RISK-FACTORS FOR GROWTH AND METASTASIS OF SMALL CHOROIDAL MELANOCYTIC LESIONS
RISK-FACTORS FOR GROWTH AND METASTASIS OF SMALL CHOROIDAL MELANOCYTIC LESIONS
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DOI：
10.1016/s0161-6420(95)30864-0
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发表时间：
1995-09-01
期刊：
影响因子：
13.7
通讯作者：
CATER, JR
中科院分区：
文献类型：
--
作者：
SHIELDS, CL;SHIELDS, JA;CATER, JR
背景：小的黑色素细胞脉络膜肿瘤的治疗是有争议的。这一争议的一个重要原因是这些病变的自然病程和转移潜力没有明确定义。先前的研究试图阐明这些病变的自然病程，主要集中在选定的小规模脉络膜黑色素瘤患者。目前还没有大型的研究，调查的生长潜力和转移潜力的频谱小黑色素细胞脉络膜肿瘤时，考虑到一个完整的群体。此外，这些肿瘤的转移预测的临床特征尚未被identified.Methods：进行了回顾性分析，对1329例小黑色素细胞脉络膜肿瘤测量3毫米或更少的厚度。获得患者和肿瘤的临床参数，并使用考克斯比例风险回归模型分析其与最终肿瘤生长和转移的关系。预测肿瘤生长的因素（多变量分析）包括更大的肿瘤厚度（P = 0.0001），后方肿瘤边缘接触视盘（P = 0.0001），闪光症状，飞蚊症（P = 0.002），视力模糊（P = 0.003）与无症状、肿瘤表面有橙子色素（P = 0.004）和存在视网膜下液（P = 0.05）相比。相对于肿瘤厚度小于等于1 mm以及后缘接触视盘（RR = 2.6），初始肿瘤厚度2.1 - 3.0 mm（RR = 5.2）和肿瘤厚度1.1 - 2.0 mm（RR = 4.3）的相对风险（RR）最大。在调整了重要的肿瘤变量后，与未治疗的持续观察相比，介入肿瘤治疗的效果显示肿瘤生长的风险降低。在1329例患者中，35例（3%）发生转移。预测转移的因素（多变量分析）包括后肿瘤边缘接触视盘（P = 0.003），记录的增长（P = 0.003），和更大的肿瘤厚度（P = 0.004）。转移的相对风险是最大的肿瘤厚度为1.1至3.0毫米（RR = 8.8）和增长（RR = 3.2）。结论：小脉络膜黑色素细胞肿瘤测量3毫米或更少的厚度在初次检查时，18%的增长和3%的转移在随访期间。基于这种分析，这些肿瘤的临床特征可用于估计肿瘤生长和转移的风险，并协助临床医生进行患者管理。
Background: The management of small melanocytic choroidal tumors is controversial. An important reason for this controversy is that the natural course and metastatic potential of these lesions are not defined clearly. Prior studies that have attempted to elucidate the natural course of these lesions have focused on selected small groups of patients with presumed small choroidal melanomas. There are no large studies investigating the growth potential and metastatic potential for the spectrum of small melanocytic choroidal tumors when considered as an unselected whole group. In addition, the clinical features of these tumors predictive of metastases have not yet been identified.Methods: A retrospective review was performed on 1329 patients with small melanocytic choroidal tumors measuring 3 mm or less in thickness. Clinical parameters of the patient and tumor were obtained and analyzed for their relation to eventual tumor growth and metastasis using a Cox proportional hazards regression model.Results: Tumor growth was documented in 18% of patients. The factors predictive of tumor growth (multivariate analysis) included greater tumor thickness (P = 0.0001), posterior tumor margin touching optic disc (P = 0.0001), symptoms of flashes, floaters (P = 0.002), and blurred vision (P = 0.003) relative to no symptoms, orange pigment on the tumor surface (P = 0.004), and the presence of subretinal fluid (P = 0.05). The relative risk (RR) was greatest for initial tumor thickness 2.1 to 3.0 mm (RR = 5.2) and tumor thickness 1.1 to 2.0 mm (RR = 4.3) relative to tumors 1 mm or less in thickness, as well as posterior margin touching the optic disc (RR = 2.6). After adjusting for significant tumor variables, the effect of interventional tumor treatment showed a decreasing risk for tumor growth compared with continued observation without treatment. Of 1329 patients, metastases developed in 35 (3%). The factors predictive of metastases (multivariate analysis) included posterior tumor margin touching the optic disc (P = 0.003), documented growth (P = 0.003), and greater tumor thickness (P = 0.004). The relative risk for metastases was greatest for tumor thickness 1.1 to 3.0 mm (RR = 8.8) and growth (RR = 3.2).Conclusion: Of small choroidal melanocytic tumors measuring 3 mm or less in thickness at the time of initial examination, 18% demonstrated growth and 3% metastasized during the period of follow-up. Based on this analysis, the clinical features of these tumors can be used to estimate the risk for tumor growth and metastases and assist the clinician with patient management.