Tuomaala Seppo, Eskelin Sebastian, Tarkkanen Ahti, Kivelä Tero
Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
Invest Ophthalmol Vis Sci. 2002 Nov;43(11):3399-408.
To identify the clinical determinants of prognosis and the incidence of malignant conjunctival melanoma in whites.
A nationwide search identified 85 patients in whom primary conjunctival melanoma was diagnosed in Finland between 1967 and 2000, all of whom were enrolled. Data were collected from the Finnish Cancer and Population Registries and from patients' charts in all involved hospitals. The age-specific and age-adjusted incidences were calculated. Clinical characteristics of the tumors were recorded and time to local recurrence and melanoma-specific survival were analyzed by Kaplan-Meier analysis and univariate and multivariate extended Cox regression.
The annual crude incidence of conjunctival melanoma in Finland was 0.51 per million inhabitants, and the age-adjusted incidence (mean, 0.54) increased from 0.4 to 0.8 during the 34-year study period. The median age at diagnosis was 60 years (range, 20-90). Clinically detectable primary acquired melanosis preceded or accompanied the primary tumor in 61% of patients. The 5-year cumulative proportion of cases with local recurrence was 0.36 (95% confidence interval [CI], 0.25-0.48). The melanoma-specific 5-and 10-year mortalities were 0.20 (95% CI, 0.12-0.32) and 0.38 (95% CI, 0.26-0.53), respectively. By multiple-event Cox regression, nonlimbal location of the primary tumor predicted a short time to local recurrence (hazard ratio [HR] 1.81, P = 0.024). Nonlimbal location of the primary tumor (HR 4.08, P = 0.023) and increasing tumor thickness (HR 1.19 for each millimeter change, P=0.063) were associated with increased mortality. Local recurrence, analyzed as a time-dependent covariate, also increased mortality (HR 1.39 for each recurrence, P = 0.014).
The incidence of conjunctival melanoma in the white population of Finland increased analogous to cutaneous melanoma. Nonlimbal tumors recur more often and are associated with decreased survival, independent of their greater thickness. Local recurrence contributes to mortality, whereas primary acquired melanosis was not associated with either outcome.
确定白人结膜恶性黑色素瘤预后的临床决定因素及发病率。
通过全国范围的搜索，在芬兰1967年至2000年间确诊的原发性结膜黑色素瘤患者中识别出85例，并将其全部纳入研究。数据收集自芬兰癌症登记处、人口登记处以及所有相关医院的患者病历。计算年龄特异性发病率和年龄调整发病率。记录肿瘤的临床特征，并通过Kaplan-Meier分析以及单因素和多因素扩展Cox回归分析局部复发时间和黑色素瘤特异性生存率。
芬兰结膜黑色素瘤的年粗发病率为每百万居民0.51例，在34年的研究期间，年龄调整发病率（平均为0.54）从0.4增至0.8。诊断时的中位年龄为60岁（范围20 - 90岁）。61%的患者中，临床上可检测到的原发性获得性黑素沉着先于或伴随原发性肿瘤出现。局部复发的5年累积比例为0.36（95%置信区间[CI]，0.25 - 0.48）。黑色素瘤特异性5年和10年死亡率分别为0.20（95%CI，0.12 - 0.32）和0.38（95%CI，0.26 - 0.53）。通过多事件Cox回归分析，原发性肿瘤的非边缘部位预示局部复发时间较短（风险比[HR]1.81，P = 0.024）。原发性肿瘤的非边缘部位（HR 4.08，P = 0.023）和肿瘤厚度增加（每增加1毫米变化，HR 1.19，P = 0.063）与死亡率增加相关联。将局部复发作为时间依赖性协变量进行分析时，其也会增加死亡率（每次复发HR 1.39，P = 0.014）。
芬兰白人人群中结膜黑色素瘤的发病率与皮肤黑色素瘤类似呈上升趋势。非边缘部位的肿瘤复发更频繁，且与生存率降低相关，与肿瘤厚度较大无关。局部复发会导致死亡率上升，而原发性获得性黑素沉着与这两种结果均无关联。
