Pinto-Proença Rita, Santos Mariana, Fonseca Cristina, Fernandes Júlia, Gaspar Maria Filomena, Proença Rui
Ophthalmology Department, Central Lisbon Hospital Center, Hospital de Santo António dos Capuchos, Alameda de Santo António dos Capuchos, 1169-050, Lisbon, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Graefes Arch Clin Exp Ophthalmol. 2018 May;256(5):989-995. doi: 10.1007/s00417-017-3864-x. Epub 2018 Jan 2.
Conjunctival melanoma is a rare but potentially lethal tumor. Its biologic profile is still largely unknown, with recent studies aiming at establishing histopathological and genetic tumor profiles. The aim of this study was to analyze the association between clinicopathological characteristics and tumor expression of cyclooxygenase-2 (COX-2) to prognosis, assessing its usefulness as a possible prognostic marker.
Case series of 50 patients from 1991 to 2008 with pathologically proven conjunctival melanoma. Demographic, clinical, and pathological characteristics were evaluated by reviewing clinical files and pathology. Expression of COX-2 was studied by immunohistochemistry of formalin-fixed paraffin-embedded tissue samples of 20 melanomas. Samples were classified in a score which included intensity of staining and percentage of cells with positive reactivity.
Clinicopathological features significantly associated (p < .05) with a poor prognosis (death) included involvement of fornix and tarsal conjunctiva, tumor thickness exceeding 2 mm, local tumor recurrence, lymph node, and systemic metastasis. In the immunohistochemistry study (n = 20), 18 cases expressed COX-2 although with different scores. However, only cases with a high score were associated with a poor outcome. Multivariate association analysis revealed that recurrence rate, metastasis, corneal invasion, and tumor thickness were associated with high score cases and, therefore, with a clinical profile with a higher risk of death.
Results suggest that higher COX-2 expression may be a negative prognostic factor in conjunctival melanoma. Further studies can address the potential use of anti-COX-2 drugs as adjuvant therapy of this disease.
结膜黑色素瘤是一种罕见但具有潜在致命性的肿瘤。其生物学特性在很大程度上仍不为人知，近期的研究旨在建立组织病理学和基因肿瘤图谱。本研究的目的是分析临床病理特征与环氧合酶-2（COX-2）肿瘤表达之间的关联对预后的影响，评估其作为可能的预后标志物的实用性。
对1991年至2008年50例经病理证实的结膜黑色素瘤患者进行病例系列研究。通过查阅临床档案和病理资料评估人口统计学、临床和病理特征。通过对20例黑色素瘤的福尔马林固定石蜡包埋组织样本进行免疫组织化学研究COX-2的表达。样本按包括染色强度和阳性反应细胞百分比的评分进行分类。
与预后不良（死亡）显著相关（p <0.05）的临床病理特征包括穹窿和睑结膜受累、肿瘤厚度超过2mm、局部肿瘤复发、淋巴结和全身转移。在免疫组织化学研究（n = 20）中，18例表达COX-2，尽管评分不同。然而，只有高分病例与不良结局相关。多变量关联分析显示，复发率、转移、角膜侵犯和肿瘤厚度与高分病例相关，因此与死亡风险较高的临床特征相关。
结果表明，较高的COX-2表达可能是结膜黑色素瘤的一个负面预后因素。进一步的研究可以探讨抗COX-2药物作为该疾病辅助治疗的潜在用途。
