眼眶内容剜除术治疗结膜黑色素瘤：个体化技术与传统技术长期疗效比较。

Orbital exenteration for conjunctival melanoma: comparison of long-term outcome between individualised and conventional techniques.

机构信息

Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China.

Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.

出版信息

Eye (Lond). 2021 Dec;35(12):3410-3418. doi: 10.1038/s41433-021-01454-9. Epub 2021 Feb 19.

DOI:10.1038/s41433-021-01454-9

PMID:33608640

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8602404/

Abstract

BACKGROUND

Growing evidence supports an individualised approach rather than radical surgery for conjunctival melanoma (CM). This study aimed to compare the long-term outcome between individualised and conventional exenteration techniques.

METHODS

Our study retrospectively recruited advanced CM (clinical T3 stage) patients treated with individualised (13 cases) or conventional (18 cases) exenteration from June 2014 to April 2019. The individualised approach preserved at least three quadrants of the orbit, and the conventional procedures removed at least one third of the orbital tissues. The medical records were collected and analyzed during April 2020, including demographics, tumour characteristics, surgical details, postoperative rehabilitation and tumour-related prognosis.

RESULTS

The tumour basal diameter was statistically (P = 0.011) larger in the conventional group (23.3 ± 7.6 mm) than in the individualised group (15.4 ± 6.3 mm). More tissues were preserved in the individualised group, resulting in a shorter duration of wound healing (2.1 ± 0.6 vs. 3.6 ± 2.0 weeks, P = 0.018) and less incidence of hollow appearance (15% vs. 72%, P = 0.003) than the conventional group. After follow-up for 39.3 ± 17.3 months, a comparison of survival curves showed no significant differences (P = 0.638) between the two groups. The 1- and 2-year overall survival rates were estimated as 100% and 80.0% in the individualised group, and 93.8% and 72.5% in the conventional group, respectively. Low or mixed pigmentation was identified as the risk factor for tumour-related mortality based on multivariate regression analysis.

CONCLUSIONS

The individualised approach to exenteration offers improved aesthetic results while still maximises the curable chance for advanced CM.

摘要

背景

越来越多的证据支持对结膜黑色素瘤（CM）采用个体化方法而非激进手术。本研究旨在比较个体化和传统眶内容剜除术的长期疗效。

方法

我们的研究回顾性招募了 2014 年 6 月至 2019 年 4 月期间接受个体化（13 例）或传统（18 例）眶内容剜除术治疗的晚期 CM（临床 T3 期）患者。个体化方法保留了至少三个象限的眼眶，而传统手术则切除了至少三分之一的眼眶组织。2020 年 4 月期间收集并分析了病历资料，包括人口统计学、肿瘤特征、手术细节、术后康复和肿瘤相关预后。

结果

传统组的肿瘤基底直径明显大于个体化组（23.3±7.6mm vs. 15.4±6.3mm，P=0.011）。个体化组保留了更多的组织，导致伤口愈合时间更短（2.1±0.6 周 vs. 3.6±2.0 周，P=0.018），出现空洞外观的发生率更低（15% vs. 72%，P=0.003）。随访 39.3±17.3 个月后，两组的生存曲线比较无显著差异（P=0.638）。个体化组的 1 年和 2 年总生存率估计分别为 100%和 80.0%，传统组分别为 93.8%和 72.5%。多因素回归分析显示，低色素或混合色素是肿瘤相关死亡的危险因素。