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In Ophthalmology. Retina

OBJECTIVE : To analyze the clinical characteristics of uveal melanoma (UM) and evaluate the relationship of congenital oculocutaneous melanosis (OCM) to the prognosis of Asian patients with UM.

DESIGN : Retrospective cohort study PARTICIPANTS: We included a total of 1151 Asian UM patients who were managed at the Beijing Tongren Hospital from Jun 26, 2005, to Jul 27, 2020.

METHODS : I-125 plaque brachytherapy, local resection, thermotherapy, or enucleation MAIN OUTCOMES AND MEASURES: Melanoma-related metastasis and death RESULT: Of 1151 Asian patients with UM and congenital OCM was present in 23 (0.20%). The melanocytosis involved the conjunctiva (78%), sclera (74%), eyelid (70%), face (26%), forehead (2.2%), iris (0.87%), choroid (0.87%) and auricle (0.4%). Univariate analysis of Cox proportional hazards regression model showed the age, tumor thickness, largest tumor basal diameter, and ciliary body involvement were the risk factors for the poor prognosis of Asian patients with UM. By multivariable analysis, the only factor predictive of melanoma-related metastasis and death was the largest tumor basal diameter (HR=1.21 [1.11, 1.33], P < .001; 1.17 [1.01, 1.35], P=0.033). Probability-of-censoring weighted (IPW) estimation was used to mitigate selection bias due to loss to follow-up. IPW estimation revealed the largest tumor basal diameter and ciliary body involvement were associated with metastasis (HR= 1.29 [1.15, 1.45], P<0.001; HR=2.64 [1.01, 6.90], P<0.048). During the median follow-up period of 53 (33-67) months, 2 OCM patients (8.7%) developed melanoma-related metastasis. Using nested case-control design and matched with the factors of the age, largest tumor basal diameter, tumor thickness, ciliary body involvement, Kaplan-Meier survival analysis showed that UM combined with OCM did not increase the risk of melanoma-related metastasis and death (p = 0.68, Log-rank test).

CONCLUSION : The prominent risk for metastasis from UM was the largest tumor basal diameter in Asian patients. IPW estimation revealed the largest tumor basal diameter and ciliary body involvement were the risk factors for UM metastasis. Patients with UM combined with OCM had a similar risk for metastasis compared with those with no OCM.

Zhou Nan, Zhang Ruiheng, Liu Yueming, Wei Wenbin

2021-Jan-11

Congenital oculocutaneous melanosis, metastasis and death, prognosis, uveal melanoma