Modifications of Callender's Classification of Uveal Melanoma at the Armed Forces Institute of Pathology.

One hundred well-documented cases of uveal melanoma accessioned at the Armed Forces Institute of Pathology before 1970 were reviewed and reclassified to identify changes made in the Callender classification. We compared the new classification with the original classification to determine the effect of the changes on the prediction of outcome for the patient after enucleation. Staff pathologists had originally classified 52 of the 100 cases as spindle-cell type melanoma.

Refined measurement of outcome for adjuvant breast carcinoma therapy.

Background: Traditional nonparametric statistical methods do not provide a quantitative measure of the lifetime benefit from adjuvant therapy. This deficiency makes it difficult to determine the long-term difference in impact between the two treatment arms of a clinical trial.

Methods: To assess the impact of breast carcinoma recurrence, parametric survival models were derived from two randomized, controlled clinical trials of adjuvant therapy for Stage II breast carcinoma.

The long-term clinical course of patients with cutaneous melanoma.

Background: The clinical course of cutaneous melanoma is associated with pathologic and clinical factors, such as thickness, ulceration, and location of tumor and gender of the patient. The authors used a parametric survival model that incorporated a cured fraction of patients to translate these factors into specific estimates of long-term outcome.

Methods: A cohort study was conducted of 5837 patients who were treated for localized cutaneous melanoma between 1978 and 1990 at the Duke Comprehensive Cancer Center.

Non-parametric comparison of relative versus cause-specific survival in Surveillance, Epidemiology and End Results (SEER) programme breast cancer patients.

Cancer-related mortality can be measured by two dissimilar methods: cause-specific survival (based on mortality attributed to a specific cause), and relative survival (based on mortality relative to a matched cohort). We used both methods to determine actuarial survival in a population of 119,502 breast cancer patients from the Surveillance, Epidemiology and End Results (SEER) programme data set, with 20 years of follow-up. The population was divided into four strata by patient age and tumour stage.

Parametric cure models of relative and cause-specific survival for grouped survival times.

With parametric cure models, we can express survival parameters (e.g. cured fraction, location and scale parameters) as functions of covariates.

End points in the analysis of breast cancer survival: relapse versus death from tumor.

Background: To determine whether relapse and death from tumor are comparable as survival end points for assessing therapeutic efficacy, five prospective, randomized clinical trials of adjuvant therapy for stage II breast cancer were analyzed. One thousand eight hundred ninety patients were combined from five clinical groups into a single group for analysis.

Methods: Actuarial and parametric survival methods were used to generate three estimates for the likelihood of cure (LOC): (1) for all patients, with relapse as the end point to survival (LOCR); (2) for all patients, with death from tumor as the end point (LOCD); and (3) for patients with relapse only with death from tumor as the end point (LOCRD).

Infiltrating ductal carcinoma of the breast: the survival impact of race.

Purpose: Breast cancer has a poorer prognosis among black women than among white women. This review was conducted to determine whether this disparity reflects the direct impact of race on likelihood of cure or on time to death from breast cancer or stems from the interaction of race with tumor stage and patient age.

Patients And Methods: We analyzed data from 115,838 patients with localized (node-negative) and regionally metastatic (node-positive) breast cancer from the Surveillance, Epidemiology, and End-Results (SEER) Program of the National Cancer Institute.

Improvement in the prognosis of breast cancer from 1965 to 1984.

Purpose: The prognosis of breast cancer has improved over the past three decades. It is uncertain, however, whether this improvement results from an increase in the cure rate, extension of the life span of uncured patients, or some combination.

Methods: From the Connecticut Tumor Registry, we obtained data on 25,091 patients with localized (node-negative) and regionally metastatic (node-positive) breast cancer who were diagnosed over the two decades between 1965 and 1984, with follow-up through 1993.

Comparison of parametric and non-parametric survival methods using simulated clinical data.

We derived three parametric survival models (the log-normal, log logit, and Weibull) from the clinical data of chemotherapy trials for stage II breast cancer. We then used these models to generate simulated survival data, which we analysed using both parametric (log-normal) and non-parametric (logrank, Gray-Tsiatis and Laska-Meisner) methods. With limited follow-up (5 years), the non-parametric tests had greater power than the log-normal model.

Ras oncogene-transformed and nontransformed cell populations are each heterogeneous but respond differently to the chemotherapeutic drug cytosine arabinoside (Ara-C).

In order to determine whether the growth of ras oncogene-transformed cells and nontransformed cells was inhibited differently by the chemotherapuetic drug cytosine arabinoside (Ara-C) their growth was analyzed by a novel colony-based assay that is sensitive and appropriate for heterogeneous cell populations. Colonies of nontransformed NIH3T3 cells, or ras oncogene-transformed NIH(ras) cells, were grown in the absence of drug and then divided into subclones. Subclones were allowed to continue to grow in the absence or presence of drug.

The impact of stage and histology on the long-term clinical course of 163,808 patients with breast carcinoma.

Background: Stage and histologic type have a significant impact on the long term clinical course of breast carcinoma. Clinical course is governed by two components: likelihood of cure and medial tumor-related survival time among uncured patients. Estimates of these components can be derived only by using survival models that incorporate cured fraction as a specific parameter.

Proliferative rate by S-phase measurement may affect cure of breast carcinoma.

Background: Standard, nonparametric statistical methods measure the interaction of covariates with survival rate or relative risk. Conversely, parametric methods measure the interaction of covariates with the two cardinal features of malignant potential: the likelihood of cure and the median time to relapse among uncured patients.

Methods: The authors performed parametric analysis on data from 810 patients with breast cancer using relapse as the survival end point.

Choroidal-ciliary body melanoma. A multivariate survival analysis of tumor location.

Background: Posterior uveal melanomas with ciliary body involvement have greater mortality when compared with choroidal melanomas. This study was conducted to determine if this association is due to an independent effect or to correlations with other parameters.

Methods: From the 4335 cases of uveal melanoma with follow-up data in the Registry of Ophthalmic Pathology, 664 were selected; therefore, approximately two thirds of the patients died of metastatic melanoma.

Parametric survival analysis of adjuvant therapy for stage II breast cancer.

Background: Standard, nonparametric statistical methods estimate only the impact of therapy on survival rate up to a selected follow-up interval. In contrast, parametric methods can estimate the impact of treatment on the two cardinal parameters of malignancy: likelihood of cure and recurrence free survival time among uncured patients.

Methods: The authors screened a total of six parametric survival models.

A stable, multivariate extension of the log-normal survival model.

When applied to survival data from a population of cancer patients, the log-normal model provides estimates of three important parameters: cured fraction, mean log survival time, and standard deviation log survival time. In the original model, however, these parameters are unrelated to prognostic covariates. Furthermore, the original algorithm is computationally unstable and highly dependent on initial parameter estimates.

Blood levels in macular cystoid spaces and their relationship to retinal vein obstruction.

Background: Blood levels in macular cystoid spaces are commonly seen in patients with branch or central retinal vein obstruction, but have not been previously reported.

Methods: To determine blood levels in cystoid spaces, a retrospective study was conducted of 102 eyes with branch retinal vein obstruction, 54 eyes with central retinal vein obstruction, 207 eyes with clinically significant diabetic macular edema, and 109 eyes with aphakic or pseudophakic cystoid macular edema seen over a 5-year period.

Results: Definite blood levels in cystoid spaces were found in 26 eyes (25%) with branch vein obstruction and in 4 eyes (8%) with central vein obstruction.

A model of long-term survival following adjuvant therapy for stage 2 breast cancer.

Following adjuvant therapy for breast cancer, some patients will die of this tumour while the remainder will die of other causes. Deaths from breast cancer tend to follow a lognormal distribution, while deaths from other causes can be approximated by national demographic data. By combining these two survival models, we have generated an age-specific method for estimating the impact of treatment on overall long-term survival.

Skin melanoma. Cured fraction and survival time as functions of thickness, site, histologic type, age, and sex.

Background: Previously, nonparametric or semiparametric methods have been used to determine the relationship of various prognostic covariates with survival of skin cancer. Unfortunately, these methods do not readily distinguish between factors that modulate cure and those that modulate survival time among uncured patients.

Methods: The multivariate lognormal model can be used to detect the association of cured fraction and median survival time with specific prognostic covariates.