From the Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic (A.D.S., V.R., J.W.), and.
From the Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic (A.D.S., V.R., J.W.), and.
Am J Ophthalmol. 2022 Sep;241:47-56. doi: 10.1016/j.ajo.2022.03.024. Epub 2022 Mar 28.
To quantify potential loss (loss of vision) and gain (freedom from metastasis) in patients with small choroidal melanoma treated after a period of surveillance to document growth.
A total of 167 patients with small choroidal melanoma (size: 5.0-16.0 mm in largest basal diameter and 1.0-2.5 mm in height) were identified: 42 treated after surveillance (documented growth) and 125 treated immediately. A prediction model was applied to each patient in the immediate treatment group to obtain the predicted risk of melanoma (high risk vs low risk). Potential loss (loss of vision) and gain (freedom from metastasis) were compared between the low-risk immediate treatment group and those treated after surveillance.
By using the optimal cut point (0.60; 95% confidence interval: 0.37-0.61) of predicted risk for small choroidal melanoma (sensitivity: 0.74, specificity: 0.95), we identified 94 (75%) patients as high risk (score: ≥0.6) and the remaining 31 (25%) as having low-risk melanoma (score: <0.6). Over a median follow-up of 34.6 months, 5 developed metastasis (high risk = 4, low risk = 1) compared with 1 patient in the surveillance group. Initial visual acuity and loss of <15-letter visual acuity were not significantly different at 36 months between the low-risk patients immediately treated and those treated after surveillance (81% vs 83%), respectively.
Low-risk choroidal melanoma identified by the prediction model can be labeled as an indeterminate melanocytic tumor. Such patients can be managed by surveillance to document growth before receiving vision-threatening treatment without increased risk of metastatic death. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
定量评估接受随诊观察后有肿瘤生长的小脉络膜黑色素瘤患者的潜在损失（视力丧失）和获得（无转移）情况。
共纳入 167 例小脉络膜黑色素瘤（最大基底直径 5.0-16.0mm，高度 1.0-2.5mm）患者：42 例经随诊观察（有肿瘤生长）后治疗，125 例立即治疗。对立即治疗组的每位患者应用预测模型以获得预测黑色素瘤风险（高风险与低风险）。比较低风险立即治疗组与观察后治疗组的潜在损失（视力丧失）和获得（无转移）。
采用最佳预测小脉络膜黑色素瘤风险的截断值（0.60；95%置信区间：0.37-0.61）（敏感度：0.74，特异度：0.95），我们将 94 例（75%）患者归为高风险（评分≥0.6），31 例（25%）为低风险黑色素瘤（评分<0.6）。在中位随访 34.6 个月期间，高风险组有 5 例（4 例为高风险，1 例为低风险）发生转移，而随诊组仅 1 例。在 36 个月时，低风险立即治疗患者和随诊后治疗患者的初始视力和视力丧失<15 个字母的比例分别为 81%和 83%，差异无统计学意义。
通过预测模型确定的低风险脉络膜黑色素瘤可被归为不定黑素细胞瘤。此类患者可通过随诊观察记录肿瘤生长，然后再进行有视力威胁的治疗，而不会增加转移死亡的风险。注：本文的发表得到了美国眼科学会的赞助。
