In the last two decades, many studies have focused on the muscles and dense connective tissues located in the suboccipital region. Our study investigated the existence of the second terminations originating from the suboccipital muscles, and the relationship between the variable types of the To Be Named Ligament (TBNL). Anatomical dissection was performed on 35 head-neck specimens. The existence of the second terminations of the suboccipital muscles was confirmed and various types of the TBNL were observed in this study. The second terminations originated from multiple suboccipital muscles including the rectus capitis posterior minor (RCPmi), rectus capitis posterior major (RCPma) and obliquus capitis inferior (OCI) muscles, merged and terminated at the TBNL. The overall incidence of the second terminations of the suboccipital muscles was 34.29% and it varied among the various suboccipital muscle origins. 28.57% of the second terminations originated from the RCPma; 11.43% was from the RCPmi and 8.57% was from the OCI. Furthermore, there was a significant relationship between the existence of second terminations and the particular type of the TBNL. 95% of the arcuate type of the TBNL was accompanied with the second terminations which attached to their turning part, whereas only 10% of all the radiate type of the TBNL was accompanied with the second terminations. This study for the first time described the second terminations originating from multiple suboccipital muscles and demonstrated the relationship with the various types of the TBNL. We speculated that the second terminations maintain the arcuate TBNL and transfer tensile forces to the Myodural Bridge (MDB), thereby modulating the physiological functions of the MDB.
IntroductionThis study aimed to develop and validate a nomogram for predicting cancer-specific survival (CSS) in patients with non-keratinized large cell squamous cell carcinoma (NKLCSCC) at 3, 5, and 8 years after diagnosis.MethodsData on SCC patients were collected from the Surveillance, Epidemiology, and End Results database. Training (70%) and validation (30%) cohorts were generated using random selection of patients. Independent prognostic factors were selected using the backward stepwise Cox regression model. To predict the CSS rates in patients with NKLCSCC at 3, 5, and 8 years after diagnosis, all of the factors were incorporated into the nomogram. Indicators such as the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), calibration curve, and decision-curve analysis (DCA) were then used to validate the performance of the nomogram.ResultsThis study included 9,811 patients with NKLCSCC. Twelve prognostic factors were identified by Cox regression analysis in the training cohort, which were age, number of regional nodes examined, number of positive regional nodes, sex, race, marital status, American Joint Committee on Cancer (AJCC) stage, surgery status, chemotherapy status, radiotherapy status, summary stage, and income. The constructed nomogram was validated both internally and externally. The nomogram had good discrimination ability, as indicated by the comparatively high C-indices and AUC values. The nomogram was properly calibrated, as indicated by the calibration curves. Our nomogram was superior to the AJCC model, as illustrated by its superior NRI and IDI values. DCA curves indicated the clinical usability of the nomogram.ConclusionThe first nomogram for prognosis predictions of patients with NKLCSCC has been developed and verified. Its performance and usability demonstrated that the nomogram could be utilized in clinical settings. However, additional external verification is still required.
Background: The effects of various surgical options and ulcerations on the survival of patients with stage IV skin malignant melanoma are unknown. Therefore, we evaluated the potential of these factors as prognostic markers in patients with stage IV malignant melanoma. Methods: We included 5760 patients from 2004–2015 who are screened from the SEER datasets in the study. The patients were divided into four groups: the R 0 group, the primary tumor resection group, the metastasectomy group, and the no-resection group. The median follow-up survival time and overall survival were compared between the four groups as primary outcomes. Result: The R0 , primary tumor resection, metastasectomy, and no-resection groups had median survival times of 11, 13, 20, and 4 months, respectively ( p <0.001). Cox (proportional hazards) regression models estimated that patients in the R 0 , primary tumor resection, and metastasectomy groups had longer survival benefits, with hazard ratios of 0.396 (95% confidence interval [CI], 0.347–0.453), 0.509 (95% CI, 0.465–0.556), and 0.481 (95% CI, 0.447–0.519), respectively. Conclusion: We highlight the importance of surgery in metastatic melanoma; each surgical group in this study is independently correlated with increased survival. In addition, the patient’s ulceration status is able to predict surgical treatment; however, in the ulcerated melanoma cases, caution should be exercised when considering a metastasectomy.
Background: Applying a competing-risks analysis to data from the Surveillance, Epidemiology, and End Results (SEER) database, we aimed to identify significant prognostic factors and evaluate the cumulative incidence of cause-specific (CS) death for skin verrucous carcinoma (SVC). The Cox proportional-hazards model, extensively employed in assessing survival trends and identifying prognostic indicators, has the potential to generate erroneous predictions. However, in the realm of clinical practice, there is still a lack of specific prognostic factors for cutaneous verrucous carcinoma, leading to disproportionate treatment. The insights derived from this analysis can serve as valuable guidance for clinical interventions Methods: The SEER database provided relevant data of patients with SVC. The reliability, precision, and logicality of estimations for cumulative incidence function (CIF) related to CS mortality and death from other causes at each time point were enhanced through the utilization of competing-risks analysis. In the univariate analyses, Gray's test and the CIF were used, while the multivariate analysis employed the Cox proportional-hazards model, CS, and the Fine-Gray model. Results: The study involved 656 eligible patients with SVC, with 332 deaths recorded: 115 attributed to SVC and 217 resulting from other causes. Univariate analyses revealed that variables such as differentiation grade, marital status, metastasis, American Joint Committee on Cancer (AJCC) stage, age, surgery, the status of radiotherapy, and chemotherapy significantly influenced the cumulative incidence rates for events of interest (P<0.05). Marital status, AJCC stage, race, age, and surgery status, emerged as independent risk factors in the multivariate Cox regression. Based on the multivariate Fine-Gray and CS model analysis, age, AJCC stage, differentiation grade, and surgery independently served as key determinants affecting the risk of specific outcomes in SVC patients (P<0.05). Conclusions: The novel competing-risks model increased the accuracy of predictions by examining the cumulative incidence rate of cancer-specific mortality. Moreover, this approach is high useful in research for obtaining data such as the prognostic variables for SVC.
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