Clinicopathologic relationships, survival, and therapy in 59 patients with observations on occupation as a new prognostic factor.

Clinicopathologic relationships, survival and therapy were reviewed in 59 patients with mycosis fungoides (MF). An analysis of patient survival disclosed that stage of disease was a significant prognostic variable only if both cutaneous and visceral manifestations were considered in the staging design. The classical three-stage format, based solely on findings of eczema (I), plaques (II), or skin tumors (III), was not a significant factor in predicting survival. However, the inclusion of lymphadenopathy (IV) and organomegaly (V) or circulation Sézary cells (VI) in an expanded model revealed a significant decline in the probability of survival with increasing stage of disease. Regarding cases where the original histopathologic material was available for review, there was no association between the histologic stage of the specimen and the morphology of skin lesions. These data militate against the use of a staging scheme based on histologic criteria. Among 30 different types of treatment employed during the course of this study, highdose electron beam was superior to all other physical and chemotherapeutic modalities. In a case-control study considering occupational factors, patients with MF who were employed in manufacturing or construction industries were at significantly increased risk (relative risk = 4.3). Patient survival was reduced considerably for those with industrial backgrounds, suggesting that this subgroup was inclined to have severe disease. The concept that occupational factors may be implicated in the etiology of mycosis fungoides provides a new dimension to previous pathogenic hypotheses that needs further evaluation.