Lorenzo Daniel, Piulats Josep Maria, Ochoa María, Arias Luis, Gutiérrez Cristina, Català Jaume, Cobos Estefanía, Garcia-Bru Pere, Dias Bruno, Padrón-Pérez Noel, Caminal Josep Maria
Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
Department of Oncology, Catalan Institute of Oncology, Barcelona, Spain.
Jpn J Ophthalmol. 2019 Mar;63(2):197-209. doi: 10.1007/s10384-019-00656-9. Epub 2019 Feb 22.
To determine the clinical factors that influence survival in patients with metastatic uveal melanoma.
Single-center, retrospective review of patients' medical records.
The following data of ninety-nine consecutive patients (49 men, 50 women) with metastatic uveal melanoma were registered: patient demographics; primary tumor characteristics; features of first melanoma-related metastasis; symptoms and patient status at distant disease debut and metastasis treatment. Overall survival was analyzed by Kaplan-Meier estimates. A Cox proportional hazards regression model was applied to identify independent predictors associated with survival.
Mean patient age at metastatic diagnosis was 60.7 years (standard deviation, 12.8). The liver was the first metastatic site in most (92.9%) cases. The median disease-free interval was 26 months (interquartile range, 34). Median overall survival after detection of the first metastasis was 8 months (interquartile range, 14). The baseline characteristics of the primary uveal melanoma were not associated with survival in patients with stage IV disease. In the multivariate analysis, the following factors at first metastatic diagnosis were associated with improved overall survival: disease-free interval > 36 months; better performance status; and normal serum lactate dehydrogenase and gamma glutamyl transpeptidase levels. Overall survival was not influenced by specific metastatic treatment.
Although metastatic uveal melanoma has a poor prognosis, this study reveals the existence of several independent prognostic factors for prolonged overall survival. These findings may help improve survival estimates in patients with advanced disease.
确定影响转移性葡萄膜黑色素瘤患者生存的临床因素。
对患者病历进行单中心回顾性研究。
记录了99例连续性转移性葡萄膜黑色素瘤患者（49例男性，50例女性）的以下数据：患者人口统计学资料；原发性肿瘤特征；首次黑色素瘤相关转移的特征；远处疾病初发及转移治疗时的症状和患者状态。采用Kaplan-Meier法估计总生存期。应用Cox比例风险回归模型确定与生存相关的独立预测因素。
转移性诊断时患者的平均年龄为60.7岁（标准差12.8）。大多数（92.9%）病例中肝脏是首个转移部位。无病间期的中位数为26个月（四分位间距34）。首次转移检测后的总生存期中位数为8个月（四分位间距14）。原发性葡萄膜黑色素瘤的基线特征与IV期疾病患者的生存无关。在多变量分析中，首次转移诊断时的以下因素与总生存期改善相关：无病间期>36个月；更好的体能状态；血清乳酸脱氢酶和γ-谷氨酰转肽酶水平正常。总生存期不受特定转移治疗的影响。
尽管转移性葡萄膜黑色素瘤预后较差，但本研究揭示了几个可延长总生存期的独立预后因素。这些发现可能有助于改善晚期疾病患者的生存预估。
