Bedikian A Y, Legha S S, Mavligit G, Carrasco C H, Khorana S, Plager C, Papadopoulos N, Benjamin R S
University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1995 Nov 1;76(9):1665-70. doi: 10.1002/1097-0142(19951101)76:9<1665::aid-cncr2820760925>3.0.co;2-j.
Liver metastasis develops in approximately two-thirds of patients with recurrent uveal melanoma. Despite therapy, the median survival of those with liver metastasis is 5 to 7 months. The recognition of a grave prognosis associated with liver metastasis has led to evaluation of new modalities of therapy, including the use of regional therapies such as intrahepatic arterial chemotherapy and either embolization or chemoembolization of hepatic metastases. In this study, the results of an institutional experience over the past 2 decades are reviewed and prognostic factors that affect survival from the time the liver metastasis is diagnosed are assessed.
In this study of 201 patients with uveal melanoma involving the liver who were treated at M. D. Anderson Cancer Center between 1968 and 1991, the authors restrospectively reviewed the cases and compared the results of systemic therapies, hepatic intra-arterial chemotherapies, and chemoembolization of liver metastases. Cox's multivariate analysis and stepwise logistic regression were then computed to determine significant prognostic variables.
The systemic therapies produced a response rate of less than 1%. Chemoembolization was the most effective treatment, inducing responses in 36% of patients. Survival curves were calculated using the life-table method of Kaplan and Meier. Patient- and tumor-related characteristics were examined and their relation to on survival from the time of diagnosis of liver metastasis was determined. Levels of serum alkaline phosphatase, total bilirubin, and lactic dehydrogenase plus response to treatment showed a strong relation to survival. In contrast, univariate analysis showed that patient age and gender, metastasis free interval, presence of extrahepatic metastasis, and type of therapy for liver metastasis did not influence survival. Multivariate stepwise regression analysis identified serum alkaline phosphatase and metastasis free interval as the main independent prognostic factors for survival after liver metastasis diagnosis.
Of the three modalities of therapy used for choroidal melanoma metastatic to the liver, only chemoembolization using cisplatin-based regimens produced a meaningful response rate. Information from this analysis can be used to predict the outcome of patients with uveal melanoma metastatic to the liver. Patients with metastatic ocular melanoma confined to the liver should be treated with chemoembolization and should not be included in chemotherapy trials designed for cutaneous melanoma.
在复发性葡萄膜黑色素瘤患者中，约三分之二会发生肝转移。尽管进行了治疗，但肝转移患者的中位生存期为5至7个月。认识到与肝转移相关的严重预后促使人们评估新的治疗方式，包括使用区域治疗，如肝动脉内化疗以及肝转移灶的栓塞或化疗栓塞。在本研究中，回顾了过去20年机构经验的结果，并评估了从肝转移诊断时起影响生存的预后因素。
在这项对1968年至1991年间在MD安德森癌症中心接受治疗的201例累及肝脏的葡萄膜黑色素瘤患者的研究中，作者回顾性地分析了病例，并比较了全身治疗、肝动脉内化疗以及肝转移灶化疗栓塞的结果。然后进行Cox多变量分析和逐步逻辑回归，以确定显著的预后变量。
全身治疗的缓解率低于1%。化疗栓塞是最有效的治疗方法，36%的患者有反应。使用Kaplan和Meier的寿命表法计算生存曲线。检查患者和肿瘤相关特征，并确定它们与肝转移诊断时起的生存关系。血清碱性磷酸酶、总胆红素和乳酸脱氢酶水平以及对治疗的反应与生存密切相关。相比之下，单变量分析表明患者年龄和性别、无转移间期、肝外转移的存在以及肝转移的治疗类型不影响生存。多变量逐步回归分析确定血清碱性磷酸酶和无转移间期是肝转移诊断后生存的主要独立预后因素。
在用于肝转移的脉络膜黑色素瘤的三种治疗方式中，只有基于顺铂方案的化疗栓塞产生了有意义的缓解率。该分析所得信息可用于预测肝转移葡萄膜黑色素瘤患者的预后。局限于肝脏的转移性眼黑色素瘤患者应接受化疗栓塞治疗，不应纳入为皮肤黑色素瘤设计的化疗试验。
