Background: We estimated metastatic-death risk when the treatment of small choroidal melanomas is deferred until growth is observed. Methods: In 24 patients with choroidal melanoma (median diameter 5.85 mm), the exponential growth rate estimated by a mixed-effects model was 4.3% per year. Using the Liverpool Uveal Melanoma Prognosticator Online v.3 (LUMPO3), we measured changes in 15-year metastatic and non-metastatic death risks according to whether the tumor is treated immediately or after observing growth 4 or 12 months later, considering age, sex, and metastasis predictors. Results: In 40-year-old females with 10 mm, disomy 3 and monosomy 3 choroidal melanomas (prevalence 16%), the 15-year absolute risks of metastatic death are 4.2% and 76.6%, respectively, increasing after a 4-month delay by 0.0% and 0.2% and by 3.0% and 2.3% with tumor growth rates of 5.0% and 20.0%, respectively. With 12-month delays, these risks increase by 0.0% and 0.5% and by 1.0% and 7.1%, respectively. Increases in metastatic-death risk are less with smaller tumors and with a higher risk of non-metastatic death. Conclusions: Deferring treatment of choroidal melanomas until documentation of growth may delay iatrogenic visual loss by months or years and is associated with minimal increase in metastatic mortality, at least with small tumors with usual growth rates of up to 40% per year.
背景：本研究旨在评估当小型脉络膜黑色素瘤的治疗推迟至观察到肿瘤生长时，其转移性死亡风险的变化。方法：通过对24例脉络膜黑色素瘤患者（中位直径5.85毫米）采用混合效应模型分析，估算出肿瘤年指数增长率为4.3%。利用利物浦葡萄膜黑色素瘤在线预后评估系统第三版（LUMPO3），结合患者年龄、性别及转移预测因子，我们比较了肿瘤立即治疗与延迟4个月或12个月（观察到生长后）治疗的15年转移性及非转移性死亡风险变化。结果：在40岁女性患者中，针对直径10毫米、3号染色体二体型与单体型脉络膜黑色素瘤（患病率16%），其15年转移性死亡绝对风险分别为4.2%和76.6%。若延迟治疗4个月，在肿瘤年增长率分别为5.0%和20.0%的情况下，风险增幅分别为0.0%/0.2%和3.0%/2.3%；延迟12个月时，风险增幅则分别为0.0%/0.5%和1.0%/7.1%。肿瘤体积越小或非转移性死亡风险越高时，转移性死亡风险的增加幅度越小。结论：将脉络膜黑色素瘤的治疗推迟至有生长记录时，可能使医源性视力丧失延迟数月或数年，且仅导致转移性死亡率轻微上升——至少对于年增长率不超过40%的常见小型肿瘤而言如此。
肿瘤(癌症)患者之家