对于不同大小脉络膜黑色素瘤治疗后因转移导致的观察到的死亡率的另一种假设。
An alternative hypothesis for observed mortality rates due to metastasis after treatment of choroidal melanomas of different sizes.
作者信息
Augsburger James J, Corrêa Zélia M, Trichopoulos Nikolaos
机构信息
Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
出版信息
Trans Am Ophthalmol Soc. 2007;105:54-59; discussion 59-60.
PURPOSE
To propose an alternative hypothesis for the observed differential survival of patients with small, medium, and large choroidal melanomas based on recently uncovered cytogenetic evidence about melanocytic choroidal tumors.
METHODS
Review and analysis of published data.
RESULTS
Recent evidence has shown that recurring nonrandom cytogenetic abnormalities are present within virtually all cytomorphologically malignant cells that compose choroidal melanomas and that certain individual cytogenetic abnormalities and combinations of these abnormalities are important prognostic factors for metastasis and metastatic death. Although these cytogenetic abnormalities are strongly correlated with recognized clinical prognostic factors (tumor size, intraocular tumor location) and histomorphologic prognostic factors (melanoma cell type, vascular mimicry pattern) for metastasis, most laboratories have found these cytogenetic abnormalities to be much more robust indicators that metastasis will or will not develop than these clinical and histopathologic factors. In most series of uveal melanomas evaluated by current cytogenetic methods, approximately 30% to 60% of the tumors have cytogenetic abnormalities indicative of high likelihood of metastasis posttreatment. Evidence suggests that these abnormalities are more frequent in larger tumors than in smaller ones. Survival analyses of uveal melanoma patients whose tumors have been evaluated cytogenetically have shown rates of metastasis that approach 100% for patients with a tumor exhibiting monosomy 3 or a class 2 gene expression profile but are very low for those with a tumor that did not exhibit these cytogenetic abnormalities.
CONCLUSION
The better prognosis of patients with smaller choroidal melanomas is likely to be attributable to a lower probability of cytogenetic abnormalities indicative of metastatic capability among smaller tumors and not to effectiveness of treatment at preventing metastasis.
目的
基于最近发现的关于脉络膜黑素细胞瘤的细胞遗传学证据，为观察到的小、中、大脉络膜黑素瘤患者的差异生存情况提出另一种假设。
方法
对已发表数据进行回顾和分析。
结果
最近的证据表明，几乎所有构成脉络膜黑素瘤的细胞形态学恶性细胞中都存在反复出现的非随机细胞遗传学异常，并且某些个体细胞遗传学异常及其组合是转移和转移死亡的重要预后因素。尽管这些细胞遗传学异常与公认的转移临床预后因素（肿瘤大小、眼内肿瘤位置）和组织形态学预后因素（黑素瘤细胞类型、血管拟态模式）密切相关，但大多数实验室发现，与这些临床和组织病理学因素相比，这些细胞遗传学异常是转移是否会发生的更有力指标。在目前通过细胞遗传学方法评估的大多数葡萄膜黑素瘤系列中，约30%至60%的肿瘤具有表明治疗后转移可能性高的细胞遗传学异常。有证据表明，这些异常在较大肿瘤中比在较小肿瘤中更常见。对肿瘤已进行细胞遗传学评估的葡萄膜黑素瘤患者的生存分析表明，肿瘤表现出3号染色体单体或2类基因表达谱的患者转移率接近100%，而肿瘤未表现出这些细胞遗传学异常的患者转移率非常低。
结论
较小脉络膜黑素瘤患者预后较好可能归因于较小肿瘤中具有转移能力的细胞遗传学异常的可能性较低，而非治疗在预防转移方面的有效性。
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