Holocaust in der Schule – Erfahrungen aus der BRD

This article explores the education and textbooks on Holocaust in German schools

Holocaust in der Schule – Erfahrungen aus der BRD

This article explores the education and textbooks on Holocaust in German schools

Computer-Schach

ISSN:0376-6829ISSN:1420-532

Prognostic Factors of Melanoma Patients with Satellite or In-Transit Metastasis at the Time of Stage III Diagnosis

Background: Prognosis of patients with loco-regional skin metastases has not been analyzed in detail and the presence or absence of concurrent lymph node metastasis represents the only established prognostic factor thus far. Most studies were limited to patients already presenting with skin lesions at the time of initial diagnosis. We aimed to analyze the impact of a broad penal of prognostic factors in patients with skin metastases at the time of first metastatic spread, including patients with synchronous lesions already present at the time of initial diagnosis, stage I/II patients with loco-regional recurrence and patients initially presenting with skin metastasis but unknown primary melanoma.Patients and Methods: We investigated disease-specific survival of 380 patients treated at our department between 1996 and 2010 using Kaplan Meier survival probabilities and Cox-proportional hazard analysis.Results: Five-year survival probability was 60.1% for patients with skin metastases only and 36.3% for those with synchronous nodal metastases. The number of involved nodes and a tumor thickness of at least 3 mm had independent negative impact on prognosis. A strong relationship was identified between the risk of death and the number of involved nodes. Neither ulceration nor the timing of the first occurrence of metastases as either in stage I/II patients, at the time of excision of the primary melanoma or initially in patients with unknown primary tumor, had additional effects on survival.Conclusion: Lymph node involvement was confirmed as the most important prognostic factor for melanoma patients with loco-regional skin metastasis including those with unknown primary tumor and stage I/II patients with skin recurrence. Consideration of the tumor thickness and of the number of involved lymph nodes instead of the exclusive differentiation into presence vs. absence of nodal disease may allow a more accurate prediction of prognosis for patients with satellite or in-transit metastases

Survival analysis of 498 patients with palpable lymph node metastases based on Kaplan Meier.

*<p>95%-CI = 95% confidence interval;</p>**<p>p-values are results of log rank tests excluding cases with missing values.</p><p>LNM = lymph node metastasis; MUP = melanoma of unknown primary.</p

Patient characteristics and survival analysis according to Kaplan-Meier.

*<p>95%-CI  = 95% confidence interval; **p-values are results of log rank tests excluding cases with missing values; log rank test excluding cases without lymph node metastasis and those with missing values.</p

Independent prognostic factors for 497 patients with macroscopic lymph node metastases according to the multivariable Cox proportional hazard analysis.

#<p>95% CI = 95% confidence interval;</p>*<p>One patient was censored before any death occurred and was automatically removed from the analysis;</p>**<p>Disease-specific death; the model was adjusted for the confounding effects of ulceration of primary tumour, age of the patient at diagnosis and for missing values for the number of positive lymph nodes (n = 17).</p><p>LNM = lymph node metastasis; MUP = melanoma of unknown primary.</p