Female sex is a risk factor for satellite and in-transit recurrences from cutaneous melanoma

: Potential sex-related differences in the periprocedural and long-term postprocedural outcomes of coronary angioplasty in patients with stable coronary artery disease have been studied thoroughly over the last few decades, to determine whether female sex should be regarded as an independent risk factor that affects clinical outcomes. Based on a significant number of observational studies and meta-analyses, sex has not yet emerged as an independent risk factor for either mortality or major cardiac and cerebrovascular events, despite the fact that in the early 1980s, for several reasons, female sex was associated with unfavourable outcomes. Therefore, it remains debatable whether female sex should be considered as an independent risk factor for periprocedural and long-term bleeding events. The pharmacological and technological advancements that support current coronary angioplasty procedures, as well as the non-delayed treatment of coronary artery disease in females have certainly lessened the outcome differences between the two sexes. However, females show fluctuations in blood coagulability through their lifetime and higher prevalence of bleeding episodes associated with the antithrombotic treatment, following transcatheter coronary reperfusion interventions. In conclusion, the clinical results of percutaneous coronary intervention in patients with stable coronary artery disease, during the periprocedural and long-term postprocedural periods, appear to show no significant differences between the two sexes, except for bleeding rates, which seem to be higher in females, a difference that mandates further systematic research.

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Development and validation of an improved pathologic nodal classification system for cutaneous melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21563 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21563-e21563

Author(s):

Anthony Tuan Nguyen ◽

Michael Luu ◽

Vina Nguyen ◽

Omid Hamid ◽

Mark B. Faries ◽

...

Keyword(s):

Cutaneous Melanoma ◽

Classification System ◽

Recursive Partitioning ◽

Cohort Analysis ◽

Retrospective Cohort Analysis ◽

Staging Systems ◽

Node Positive Disease ◽

In Transit ◽

Cubic Spline Function ◽

Development And Validation

e21563 Background: Given recent therapeutic advances and evolving patterns of lymph node (LN) evaluation for cutaneous melanoma, accurate and precise LN staging is needed to guide adjuvant treatment and future investigations. Current staging was developed primarily for patients undergoing completion LN dissection (CLND) for node-positive disease and do not produce LN classification groups with continuously increasing mortality. Thus, we developed and validated an improved LN classification system for cutaneous melanoma. Methods: Retrospective cohort analysis of 105,785 patients with cutaneous melanoma who underwent surgery from 2004 to 2015 in the National Cancer Database. Extent of LN dissection (sentinel LN biopsy [SLNB] and/or CLND) was available for patients diagnosed 2012 onward. Multivariable models were generated with number of positive LNs modeled using a non-linear restricted cubic spline function. Recursive partitioning analysis (RPA) was used to derive a modified LN classification system based on LN variables independently associated with overall survival (OS). The proposed LN classification system was validated in 85,499 patients from SEER-18. Results: Number of positive LNs (1-2 LN+: hazard ratio [HR] 2.48 per LN, 95% CI, 2.37-2.61, P< 0.001; ≥3 LN+: HR 1.10 per LN, 95% CI, 1.07-1.13, P< 0.001), clinically detected metastases (HR 1.35, 95% CI 1.27-1.42; P< 0.001), and in-transit metastases (HR 1.48; 95% CI 1.34-1.65; P< 0.001) were associated with OS. An RPA-derived LN classification system using these variables demonstrated continuously increasing mortality risk for each proposed LN classification group (HR: 1.83, 2.72, 3.79, 4.56, 6.15, and 8.25 for the proposed N1a-N3b groups, Table, P< 0.001). By contrast, AJCC 8E produced a more haphazard mortality profile (HR: 1.83, 3.81, 2.59, 2.71, 4.51, 3.44, 6.06, 8.15, and 6.90 for N1a-N3c). As a sensitivity analysis, the proposed system continued to accurately predict outcomes when we excluded patients undergoing CLND for microscopic LN metastases. Lastly, we validated this system for OS and cause-specific mortality in SEER-18 ( P< 0.001). Conclusions: A modified and simplified LN classification system can accurately predict mortality in cutaneous melanoma in an era of increasing use of SLNB without CLND and should be considered for future staging systems.[Table: see text]

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Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants

Cardiovascular Therapeutics ◽

10.1155/2020/1743927 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Mariacarla Gallù ◽

Giulia Marrone ◽

Jacopo Maria Legramante ◽

Antonino De Lorenzo ◽

Nicola Di Daniele ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Stroke Risk ◽

Current Knowledge ◽

Oral Anticoagulants ◽

Optimal Time ◽

Complete Evaluation ◽

Thromboembolic Risk ◽

Female Patients ◽

Female Sex

Sex-specific differences have been definitively demonstrated in cardiovascular (CV) diseases. These differences can also impact on the effects of CV therapies. Female sex is recognized as an independent predictor of thromboembolic risk, particularly in older patients. Most of strokes are due to atrial fibrillation (AF). Women affected by AF have higher stroke risk compared to men. The introduction of novel oral anticoagulants (NOACs) for long-term anticoagulation completely changed the anticoagulant therapeutic approach and follow-up of patients affected by nonvalvular atrial fibrillation (NVAF). CHA2DS2-VASc stroke risk scoring in use in the current international guidelines attributes 1 point to “female sex”. Besides, no anticoagulation is indicated for AF female patients without other risk factors. Interestingly, NOACs seem to normalize the differences between males and females both in terms of safety and efficacy, whereas residual higher stroke risk and systemic embolism persist in AF women treated with vitamin K antagonist anticoagulants VKA with optimal time in therapeutic range. Based on the CHA2DS2-VASc score, NOACs represent the preferred choice in NVAF patients. Moreover, complete evaluation of apparently lower risk factor along with concomitant clinical conditions in AF patients appears mandatory, particularly for female patients, in order to achieve the most appropriate anticoagulant treatment, either in male or in female patients. The present review was performed to review sex differences in AF-related thromboembolic risk reported in the literature and possibly highlight current knowledge gaps in prevention and management that need further research.

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