Prolonged survival after complete resection of metastases from intraocular melanoma
Prolonged survival after complete resection of metastases from intraocular melanoma
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DOI：
10.1002/cncr.11872
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发表时间：
2004-01-01
期刊：
影响因子：
6.2
通讯作者：
Morton, DL
中科院分区：
文献类型：
--
作者：
Hsueh, EC;Essner, R;Morton, DL
背景。诊断为眼内黑色素瘤转移后的中位生存时间仅为2-6个月。由于从皮肤原发肿瘤中完全切除转移性黑色素瘤可以延长生存期，作者假设切除也可能有利于眼内转移的患者。从1971年到1999年，112例眼内转移性黑色素瘤患者在获得知情同意后被纳入各种治疗方案。从患者数据库中检索前瞻性记录的临床变量和随访信息。使用Kaplan-Meier法估计生存曲线。采用log-rank检验进行单因素分析。采用Cox比例风险回归模型进行多因素分析。倾向评分分析用于减少亚组之间的不平衡，并评估治疗效果。78例（70%）患者表现为肝脏受累。24例（21%）患者行转移灶切除术。中位随访时间为11个月（1-97个月，存活者为36个月），中位生存期为11个月，5年生存率为7%。单因素分析显示，手术切除、转移部位、转移灶数量、无病间隔与生存率显著相关（P < 0.001、P < 0.001、P < 0.001、P = 0.031）。多因素分析显示手术切除有显著性意义（P = 0.008），而转移部位无显著性意义（P = 0.146）。手术患者的中位生存期和5年生存率分别为38个月和39%，而非手术患者的中位生存期和5年生存率分别为9个月和0%。通过倾向评分分析调整协变量不平衡后，多变量分析显示手术仍然显著（P = 0.021）。完全切除可能延长某些眼内原发性黑色素瘤远处转移患者的生存期。然而，总体的不良预后表明迫切需要更有效的非手术干预。(C) 2003年美国癌症协会。
BACKGROUND. The median survival time is only 2-6 months after a diagnosis of metastases from intraocular melanoma. Because complete resection of metastatic melanoma from a cutaneous primary tumor can prolong survival, the authors hypothesized that resection also might benefit patients with metastases from an intraocular site.METHODS. From 1971 to 1999, 112 patients with metastatic melanoma from an intraocular site were enrolled in various treatment protocols after informed consent was obtained. Prospectively recorded clinical variables and follow-up information were retrieved from the patient database. Survival curves were estimated using the Kaplan-Meier method. Univariate analysis was performed with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model. Propensity score analysis was used to reduce the imbalance between subgroups and to assess treatment effect.RESULTS. Seventy-eight patients (70%) presented with liver involvement. Twenty-four patients (21%) underwent resection of metastatic lesions. At a median follow-up time of 11 months (range, 1-97 months; > 36 months for survivors), the median survival period was 11 months and the 5-year survival rate was 7%. Univariate analysis showed that surgical resection, site of metastases, number of metastatic lesions, and disease-free interval were correlated significantly with survival (P < 0.001, P < 0.001, P < 0.001, and P = 0.031, respectively). Multivariate analysis showed that surgical resection was significant (P = 0.008) but that the site of metastases was not (P = 0.146). The median survival and the 5-year survival rate were 38 months and 39%, respectively, for surgical patients, versus 9 months and 0%, respectively, for nonsurgical patients. After adjusting for covariate imbalance by propensity score analysis, surgery remained significant (P = 0.021) on multivariate analysis.CONCLUSIONS. Complete resection may prolong survival in certain patients with distant metastases from intraocular primary melanoma. However, the overall unfavorable prognosis indicates an urgent need for more effective nonsurgical interventions. (C) 2003 American Cancer Society.