Objective: The aim of this study was to compare the clinical outcomes of adolescents and young adults (AYAs) with those of elder adult patients treated with proton therapy (PT) for uveal melanoma (UM). Material and Methods: A retrospective, comparative study was conducted in UM patients who underwent PT at the Ocular Oncology Unit of the Jules-Gonin Eye Hospital (University of Lausanne, Lausanne, Switzerland) and the Paul Scherrer Institute (PSI); (Villigen, Switzerland) between January 1997 and December 2007. Propensity score matching (PSM) was used to select for each AYA (between 15–39 years old) an elder adult patient (≥40 years) with similar characteristics. We assessed ocular follow-up, local tumor control, metastasis incidence, and overall and relative survival (OS and RS). Non-terminal outcomes were then compared between the two groups using competing risk survival analysis. Results: Out of a total of 2261 consecutive UM patients, after excluding 4 children (<15 years) and 6 patients who were metastatic at presentation, we identified 272 AYA patients and matched 270 of them with 270 elder adult patients. Before PSM, the AYA patients had a higher incidence of primary iris melanoma (4.0% vs. 1.4%;p= 0.005), while the elder patients were more likely to have other neoplastic diseases at presentation (9% vs. 3.7%;p= 0.004). Ocular outcomes and local tumor control were similar in both groups. Cumulative metastasis incidence for the AYA and elder adult groups was 13% and 7.9% at 5 years and 19.7% and 12.7% at 10 years, respectively, which was not significantly different between the groups (p= 0.214). The OS was similar in the two groups (p= 0.602), with estimates in the AYA and elder adult groups of 95.5% and 96.6% at 5 years and 94.6% and 91.4% at 10 years, respectively. However, the relative survival (RS) estimation was worse in the AYA group than the elder group (p= 0.036). Conclusion: While AYAs treated with PT for UM have similar ocular outcomes and present the same metastasis incidence and OS as elder adults, their RS is worse than that in elder adults, when compared with the population in general.
目的：本研究旨在比较青少年与年轻成人（AYAs）与老年成人患者接受质子治疗（PT）治疗葡萄膜黑色素瘤（UM）的临床结局。材料与方法：对1997年1月至2007年12月期间在瑞士洛桑大学Jules-Gonin眼科医院眼肿瘤科及保罗谢勒研究所（PSI）接受PT治疗的UM患者进行回顾性比较研究。采用倾向评分匹配（PSM）方法，为每位AYA患者（15-39岁）匹配一名具有相似特征的老年成人患者（≥40岁）。评估指标包括眼部随访情况、局部肿瘤控制、转移发生率、总生存期（OS）及相对生存期（RS）。采用竞争风险生存分析法比较两组非终末结局。结果：在连续纳入的2261例UM患者中，排除4例儿童（<15岁）及6例初诊时已发生转移的患者后，共识别出272例AYA患者，其中270例成功匹配270例老年成人患者。PSM前，AYA患者原发性虹膜黑色素瘤发生率更高（4.0% vs. 1.4%；p=0.005），而老年患者初诊时合并其他肿瘤性疾病的比例更高（9% vs. 3.7%；p=0.004）。两组眼部结局及局部肿瘤控制情况相似。AYA组与老年组5年累积转移发生率分别为13%与7.9%，10年分别为19.7%与12.7%，组间无显著差异（p=0.214）。两组OS相似（p=0.602），AYA组与老年组5年OS分别为95.5%与96.6%，10年分别为94.6%与91.4%。然而，AYA组的RS显著低于老年组（p=0.036）。结论：虽然接受PT治疗的UM患者中，AYAs与老年成人的眼部结局、转移发生率及OS相似，但与普通人群相比，AYAs的RS较老年成人更差。
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