Rantala Elina S, Kivelä Tero T, Hernberg Micaela M
Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital.
Comprehensive Cancer Center, Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Melanoma Res. 2021 Jun 1;31(3):224-231. doi: 10.1097/CMR.0000000000000728.
No data exist regarding whether any first-line treatment for metastatic uveal melanoma provides overall survival (OS) benefit, if staged and compared to best supportive care (BSC). We analyzed OS in a nationwide, consecutive cohort diagnosed with metastatic uveal melanoma between January 1999 and December 2016. The Helsinki University Hospital Working Formulation was used to assign patients to stage IVa, IVb and IVc, corresponding to predicted median OS ≥12, <12-6 and <6 months, respectively. OS of 216 actively treated patients was compared by treatment and working formulation stage against 108 similarly staged, concurrent patients managed with BSC using Kaplan-Meier analysis and Cox regression. The median OS with active treatment was 18 (range, 0.7-162), 6.9 (range, 1.3-30) and 1.9 (range, 0.2-18) months in working formulation stage IVa, IVb and IVc, respectively. Patients who received chemoimmunotherapy, selective internal radiation therapy, or underwent surgical resection survived longer - median OS 13, 16 and 24 months, respectively - than those receiving conventional chemotherapy - median OS 5.1 months - but only with surgical resection their OS exceeded that with BSC, both overall and in stage IVa (P < 0.001, P = 0.010). In stage IVb and IVc, no difference in OS was observed in any comparison. Staging of patients is crucial when comparing survival after metastatic uveal melanoma. Only surgical resection for stage IVa disease provided longer OS in our national cohort. We additionally recommend stage-specific comparison of novel treatments against available BSC data.
关于转移性葡萄膜黑色素瘤的任何一线治疗与最佳支持治疗（BSC）相比，在分期的情况下是否能带来总生存期（OS）获益，目前尚无相关数据。我们分析了1999年1月至2016年12月期间全国范围内连续诊断为转移性葡萄膜黑色素瘤的队列的总生存期。采用赫尔辛基大学医院工作分类法将患者分为IVa期、IVb期和IVc期，分别对应预计中位总生存期≥12个月、<12至6个月和<6个月。使用Kaplan-Meier分析和Cox回归，将216例接受积极治疗的患者的总生存期按治疗方式和工作分类阶段与108例分期相似、同时接受最佳支持治疗的患者进行比较。在工作分类IVa期、IVb期和IVc期，接受积极治疗的患者的中位总生存期分别为18个月（范围0.7至162个月）、6.9个月（范围1.3至30个月）和1.9个月（范围0.2至18个月）。接受化学免疫疗法、选择性内放射疗法或接受手术切除的患者的生存期更长——中位总生存期分别为13个月、16个月和24个月——比接受传统化疗的患者——中位总生存期5.1个月——但只有手术切除患者的总生存期在总体上和IVa期超过了最佳支持治疗（P<0.001，P = 0.010）。在IVb期和IVc期，任何比较中均未观察到总生存期的差异。在比较转移性葡萄膜黑色素瘤后的生存率时，患者的分期至关重要。在我们的全国队列中，只有IVa期疾病的手术切除提供了更长的总生存期。我们还建议针对新疗法与现有最佳支持治疗数据进行特定阶段的比较。
