Background/Objectives: Metastatic posterior uveal melanoma (PUM) is one of the deadliest types of melanomas. Though the median survival is short, some patients with metastatic disease live for a long time. In this study, we investigated whether the anatomical location of the metastatic lesions is associated with differences in survival.Methods: One hundred and seventy-eight patients with metastatic PUM with baseline whole-body imaging were retrospectively included. The patients were divided into three groups based on the anatomical location of metastases: (1) exclusive liver metastases (hepatic pattern), (2) both hepatic and extrahepatic metastatic lesions (hepatic–extrahepatic pattern), and (3) exclusive extrahepatic lesions (extrahepatic pattern). Survival was investigated using Kaplan–Meier plots, log-rank test, and the Cox proportional hazard model.Results: In total, 95 patients (53%) presented with hepatic pattern, 66 patients (37%) presented with hepatic–extrahepatic pattern, and 17 patients (10%) presented with extrahepatic pattern. Overall survival was significantly longer in patients with extrahepatic pattern (median 17.0 months) compared to those with hepatic pattern (median 11.0 months) and hepatic–extrahepatic pattern (median 7.0 months) (p< 0.001, log-rank test). Multivariate Cox regression analysis showed increased hazard ratios (HR) for hepatic pattern (HR 2.37, 95% CI 1.08–5.17,p= 0.031) and hepatic–extrahepatic pattern (3.25, 95% CI 1.42–7.41,p= 0.005) compared to extrahepatic pattern. Most patients with hepatic (95%) and hepatic–extrahepatic patterns (82%) were diagnosed with metastases by liver ultrasonography screening, whereas 81% of patients with extrahepatic pattern developed symptoms that led to the diagnosis.Conclusions: Extrahepatic pattern was associated with prolonged survival in patients with metastatic PUM, despite there being a larger proportion of symptomatic patients. It is therefore important to consider the anatomical location of the metastatic lesions when stratifying patients into clinical trials.
背景/目的：转移性后葡萄膜黑色素瘤（PUM）是致死率最高的黑色素瘤类型之一。尽管患者中位生存期较短，但部分转移性疾病患者可长期存活。本研究旨在探讨转移病灶的解剖位置是否与生存差异相关。 方法：本研究回顾性纳入178例接受基线全身影像学检查的转移性PUM患者。根据转移灶解剖位置将患者分为三组：（1）仅肝转移（肝转移型）、（2）肝内及肝外转移并存（肝-肝外转移型）、（3）仅肝外转移（肝外转移型）。采用Kaplan-Meier曲线、对数秩检验和Cox比例风险模型进行生存分析。 结果：95例患者（53%）为肝转移型，66例（37%）为肝-肝外转移型，17例（10%）为肝外转移型。肝外转移型患者总生存期（中位17.0个月）显著长于肝转移型（中位11.0个月）和肝-肝外转移型（中位7.0个月）（p<0.001，对数秩检验）。多变量Cox回归分析显示，与肝外转移型相比，肝转移型（HR 2.37，95% CI 1.08-5.17，p=0.031）和肝-肝外转移型（HR 3.25，95% CI 1.42-7.41，p=0.005）的风险比显著升高。肝转移型（95%）和肝-肝外转移型（82%）患者多通过肝脏超声筛查确诊转移，而肝外转移型患者中81%因出现症状而确诊。 结论：尽管肝外转移型患者出现症状的比例更高，但其在转移性PUM患者中仍与更长的生存期相关。因此，在将患者分层纳入临床试验时，必须充分考虑转移病灶的解剖位置。
肿瘤(癌症)患者之家