Introduction:Historically, approximately 30–32% of uveal melanoma patients develop metastases and die within 5 years. Larger tumor dimensions and monosomy 3 and/or Class 2 gene expression profile of the tumor are associated with an increased risk of metastasis. We evaluated the performance of these prognostic markers in patients undergoing surveillance in a community medical oncology practice.Methods:Uveal melanoma patients treated by a single vitreoretinal surgical oncologist and monitored by a single medical oncologist were identified via a clinical database search for analysis. Specified prognostic markers were evaluated for sensitivity, specificity, positive and negative predictive value, as well as prognostic accuracy.Results:We identified 37 uveal melanoma patients, followed for a median of 4.0 ± 3.7 years. Twenty-seven (73%) patients underwent plaque brachytherapy with vitrectomy and silicone oil for radiation attenuation; seven (19%) patients underwent brachytherapy alone; three (8%) had enucleation. There were no intraocular treatment failures. Six (16.2%) patients developed metastasis, and only one patient died of metastatic disease. Disomy 3 and Class 1 accurately predicted a low risk for metastasis (>90% negative predictive value). However, monosomy 3 and Class 2 had a low positive predictive value and prognostic accuracy in “high-risk” patients.Conclusions:In this single-center cohort, we observed an unexpectedly low rate of 5-year metastasis. AJCC stage correlated poorly with metastasis or survival. Molecular prognostic results of Disomy 3 and Class 1 gene expression profile accurately predicted a “low” risk for metastasis (>90% negative predictive value). Further evaluation of these unique surgical techniques needs to be carried out.
引言：历史上，约30-32%的葡萄膜黑色素瘤患者在5年内发生转移并死亡。较大的肿瘤尺寸以及肿瘤的单体性3号和/或2类基因表达谱与转移风险增加相关。我们评估了这些预后标志物在社区肿瘤内科实践中接受监测患者中的表现。 方法：通过临床数据库检索，识别出由同一位玻璃体视网膜外科肿瘤学家治疗并由同一位内科肿瘤学家监测的葡萄膜黑色素瘤患者进行分析。评估了特定预后标志物的敏感性、特异性、阳性和阴性预测值以及预后准确性。 结果：我们确定了37例葡萄膜黑色素瘤患者，中位随访时间为4.0±3.7年。27例（73%）患者接受了斑块近距离放射治疗联合玻璃体切除术和硅油填充以减弱辐射；7例（19%）患者仅接受近距离放射治疗；3例（8%）患者进行了眼球摘除术。无眼内治疗失败病例。6例（16.2%）患者发生转移，仅1例患者死于转移性疾病。二体性3号和1类基因表达谱准确预测了低转移风险（阴性预测值>90%）。然而，在“高风险”患者中，单体性3号和2类基因表达谱的阳性预测值和预后准确性较低。 结论：在这个单中心队列中，我们观察到5年转移率意外较低。AJCC分期与转移或生存率相关性较差。二体性3号和1类基因表达谱的分子预后结果准确预测了“低”转移风险（阴性预测值>90%）。需要对这些独特的手术技术进行进一步评估。
肿瘤(癌症)患者之家