Gurayah Aaron A, Peters Vanessa A, Jin William, Kalahasty Karthik, Kwon Deukwoo, Zhao Wei, Patel Nirav V, Markoe Arnold M, Correa Zelia M, Studenski Matthew T, Harbour J William, Samuels Stuart E
University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Radiation Oncology, University of Miami, Miami, Florida, USA.
Ocul Oncol Pathol. 2022 Nov;8(3):175-180. doi: 10.1159/000526771. Epub 2022 Aug 29.
Iodine-125 brachytherapy is an effective eye-sparing treatment for uveal melanoma. Previous work has shown that uveal melanomas cluster into distinct molecular classes based on gene expression profiles - discriminating low-grade from high-grade tumors. Our objective was to identify clinical and molecular predictors of local recurrence (LR) and progression-free survival (PFS).
We constructed a retrospective database of uveal melanoma patients from the University of Miami's electronic medical records that were treated between January 8, 2012, and January 5, 2019, with either COMS-style or Eye Physics plaque. Data on tumor characteristics, pretreatment retinal complications, post-plaque treatments, LR, and PFS were collected. Univariate and multivariate Cox models for cumulative incidence of LR and PFS were conducted using SAS version 9.4.
We identified 262 patients, with a median follow-up time of 33.5 months. Nineteen patients (7.3%) had LR, and 56 patients (21.4%) were classified as PFS. We found that ocular melanocytosis (hazard ratio = 5.55, < 0.001) had the greatest impact on PFS. Genetic expression profile did not predict LR outcomes (hazard ratio = 0.51, = 0.297).
These findings help physicians identify predictors for short-term brachytherapy outcomes, allowing better shared decision making with patients preoperatively when deciding between brachytherapy versus enucleation. Patients stratified to higher risk groups based on preoperative characteristics such as ocular melanocytosis should be monitored more closely. Future studies must validate these findings using a prospective cohort study.
碘-125近距离放射治疗是一种有效的葡萄膜黑色素瘤保眼治疗方法。先前的研究表明，葡萄膜黑色素瘤可根据基因表达谱聚类为不同的分子类别，从而区分低级别和高级别肿瘤。我们的目的是确定局部复发（LR）和无进展生存期（PFS）的临床和分子预测因素。
我们从迈阿密大学的电子病历中构建了一个葡萄膜黑色素瘤患者的回顾性数据库，这些患者在2012年1月8日至2019年1月5日期间接受了COMS式或眼物理斑块治疗。收集了肿瘤特征、治疗前视网膜并发症、斑块治疗后、LR和PFS的数据。使用SAS 9.4版对LR和PFS的累积发生率进行单变量和多变量Cox模型分析。
我们确定了262例患者，中位随访时间为33.5个月。19例患者（7.3%）发生LR，56例患者（21.4%）被归类为PFS。我们发现眼黑变病（风险比=5.55，<0.001）对PFS的影响最大。基因表达谱不能预测LR结果（风险比=0.51，=0.297）。
这些发现有助于医生识别短期近距离放射治疗结果的预测因素，从而在术前决定近距离放射治疗与眼球摘除术时，能更好地与患者进行共同决策。根据眼黑变病等术前特征分层为高风险组的患者应进行更密切的监测。未来的研究必须使用前瞻性队列研究来验证这些发现。
