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中国患者的结膜黑色素瘤:局部复发,转移,死亡,并与白种人进行比较 Conjunctival Melanoma in Chinese Patients: Local Recurrence, Metastasis, Mortality, and Comparisons With Caucasian Patients

Zhou, C., Wang, Y., Jia, R., Fan, X.

期刊名称:Investigative Ophthalmology & Visual Science



摘要:目的:旨在评估中国结膜黑色素瘤患者的预后,并确定其预测因子。此外,探讨中国和高加索患者的临床特征和预后之间的种族差异。方法:本研究纳入1996年至2016年经病理确诊的连续57例结膜黑色素瘤患者的57只眼,对其病因进行回顾性分析。回顾了病历中与局部复发,转移和肿瘤相关死亡相关的因素。所有符合条件的患者均接受这三种结局指标的随访。对中国人和高加索人的人口学资料,临床特征和预后进行比较。结果:平均随访时间为52.2±49.4个月。在57例患者中,29例(51%)患者发生局部复发。 1年,5年和10年复发率分别为31.0%,59.7%和66.4%。随访中发现的治疗并发症包括干眼(32,56.1%),不规则眼睑边缘(2543.9%),眼睑退缩(1831.6%),上睑下垂(915.8%),粘膜移植眼睑软骨重建混合色素沉着,角膜混浊(610.5%),睑球粘连(23.5%)。20例患者(35%)发生转移。 1年,5年和10年转移率分别为16.7%,38.7%和50.9%。 14例患者(25%)死于结膜黑色素瘤,中位生存期为24个月。 1年,5年和10年肿瘤相关死亡率分别为3.8%,30.5%和37.4%。肿瘤出血是肿瘤相关性死亡(危险比[HR]18.81P = 0.01)和转移(HR4.57P = 0.02)的独立危险因素。中国人和来自美国,德国和英国的高加索人患者的人口统计学,临床特征和预后方面存在明显差异。与高加索人相比,中国患者的男性更多(P <0.01),更年轻(P = 0.03)。在最初的表现上,更多的中国患者具有新的肿瘤起源(P <0.01),上皮样细胞型(P <0.01),非眼球肿瘤位置(P <0.01),基底直径大(P = 0.04),多灶性肿瘤(P < P <0.01),眼睑(P <0.01)和眼眶受累(P <0.01),晚期T分期(P <0.01)。在与高加索人相似的随访期内(52.2 52个月,P = 0.97),中国患者发生随访时眼睑浸润(P = 0.04)和眼眶浸润(P <0.01),局部复发(P <0.01),转移(P <0.01)和肿瘤相关性死亡(P <0.01)的比例明显较高。结论:结膜黑色素瘤是一种罕见的恶性肿瘤,死亡率高。应特别注意肿瘤出血患者。与高加索人相比,中国患者的临床体征出更具侵袭性。

Purpose:To evaluate the prognosis in Chinese patients with conjunctival melanoma and determine its predictors. Further, to explore the racial differences in clinical characteristics and outcomes between Chinese and Caucasian patients.Methods:This cohort study included 57 eyes of 57 consecutive patients with pathologically verified conjunctival melanoma between 1996 and 2016. Medical records were reviewed for factors associated with the local recurrence, metastasis, and tumor-related mortality. All eligible patients were followed up for these three outcome measures. The demographic data, clinical characteristics, and outcomes were compared between Chinese and Caucasian patients.Results:The mean follow-up period was 52.2 ± 49.4 months. Among the total 57 patients, 29 (51%) patients experienced local recurrence. The 1-, 5-, and 10-year recurrence rate was 31.0%, 59.7%, and 66.4%, respectively. Treatment complications detected in the follow-up included dry eye (32, 56.1%), irregular eyelid margin (25, 43.9%), eyelid retraction (18, 31.6%), blepharoptosis (9, 15.8%), mixed pigmentation of the tarsus reconstructed by mucosal membrane graft, corneal opacities (6, 10.5%), and symblepharon (2, 3.5%). Twenty (35%) patients developed metastasis. The 1-, 5-, and 10-year metastasis rate was 16.7%, 38.7%, and 50.9%, respectively. Fourteen (25%) patients died of conjunctival melanoma, with a median survival time of 24 months. The 1-, 5-, and 10-year tumor-related mortality was 3.8%, 30.5%, and 37.4%, respectively. Tumor hemorrhage is an independent risk factor for tumor-related death (hazard ratio [HR]: 18.81, P = 0.01) and metastasis (HR: 4.57, P = 0.02). Significant differences were noted between Chinese and Caucasians patients from America, Germany, and England in demographics, clinical characteristics, and outcomes. Compared to Caucasians, Chinese patients tended to have more male cases (P < 0.01) and to be younger (P = 0.03). At initial presentation, more Chinese patients had de novo tumor origin (P < 0.01), epithelioid cell type (P < 0.01), nonbulbar tumor location (P < 0.01), greater basal diameter (P = 0.04), multifocal tumor (P < 0.01), feeder vessels (P < 0.01), eyelid (P < 0.01) and orbit involvement (P < 0.01), and advanced T stages (P < 0.01). Over a similar follow-up period with Caucasians patients (52.2 vs. 52 months, P = 0.97), a significantly larger proportion of Chinese patients exhibited eyelid invasion (P = 0.04) and orbital invasion (P < 0.01) at follow-up, local recurrence (P < 0.01), metastasis (P < 0.01), and tumor-related death (P < 0.01).Conclusions:Conjunctival melanoma is a rare malignancy with great potential for mortality in Chinese. Special attention should be paid to patients with tumor hemorrhage. Compared to Caucasians, Chinese patients exhibit more aggressive clinical signs 


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