Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, Iowa; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Ophthalmol Retina. 2020 Jun;4(6):620-629. doi: 10.1016/j.oret.2019.12.020. Epub 2020 Jan 7.
Investigate the influence of tumor size by American Joint Committee on Cancer (AJCC) stage, Collaborative Ocular Melanoma Study (COMS) size, tumor largest basal diameter (LBD), and tumor thickness on prognostication by gene expression profiling (GEP) class.
Two-center retrospective study.
Two hundred fifteen consecutive patients diagnosed with posterior uveal melanoma over a 5-year period who were evaluated with prognostic fine-needle aspiration biopsy at the time of primary treatment.
Patient demographics, tumor clinical size, AJCC stage, COMS size, GEP class, presence of metastasis, and mortality data were collected. Metastasis-free-survival (MFS) was defined as time to metastasis or death from any cause. Comparisons were made using Pearson chi-square tests or Fisher exact tests for categorical factors, and t tests or Kruskal-Wallis tests for continuous measures. Cox proportional hazards models were fit to identify whether size measurements increased the prognostic discrimination index (C-statistic).
Metastasis-free-survival.
The average follow-up interval was 22.0 months (range, 12.0-37.0 months). Eighty-nine tumors were class 1A, 48 class 1B, and 78 class 2. Twenty-one patients developed metastatic disease detected by surveillance and confirmed by liver biopsy. Three-year MFS was 96% for class 1 and 63% for class 2. Five-year MFS was 96% for class 1 and 49% for class 2. All size measures significantly improved prognostic discrimination index by GEP class, as shown by increase in the C-statistic with addition of size variables (C-statistic 0.750 GEP alone, 0.830 GEP with AJCC [P = 0.016], 0.822 GEP with COMS [P < 0.001], 0.842 GEP with LBD [P <0.001], and 0.847 GEP with tumor thickness [P < 0.001]). Class 2 patients with metastasis had larger tumors compared with nonmetastatic class 2 tumors (AJCC class, P = 0.004; COMS class, P = 0.024; with metastasis mean thickness 6.5 mm [interquartile range (IQR), 3.8-9.5 mm]; without metastasis, 3.9 mm [SD, 3.1-6.0 mm]; P = 0.008), with metastasis mean LBD 14.9±2.8 mm, without metastasis, 12.3±2.7 mm (P < 0.001). All class 1 tumors with metastasis were large and required enucleation.
Incorporation of tumor size enhances the prognostic discrimination index of the GEP test in patients with posterior uveal melanoma. All size tumor parameters are equivalent in their ability to enhance GEP prognostication.
研究美国癌症联合委员会（AJCC）分期、协作眼黑色素瘤研究（COMS）大小、肿瘤最大基底直径（LBD）和肿瘤厚度对基因表达谱（GEP）分类预后的影响。
两中心回顾性研究。
在 5 年内通过初步治疗时的预后性细针抽吸活检评估，连续诊断为后葡萄膜黑色素瘤的 215 例患者。
收集患者人口统计学、肿瘤临床大小、AJCC 分期、COMS 大小、GEP 分级、转移存在和死亡率数据。无转移生存（MFS）定义为转移或任何原因导致的死亡时间。使用 Pearson 卡方检验或 Fisher 精确检验比较分类因素，使用 t 检验或 Kruskal-Wallis 检验比较连续测量值。使用 Cox 比例风险模型确定大小测量值是否增加了预后判别指数（C 统计量）。
无转移生存。
平均随访间隔为 22.0 个月（范围，12.0-37.0 个月）。89 个肿瘤为 1A 级，48 个为 1B 级，78 个为 2 级。21 例患者出现经监测发现并经肝活检证实的转移性疾病。1A 级的 3 年 MFS 为 96%，2 级为 63%。1A 级的 5 年 MFS 为 96%，2 级为 49%。所有大小测量值均显著提高了 GEP 分级的预后判别指数，增加了大小变量的 C 统计量（C 统计量单独为 GEP 0.750，联合 AJCC 为 0.830[P=0.016]，联合 COMS 为 0.822[P<0.001]，联合 LBD 为 0.842[P<0.001]，联合肿瘤厚度为 0.847[P<0.001]）。与非转移性 2 级肿瘤相比，转移性 2 级患者的肿瘤更大（AJCC 分级，P=0.004；COMS 分级，P=0.024；转移组平均厚度 6.5mm[四分位间距（IQR），3.8-9.5mm]；无转移组 3.9mm[标准差（SD），3.1-6.0mm]；P=0.008），转移组平均 LBD 为 14.9±2.8mm，无转移组为 12.3±2.7mm（P<0.001）。所有发生转移的 1A 级肿瘤均较大，需要眼球摘除。
肿瘤大小的纳入增强了 GEP 检测在后葡萄膜黑色素瘤患者中的预后判别指数。所有大小肿瘤参数在增强 GEP 预后预测方面的能力都是等效的。
