Patel Mrinali, Winston Corinne B, Marr Brian P, Carvajal Richard D, Schwartz Gary K, Wolchok Jedd, Busam Klaus, Abramson David H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 70 E 66th St, New York, NY 10065, USA.
Arch Ophthalmol. 2011 Dec;129(12):1576-82. doi: 10.1001/archophthalmol.2011.263.
To describe the computed tomography (CT) features in patients with biopsy-proven hepatic metastases of uveal melanoma and correlate these findings with survival.
The medical records of patients with uveal melanoma evaluated at Memorial Sloan-Kettering Cancer Center from January 1998 to September 2009 were reviewed. Inclusion criteria were biopsy-proven liver metastasis and CT scan images available within 2 months of biopsy. Exclusion criteria were prior systemic or liver-directed therapy for uveal melanoma. Statistical analyses were carried out using the t test, χ(2) test, and Kaplan-Meier log-rank analyses.
Of 505 medical records reviewed, 76 were selected for study. Characteristic CT findings included multiple (68 patients [90%]), hypodense (100%), heterogeneous (100%), and enhancing (100%) hepatic lesions with a mean dominant lesion size of 46.8 cm(2). Eighteen patients (24%) exhibited hepatomegaly. Predominant lesion size larger than 100 cm(2), hepatomegaly, and ascites correlated with a lower survival rate (P = .008, P < .001, and P < .001, respectively). Radiographic evidence of extrahepatic metastases was present in 40 patients (53%). However, the presence of extrahepatic metastases did not affect survival. The results of at least 1 liver function test were abnormal in 46 of 67 patients (69%), and elevation of at least 1 serum transaminase and elevation of alkaline phosphatase were associated with larger lesions (P = .009 and P = .004, respectively) and hepatomegaly (P < .001 for both).
Radiographic evidence of predominant lesion size larger than 100 cm(2), hepatomegaly, and ascites-but not radiographic evidence of extrahepatic metastases-correlate with a lower survival rate in patients with biopsy-proven hepatic metastases of uveal melanoma.
描述经活检证实为葡萄膜黑色素瘤肝转移患者的计算机断层扫描（CT）特征，并将这些发现与生存率相关联。
回顾了1998年1月至2009年9月在纪念斯隆凯特琳癌症中心接受评估的葡萄膜黑色素瘤患者的病历。纳入标准为经活检证实的肝转移以及活检后2个月内可获得的CT扫描图像。排除标准为既往针对葡萄膜黑色素瘤的全身或肝定向治疗。使用t检验、χ²检验和Kaplan-Meier对数秩检验进行统计分析。
在审查的505份病历中，76份被选入研究。CT特征性表现包括多发（68例患者[90%]）、低密度（100%）、不均匀（100%）且有强化（100%）的肝脏病变，主要病变平均大小为46.8平方厘米。18例患者（24%）出现肝肿大。主要病变大小大于100平方厘米、肝肿大和腹水与较低的生存率相关（分别为P = 0.008、P < 0.001和P < 0.001）。40例患者（53%）有肝外转移的影像学证据。然而，肝外转移的存在并不影响生存率。67例患者中有46例（69%）至少1项肝功能检查结果异常，至少1种血清转氨酶升高和碱性磷酸酶升高与较大病变相关（分别为P = 0.009和P = 0.004）以及肝肿大相关（两者均为P < 0.001））。
经活检证实为葡萄膜黑色素瘤肝转移的患者中，主要病变大小大于100平方厘米、肝肿大和腹水的影像学证据——而非肝外转移的影像学证据——与较低的生存率相关。
