Aoyama T, Mastrangelo M J, Berd D, Nathan F E, Shields C L, Shields J A, Rosato E L, Rosato F E, Sato T
Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Cancer. 2000 Oct 1;89(7):1561-8. doi: 10.1002/1097-0142(20001001)89:7<1561::aid-cncr21>3.0.co;2-r.
The objective of this study was to evaluate the usefulness of resection of metastatic uveal melanoma and to analyze the characteristics of patients who may benefit from surgical intervention. PATIENTS AND METHODS Twelve patients underwent surgical removal of metastasis between 1976 and 1998. Data regarding primary uveal melanoma, systemic metastasis, surgical procedures, and outcomes were reviewed retrospectively.
There were seven patients with liver metastases, two with lung metastases, one with brain metastasis, and two patients with metastases in the liver and other organs. Median time to systemic metastasis was 8 years. Seven of 12 patients were asymptomatic when they were found to have metastasis. Ten patients underwent complete resection of metastasis. No significant surgical complications were experienced. Median recurrence free and overall survival periods after complete resection were 19 months (range, 6-78 months) and greater than 27 months (range, 11-86 months), respectively. Recurrence free and overall 5-year survival rates of those patients were 15.6% and 53.3%, respectively. Three of these patients had no further systemic recurrence. All patients whose time to systemic metastasis was within 5 years developed further systemic recurrence within 2 years after surgery. In contrast, in 8 patients whose time to systemic metastases was greater than 5 years, 4 patients either were recurrence free or developed second metastasis more than 4 years after surgery.
Complete surgical removal of metastatic uveal melanoma provided unexpectedly long survival without significant morbidity for the selected patients. These results are encouraging and justify a trial in which patients eligible for resection are randomized between standard treatment and surgery.
本研究的目的是评估转移性葡萄膜黑色素瘤切除术的有效性，并分析可能从手术干预中获益的患者特征。
1976年至1998年间，12例患者接受了转移灶的手术切除。回顾性分析了有关原发性葡萄膜黑色素瘤、全身转移、手术方式及预后的数据。
7例患者有肝转移，2例有肺转移，1例有脑转移，2例有肝及其他器官转移。发生全身转移的中位时间为8年。12例患者中有7例在发现转移时无症状。10例患者接受了转移灶的完整切除。未发生严重手术并发症。完整切除术后的中位无复发生存期和总生存期分别为19个月（范围6 - 78个月）和大于27个月（范围11 - 86个月）。这些患者的5年无复发生存率和总生存率分别为15.6%和53.3%。其中3例患者未发生进一步的全身复发。所有全身转移发生时间在5年内的患者在术后2年内均出现了进一步的全身复发。相比之下，在全身转移发生时间大于5年的8例患者中，4例患者无复发或在术后4年以上发生了第二次转移。
对于部分选择的患者，完整手术切除转移性葡萄膜黑色素瘤可带来意外的长期生存，且无明显并发症。这些结果令人鼓舞，为进行一项将符合切除条件的患者在标准治疗和手术之间进行随机分组的试验提供了依据。
