Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26.
Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26.
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DOI：
10.1001/archopht.123.12.1639
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发表时间：
2005-12
影响因子：
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通讯作者：
M. Diener-West;S. Reynolds;Donna J Agugliaro;R. Caldwell;K. Cumming;J. Earle;B. Hawkins;J. Hayman;I. Jaiyesimi;L. Jampol;J. Kirkwood;W. Koh;D. Robertson;J. Shaw;B. Straatsma;J. Thoma
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文献类型：
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作者：
M. Diener-West;S. Reynolds;Donna J Agugliaro;R. Caldwell;K. Cumming;J. Earle;B. Hawkins;J. Hayman;I. Jaiyesimi;L. Jampol;J. Kirkwood;W. Koh;D. Robertson;J. Shaw;B. Straatsma;J. Thoma
目的描述脉络膜黑色素瘤治疗与首次诊断转移性疾病之间的时间、转移部位、转移治疗以及诊断转移与死亡之间的时间。设计：对眼黑色素瘤协作研究组的2项随机试验中诊断为脉络膜黑色素瘤的患者进行前瞻性纵向随访。方法：根据标准方案，在随访期间对2320例参与眼黑色素瘤协作研究试验的患者进行系统和实验室评估，这些患者在基线时没有黑色素瘤转移或其他原发性癌症的证据。结果739例患者在脉络膜黑色素瘤治疗后的随访中被诊断出至少有一个转移部位。5年和10年累积转移率分别为25%（95%置信区间，23%-27%）和34%（95%置信区间，32%-37%）。肝脏是最常见的部位（89%）。报告黑色素瘤转移后的死亡率在1年时为80%（95%置信区间，77%-83%），在2年时为92%（95%置信区间，89%-94%）。转移后的总生存率不因原发肿瘤的基线大小或转移治疗（已知时）而变化。诊断转移后的长期生存是罕见的，只有8例患者生存5年或以上。结论：随着患者入组时原发性肿瘤尺寸的增加，转移率显着增加。转移性疾病后的预后仍然很差。需要有效的方法来预防、诊断和治疗脉络膜黑色素瘤的转移。
OBJECTIVE To describe the time between treatment for choroidal melanoma and first diagnosis of metastatic disease, sites of metastasis, treatments for metastasis, and time between diagnosis of metastasis and death. DESIGN Prospective, longitudinal follow-up of patients diagnosed with choroidal melanoma who were enrolled in 2 randomized trials conducted by the Collaborative Ocular Melanoma Study Group. METHODS Systemic and laboratory evaluations were performed during follow-up according to a standard protocol for 2320 patients enrolled in the Collaborative Ocular Melanoma Study trials without evidence of melanoma metastasis or other primary cancer at baseline. RESULTS Seven hundred thirty-nine patients were diagnosed with at least 1 site of metastasis during follow-up after treatment for choroidal melanoma. Five- and 10-year cumulative metastasis rates were 25% (95% confidence interval, 23%-27%) and 34% (95% confidence interval, 32%-37%), respectively. Liver was the most common site (89%). The death rate following the report of melanoma metastasis was 80% at 1 year (95% confidence interval, 77%-83%) and 92% at 2 years (95% confidence interval, 89%-94%). Overall survival after metastasis did not vary by baseline size of primary tumor nor treatment for metastasis (when known). Long-term survival after diagnosis of metastasis was uncommon; only 8 patients survived 5 or more years. CONCLUSION Metastasis rate increased significantly with increasing primary tumor dimensions at time of patient enrollment. Prognosis after metastatic disease remains poor. Effective methods are needed to prevent, diagnose, and treat metastasis from choroidal melanoma.