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Long-term Outcome of 525 Patients With Mycosis Fungoides and Sézary Syndrome
Clinical Prognostic Factors and Risk for Disease Progression
Youn H. Kim, MD;
Howard L. Liu, MD;
Serena Mraz-Gernhard, MD;
Anna Varghese, BA;
Richard T. Hoppe, MD
Arch Dermatol. 2003;139:857-866.
Objectives To study and update the clinical characteristics and long-term outcome of our patients with mycosis fungoides (MF) and Sézary syndrome (SS), and to identify important clinical factors predictive of survival and disease progression.
Design A single-center, retrospective cohort analysis.
Setting Academic referral center for cutaneous lymphoma.
Patients Five hundred twenty-five patients with MF and SS evaluated and managed at Stanford University Cutaneous Lymphoma Clinic, Stanford, Calif, from 1958 through 1999.
Main Outcome Measures We calculated long-term actuarial overall and disease-specific survivals and disease progression by the Kaplan-Meier method, and relative risk (RR) for survival calculated from expected survivals in control populations.
Results The majority of our patients presented with T1 (30%) or T2 (37%) disease; 18% presented with T3 and 15% with T4 skin involvement. Forty-three percent of deaths were attributable to MF, primarily in patients with T3 or T4 disease. The patients with a more advanced T classification and clinical stage had a worse survival outcome. Except for patients with T1 or stage IA disease, the RR for death is greater in patients with MF than in a control population (RR, 2.2 in stage IB/IIA disease, 3.9 in stage IIB/III disease, and 12.8 in stage IV disease). Despite similar overall survival in patients with stage IB or IIA disease, their disease-specific survivals were significantly different (P = .006). The most significant clinical prognostic factors in the univariate analysis were patient age, TNM and B classifications, overall clinical stage groupings, and the presence or absence of extracutaneous disease. In the multivariate analysis, patient age, T classification, and the presence of extracutaneous disease were the most important independent factors. The risk for disease progression to a more advanced TNM or B classification, worse clinical stage, or death due to MF correlated with the severity of the initial T classification. The risk for development of extracutaneous disease also correlated with T classification; none of these patients had T1 disease when their extracutaneous disease was detected.
Conclusions Patients with MF and SS have varying risks for disease progression or death. The most important clinical predictive factors for survival include patient age, T classification, and the presence of extracutaneous disease. The significant disease-specific survival differences between different clinical stages validate the usefulness of the present MF clinical staging system of the National Cancer Institute.
From the Departments of Dermatology (Drs Kim, Liu, and Mraz-Gernhard and Ms Varghese) and Radiation Oncology (Dr Hoppe), Stanford University School of Medicine, Stanford, Calif. The authors have no relevant financial interest in this article.
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