Mäkitie T, Summanen P, Tarkkanen A, Kivelä T
Department of Ophthalmology, Helsinki University Central Hospital, Finland.
J Natl Cancer Inst. 1999 Feb 17;91(4):359-67. doi: 10.1093/jnci/91.4.359.
Malignant melanoma of the ciliary body and choroid of the eye is a tumor that disseminates frequently, and 50% of the diagnosed patients die within 10 years. We investigated the hypothesis that, by histopathologic analysis of the arrangement of microvessels (i.e., small blood vessels) in loops and networks, we might be able to differentiate better those patients with a favorable prognosis from those with a poor prognosis.
We conducted a population-based, retrospective cohort study of melanoma-specific and all-cause mortality for 167 consecutive patients who had an eye surgically removed because of malignant choroidal or ciliary body melanoma during the period from 1972 through 1981. Microvascular loops and networks were evaluated independently by two pathologists who were unaware of patient outcome.
Microvascular patterns could be assessed in 134 (80%) of 167 melanoma specimens. The 10-year probability of melanoma-specific survival was worse if microvascular loops (0.45 versus 0.83; two-sided P<.0001) and networks (0.41 versus 0.72, two-sided P<.0001) were present. In multivariate Cox regression analysis of melanoma-specific survival, the hazard ratios were 1.66 (95% confidence interval [CI] = 1.19-2.30) for the presence of loops and networks as a combined three-category variable, 2.36 (95% CI = 1.37-4.05) for the presence of epithelioid cells, 1.11 (95% CI = 1.03-1.19) for the largest basal tumor diameter (evaluated as a continuous variable), and 2.14 (95% CI = 1.25-3.67) for ciliary body involvement.
Patients with malignant uveal melanoma who have a favorable prognosis can be distinguished from those with a poor prognosis by histopathologic analysis of microvascular patterns in uveal melanoma tumor specimens.
眼睫状体和脉络膜恶性黑色素瘤是一种常发生转移的肿瘤，50%的确诊患者会在10年内死亡。我们研究了这样一个假设，即通过对微血管（即小血管）呈环状和网状排列进行组织病理学分析，或许能够更好地区分预后良好和预后不良的患者。
我们对1972年至1981年期间因脉络膜或睫状体恶性黑色素瘤而接受眼球摘除手术的167例连续患者进行了一项基于人群的回顾性队列研究，分析黑色素瘤特异性死亡率和全因死亡率。两名不了解患者预后情况的病理学家独立评估微血管环和微血管网。
167例黑色素瘤标本中有134例（80%）可以评估微血管模式。如果存在微血管环（0.45对0.83；双侧P<0.0001）和微血管网（0.41对0.72，双侧P<0.0001），黑色素瘤特异性生存的10年概率更差。在黑色素瘤特异性生存的多变量Cox回归分析中，作为一个联合的三类变量，存在环和网的风险比为1.66（95%置信区间[CI]=1.19 - 2.30），存在上皮样细胞的风险比为2.36（95%CI = 1.37 - 4.05），最大基底肿瘤直径（作为连续变量评估）的风险比为1.11（95%CI = 1.03 - 1.19），睫状体受累的风险比为2.14（95%CI = 1.25 - 3.67）。
通过对葡萄膜黑色素瘤肿瘤标本中的微血管模式进行组织病理学分析，可以区分预后良好和预后不良的葡萄膜恶性黑色素瘤患者。
