Iris Melanoma Outcomes Based on the American Joint Committee on Cancer Classification (Eighth Edition) in 432 Patients-猫眼课题宝

DOI：

10.1016/j.ophtha.2017.11.040

发表时间：

2018-06-01

期刊：

OPHTHALMOLOGY

影响因子：

13.7

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Shields, Carol L.;Di Nicola, Maura;Shields, Jerry A.

目的：美国癌症联合委员会(AJCC)的分类于2017年1月更新为第八版，为虹膜黑色素瘤提供分期。这项研究评估了虹膜黑色素瘤的预后。设计：回顾性病例系列。参与者：432名虹膜黑色素瘤患者。方法：包括肿瘤切除、斑块放射治疗或眼球摘除。结果：在432例虹膜黑色素瘤患者中，AJCC分型为T1类324例(75%)，T2类83例[19%]，T3类2例[1%]，T4类23例[5%]。在T类别中，年龄、种族、性别、眼睛或虹膜颜色没有差异。总体而言，Kaplan-Meier分析结果显示，视力下降3行或以上(分别为42%和54%)、继发性青光眼(分别为29%和33%)、局部复发(分别为8%和17%)、继发性眼球摘除(分别为12%和19%)、淋巴结转移(分别为1%和1%)、黑色素瘤相关全身转移(分别为5%和10%)以及黑色素瘤相关死亡(分别为3%和4%)。与T1分类相比，非摘除眼局部复发的危险性比(HR)T2为1.31，不可估计性(NE)为T3(小队列)，T4为6.61；转移风险比T2为3.41，NE为T3(小队列)，T4为25.6；死亡风险比T2为7.51，T3为NE(小队列)，T4为26.5；摘除的优势比为T2 1.23，T3 3.63，T4 4.72。预测黑色素瘤相关转移的特征(多变量分析)包括继发性青光眼(P&lt；0.001；HR，4.51)、T2类型(vs T1；P=0.01；HR，4.09)和T4类型(vs T1；P&lt；0.001；HR，30.8)。预测黑色素瘤相关死亡的特征(多变量分析)包括高龄(P=0.008；HR，每10年增加2.16%)，T2分类(VS T1；P=0.005；HR，8.07)和T4分类(VS T1；P&lt；0.001；HR，20.3)。经多因素分析，T2组黑色素瘤相关转移率是T1组的4倍，T4组是T1组的31倍。与T1相比，与黑色素瘤相关的死亡比率T2和T4分别高出8倍和20倍。T3的队列规模太小，无法提供有用的信息。(C)2018年美国眼科学会

Purpose: The American Joint Committee on Cancer (AJCC) classification was updated to the eighth edition in January 2017, providing staging for iris melanoma. This study evaluated outcomes of iris melanoma per the AJCC classification, eighth edition.Design: Retrospective case series.Participants: Four hundred thirty-two patients with iris melanoma.Methods: Management including tumor resection, plaque radiotherapy, or enucleation. Main Outcome Measures: Local tumor recurrence, melanoma-related systemic metastasis, and melanoma-related death.Results: Of 432 patients with iris melanoma, AJCC classification was category T1 (n = 324 [75%]), T2 (n = 83 [19%]), T3 (n = 2 [< 1%]), and T4 (n = 23 [5%]). There was no difference in age, race, gender, eye, or iris color among T categories. Overall, Kaplan-Meier analysis of outcomes (at 5 and 10 years) revealed visual acuity reduction by 3 lines or more (42% and 54%, respectively), secondary glaucoma (29% and 33%, respectively), local recurrence (8% and 17%, respectively), secondary enucleation (12% and 19%, respectively), lymph node metastasis (1% and 1%, respectively), melanoma-related systemic metastasis (5% and 10%, respectively), and melanoma-related death (3% and 4%, respectively). Compared with T1 category, the hazard ratio (HR) for local recurrence in nonenucleated eyes was 1.31 for T2, not evaluable (NE) for T3 (because of small cohort), and 6.61 for T4; the HR for metastasis was 3.41 for T2, NE for T3 (because of small cohort), and 25.6 for T4; the HR for death was 7.51 for T2, NE for T3 (because of small cohort), and 26.5 for T4; and the odds ratio for enucleation was 1.23 for T2, 3.63 for T3, and 4.72 for T4. Features predictive of melanoma-related metastasis (multivariate analysis) included secondary glaucoma (P < 0.001; HR, 4.51), T2 category (vs. T1; P = 0.01; HR, 4.09), and T4 category (vs. T1; P < 0.001; HR, 30.8). Features predictive of melanoma-related death (multivariate analysis) included older age (P = 0.008; HR, 2.16 per 10-year increase), T2 category (vs. T1; P = 0.005; HR, 8.07), and T4 category (vs. T1; P < 0.001; HR, 20.3).Conclusions: The AJCC eighth edition classification provides prognostic stratification of iris melanoma. By multivariate analysis, the ratio for melanoma-related metastasis was 4 times greater in category T2 and 31 times greater in T4 compared with T1. The ratio for melanoma-related death was 8 times greater in category T2 and 20 times greater in T4 compared with T1. The cohort size for T3 was too small to provide useful information. (C) 2018 by the American Academy of Ophthalmology

Iris Melanoma Outcomes Based on the American Joint Committee on Cancer Classification (Eighth Edition) in 432 Patients

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