This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Dermatologic Disorders  • Neoplasms  • Prognosis/ Outcomes  • Genetics  • Genetic Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

Characterization of Clinical Subset With Worse Outcome

Denise K. Woo, MD, MS; Christopher R. Jones, MD; Monique N. Vanoli-Storz, MD; Sabine Kohler, MD; Sunil Reddy, MD; Ranjana Advani, MD; Richard T. Hoppe, MD; Youn H. Kim, MD

Arch Dermatol. 2009;145(6):667-674.

Objectives  To identify prognostic factors in primary cutaneous anaplastic large cell lymphoma (pcALCL), focusing on extensive limb disease (ELD), defined as initial presentation or progression to multiple skin tumors in 1 limb or contiguous body regions, and to study gene expression profiles of patients with pcALCL.

Design  Retrospective cohort study.

Setting  The Stanford Comprehensive Cancer Center and dermatology ambulatory clinics.

Patients  A total of 48 patients with pcALCL evaluated from 1990 through 2005.

Main Outcome Measures  Hazard ratios (HRs) for prognostic factors for overall survival (OS) and disease-specific survival (DSS) and risk factors for progression to extracutaneous disease were identified using Cox regression. Gene expression profiles of 9 typical pcALCL and 3 ELD samples were investigated using complementary DNA microarrays.

Results  Univariate analysis demonstrated age, ELD, and progression to extracutaneous disease as significant prognostic factors for OS, whereas ELD and progression to extracutaneous disease were significant for DSS. In multivariate analysis, age (HR, 1.83; 95% confidence interval [CI], 1.02-3.26) and progression to extracutaneous disease (HR, 6.42; 95% CI, 1.39-29.68) remained significant for OS, whereas ELD (HR, 29.31; 95% CI, 1.72-500.82) and progression to extracutaneous disease (HR, 13.12; 95% CI, 1.03-167.96) remained independent prognostic factors for DSS. Presentation with T3 disease was a risk factor for progression to extracutaneous disease (HR, 10.20; 95% CI, 1.84-56.72). Microarray data revealed that patients with ELD and typical pcALCL formed distinct clusters.

Conclusions  Patients with ELD have a more aggressive course associated with a differential gene expression profile. More aggressive treatments may be indicated for patients with ELD and those whose disease progresses to extracutaneous disease because they have poorer outcomes.

Author Affiliations: Departments of Dermatology (Drs Woo, Jones, Kohler, and Kim), Health Research and Policy (Dr Woo), Pathology (Dr Vanoli-Storz and Kohler), Medicine, Division of Medical Oncology (Drs Reddy and Advani), and Radiation Oncology (Dr Hoppe), Stanford University, Stanford, California. Dr Woo is now with the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Cutaneous Lymphomas: What Can We Learn From Location?
Florent Grange and Frank Antonicelli
Arch Dermatol. 2009;145(6):710-712.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

CD30+ Lymphoproliferative Disease: The Mysterious Case of the Leg
Journal Watch Dermatology 2009;2009:3-3.
FULL TEXT  

Cutaneous Lymphomas: What Can We Learn From Location?
Grange and Antonicelli
Arch Dermatol 2009;145:710-712.
FULL TEXT