Jain Puneet, Finger Paul T, Filì Maria, Damato Bertil, Coupland Sarah E, Heimann Heinrich, Kenawy Nihal, Brouwer Niels J, Marinkovic Marina, van Duinen Sjoerd, Caujolle Jean-Pierre, Maschi Celia, Seregard Stefan, Pelayes David E, Folgar Martin, Yousef Yacoub, Krema Hatem, Gallie Brenda, Calle Vasquez Carlos Alberto
Eye Cancer Center, New York, New York, USA.
Eye Cancer Center, New York, New York, USA
Br J Ophthalmol. 2025 May 30;109(6):652-659. doi: 10.1136/bjo-2024-326043.
To reveal clinical findings related to metastatic conjunctival melanoma.
10 ophthalmic oncology centres (9 countries and 4 continents) shared data to create a large clinical case series. The main outcome measures were the incidence and cumulative risk of systemic metastasis, study mortality rates and Kaplan-Meier patient mortality after developing conjunctival melanoma metastasis.
Of 288 patients, 29 developed metastasis. Five had metastasis at presentation, were American Joint Committee on Cancer (AJCC) cT3-category and exhibited tumour-surface ulceration. Four of five (80%) had melanotic tumours with plical and/or caruncular involvement and died within 1 year. One survived 21 months. In contrast, 24 developed metastases during follow-up (mean 4.6±3.2 years). Their primary tumours were cT1 (n=13/24, 54.1%), cT2 (n=6/24, 25%), cT3 (n=2/24, 8.3%) and 3 cTx (12.5%) at presentation. Death had occurred in 17 patients (n=17/24, 71%) by the end of the study. The cumulative risk of systemic metastasis after treatment was 0.4% (95% CI 0.6% to 2.9%) at 1 year, 8.6% (95% CI 5.1% to 14.3%) at 5 years and 22.3% (95% CI 14.5% to 33.5%) at 10 years. Each increase in AJCC cT category was associated with an 89% higher risk for metastasis (HR=1.89, p<0.001). Among all 29 patients who developed metastasis, those who presented with AJCC cT3 disease were at highest risk (p<0.001). Liver and lung (n=13 each) were the most reported metastatic sites.
Metastatic conjunctival melanoma was found in 10% of conjunctival melanoma patients. Tumour-specific characteristics including AJCC cT3-category, conjunctival location and surface ulceration were associated with metastatic risk. Survival durations were shorter for those presenting with metastasis.
揭示与转移性结膜黑色素瘤相关的临床发现。
10个眼科肿瘤中心（分布于9个国家和4大洲）共享数据以创建一个大型临床病例系列。主要观察指标为全身转移的发生率和累积风险、研究死亡率以及结膜黑色素瘤转移后患者的Kaplan-Meier死亡率。
288例患者中，29例发生转移。5例在初诊时即有转移，属于美国癌症联合委员会（AJCC）cT3类别，且表现为肿瘤表面溃疡。5例中有4例（80%）为黑色素性肿瘤，累及睑褶和/或泪阜，在1年内死亡。1例存活了21个月。相比之下，24例在随访期间发生转移（平均4.6±3.2年）。其原发肿瘤初诊时cT1（n = 13/24，54.1%）、cT2（n = 6/24，25%）、cT3（n = 2/24，8.3%），3例为cTx（12.5%）。到研究结束时，17例患者（n = 17/24，71%）已死亡。治疗后全身转移的累积风险在1年时为0.4%（95%CI 0.6%至2.9%），5年时为8.6%（95%CI 5.1%至14.3%），10年时为22.3%（95%CI 14.5%至33.5%）。AJCC cT类别每增加一级，转移风险高89%（HR = 1.89，p < 0.001）。在所有发生转移的29例患者中，初诊时为AJCC cT3疾病的患者风险最高（p < 0.001）。肝脏和肺（各n = 13）是最常报告的转移部位。
10%的结膜黑色素瘤患者发生转移性结膜黑色素瘤。包括AJCC cT3类别、结膜位置和表面溃疡在内的肿瘤特异性特征与转移风险相关。发生转移的患者生存时间较短。
