Kroll S, Char D H, Quivey J, Castro J
Department of Ophthalmology, University of California, San Francisco 94143, USA.
Ophthalmology. 1998 Nov;105(11):2035-45. doi: 10.1016/S0161-6420(98)91121-6.
To determine the causes and patterns of mortality after uveal melanoma radiation.
A cohort study from a single institution was performed. Mortality was modeled using semiparametric survival techniques. All cause and cause-specific mortality analyses were performed. Mortality was compared with expected mortality from the U.S. census data.
A total of 731 patients were studied, and 710 (97%) of these had medium or large melanomas. The mean tumor diameter was 11.3 mm, and the mean tumor thickness was 5.8 mm. Ciliary body was involved in 122 (17%) of patients. Complete follow-up was available on 99.6% (728 of 731) of patients.
The authors analyzed the distribution and causes of post-treatment mortality.
The 5- and 10-year all-cause Kaplan-Meier survival rates were 75.6% and 62.3%, respectively. Both melanoma risk factors (older age, ciliary body involvement, and larger tumor diameter) and nonmelanoma risk factors (older age and medical condition) were significant prognostic factors of all-cause mortality. Deaths from nonmelanoma causes accounted for 91 (42.3%) of 215 deaths. The 5-year and 10-year estimates of nonmelanoma deaths were 8.3% and 15.9%, respectively. Nonmelanoma mortality was similar to that observed in the general U.S. population (91 observed, 98.1 expected). Melanoma metastases accounted for 124 (57.7%) of 215 deaths. The 5- and 10-year estimates for probability of metastatic death were 16.1% and 21.8%, respectively. The largest tumor diameter was the best predictor for melanoma mortality; ciliary body involvement, older age, and distance from the fovea also were significant in multivariate analyses.
A significant proportion of patients with uveal melanoma die of nonmelanoma causes after radiation. In analyzing prognostic factors, considerable information may be lost if analyses are based on all-cause mortality rather than cause-specific mortality.
确定葡萄膜黑色素瘤放疗后的死亡原因及模式。
开展了一项来自单一机构的队列研究。采用半参数生存技术对死亡率进行建模。进行了全因死亡率和特定病因死亡率分析。将死亡率与美国人口普查数据的预期死亡率进行比较。
共研究了731例患者，其中710例（97%）患有中大型黑色素瘤。肿瘤平均直径为11.3毫米，平均厚度为5.8毫米。122例（17%）患者的睫状体受累。99.6%（731例中的728例）的患者有完整随访数据。
作者分析了治疗后死亡率的分布及原因。
5年和10年全因Kaplan-Meier生存率分别为75.6%和62.3%。黑色素瘤危险因素（年龄较大、睫状体受累和肿瘤直径较大）和非黑色素瘤危险因素（年龄较大和健康状况）均为全因死亡率的显著预后因素。215例死亡病例中，91例（42.3%）死于非黑色素瘤病因。非黑色素瘤死亡的5年和10年估计率分别为8.3%和15.9%。非黑色素瘤死亡率与美国普通人群观察到的死亡率相似（观察到91例，预期98.1例）。黑色素瘤转移导致215例死亡中的124例（57.7%）。转移死亡概率的5年和10年估计率分别为16.1%和21.8%。最大肿瘤直径是黑色素瘤死亡率的最佳预测指标；在多变量分析中，睫状体受累、年龄较大以及与黄斑中心凹的距离也具有显著性。
相当一部分葡萄膜黑色素瘤患者放疗后死于非黑色素瘤病因。在分析预后因素时，如果基于全因死亡率而非特定病因死亡率进行分析，可能会丢失大量信息。
