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| 2. |
- Eriksson, Hanna, et al.
(författare)
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Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma : A nationwide population-based study in Sweden
- 2013
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Ingår i: European Journal of Cancer. - Oxford : Elsevier. - 0959-8049 .- 1879-0852. ; 49:12, s. 2705-2716
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:A worse outcome has been reported for cutaneous malignant melanoma (CMM) patients with low socioeconomic status. We have investigated the association between level of education, clinical stage at diagnosis (stage at diagnosis) and CMM-specific survival in Sweden.METHODS:We identified 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based, health and census registers with a follow-up to 2010.RESULTS:The odds ratio (OR) of higher disease stage at diagnosis was significantly increased in lower education groups (OR stage II versus I=1.6; 95% confidence interval (CI)=1.5-1.7. OR stage III-IV versus I=2.3; 95% CI=1.8-2.9). The risk of dying of CMM, was significantly increased in patients with low (hazard ratio (HR) low versus high=2.02; 95% CI=1.80-2.26; p<0.0001) and intermediate (HR intermediate versus high=1.35; 95% CI=1.20-1.51; p<0.0001) level of education. After adjustment for age, gender, stage at diagnosis and other known prognostic factors, the HRs remained significant for low versus high (HR=1.13; 95% CI=1.01-1.27; p=0.04) but not for intermediate versus high (HR=1.11; 95% CI=0.99-1.24; p=0.08) education. The HR associated with low level of education was significantly higher among female patients, patients <55years, patients with truncal tumours and during the first 5years after diagnosis.CONCLUSION:Lower level of education is associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. These results emphasise the need for improved early detection strategies.
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- Helgadottir, Hildur, et al.
(författare)
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CDKN2a mutation-negative melanoma families have increased risk exclusively for skin cancers but not for other malignancies.
- 2015
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 137:9, s. 2220-2226
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Tidskriftsartikel (refereegranskat)abstract
- Germline CDKN2A mutations are found in 5-20% of melanoma families. Numerous studies have shown that carriers of CDKN2A mutations have increased risks of non-melanoma cancers, but so far there have been no studies investigating cancer risks in CDKN2A wild type (wt) melanoma families. In this prospective cohort study, index melanoma cases (n = 224) and their first-degree relatives (n = 944) were identified from 154 confirmed CDKN2A wt melanoma families. Cancer diagnoses in family members and matched controls were obtained from the Swedish Cancer Registry. Relative risks (RR), odds ratios (OR) and two-sided 95% confidence intervals (95% CI) were calculated. In index cases and first-degree relatives, the prospective RR for melanoma was 56.9 (95% CI 31.4-102.1) and 7.0 (95% CI 4.2-11.4), respectively, and for squamous cell skin cancers 9.1 (95% CI 6.0-13.7) and 3.4 (95% CI 2.2-5.2), respectively. In neither group, elevated risks were seen for non-skin cancers. In a subgroup analysis, CDKN2A wt melanoma families with young (<40 years) melanoma cases were found to have increased risk of non-skin cancers (RR 1.5, 95% CI 1.0-1.5). Further, MC1R gene variants were increased in familial melanoma cases compared to controls (OR 2.4, 95% CI 1.6-3.4). Our findings suggest that in the majority of CDKN2A wt melanoma families, a segregation of variants in low-risk melanoma genes such as MC1R causes increased skin cancer susceptibility, rather than mutations in high-risk cancer predisposing genes, such mutations are more probable to be found in melanoma families with young melanoma cases. This study further supports an implication of CDKN2A mutation screening as a clinical test that determines counseling and follows up routines of melanoma families.
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| 5. |
- Masucci, Giuseppe Valentino, et al.
(författare)
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Alternating chemo-immunotherapy with temozolomide and low-dose interleukin-2 in patients with metastatic melanoma
- 2006
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Ingår i: Melanoma research. - : Ovid Technologies (Wolters Kluwer Health). - 0960-8931 .- 1473-5636. ; 16:4, s. 357-363
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Tidskriftsartikel (refereegranskat)abstract
- Temozolomide is a rapidly absorbed chemotherapeutic agent, achieving significant central nervous system penetration. Previous clinical trials suggested that temozolomide in sequence with low-dose recombinant human interleukin-2 might be an efficacious and relatively non-toxic chemo-immunotherapeutic treatment, which may synergistically eliminate tumours. The primary objective was to determine the safety and tolerance of temozolomide administered orally 200 mg/m(2) days 1-5, in sequential combination with subcutaneous injections of 4.5 x 10(6) IU recombinant human interleukin-2 on days 8-11, 15-18 and 22-25 in patients with measurable, progressive metastatic malignant melanoma without radiological signs of central nervous system metastases. The secondary objectives were to determine tumour response and time to progression. Twenty-seven patients were included, of which four were non-evaluable for response. Twenty-three patients tolerated the regimen with side effects below grade 3 according to the World Health Organization (WHO) scale. Three patients suspended the treatment because of WHO grade 3 side effects already during the first 3 days of the first course of temozolomide. Seven patients showed no tumour progression during the first four treatment cycles. Two patients had complete responses, three partial responses and two stable disease at the end of the four cycles defined by the protocol and they continued the treatment until signs of relapse or a maximum of 21 courses. Five of these patients are still alive. Thrombocytopenia was significantly more pronounced in patients with objective response and stable disease than in non-responders to therapy. The median time to progression for all patients was 3.1 months and for responding and stable disease patients was 15 months. Five of 23 treated patients (22%) developed brain metastases during follow-up. Temozolomide in combination with recombinant human interieukin-2 is a well-tolerated regimen for outpatient treatment and the bio-chemotherapy combination induced durable clinical responses. Thrombocytopenia might be a positive predictive factor for response to therapy.
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| 6. |
- Månsson-Brahme, Eva
(författare)
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Cutaneous malignant melanoma aspects of prognostic factors and time : trends in a Swedish population
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One of the aims of this thesis was to assess the possible impact of primary and secondary preventive activities in the population of Stockholm-Gotland with the objective to reduce the incidence and mortality from cutaneous melanoma. Another aim was to investigate whether thin melanomas and hereditary melanomas represent separate biologic entities. The study base was cases with cutaneous melanoma reported to the Swedish Cancer Registry 1976 - 1994, patients registered in the Stockholm-Gotland Regional Melanoma Registry 1976-1994, individuals reported with malignant melanoma as an underlying cause of death to the Swedish Cause- of-Death Registry 1970-1996, and patients reported to the National Familial Melanoma data base 1987-1994. The average annual increase of the age-standardised incidence was about 5 % in both genders. The increase mainly concerned thin turnouts and melanoma in situ. During the 1990s the incidence in males levelled off. This apparent change in trend was not observed outside the Stockholm-Gotland region. The estimated five-year melanoma-specific survival rate in patients diagnosed with localised cutaneous melanoma increased from 84 % to 92 % during 1976-1994. No time-trend for melanoma-specific survival was observed among patients with regional or distant metastases. The increased survival during 1976-1989 could be fully explained by a trend towards more favourable tumour characteristics. During 1990-1994, screening activities may have contributed to the observed survival improvement. An upward trend in melanoma mortality appeared to level off in the mid 1980s. In females a slight decrease was observed during 1987-1996. The change in trend was most pronounced in the Stockholm-Gotland region. The results indicate that the interventional activities in Stockholm-Gotland may have influenced both melanoma incidence and mortality. Of patients diagnosed with thin cutaneous melanoma (< 0.8 nun), four percent developed recurrent disease after a median follow-up of 50 months. Anatomic site, tumour thickness, level of invasion and turnout regression were significant prognostic factors. No subgroup of patients could be identified that was without risk of recurrent disease. Thin melanomas did not appear to constitute a separate biologic entity. A family history of melanoma was reported in five percent of patients diagnosed with cutaneous melanoma. Familial melanoma was associated with young age at diagnosis, the presence of dysplastic nevi, multiple melanoma and melanomas detected at an early stage. The prognosis of the familial cases did not differ from that of sporadic melanomas when established prognostic factors were taken into account.
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| 7. |
- Titus-Ernstoff, Linda, et al.
(författare)
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Factors associated with atypical nevi : A population-based study
- 1998
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 7:3, s. 207-210
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Tidskriftsartikel (refereegranskat)abstract
- We conducted a case-control study to identify factors associated with the presence of clinically atypical nevi. Potential participants were selected, using a two-staged sampling scheme, from a population-based cohort of 50,000 Swedish women who had responded to a previous health survey questionnaire. Of 500 women sampled for study recruitment, 400 (80%) agreed to participate. Study participants underwent a physician-conducted skin examination, which identified 130 women who had at least one clinically atypical nevus (cases) and 270 women without these lesions (controls). The physician-conducted skin examination also assessed women for benign nevus counts; other risk factor information was based upon responses to a health survey questionnaire. We found a strong and highly statistically significant relationship between number of benign nevi and the presence of at least one clinically atypical nevus (P < 0.0001). Women with 100 or more benign nevi had a 26-fold increased likelihood of having an atypical nevus. We noted statistically significant interactions between number of benign nevi and other factors of interest; thus, the results are reported separately for women with low (<50) or high (> or =50) counts of benign nevi. Among women with low counts of benign nevi, the likelihood of having an atypical nevus increased with degree of freckling; there was also a suggested role for early sun exposure. Among women with high counts of benign nevi, difficulty tanning and lack of peeling sunburns between ages 10 and 19 appeared to increase the likelihood of case status; our data also suggested an inverse relationship between parity and atypical nevi in this subgroup.
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