Local Recurrence Significantly Increases the Risk of Metastatic Uveal Melanoma

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• 作者：The Ophthalmic Oncology Task ForceBrenda L. Gallie ; MD ; E. Rand Simpson ; MD ; Svetlana Saakyan ; MD ; Anush Amiryan ; MD ; Vladimir Valskiy ; MD ; PhD ; Paul T. Finger ; MD ; Kimberly J. Chin ; OD ; Ekaterina Semenova ; MD ; Stefan Seregard ; MD ; Maria Fili ; MD ; Matthew Wilson ; MD ; Barrett Haik ; MD ; Jose M. Caminal ; MD ; Jaume Català ; MD ; Cristina Gutierrez ; MD ; David E. Pelayes ; MD ; PhD ; Anibal Martí ; n Folgar ; MD ; Martine J. Jager ; MD ; Mehmet Dogrusö ; z ; MD ; Gregorius P.M. Luyten ; MD ; Arun Singh ; MD ; Andrew P. Schachat ; MD ; Shigenobu Suzuki ; MD ; Yukiko Aihara ; MD
• 关键词：AJCC ; American Joint Committee on Cancer ; CBC ; ciliary body and choroidal ; CI ; confidence interval ; EXE ; extrascleral extension ; HR ; hazard ratio ; T size ; tumor size (T-size refers to AJCC cT stage)
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：123
• 期：1
• 页码：86-91
• 全文大小：618 K

文摘

To assess of the effect of local recurrence of uveal melanoma on metastasis using a multicenter international tumor registry.

Design

Retrospective study using an online tumor registry.

Participants

Patients with uveal melanoma diagnosed between 2001 and 2011.

Methods

A committee was formed to create uveal melanoma patient-specific data fields. Ten subspecialty ophthalmic oncology centers from 4 continents shared data. Patient selection criteria included diagnosis of uveal melanoma and adequate records to allow tumor staging by American Joint Committee on Cancer (AJCC) criteria and follow-up for metastatic melanoma.

Main Outcome Measures

Local tumor recurrence and metastatic uveal melanoma.

Results

Of 3809 total entries, 3217 patients with ciliary body and choroidal (CBC) melanoma and 160 with iris melanoma were evaluated. There was a median follow-up of 3.7 years (95% confidence interval [CI], 3.5–3.8). One hundred fifty-two patients (4.7%) with CBC melanoma experienced local recurrence, with a cumulative incidence of 11%. Kaplan-Meier point estimates for remaining free of local recurrence were 99% (95% CI, 99–99) at 1 year, 93% (95% CI, 92–94) at 5 years, and 89% (95% CI, 86–91) at 10 years. Five- and 10-year metastasis-free Kaplan-Meier estimates for the recurrence-free group were 87% (95% CI, 86–89) and 82% (95% CI, 79–84), and those for the local recurrence group were 71% (95% CI, 62–78) and 62% (95% CI, 49–72). The difference between these 2 groups was statistically significant (P < 0.001). Furthermore, local tumor recurrence increased the risk of metastasis by a hazard ratio (HR) of 6.28 (95% CI, 4.4–8.9; P < 0.001). Local recurrence was detected up to 9.8 years after treatment. Extrascleral extension also was associated with local recurrence (HR, 3.2; 95% CI, 1.5–6.7; P = 0.003), but higher AJCC T-size category was not (P = 0.63). Five patients (n = 5/161 [3.1%]) with iris melanoma demonstrated local recurrence and 1 metastasized.

Conclusions

International multicenter data sharing was used to evaluate the effect of local tumor recurrence on metastatic rate. In that local tumor recurrence was associated with a significantly higher risk of systemic metastasis, effective initial treatment and long-term surveillance of treated uveal melanoma patients is necessary.