经巩膜局部切除术后葡萄膜黑色素瘤残留和复发的危险因素。
Risk factors for residual and recurrent uveal melanoma after trans-scleral local resection.
作者信息
Damato B E, Paul J, Foulds W S
机构信息
Tennent Institute of Ophthalmology, Western Infirmary, University of Glasgow.
出版信息
Br J Ophthalmol. 1996 Feb;80(2):102-8. doi: 10.1136/bjo.80.2.102.
AIMS
The aims of this study were to report local tumour control after trans-scleral local resection of uveal melanoma and to identify risk factors for (i) clinical residual tumour recognised immediately after surgery, and (ii) delayed tumour recurrence from subclinical microscopic deposits.
METHODS
The sample included 310 patients, treated by choroidectomy (188), cyclochoroidectomy (87), or iridocyclectomy (35), with follow up ranging from 42 days to 20.9 years (median 36 months), a mean basal largest tumour diameter of 13.2 mm, and a mean tumour thickness of 7.4 mm.
RESULTS
There were 24 patients with residual tumour. Forward stepwise logistic regression indicated that posterior extension to within 1 disc diameter of the optic disc or fovea was the sole best indicator of the risk of residual disease (p < 0.001). After excluding these cases, 286 patients were studied for the development of delayed local recurrence, which occurred in 57 cases. Forward stepwise multivariate analysis showed the statistically significant predictors for recurrent tumour to be epithelioid cellularity (p = 0.002), posterior tumour extension to < 1 disc diameter of disc of fovea (p = 0.002), large tumour diameter > or = 16 mm (p = 0.019) and lack of adjunctive plaque radiotherapy (p = 0.018).
CONCLUSIONS
The recurrence rate at 4 years varied from 6% if no risk factors were present to 57% if there were more than two risk factors.
目的
本研究旨在报告经巩膜局部切除葡萄膜黑色素瘤后的局部肿瘤控制情况，并确定（i）手术后立即识别出的临床残留肿瘤，以及（ii）亚临床微小病灶导致的延迟肿瘤复发的危险因素。
方法
样本包括310例患者，接受脉络膜切除术（188例）、睫状体脉络膜切除术（87例）或虹膜睫状体切除术（35例），随访时间从42天至20.9年（中位时间36个月），平均基底最大肿瘤直径为13.2 mm，平均肿瘤厚度为7.4 mm。
结果
有24例患者存在残留肿瘤。向前逐步逻辑回归表明，肿瘤向后延伸至距视盘或黄斑中心凹1个视盘直径范围内是残留疾病风险的唯一最佳指标（p < 0.001）。排除这些病例后，对286例患者进行了延迟局部复发情况的研究，其中57例发生了延迟局部复发。向前逐步多变量分析显示，复发性肿瘤的统计学显著预测因素为上皮样细胞成分（p = 0.002）、肿瘤向后延伸至距视盘或黄斑中心凹< 1个视盘直径（p = 0.002）、肿瘤直径≥16 mm（p = 0.019）以及未进行辅助斑块放射治疗（p = 0.018）。
结论
4年复发率在无危险因素时为6%，有两个以上危险因素时为57%。
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