Objective To construct nomogram models to predict the risk factors for early death in patients with metastatic melanoma(MM).Methods The study covered 2138 cases from the Surveillance,Epidemiology,and End Results Program(SEER)database and all these patients were diagnosed with MM between 2010 and 2015.Logistic regression was performed to identify independent risk factors affecting early death in MM patients.These risk factors were then used to construct nomograms of all-cause early death and cancer-specific early death.The efficacy of the model was assessed with receiver operating characteristic(ROC)curves,calibration curves,and decision curve analysis(DCA).In addition,external validation of the model was performed with clinicopathologic data of 105 patients diagnosed with MM at Sichuan Cancer Hospital between January 2015 and January 2020.Results According to the results of logistic regression,marital status,the primary site,N staging,surgery,chemotherapy,bone metastases,liver metastases,lung metastases,and brain metastases could be defined as independent predictive factors for early death.Based on these factors,2 nomograms were plotted to predict the risks of all-cause early death and cancer-specific early death,respectively.For the models for all-cause and cancer-specific early death,the areas under the curve(AUCs)for the training group were 0.751(95%confidence interval[CI]:0.726-0.776)and 0.740(95%CI:0.714-0.765),respectively.The AUCs for the internal validation group were 0.759(95%CI:0.722-0.797)and 0.757(95%CI:0.718-0.780),respectively,while the AUCs for the external validation group were 0.750(95%CI:0.649-0.850)and 0.741(95%CI:0.644-0.838),respectively.The calibration curves showed high agreement between the predicted and the observed probabilities.DCA analysis indicated high clinical application value of the models.Conclusion The nomogram models demonstrated good performance in predicting early death in MM patients and can be used to help clinical oncologists develop more individualized treatment strategies.

OBJECTIVE: The aim of this study was to investigate associations between the morphology score of blastocysts and blastocoele re-expansion speed after warming with clinical outcomes, which could assist in making correct and cost-effective decisions regarding the appropriate time to vitrify blastocysts and to transfer vitrified-warmed blastocysts. METHODS: A total of 327 vitrified-warmed two-blastocyst transfer cycles in women 38 years old and younger were included in this retrospective study. RESULTS: The clinical pregnancy rate (CPR) and implantation rate (IR) of transfers of two good-morphology grade 4 blastocysts vitrified on day 5 (64.1% and 46.8%, respectively) were significantly higher than the CPR and IR associated with the transfers of two good-morphology grade 3 blastocysts vitrified on day 5 (46.7% and 32.2%, respectively). No significant differences were found in the CPR and IR among the transfers of two good-morphology grade 4 blastocysts regardless of the day of cryopreservation. Logistic regression analysis showed that blastocoele re-expansion speed after warming was associated with the CPR. CONCLUSION: The selection of a good-morphology grade 4 blastocyst to be vitrified could be superior to the choice of a grade 3 blastocyst. Extending the culture of grade 3 blastocysts and freezing grade 4 or higher blastocysts on day 6 could lead to a greater likelihood of pregnancy. Since re-expansion was shown to be a morphological marker of superior blastocyst viability, blastocysts that quickly re-expand after warming should be prioritized for transfer.
Blastocyst* ; Cardiopulmonary Resuscitation ; Cryopreservation ; Embryo Transfer ; Embryonic Development ; Female ; Freezing ; Humans ; Logistic Models ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Rate ; Pregnancy* ; Retrospective Studies