Risultati per: Raccomandazioni Melanoma per pazienti e cittadini

Sebastiani: ‘La diagnosi precoce rappresenta la vera sfida’

New England Journal of Medicine, Ahead of Print.

A 7 anni dalla diagnosi, in pazienti con metastasi cerebrali 

Sono 1745 realtà secondo primo censimento Libro Bianco Ropi

Objective
This study aimed to construct prognostic models to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with primary gastrointestinal melanoma (PGIM).

Design
An observational and retrospective study.

Setting
Data were obtained from the Surveillance, Epidemiology and End Results (SEER) programme database, encompassing a broad geographical and demographic spectrum of patients across the USA.

Participants
A total of 991 patients diagnosed with PGIM were included in this study.

Methods
A total of 991 patients with PGIM were selected from the SEER database. They were further divided into a training cohort and a validation cohort. Independent prognostic factors were identified by Cox regression analysis. Two prognostic models were constructed based on the results of multivariable Cox regression analysis. The concordance index (C-index) and area under the time-dependent receiver operating characteristic curve (time-dependent AUC) were used to evaluate the discriminative ability. Calibration curves were plotted to evaluate the agreement between the probability as predicted by the models and the actual probability. Risk stratification was developed given the model.

Results
By the multivariable Cox regression analysis, we identified four independent risk factors (age, stage, lymph node density and surgery) for OS, and three independent risk factors (stage, lymph node density and surgery) for CSS, which were used to construct prognostic models. C-index, time-dependent AUC, calibration curves and Kaplan-Meier curves of risk stratification indicated that these two models had good discriminative ability, predictive ability as well as clinical value.

Conclusions
The prognostic models of OS and CSS had satisfactory accuracy and were of clinical value in evaluating the prognosis of patients with PGIM.

This cohort study estimates the prevalence and describes tumor types of melanoma-astrocytoma syndrome.

This case report describes a patient in their 60s with metastatic colon cancer who developed multiple new dark nevi within 2 months of initiating encorafenib and panitumumab therapy.

This randomized clinical trial presents the final 5-year follow-up results of neoadjuvant talimogene laherparepvec (T-VEC) plus surgery in patients with advanced melanoma.

This meta-analysis investigates the efficacy and safety of nivolumab plus ipilimumab vs nivolumab alone in the treatment of advanced cancers other than melanoma.

This case-control study compares differences in the fecal microbiota—including overall diversity, composition, and putative function—between control participants and patients with melanoma and between patients with early- and late-stage melanoma.

The gut contains approximately 100 trillion commensal microorganisms, including viruses, archaea, bacteria, and unicellular eukaryotes that influence the development and function of the human neurological, immunological, and digestive systems from birth through adulthood. These collective microbes and their genes comprise the gut microbiome, which has gained clinical interest in many specialties as a diagnostic and potential therapeutic tool for several diseases and malignant neoplasms. The bacterial component of the gut microbiome is the most well-characterized and can be studied in a culture-independent manner using 16S ribosomal RNA sequencing. Alpha diversity describes the richness (number of unique species) in a single sample. Beta diversity describes differences between population samples. Dysbiosis describes a deviation from normal composition or metabolic activity.

Objectives
To identify prognostic models for melanoma survival, recurrence and metastasis among American Joint Committee on Cancer stage I and II patients postsurgery; and evaluate model performance, including overall survival (OS) prediction.

Design
Systematic review and narrative synthesis.

Data sources
Searched MEDLINE, Embase, CINAHL, Cochrane Library, Science Citation Index and grey literature sources including cancer and guideline websites from 2000 to September 2021.

Eligibility criteria
Included studies on risk prediction models for stage I and II melanoma in adults ≥18 years. Outcomes included OS, recurrence, metastases and model performance. No language or country of publication restrictions were applied.

Data extraction and synthesis
Two pairs of reviewers independently screened studies, extracted data and assessed the risk of bias using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist and the Prediction study Risk of Bias Assessment Tool. Heterogeneous predictors prevented statistical synthesis.

Results
From 28 967 records, 15 studies reporting 20 models were included; 8 (stage I), 2 (stage II), 7 (stages I–II) and 7 (stages not reported), but were clearly applicable to early stages. Clinicopathological predictors per model ranged from 3–10. The most common were: ulceration, Breslow thickness/depth, sociodemographic status and site. Where reported, discriminatory values were ≥0.7. Calibration measures showed good matches between predicted and observed rates. None of the studies assessed clinical usefulness of the models. Risk of bias was high in eight models, unclear in nine and low in three. Seven models were internally and externally cross-validated, six models were externally validated and eight models were internally validated.

Conclusions
All models are effective in their predictive performance, however the low quality of the evidence raises concern as to whether current follow-up recommendations following surgical treatment is adequate. Future models should incorporate biomarkers for improved accuracy.

PROSPERO registration number
CRD42018086784.

Introduction
Three-dimensional (3D) total body photography may improve early detection of melanoma and facilitate surveillance, leading to better prognosis and lower healthcare costs. The Australian Centre of Excellence in Melanoma Imaging and Diagnosis (ACEMID) cohort study will assess long-term outcomes from delivery of a precision strategy of monitoring skin lesions using skin surface imaging technology embedded into health services across Australia.

Methods and analysis
A prospective cohort study will enrol 15 000 participants aged 18 years and above, across 15 Australian sites. Participants will attend study visits according to their melanoma risk category: very high risk, high risk or low/average risk, every 6, 12 and 24 months, respectively, over 3 years. Participants will undergo 3D total body photography and dermoscopy imaging at study visits. A baseline questionnaire will be administered to collect sociodemographic, phenotypic, quality of life and sun behaviour data. A follow-up questionnaire will be administered every 12 months to obtain changes in sun behaviour and quality of life. A saliva sample will be collected at the baseline visit from a subsample.

Ethics and dissemination
The ACEMID cohort study was approved by the Metro South Health Human Research Ethics Committee (approval number: HREC/2019/QMS/57206) and the University of Queensland Human Research Ethics Committee (approval number: 2019003077). The findings will be reported through peer-reviewed and lay publications and presentations at conferences.

Trial registration number
ACTRN12619001706167.

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