Sentinel node tumor burden in prediction of prognosis in melanoma patients

Recent data have demonstrated no survival benefit to immediate completion lymph node dissection (CLND) for positive sentinel node (SN) disease in melanoma. It is important to identify parameters in positive SNs, which predict prognosis in melanoma patients. These might provide prognostic value in staging systems and risk models by guiding high-risk patients' adjuvant therapy in clinical practice. In this retrospective study of university hospital melanoma database we analyzed tumor burden and prognosis in patients with positive SNs. Patients were stratified by the diameter of tumor deposit, distribution of metastatic focus in SN, ulceration and number of metastatic SNs. These were incorporated in Cox proportional hazard regression models. Predictive ability was assessed using Akaike information criterion and Harrell's concordance index. A total of 110 patients had positive SN and 104 underwent CLND. Twenty-two (21%) patients had non-SN metastatic disease on CLND. The 5-year melanoma specific survival for CLND-negative patients was 5.00 years (IQR 3.23-5.00, range 0.72-5.00) compared to 3.69 (IQR 2.28-4.72, range 1.01-5.00) years in CLND-positive patients (HR 2.82 (95% CI 1.17-6.76, p = 0.020).The models incorporating distribution of metastatic focus and the largest tumor deposit in SN had highest predictive ability. According to Cox proportional hazard regression models, information criterions and c-index, the diameter of tumor deposit > 4 mm with multifocal location in SN despite of number of metastatic SN were the most important parameters. According to the diameter of tumor deposit and distribution of metastatic focus in SN, adequate stratification of positive SN patients was possible and risk classes for patients were identified.Peer reviewe

Laatukriteerit kolposkopiatoiminnan kehittämisen tukena : esimerkkinä PSHP

Lähtökohdat : Kolposkopia on luonteeltaan subjektiivinen ja dynaaminen tutkimus, jonka laadukkaasta toteutuksesta on annettu ohjeita kansallisessa Käypä hoito -suosituksessa sekä eurooppalaisessa laatukriteeristössä. Menetelmät : Selvitimme takautuvasti potilaskertomustekstien avulla, miten kolposkopian ja sähkösilmukka- eli loop-hoitojen kansalliset ja eurooppalaiset laatukriteerit toteutuivat Pirkanmaan sairaanhoitopiirissä (PSHP) vuonna 2019. Tulokset : Suositeltuja Swede Score- ja TZ-luokituksia käytettiin PSHP:ssä vuonna 2019 vähän, mutta löydösten sanallinen kuvailu oli yleistä. Etikka- ja jodivärjäysten käytöstä raportoitiin vainpuolessa tutkimuksista. Koepaloja otettiin riittävästi, mutta kohdennettujen näytteiden osuus oli pienempi kuin kohdistamattomien. Kohdunkaulan sähkösilmukkahoidot toteutettiin perustellusti. Päätelmät : Diagnostiikassa ja kirjauksissa PSHP:n käytännöissä on kehitettävää, mutta hoito käytännöt vastaavat jo nyt laatukriteereitä. Suositusten mukaisen kolposkopiatoiminnan ja siihenliittyvien kirjausten toteutuminen käytännössä ei ole itsestäänselvyys, mutta laatukriteerien avulla mahdolliset kehitystarpeet saadaan esiin. Tällöin myös kolposkopiaan liittyvä koulutus voidaan kohdentaa parhaiten.publishedVersionPeer reviewe

Predictive risk factors of complications in reduction mammoplasty—analysis of three different pedicles

Background: Reduction mammoplasty can be performed in several different techniques. Understanding the complication profile and risk factors in different reduction methods can help in choosing a technique, which serves the patient best. The authors present their experience of three different reduction techniques [superomedial pedicle (SMP), superior pedicle (SP) and inferior pedicle (IP)] with an emphasis on predictors of complications. Methods: A retrospective review of a prospectively maintained database of breast reductions between 2014 and 2020 was performed. Patient’s demographics [age, body mass index (BMI), comorbidities, smoking, nipple to sternal notch distance (N-SN)], operative details (pedicle, tissue resected, drains, operating surgeon) and complications according to Clavien-Dindo classification were assessed. Study variables were compared against overall complication rates for the three techniques. Results: In total, 760 patients underwent reduction mammoplasty, including 578 (76%) bilateral and 182 (24%) unilateral operations. Of patients, 477 (63%) were operated with SMP, 201 (26%) with IP and 82 (11%) with SP. An average weight of resected tissue per breast was 460 g. Overall complication rate was 38%. The rate was higher in IP group (50%) compared to SMP (36%) and SP (22%) groups (P<0.001). Complications were mainly minor and related to delayed wound healing. The rate for major complications was 4%. Multivariable analysis showed that complications were associated independently with IP [odds ratio (OR) 1.89, 95% confidence interval (CI): 1.33–2.69], age <50 years (OR 1.87, 95% CI: 1.32–2.65), bilateral operation (OR 1.67, 95% CI: 1.00–2.76) and resected tissue weight ≥650 g per breast (OR 2.02, 95% CI: 1.36–2.99). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the presence of statistically significant risk factors (IP, age <50, bilateral operation and/or resected tissue ≥650 g per breast) increased (31%, 38%, 59% and 90% for number of 1, 2, 3 and 4 risk factors respectively, P<0.001). Conclusions: The rate of complication can be predicted by a risk-scoring system. In increasing variety of patients undergoing reduction mammoplasty, careful consideration of the best operation technique is important to prevent complications and costs.publishedVersionPeer reviewe

Survival with lung cancer in Finland has not improved during 2007–2019–a single center retrospective population-based real-world study

Objectives: According to the CONCORD-3 study, the 5-year survival rate of lung cancer patients in Finland has not improved during the twenty-first century. In the present study, we evaluated the survival trends of lung cancer patients diagnosed and treated in one of the five university hospitals in Finland to determine possible explanatory factors behind the lack of improved survival. Material and methods: This retrospective population-based study included all lung cancer patients diagnosed in Tampere University Hospital in 2007–2019 (N = 3041). The study population was divided into two subcohorts: the patients diagnosed in 2007–2012 and those diagnosed in 2013–2019. The two subcohorts were then compared to analyze the temporal changes in survival and the distribution of prognostic factors. Results: A comparison of the patients diagnosed in 2007–2012 and 2013–2019 showed that the patients’ overall survival had remained unchanged. The median overall survival was 8.7 months in the earlier subcohort and 9.2 months in the later subcohort. The respective 5-year survival rates were 16.6% and 17.8%, and these differences were not statistically significant. The proportion of stage IV patients (approximately 59% in both subcohorts) and their risk of death were similar for the two subcohorts. According to the regression analysis, male gender, advanced stage, and poor Eastern Cooperative Oncology Group performance status were independent risk factors for death, while a never-smoking status and mutation-positive disease were associated with a decreased risk of death, but only in the later cohort. Conclusion: Echoing the results of CONCORD-3, this study confirmed that the real-world survival of unselected lung cancer populations in Finland has not improved over the last 15 years, mainly because of the unchanged proportions of patients with late-stage lung cancer. This calls for earlier recognition of lung cancer, achieved by screening and increasing awareness of the disease.Peer reviewe

Lonkkamurtumapotilaan kalsiumin ja D-vitamiinin saanti kannattaa varmistaa yksilöllisesti

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Health-related Quality of Life of Patients Treated With Different Fractionation Schedules for Early Prostate Cancer Compared to the Age-standardized General Male Population

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Combining diagnostic memory clinic with rehabilitation follow-up after hip fracture

Purpose: Cognitive impairment and dementia are common in older hip fracture patients. We describe new diagnoses of cognitive disorders (NDCDs) and associated factors in a two-year post-hip fracture follow-up including the use of the diagnostic facilities of a memory clinic.Methods: Data were collected on admission and at outpatient assessment 4–6 months post-hip fracture. Diagnoses of cognitive disorders followed the evidence-based Finnish national care guideline including internationally accepted criteria. NDCDs up to 2 years post-hip fracture were extracted manually from the patient files. Logistic regression models were computed to examine the associations between the pre-fracture factors and the domains of the outpatient geriatric assessment and NDCDs.Results: Of the 1165 hip fracture patients aged ≥ 65 years, 831 had no previous diagnosis of cognitive disorder. Of these, NDCD was documented in 23.3%. Alzheimer’s disease (AD) with or without vascular cognitive impairment (VCI) was the most common diagnosis. Cognitive disorder was usually at a moderate stage. Age, higher ASA score and poor nutritional status on admission were associated with new cognitive disorders. At the outpatient follow-up, poorer activities of daily living and mobility disability were associated with NDCD. Patients with a NDCD were more likely to suffer greater mobility impairment, poorer nutritional status and to have more supported living arrangements at follow-up than in the pre-fracture situation.Conclusion: NDCDs are common after hip fracture and associated with impaired rehabilitation outcomes and poor nutritional status. A post-hip fracture assessment co-organized in the form of a memory clinic seems to be feasible to detect previously undiagnosed cognitive disorders. Earlier diagnosis of cognitive disorders is warranted.</p

Sociodemographic factors affecting glycaemic control in Finnish paediatric patients with type 1 diabetes

Aims: Socioeconomic problems may present significant challenges when trying to reach optimal glycaemic control in paediatric patients with type 1 diabetes. We examined sociodemographic factors affecting metabolic control in patients in one of the biggest paediatric diabetes clinics in Finland. Methods: One hundred ninety-one children (age 2–15 years; median 11 years; 47% female) with type 1 diabetes and their families were recruited during outpatient visits in the paediatric diabetes clinic of Tampere University Hospital, Finland. The participants completed a questionnaire on the family's sociodemographic background. The child's glycaemic control was assessed by both glycosylated haemoglobin (HbA1c) and time in range (TIR). Risk factors for poor (HbA1c ≥75 mmol/mol; TIR <40%) and optimal (HbA1c <53 mmol/mol; TIR ≥70%) metabolic control were searched using logistic regression analyses. Results: Living in a nuclear family, male gender, younger age and a school assistant for diabetes management were associated with the simultaneous presence of both indicators of optimal metabolic control. Poor glycaemic control, as estimated by HbA1c, was associated with lower parental education and the child's older age. Parental smoking and the child's older age were associated with poor TIR. Conclusion: This study confirms the importance of sociodemographic factors in care of Finnish paediatric patients with type 1 diabetes. Sociodemographic status markers of the family could be used as triggers to alert paediatric diabetes teams to offer more tailored care to families with new-onset type 1 diabetes mellitus.Peer reviewe

Yksilöllinen hoidon suunnittelu paransi kalsiumin ja D-vitamiinin saantia lonkkamurtuman jälkeen

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