Screening for metastasis from choroidal melanoma: The Collaborative Ocular Melanoma Study Group report 23
Screening for metastasis from choroidal melanoma: The Collaborative Ocular Melanoma Study Group report 23
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DOI：
10.1200/jco.2004.08.194
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发表时间：
2004-06-15
影响因子：
45.3
通讯作者：
Thoma, J
中科院分区：
文献类型：
--
作者：
Diener-West, M;Reynolds, SM;Thoma, J
PurposeTo描述的预测值肝功能检查（LFTs），胸部X线，诊断成像检测黑色素瘤转移在常规随访治疗后脉络膜Melanoma.Materials and MethodsProspective纵向随访的患者入组到两个随机试验进行了合作眼黑色素瘤研究（COMS）组。基线和年度或半年一次的系统和实验室评价进行了根据标准协议的2,320例COMS.ResultsCOMS患者每年进行筛选转移和新的癌症使用LFT（碱性磷酸酶，AST，ALT，或胆红素）。LFT的升高结果（正常上限的1.5至2倍）提示诊断或影像学检查以确认或排除癌症复发。在714例有转移临床报告的患者中，675例患者死亡。在这675例患者中，除4例外，所有患者在死亡时均患有组织病理学证实或临床疑似转移性黑色素瘤。在所有患者中，转移性黑色素瘤的5年累积诊断率为24%（95%CI，22%至27%）。根据所有患者报告的转移，敏感性，特异性，阳性预测值和阴性预测值与至少一个异常LFT在任何部位的转移首次诊断前分别为14.7%，92.3%，45.7%和71.0%.ConclusionUse的LFT的结果，其次是诊断测试具有较高的特异性和预测值，但敏感性较低。需要更好的检测来识别与脉络膜黑色素瘤相关的早期转移性疾病。(C)2004年，美国临床肿瘤学会。
PurposeTo describe the predictive value of liver function tests (LFTs), chest x-ray, and diagnostic imaging for detecting melanoma metastasis during routine follow-up after treatment for choroidal melanoma.Materials and MethodsProspective longitudinal follow-up of patients enrolled onto two randomized trials was conducted by the Collaborative Ocular Melanoma Study (COMS) Group. Baseline and annual or semiannual systemic and laboratory evaluations were performed according to a standard protocol for 2,320 patients enrolled on the COMS.ResultsCOMS patients were screened annually for metastasis and new cancers using LFTs (alkaline phosphatase, AST, ALT, or bilirubin). Elevated findings (1.5 to 2 times upper limit of normal) on LFT prompted a diagnostic or imaging test to confirm or rule out cancer recurrence. Of 714 patients with clinical reports of metastasis, 675 patients died. Of these 675 patients, all but four had either histopathologically confirmed or clinically suspected metastatic melanoma present at the time of death. Among all patients, the 5-year cumulative diagnosis rate of metastatic melanoma was 24% (95% CI, 22% to 27%). Based on all patients with reported metastasis, the sensitivity, specificity, positive predictive value and negative predictive value associated with at least one abnormal LFT before first diagnosis of metastasis at any site was 14.7%, 92.3%, 45.7% and 71.0%, respectively.ConclusionUse of LFTs results followed by diagnostic tests has high specificity and predictive values but low sensitivity. Better tests are needed to identify earlier metastatic disease associated with choroidal melanoma. (C) 2004 by American Society of Clinical Oncology.