Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Kaliki is in practice at the Ocular Oncology Service, L. V. Prasad Eye Institute, Hyderabad, India.
Ophthalmology. 2013 Oct;120(10):2066-71. doi: 10.1016/j.ophtha.2013.03.012. Epub 2013 May 9.
To evaluate the clinical features and prognosis of posterior uveal (ciliary body and choroid) melanoma based on the American Joint Committee on Cancer (AJCC) classification (7th edition) of primary tumor (T).
Retrospective, interventional case series.
Seven thousand seven hundred thirty-one patients.
Ocular management including plaque radiotherapy, enucleation, local resection, or laser therapy.
Melanoma-related metastasis and death.
Of 7731 patients with posterior uveal melanoma, the AJCC classification based on T was category T1 in 3557 (46%), T2 in 2082 (27%), T3 in 1599 (21%), and T4 in 493 (6%). Based on tumor categories T1, T2, T3, and T4, respectively, features that showed significant increase with tumor category included patient age at presentation (57, 58, 58, and 61 years; P<0.001), tumor base (8, 12, 15, and 20 mm; P<0.001), tumor thickness (3.5, 5.2, 8.9, and 11.4 mm; P<0.001), mushroom configuration (8%, 20%, 38%, and 39%; P<0.001), associated subretinal fluid (64%, 80%, 82%, and 83%; P<0.001), intraocular hemorrhage (5%, 12%, 17%, and 18%; P<0.001), rupture of Bruch's membrane (9%, 24%, 40%, and 40%; P<0.001), and extraocular extension (1%, <1%, 4%, and 12%; P<0.001). After therapy, Kaplan-Meier estimates of metastasis at 5, 10, and 20 years were 8%, 15%, and 25% for category T1, 14%, 25%, and 40% for category T2, 31%, 49%, and 62% for category T3, and 51%, 63%, and 69% for category T4, respectively (P<0.001). Kaplan-Meier estimates of death at 5, 10, and 20 years were 4%, 8%, and 11% for category T1, 8%, 13%, and 24% for category T2, 19%, 27%, and 36% for category T3, and 30%, 43%, and 51% for category T4, respectively (P<0.001). Compared with category T1, the hazard ratio for metastasis and death for T2 was 1.8 and 1.9, respectively, that for T3 was 4.5 and 4.7, respectively, and that for T4 was 8.2 and 8.8, respectively.
Based on the AJCC classification, increasing tumor category was associated with older age, larger tumor, and greater incidence of subretinal fluid, hemorrhage, and extraocular extension. Compared with uveal melanoma classified as T1, the rate of metastasis and death was 2 times greater for T2, 4 times greater for T3, and 8 times greater for T4. The risk for metastasis and death increased 2-fold with each increasing melanoma category.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
根据美国癌症联合委员会（AJCC）原发性肿瘤 T 分期（第 7 版）评估后葡萄膜（睫状体和脉络膜）黑色素瘤的临床特征和预后。
回顾性、干预性病例系列。
7731 名患者。
包括眼贴放疗、眼球摘除、局部切除或激光治疗的眼部治疗。
与黑色素瘤相关的转移和死亡。
在 7731 名后葡萄膜黑色素瘤患者中，AJCC 基于 T 的分类为 T1 期 3557 例（46%），T2 期 2082 例（27%），T3 期 1599 例（21%），T4 期 493 例（6%）。分别基于肿瘤类别 T1、T2、T3 和 T4，与肿瘤类别显著相关的特征包括患者就诊时的年龄（分别为 57、58、58 和 61 岁；P<0.001）、肿瘤基底（分别为 8、12、15 和 20mm；P<0.001）、肿瘤厚度（分别为 3.5、5.2、8.9 和 11.4mm；P<0.001）、蘑菇样形态（分别为 8%、20%、38%和 39%；P<0.001）、合并视网膜下积液（分别为 64%、80%、82%和 83%；P<0.001）、眼内出血（分别为 5%、12%、17%和 18%；P<0.001）、Bruch 膜破裂（分别为 9%、24%、40%和 40%；P<0.001）和眼外扩展（分别为 1%、<1%、4%和 12%；P<0.001）。治疗后，Kaplan-Meier 估计的 5、10 和 20 年转移率分别为 T1 类别 8%、15%和 25%，T2 类别 14%、25%和 40%，T3 类别 31%、49%和 62%，T4 类别 51%、63%和 69%（P<0.001）。Kaplan-Meier 估计的 5、10 和 20 年死亡率分别为 T1 类别 4%、8%和 11%，T2 类别 8%、13%和 24%，T3 类别 19%、27%和 36%，T4 类别 30%、43%和 51%（P<0.001）。与 T1 类别相比，T2 转移和死亡的风险比分别为 1.8 和 1.9，T3 为 4.5 和 4.7，T4 为 8.2 和 8.8。
根据 AJCC 分类，肿瘤类别增加与年龄较大、肿瘤较大以及合并视网膜下积液、出血和眼外扩展的发生率较高有关。与 T1 期葡萄膜黑色素瘤相比，T2 期转移和死亡的发生率增加了 2 倍，T3 期增加了 4 倍，T4 期增加了 8 倍。每增加一个黑色素瘤类别，转移和死亡的风险就会增加 2 倍。
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