Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
Ophthalmology. 2022 Jul;129(7):771-780. doi: 10.1016/j.ophtha.2022.02.029. Epub 2022 Mar 1.
To assess the predictive value of the tumor staging system in the AJCC Cancer Staging Manual, Eighth Edition, and histologic features for outcomes and metastasis patterns in conjunctival melanoma (CM).
Retrospective, single-center cohort study.
Eighty-three patients with CM were treated at Shanghai Ninth People's Hospital between 2000 and 2021.
We reviewed the clinical and histologic parameters and used Kaplan-Meier survival curves and Cox proportional hazards regression models for risk factor analyses.
Time to nodal/distant metastasis, disease-specific survival, metastatic pattern, and metastatic site.
At presentation, 5 patients (6%) had clinical tumor (cT)1 disease, 34 patients (41%) had cT2 disease, and 44 patients (53%) had cT3 disease. Four patients (5%) had nodal metastasis (N1), and none had distant metastasis (M1). During follow-up, 12 patients (14%) developed nodal metastasis, 29 patients (35%) developed distant metastasis, and 26 patients (31%) died of disease. The brain, liver, and lung were common distant metastasis sites. Higher cT category was associated with increased risks of distant metastasis (P < 0.001) and disease-specific death (P = 0.002). The separate analysis of primary and recurrent tumors at presentation showed that the patients with cT3 tumors had a higher risk of distant metastasis than those with cT2 tumors. Greater tumor thickness, ulceration, and the presence of regression were correlated with distant metastasis. Previously unreported mutations were detected in the tumor suppressor genes FAT atypical cadherin 4 (FAT4) and spleen associated tyrosine kinase (SYK). Among the 29 patients who developed distant metastasis, we analyzed 2 patterns of metastasis: Eleven patients (38%) developed nodal metastasis before distant metastasis, and 18 patients (62%) developed distant metastasis without previously known nodal metastasis. The patients with cT3 tumors were more likely to follow the latter metastasis pattern (P = 0.02).
Conjunctival melanoma presented with mostly advanced stages and high rates of distant metastasis in the current Chinese cohort. This study confirmed the prognostic value of the tumor staging system in the AJCC Cancer Staging Manual, Eighth Edition, for Chinese patients. Histologic features, such as tumor thickness and ulceration, should be emphasized when assessing prognosis and guiding the treatment of CM.
评估第八版 AJCC 癌症分期手册中的肿瘤分期系统和组织学特征对结膜黑色素瘤（CM）患者结局和转移模式的预测价值。
回顾性、单中心队列研究。
2000 年至 2021 年，上海第九人民医院共收治 83 例 CM 患者。
我们回顾了临床和组织学参数，并使用 Kaplan-Meier 生存曲线和 Cox 比例风险回归模型进行风险因素分析。
淋巴结/远处转移时间、疾病特异性生存率、转移模式和转移部位。
就诊时，5 例（6%）患者为临床肿瘤（cT）1 期，34 例（41%）患者为 cT2 期，44 例（53%）患者为 cT3 期。4 例（5%）患者有淋巴结转移（N1），无远处转移（M1）。随访期间，12 例（14%）患者发生淋巴结转移，29 例（35%）患者发生远处转移，26 例（31%）患者死于疾病。脑、肝和肺是常见的远处转移部位。较高的 cT 分期与远处转移（P<0.001）和疾病特异性死亡（P=0.002）的风险增加相关。对初诊和复发肿瘤的单独分析显示，cT3 期肿瘤患者的远处转移风险高于 cT2 期肿瘤患者。肿瘤厚度较大、溃疡和退行性变与远处转移相关。在肿瘤抑制基因 FAT 非典型钙黏蛋白 4（FAT4）和脾相关酪氨酸激酶（SYK）中检测到先前未报道的突变。在 29 例发生远处转移的患者中，我们分析了 2 种转移模式：11 例（38%）患者在远处转移前发生淋巴结转移，18 例（62%）患者在无已知淋巴结转移的情况下发生远处转移。cT3 期肿瘤患者更有可能出现后一种转移模式（P=0.02）。
在当前的中国队列中，结膜黑色素瘤表现为晚期且远处转移率较高。本研究证实了 AJCC 癌症分期手册第八版中的肿瘤分期系统对中国患者的预后价值。组织学特征，如肿瘤厚度和溃疡，在评估预后和指导 CM 治疗时应予以重视。
