Jang Bum-Sup, Chang Ji Hyun, Oh Sohee, Lim Yu Jin, Kim Il Han
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea (Republic of).
Department of Radiation Oncology, SMG-SNU Boramae Medical Center, 39 Boramae-Gil, Dongjak-gu, Seoul, Korea (Republic of).
Strahlenther Onkol. 2017 Nov;193(11):931-942. doi: 10.1007/s00066-017-1203-0. Epub 2017 Sep 6.
The treatment modalities for uveal melanoma (UM) include surgery and radiotherapy (RT). The utilization of RT as a strategy for organ preservation has been increasing, but the survival difference between the two aforementioned treatment modalities has not been reported.
An observational and cohort study was performed using a propensity score with an already existing public database. Patients diagnosed with UM within the period from 2004-2013 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. One-to-one matching and inverse probability of treatment weighting (IPTW) using the propensity score were used to estimate and compare survival rates.
Overall, 3291 patients were treated: 2503 received RT only (RT group) and 788 received surgical resection only (surgery group). The RT group had an improved crude 5‑year overall survival (OS) rate compared with the surgery group (76% vs. 60%, P < 0.001), and an improved 5‑year melanoma-specific survival (MSS) rate (89% vs. 73%, P < 0.001). Compared to the surgery group, the RT group was associated with improved OS (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.38-0.73, P < 0.001) and MSS (HR 0.48, 95% CI 0.35-0.65, P < 0.001) in the matched cohort. The survival benefit of the RT group maintained after adjustment with IPTW, both in OS and MSS.
To our knowledge, the present study was the first to demonstrate the survival difference between the two treatment modalities for UM using both the propensity score matching and weighting methods with the SEER database. The current study suggests that RT may provide a survival advantage over surgery in the treatment of UM.
葡萄膜黑色素瘤（UM）的治疗方式包括手术和放射治疗（RT）。将RT作为一种器官保留策略的应用一直在增加，但上述两种治疗方式之间的生存差异尚未见报道。
使用倾向评分和现有的公共数据库进行了一项观察性队列研究。从监测、流行病学和最终结果（SEER）数据库中选取2004年至2013年期间被诊断为UM的患者。采用倾向评分进行一对一匹配和治疗权重逆概率（IPTW）来估计和比较生存率。
总体而言，共治疗了3291例患者：2503例仅接受RT（RT组），788例仅接受手术切除（手术组）。与手术组相比，RT组的5年总生存率（OS）粗率有所提高（76%对60%，P<0.001），5年黑色素瘤特异性生存率（MSS）也有所提高（89%对73%，P<0.001）。在匹配队列中，与手术组相比，RT组的OS（风险比[HR]0.52，95%置信区间[CI]0.38 - 0.73，P<0.001）和MSS（HR 0.48，95%CI 0.35 - 0.65，P<0.001）均有所改善。经IPTW调整后，RT组在OS和MSS方面的生存获益均得以维持。
据我们所知，本研究首次使用倾向评分匹配和加权方法以及SEER数据库证明了UM两种治疗方式之间的生存差异。当前研究表明，在UM的治疗中，RT可能比手术具有生存优势。
