Paridaens A D, Minassian D C, McCartney A C, Hungerford J L
Department of Pathology, Moorfields Eye Hospital, London.
Br J Ophthalmol. 1994 Apr;78(4):252-9. doi: 10.1136/bjo.78.4.252.
A series of 256 consecutive cases of invasive primary conjunctival malignant melanomas was examined to identify clinical and histopathological prognostic factors. The follow up period varied between 0.3 and 45.9 years (mean 9 years, median 6.3 years). The 5 year survival rate was estimated at 82.9%, the 10 year survival rate at 69.3%. Multiple regression analysis with the Cox proportional hazards model was used to assess sex, age, and a number of baseline features of conjunctival malignant melanoma as possible prognostic factors influencing melanoma related mortality. In assessing each potential prognostic factor, the effects of all other factors were taken into account in the modelling process. Tumours in unfavourable locations--that is, those involving the palpebral conjunctiva, fornices, plica, caruncle, and lid margins, were associated with 2.2 times higher mortality compared with (epi)bulbar melanomas. Patients with mixed cell type tumours had about three times higher mortality compared with those with pure spindle cell melanomas, and histological evidence of lymphatic invasion by tumour cells was also a prognostic feature, carrying a fourfold increase in the death rate. Multifocal tumours were associated with a fivefold increase in mortality among those with tumours in favourable (epi)bulbar locations, but were not prognostic in patients with melanomas in unfavourable sites. The death rate was significantly higher in those with initial tumour thickness of more than 4 mm, but only among patients with unfavourably located melanomas. Sex, age, and clinical origin of the tumour (primary acquired melanosis, pre-existing naevus, or de novo) were not useful prognostic indicators in this study.
对连续256例原发性浸润性结膜恶性黑色素瘤病例进行了检查，以确定临床和组织病理学预后因素。随访时间为0.3至45.9年（平均9年，中位数6.3年）。估计5年生存率为82.9%，10年生存率为69.3%。采用Cox比例风险模型进行多元回归分析，以评估性别、年龄以及结膜恶性黑色素瘤的一些基线特征，作为影响黑色素瘤相关死亡率的可能预后因素。在评估每个潜在的预后因素时，建模过程中考虑了所有其他因素的影响。位于不利部位的肿瘤，即累及睑结膜、穹窿、皱襞、泪阜和睑缘的肿瘤，与（球）结膜黑色素瘤相比，死亡率高2.2倍。混合细胞型肿瘤患者的死亡率比纯梭形细胞黑色素瘤患者高约三倍，肿瘤细胞淋巴管浸润的组织学证据也是一个预后特征，死亡率增加四倍。多灶性肿瘤在有利（球）结膜部位的肿瘤患者中死亡率增加五倍，但在不利部位的黑色素瘤患者中不是预后因素。初始肿瘤厚度超过4mm的患者死亡率显著更高，但仅在肿瘤部位不利的患者中如此。在本研究中，性别、年龄和肿瘤的临床起源（原发性获得性黑色素沉着、既往痣或新发）不是有用的预后指标。
