Seddon J M, Polivogianis L, Hsieh C C, Albert D M, Gamel J W, Gragoudas E S
Arch Ophthalmol. 1987 Jun;105(6):801-6. doi: 10.1001/archopht.1987.01060060087039.
Criteria for the Callender classification of uveal melanoma are subjective and lead to variations among observers of the same tumor. Two other measures for cell type-the number of epithelioid cells per high-power field (Epi/HPF) and the inverse SD of nucleolar area (ISDNA)-were evaluated as prognostic factors for survival following enucleation for uveal melanoma in 232 patients. Variables significantly related to the number of Epi/HPF were related to ISDNA. Larger, more anteriorly located tumors had a high number of Epi/HPF and a low ISDNA. The two measures were also correlated. Using Kaplan-Meier survival analysis, both measures were related to tumor deaths. Worse prognosis was associated with a higher number of Epi/HPF and a lower ISDNA. Considered together in Cox' proportional hazards analysis, both measures independently predicted outcome. Separately, each measure predicted uveal melanoma-related deaths, in combination with largest tumor dimension, invasion of tumor to the line of transection, and location of the anterior tumor margin. Although ISDNA is the more objective measure of cell type, its practicality compared with other measures of cell type must also be considered.
葡萄膜黑色素瘤的卡伦德分类标准具有主观性，会导致不同观察者对同一肿瘤的判断存在差异。在232例因葡萄膜黑色素瘤行眼球摘除术的患者中，评估了另外两种细胞类型的指标——每高倍视野上皮样细胞数量（Epi/HPF）和核仁面积的倒数标准差（ISDNA），作为生存的预后因素。与Epi/HPF数量显著相关的变量与ISDNA相关。更大、位置更靠前的肿瘤Epi/HPF数量较多，ISDNA较低。这两项指标也具有相关性。采用Kaplan-Meier生存分析，这两项指标均与肿瘤死亡相关。预后较差与较高的Epi/HPF数量和较低的ISDNA相关。在Cox比例风险分析中综合考虑，这两项指标均能独立预测预后。单独来看，每项指标与葡萄膜黑色素瘤相关死亡的预测，均结合了最大肿瘤直径、肿瘤侵犯横断线情况以及肿瘤前界位置。尽管ISDNA是细胞类型更客观的指标，但与其他细胞类型指标相比，其实际应用价值也必须予以考虑。
