Yarovaya V A, Shatskikh A V, Zaretsky A R, Levashov I A, Volodin D P, Yarovoy A A
Acad. S.N. Fyodorov «Eye Microsurgery» Interdisciplinary Scientific and Technical Complex of the Ministry of Health of Russia, Moscow, Russia.
N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia.
Arkh Patol. 2021;83(4):14-21. doi: 10.17116/patol20218304114.
To determine the prognostic value of a uveal melanoma (UM) cell type for the development of metastases (MTS).
The investigation enrolled 96 patients (96 eyes) with UM after enucleation. Forty-one patients without signs of MTS were included in this group, who were followed up for more than 36 months (mean, 70.5 months (36 to 105 months)), 55 patients with MTS who were followed up for an average of 21 months (2 to 44 months). The MTS and non-MTS groups were statistically homogeneous in age, gender, tumor size, location, and ciliary body involvement in the process, as well as in extrabulbar growth.
There were spindle cell, mixed cell, and epithelioid cell UMs in 44, 35, and 21% of patents, respectively. The tumors in patients without MTS were noted to be significantly more likely to have spindle cell-type UM (<0.0001). Mixed cell and epithelioid cell UMs were more frequently detected in patients with MTS (<0.0001), which was believed to be due to the presence of epithelioid cells in both cell types. A survival analysis showed that the 3- and 5-year survival rates for patients with spindle cell UM were significantly higher than that for those with epithelioid cell or mixed cell UM (<0.001); the 3-and 5-year survival rates for spindle cell UM were 78 and 70%, respectively; those for mixed cell UM were 37 and 24%; and those for epithelioid cell UM were 50 and 31%.
The similar survival rates for patients with mixed cell or epithelioid cell type UM could conclude that it is advisable to use the binary principle - the presence or absence of epithelioid cells in the tumor, when assessing a UM cell type as a prognostic factor.
确定葡萄膜黑色素瘤（UM）细胞类型对转移（MTS）发生的预后价值。
本研究纳入96例摘除眼球后的UM患者（96只眼）。该组包括41例无MTS迹象的患者，对其进行了超过36个月的随访（平均70.5个月（36至105个月）），55例有MTS的患者平均随访21个月（2至44个月）。MTS组和非MTS组在年龄、性别、肿瘤大小、位置、病程中睫状体受累情况以及球外生长方面在统计学上具有同质性。
分别有44%、35%和21%的患者为梭形细胞型、混合细胞型和上皮样细胞型UM。无MTS的患者的肿瘤被发现更有可能是梭形细胞型UM（<0.0001）。混合细胞型和上皮样细胞型UM在有MTS的患者中更频繁地被检测到（<0.0001），这被认为是由于这两种细胞类型中都存在上皮样细胞。生存分析表明，梭形细胞型UM患者的3年和5年生存率显著高于上皮样细胞型或混合细胞型UM患者（<0.001）；梭形细胞型UM的3年和5年生存率分别为78%和70%；混合细胞型UM的为37%和24%；上皮样细胞型UM的为50%和31%。
混合细胞型或上皮样细胞型UM患者的相似生存率可以得出结论，在将UM细胞类型评估为预后因素时，采用二元原则——肿瘤中上皮样细胞的有无是可取的。
