Melanoma skin cancer and organ failure
As part of the ceremonies on the occasion of the 539th anniversary of the founding of Ludwig-Maximilians-Universität (LMU) München, the Georg Heberer Award 2011 was presented to two medical researchers based at the University. Dr. Christian Kunte of the Department of Dermatology and Allergology and Dr. Christian Schneider of the Department of Surgery (Großhadern Campus) share the award and the prize money of 25,000 euros. Kunte received the award for a study of the clinical relevance of certain surgical interventions in the treatment of malignant melanoma. The work has practical implications for clinical assessment and prognosis in cases of malignant melanoma. Schneider was honored for a cohort study of the long-term survival of critically ill patients who required a prolonged period of organ support therapy before being discharged from intensive care. The results of this investigation have significant repercussions for the treatment of patients in intensive-care units. Both studies are particularly notable for the fact that they were based on long-term data that included lengthy periods of monitoring and follow-up of patients.
Dr. Christian Kunte
The incidence of malignant melanoma, a life-threatening form of cancer that is characterized by the uncontrolled growth of pigmented cells in the skin, is increasing worldwide. The aim of Dr. Kunte’s study, entitled “Prognostic factors associated with sentinel lymph node positivity and effect of sentinel status on survival: an analysis of 1049 patients with cutaneous melanoma”, was to analyze data bearing on the clinical utility of a particular surgical procedure used to assess the severity of the disease in patients suffering from malignant melanoma. The study focused on the diagnostic significance of the so-called sentinel lymph-node biopsy (SLNB). This procedure involves the surgical removal and pathological analysis of the lymph node nearest to the primary tumor. The clinical value of the operation is the subject of intense debate. Current guidelines suggest that SLNB should be performed when the thickness of the primary tumor exceeds 1 mm, or when other factors, such as a high rate of cell division, indicate an unfavorable clinical outcome. The study carried out by Kunte and his colleagues was designed to assess the influence of a positive SLNB test on subsequent treatment options and on survival times (disease-free and overall) of patients with tumors of different histological types. The team analyzed data from patients who had undergone SLNB in association with removal of the primary tumor in the period between 1996 and 2007. The researchers focused in particular on SLN status, i.e. whether or not the sentinel lymph node showed signs of metastatic disease. Using various statistical techniques, Kunte and his colleagues were able to show that not only the size of the tumor, but also the tumor subtype determines the probability of involvement of the sentinel node. In addition to tumor size, the presence of a particular class of tumor – so-called nodular malignant melanoma – is positively correlated with the direct metastatic involvement of the sentinel lymph node. Both SLN status and tumor size, in turn, have a significant impact on the probability that the patients remain disease free for at least 5 years following the intervention, with SLN status being the more important of the two. The study clearly showed that SLNB is both diagnostically and prognostically useful, and together with the size of the tumor, also has significant predictive value for survival. Furthermore, the data suggest that SLNB is indicated in certain cases where tumor thickness is less than 1 mm, specifically in patients with nodular subtypes of malignant melanoma.
Christian Kunte was born in Munich in 1968, and studied medicine there from 1988 until 1995. Since completion of his studies, Kunte has worked at the University’s Department of Dermatology and Allergology and at Munich City Hospital. In 1999 he earned his doctoral degree at the Walther Straub Institute of Pharmacology and Toxicology at LMU. Two years later he qualified as a Consultant in Dermatology and Venereal Diseases, and later went on to complete specialist training in allergology. Kunte became a Senior Consultant in 2007, and joined the Board of the German Society of Dermatologic Surgery in 2009.
Dr. Christian Schneider
The purpose of Christian Schneider’s study of “Long-term survival after surgical critical illness: The impact of prolonged preceding organ support therapy” was to assess the long-term prognosis for patients who have spent extended periods in intensive-care units. Patients who are critically ill and show signs of serious organ dysfunction, or are in danger of organ failure, need intensive care. If organ failure does occur, the patient must receive organ support therapy. Schneider and his colleagues set out to assess the impact of therapies such as pharmacological stabilization of the cardiovascular system, invasive ventilation or dialysis, on the long-term prognosis. The study took advantage of a database containing information on a wide range of physiologically relevant parameters collected over a period of 12 years, and documenting the survival status of patients for at least two years after admission to the intensive care unit. The study revealed that, for patients who had been in intensive care for more than four days, survival rates attained a stable plateau 195 days after admission. Statistical analysis of the effects of organ-support therapies furthermore showed that the duration of such procedures during the acute phase had no significant influence on the long-term prognosis. The major determinants of long-term outcome were the nature of the underlying disease and the oncological status of the patient. However, the scope of organ failure during the intensive-care phase was not entirely decoupled from the long-term outcome. The researchers detected a minor but significant association between the maximal extent of physiological perturbation and long-term survival. The number of organ systems that required support, on the other hand, was of no prognostic significance. Schneider’s results show, first of all, that patients who spent more than four days under intensive care took up to six months to overcome the acute sequelae of the underlying condition. Secondly, such patients seem to suffer from a “post-intensive-care syndrome”, the duration of which is mainly determined by the severity of the preceding organ failure. This finding underlines the need to ensure that all necessary interventions should be initiated as quickly as possible, in order to minimize the extent of damage to vital organs.
Christian Schneider was born in Munich in 1972, and studied medicine there from 1993 to 1999. He obtained his clinical research doctorate in surgery in 2007 at the Medical Center of the University of Munich. Following a research fellowship in the US, he received a position at the Department of Surgery at the Medical Center of the University of Munich in 2001, and became a member of the Munich Lung Transplant Group based there in the following year. In 2009 Schneider completed his training as a Consultant Surgeon, and in October 2010 he was sent on rotation to the Department of Thoracic Surgery at the Asklepios Lung Medical Center in München-Gauting.
The Heberer Award
The Georg Heberer Award, which is named after the surgeon Prof. Dr. Dr. h. c. Georg Heberer (1920-1999) and is sponsored by the Chiles Foundation (Portland, Oregon), was presented for the first time in the year 2000. Heberer was Professor of Surgery and Director of the Department of Surgery at the Großhadern Medical Campus. As a teacher and researcher, he was greatly respected for the breadth of his knowledge, and his surgical skills were internationally recognized. The Heberer Award is presented annually to researchers who have made notable contributions to surgery during the preceding year.
The Prize is sponsored by the Chiles Foundation, which was founded over 50 years ago with the aim of supporting medical research particularly in the field of cancer. The Foundation has endowed large institutes at Boston University and Stanford University as well as the Earle A. Chiles Research Institute at Providence Medical Center in Portland. In 1986, intensive scientific contacts and exchanges were initiated between the Department of Surgery at the Medical Center of the University of Munich, Harvard Medical School and Oregon Health & Science University. The generously endowed Georg Heberer Awards are intended to support and encourage talented junior researchers based at German universities to pursue scientific projects in cooperation with international collaborators.
Prof. Dr. med. Rudolf A. Hatz, FACS
Department of Surgery, Medical Center of the University of Munich
Phone: +49 (0)89 / 7095 - 3511
Fax: +49 (0) 89 / 7095 - 3508