Iris melanoma - Risk factors for metastasis in 169 consecutive patients
Iris melanoma - Risk factors for metastasis in 169 consecutive patients
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DOI：
10.1016/s0161-6420(00)00449-8
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发表时间：
2001-01-01
期刊：
影响因子：
13.7
通讯作者：
Smith, A
中科院分区：
文献类型：
--
作者：
Shields, CL;Shields, JA;Smith, A
目的：确定预测虹膜恶性黑色素瘤远处转移的危险因素，设计：回顾性病例系列。参与者：参与者包括 1974 年至 1999 年间在威尔斯眼科医院肿瘤科接受治疗的 169 名连续显微镜确诊虹膜恶性黑色素瘤患者，主要结果指标：主要结果指标是远处肿瘤转移的发生。使用Cox比例回归模型计算最终转移扩散的风险。结果：在25年的时间里，在1054名疑似虹膜黑色素瘤（排除恶性黑色素瘤）的患者中，169名患者（16%）经显微镜证实患有虹膜黑色素瘤，其余（84%）经临床诊断为虹膜痣。在虹膜黑色素瘤患者中，诊断时的平均年龄年龄为 43 岁（中位数为 45 岁；范围为 1-90 岁）。所有患者均为白种人，平均肿瘤基底为 6 mm（中位，5 mm；范围，1-17 mm），平均肿瘤厚度为 2 mm（中位，2 mm；范围，1-4 mm），肿瘤累及虹膜的平均时钟小时数为 4，虹膜上肿瘤种植为 4，前房角肿瘤种植为 4。 10 只眼（6%）出现眼外延伸，102 名患者（60%）的肿瘤治疗包括局部切除（虹膜切除术、虹膜睫状体切除术或虹膜睫状体切除术），51 名患者（30%）摘除术，9 名患者（5%）进行斑块放疗，7 名患者（4%）观察，9 名患者（5%）发生转移。使用 Kaplan-Meier 生命表分析，3% 的患者在 5 年时发现转移，5% 在 10 年时发现转移，10% 在 20 年时发现转移。初步评估时预测虹膜黑色素瘤最终转移的临床因素包括诊断时年龄增加（P = 0.03）、眼内压升高（P = 0.03）、肿瘤后缘位于角部或虹膜根部（与中区相比）（P = 0.02）、眼外扩展（P = 0.02）以及转诊前在其他地方接受过肿瘤手术治疗（与观察相比）（P = 0.006）。治疗方法（切除、放疗或摘除）对转移没有影响。结论：显微镜证实的虹膜黑色素瘤在 10 年随访中显示 5% 的患者发生远处转移。年龄较大且表现出虹膜根/角位置肿瘤特征、眼内压升高和眼外延伸的患者更容易发生转移。眼科 2001；108:172-178 (C) 2001 年，美国眼科学会。
Objective: To identify risk factors that predict distant metastases of iris malignant melanoma,Design: Retrospective case series.Participants: The participants included 169 consecutive patients with microscopically confirmed iris malignant melanoma managed on the Oncology Service at Wills Eye Hospital between 1974 and 1999,Main Outcome Measures: The main outcome measure was the development of distant tumor metastasis. Cox proportional regression models were used to calculate the risk of eventual metastatic spread.Results: Of 1054 patients referred with suspicious iris melanocytic tumors (rule out malignant melanoma) over a 25-year period, 169 patients (16%) had microscopically proven iris melanoma, and the remainder (84%) had clinically diagnosed iris nevus, Of the patients with iris melanoma, the mean age at the time of diagnosis was 43 years (median, 45 years; range, 1-90 years). All patients were Caucasian, The mean tumor base was 6 mm (median, 5 mm; range, 1-17 mm), and mean tumor thickness was 2 mm (median, 2 mm; range, 1-4 mm), The mean number of clock hours of tumor involvement in the iris was four, tumor seeding on the iris was four, and tumor seeding into the anterior chamber angle was four. Extraocular extension was present in 10 eyes (6%), The tumor management consisted of local resection (iridectomy, iridocyclectomy, or iridocyclogoniectomy) in 102 patients (60%), enucleation in 51 (30%), plaque radiotherapy in 9 (5%), and observation in 7 patients (4%),Metastasis developed in nine patients (5%). Using Kaplan-Meier life table analysis, metastasis was found in 3% of patients at 5 years, 5% at 10 years, and 10% at 20 years. The clinical factors at initial evaluation predictive of eventual metastasis from iris melanoma included increasing age at diagnosis (P = 0.03), elevated intraocular pressure (P = 0.03), posterior tumor margin at angle or iris root (versus midzone) (P = 0.02), extraocular extension (P = 0.02), and prior surgical treatment of the tumor elsewhere before referral (versus observation) (P = 0.006). The method of management (resection, radiotherapy, or enucleation) did not have an impact on metastasis.Conclusions: Microscopically confirmed iris melanoma demonstrates distant metastasis in 5% of patients at 10 years follow-up. Metastases are more likely to develop in those patients who are older and show tumor features of iris root/angle location with elevated intraocular pressure and extraocular extension. Ophthalmology 2001;108:172-178 (C) 2001 by the American Academy of Ophthalmology.