后巩膜外放射治疗时代（2004 - 2013年）葡萄膜黑色素瘤治疗后的护理模式及生存结果：一项监测、流行病学和最终结果分析
Patterns of care and survival outcomes after treatment for uveal melanoma in the post-coms era (2004-2013): a surveillance, epidemiology, and end results analysis.
作者信息
Rao Yuan James, Sein Julia, Badiyan Shahed, Schwarz Julie K, DeWees Todd, Grigsby Perry, Rao Prabakar Kumar
机构信息
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO.
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO.
出版信息
J Contemp Brachytherapy. 2017 Oct;9(5):453-465. doi: 10.5114/jcb.2017.70986. Epub 2017 Oct 20.
PURPOSE
The Collaborative Ocular Melanoma Study (COMS) established modern treatment recommendations for uveal melanoma. We aim to evaluate patterns of care and survival outcomes in the time after COMS.
MATERIAL AND METHODS
The retrospective study population includes 2,611 patients in the SEER database treated for uveal melanoma between 2004-2013. Patients stage were T1-4N0M0. Data analyzed included age, clinical stage, tumor size, race, and treatment. Treatments included enucleation (EN) and globe preserving therapy (GPT), which consisted of limited surgical resection or ablation (LSRA), external beam radiation (EBRT), or brachytherapy (BT). Patients treated with radiation may receive radiation therapy alone (RTA) or radiation therapy and supplemental laser therapy (RT+SLT). We evaluated disease specific survival (DSS) and overall survival (OS) using log-rank statistics, and Cox univariate and multivariate analysis.
RESULTS
The median follow-up was 44 months. Treatment strategy was EN in 538 (20.6%) patients, LSRA in 80 (3.1%), EBRT in 609 (23.3%), and BT in 1,384 (53.0%). 1,876 patients received RTA and 117 received RT+SLT. Enucleation was associated with inferior DSS and OS compared to GPT in multivariate analysis (MVA) ( < 0.01). Limited surgical resection or ablation and radiation had similar DSS and OS. Brachytherapy and EBRT had similar DSS and OS. Radiation therapy and supplemental laser therapy was associated with improved DSS compared to RTA in UVA ( = 0.03), but not MVA. The 5-year DSS for enucleation, RTA, and RT+SLT were 66.7%, 87.0%, and 94.7% ( < 0.01), respectively.
CONCLUSIONS
Globe preserving treatments such as limited surgery or radiation are commonly utilized alternatives to enucleation, and resulted in favorable survival outcomes. Additional research is required to compare the outcomes of the various globe preserving treatment strategies.
目的
协作性眼黑色素瘤研究（COMS）确立了葡萄膜黑色素瘤的现代治疗建议。我们旨在评估COMS之后一段时间内的治疗模式和生存结果。
材料与方法
回顾性研究人群包括2004年至2013年间在监测、流行病学和最终结果（SEER）数据库中接受葡萄膜黑色素瘤治疗的2611例患者。患者分期为T1 - 4N0M0。分析的数据包括年龄、临床分期、肿瘤大小、种族和治疗方式。治疗方式包括眼球摘除术（EN）和保眼球治疗（GPT），后者包括有限手术切除或消融（LSRA）、外照射放疗（EBRT）或近距离放疗（BT）。接受放疗的患者可能单独接受放射治疗（RTA）或放射治疗加补充激光治疗（RT + SLT）。我们使用对数秩统计、Cox单因素和多因素分析评估疾病特异性生存（DSS）和总生存（OS）。
结果
中位随访时间为44个月。治疗策略为眼球摘除术的患者有538例（20.6%），有限手术切除或消融的患者有80例（3.1%），外照射放疗的患者有609例（23.3%），近距离放疗的患者有1384例（53.0%）。1876例患者接受了单独放射治疗，117例患者接受了放射治疗加补充激光治疗。在多因素分析（MVA）中（P < 0.01），与保眼球治疗相比，眼球摘除术与较差 的疾病特异性生存和总生存相关。有限手术切除或消融与放疗的疾病特异性生存和总生存相似。近距离放疗和外照射放疗的疾病特异性生存和总生存相似。在单因素分析（UVA）中（P = 0.03），与单独放射治疗相比，放射治疗加补充激光治疗与改善的疾病特异性生存相关，但在多因素分析中并非如此。眼球摘除术、单独放射治疗和放射治疗加补充激光治疗的5年疾病特异性生存率分别为66.7%、87.0%和94.7%（P < 0.01）。
结论
诸如有限手术或放疗等保眼球治疗是常用的替代眼球摘除术的方法，并产生了良好的生存结果。需要进一步研究以比较各种保眼球治疗策略的结果。
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