ABSTRACT
BACKGROUND: Several clinical and histological factors of primary melanomas comprise a relatively large quantity of prognostic information. OBJECTIVE: To find immunohistochemical markers that can improve the prognostic accuracy achieved by factors that are available without extra laboratory work, i.e. mitotic rate, tumour thickness, ulceration, localization, gender and age. METHODS: Immunohistochemical markers were determined on frozen sections. Univariate and multivariate Cox regression analyses were performed after 5-10 years follow-up. RESULTS: Seven immunohistochemical markers were related to disease-free and overall survival in univariate Cox regression analysis: Ki-67, human leucocyte antigen (HLA) -DQ, HLA-DP, Muc 18, A-10-33, transferrin receptor, and H-2-8-10. Only Ki-67 (n = 399) and HLA-DQ (n = 452) retained prognostic significance when evaluated in multivariate analyses in several models together with tumour thickness alone and with tumour thickness, gender, mitotic rate, age, localization and ulceration. CONCLUSIONS: Ki-67 and HLA-DQ may be useful for risk assessments in primary melanomas.
Subject(s)
Antigens, CD , Biomarkers, Tumor/metabolism , Melanoma/metabolism , Neural Cell Adhesion Molecules , Skin Neoplasms/metabolism , Adolescent , Adult , Age Factors , Aged , CD146 Antigen , Child , Child, Preschool , Disease-Free Survival , Female , Frozen Sections , HLA-DP Antigens/metabolism , HLA-DQ Antigens/metabolism , Humans , Infant , Infant, Newborn , Ki-67 Antigen/metabolism , Male , Melanoma/pathology , Membrane Glycoproteins/metabolism , Middle Aged , Mitotic Index , Prognosis , Receptors, Transferrin/metabolism , Regression Analysis , Sex Factors , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: In addition to tumor thickness, several other prognostic parameters have been identified in primary human melanomas. Some are available readily (localization, gender, age, and ulceration). Others must be evaluated with a moderate or even substantial amount of work (mitoses and immunohistochemical markers). This study was undertaken to determine whether this extra effort is justified because it actually improves the precision of prognostic statements. METHODS: Immunohistologic markers were determined on frozen sections from 691 biopsies of human melanomas with the immunoperoxidase method. Univariate and multivariate Cox regression analyses were performed with metastases and with death as endpoints. RESULTS: Fifteen parameters were related to disease free survival in univariate Cox regression analysis: tumor thickness, ulceration, localization, gender, age, mitoses, and the immunohistochemical markers very late antigen (VLA)-2, human leukocyte antigen (HLA)-ABC, HLA-DR, NKI-beteb, Mel 14, intercellular adhesion molecule (ICAM-1), K-1-2, G-7-E2, and H-2-4-7. Three of the easily available parameters exhibited independent significance in multivariate Cox regression analysis: tumor thickness, ulceration, and localization. If mitotic rate was included in this model, then it had independent prognostic significance but ulceration was no longer significant. However, the model that included tumor thickness, localization, and ulceration had a slightly higher overall chi-square test score, indicating a better performance compared with thickness, localization, and mitoses. The model that included tumor thickness, localization, and mitoses could not be improved by any of the immunohistochemical markers in this study. CONCLUSIONS: Nine immunohistochemical markers with established prognostic significance for primary human melanoma were not found to improve a prognostic model that included tumor thickness, localization, and mitoses. If mitoses was replaced by ulceration, then the model performed slightly better, although ulceration was not significant in the presence of mitoses.
Subject(s)
Biomarkers, Tumor/analysis , Melanoma/chemistry , Mitosis/physiology , Aged , Follow-Up Studies , Humans , Immunoenzyme Techniques , Male , Multivariate Analysis , Prognosis , Reproducibility of ResultsABSTRACT
Starting from the current level of research on the amount and detection of support requirements of tumour patients a lack of practicable screening instruments in psychooncology becomes evident for valid and reliable identification of highly distressed patients in order to offer them treatment-integrated specific interventions. The following report bases on the results of a research project with facial and skin cancer patients and so closes the gap. Patients in need of support can be identified by means of the "Hornheide Questionnaire", developed for this purpose. The support requirement is ascertained by a connexion of a patient self-assessment and an expert-defined cut-off point. Extensive data concerning support requirements and indications are presented and discussed.
Subject(s)
Adaptation, Psychological , Facial Neoplasms/psychology , Patient Care Team , Sick Role , Skin Neoplasms/psychology , Social Support , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Personality Inventory , Referral and ConsultationABSTRACT
Assisted by Deutsche Krebshilfe, the German cancer aid fund, a questionnaire for assessment of quality of life in patients with life-threatening skin tumours and disfiguring tumour sequels was developed at Fachklinik Hornheide between 1986 and 1988. A first step toward determining quality of life and for enhancing treatment-integrated rehabilitative work is the assessment of the subjective distress and problems experienced due to the illness and its treatment. This is the objective of the Hornheider Fragebogen, a questionnaire developed in the framework of the study on the basis of extensive literature search, structured interviews with patients and treating staff. This self-assessment instrument was answered by 131 patients with malignant tumours of the skin, twice during in-patient treatment and a third time some 6 months after discharge. Statistical analysis of the data collected proved the questionnaire to be valid, reliable and practicable. Additionally, it has been possible to draw up a number of significant results of immediate relevancy. It turned out that persons who are unemployed, divorced, or married but separated, as well as persons without school leaving certificate, experienced greater distress and more problems in many dimensions than the other respondents. The questionnaire was viewed as meaningful and as helpful by the patients in order to voice unspecific anxiety and questions. Also, the study entailed positive implications for our rehabilitative work already in this initial testing phase, by enabling us to give more specific support to the patients. The Hornheider Fragebogen, after review and abridgment, consists of 27 problem-oriented questions relating to eight dimensions of life.
