology. Two authors independently took all the steps of this review, and finally performed narrative synthesis to report the findings. RESULTS: : Our initial search identified 421 studies, of which 10 met the inclusion criteria. The data analysis showed that all the m-health interventions had positive effects on the health of the elderly. The m-health services for the elderly during the current pandemic were used for therapy, information provision, self-help, monitoring, and mental health consultation purposes. The results also indicated that various factors affected the elderly's use of m-health tools. CONCLUSION: : The application of m-health keeps the elderly and healthcare providers safe, accelerates health service provision, reduces the costs of service provision, and decreases the risk of morbidity and mortality during the COVID-19 outbreak. The successful use of m-health tools for the elderly in health programs during the current crisis greatly depends on supporting the elderly and overcoming the barriers.

The Relationship Between Open Access Article Publishing and Short-Term Citations in Otolaryngology.

OBJECTIVES: The purpose of this study is to compare the number of citations received by open access articles versus subscription access articles in subscription journals in the Otolaryngology literature. METHODS: Using the Dimensions research database, we examined articles indexed to PubMed with at least 5 citations published in 2018. Articles were included from Otolaryngology-Head and Neck Surgery, The Laryngoscope, JAMA Otolaryngology-Head and Neck Surgery, Annals of Otology, Rhinology, and Laryngology, and American Journal of Otolaryngology. Multivariate Poisson regression modeling was used to adjust for journal, article type, and topic. Practice guidelines, position statements, or retractions were excluded as potential outliers. RESULTS: 137 open access articles and 337 subscription access articles meeting inclusion criteria were identified, with a median citation number of 8 (IQR 6-11). The most common article type was original investigation (82.5%), and the most common study topic was head and neck (28.9%). Open access articles had a higher median number of citations at 9 (IQR 6-13) when compared to subscription access articles at 7 (IQR 6-10) (P = .032). Open access status was significantly associated with a higher number of citations than subscription access articles when adjusting for journal, article type, and topic (ß = .272, CI 0.194-0.500, P < .001). CONCLUSIONS: Although comprising a minority of articles examined in this study of subscription journals, open access articles were associated with a higher number of citations than subscription access articles. Open access publishing may facilitate the spread of novel findings in Otolaryngology.