Purpose

The American Joint Committee on Cancer (AJCC) classification was updated to the eighth edition in January 2017, providing staging for iris melanoma. This study evaluated outcomes of iris melanoma per the AJCC classification, eighth edition.

Design

Retrospective case series.

Participants

Four hundred thirty-two patients with iris melanoma.

Methods

Management including tumor resection, plaque radiotherapy, or enucleation.

Main Outcome Measures

Local tumor recurrence, melanoma-related systemic metastasis, and melanoma-related death.

Results

Of 432 patients with iris melanoma, AJCC classification was category T1 (n = 324 [75%]), T2 (n = 83 [19%]), T3 (n = 2 [<1%]), and T4 (n = 23 [5%]). There was no difference in age, race, gender, eye, or iris color among T categories. Overall, Kaplan-Meier analysis of outcomes (at 5 and 10 years) revealed visual acuity reduction by 3 lines or more (42% and 54%, respectively), secondary glaucoma (29% and 33%, respectively), local recurrence (8% and 17%, respectively), secondary enucleation (12% and 19%, respectively), lymph node metastasis (1% and 1%, respectively), melanoma-related systemic metastasis (5% and 10%, respectively), and melanoma-related death (3% and 4%, respectively). Compared with T1 category, the hazard ratio (HR) for local recurrence in nonenucleated eyes was 1.31 for T2, not evaluable (NE) for T3 (because of small cohort), and 6.61 for T4; the HR for metastasis was 3.41 for T2, NE for T3 (because of small cohort), and 25.6 for T4; the HR for death was 7.51 for T2, NE for T3 (because of small cohort), and 26.5 for T4; and the odds ratio for enucleation was 1.23 for T2, 3.63 for T3, and 4.72 for T4. Features predictive of melanoma-related metastasis (multivariate analysis) included secondary glaucoma (P < 0.001; HR, 4.51), T2 category (vs. T1; P = 0.01; HR, 4.09), and T4 category (vs. T1; P < 0.001; HR, 30.8). Features predictive of melanoma-related death (multivariate analysis) included older age (P = 0.008; HR, 2.16 per 10-year increase), T2 category (vs. T1; P = 0.005; HR, 8.07), and T4 category (vs. T1; P < 0.001; HR, 20.3).

Conclusions

The AJCC eighth edition classification provides prognostic stratification of iris melanoma. By multivariate analysis, the ratio for melanoma-related metastasis was 4 times greater in category T2 and 31 times greater in T4 compared with T1. The ratio for melanoma-related death was 8 times greater in category T2 and 20 times greater in T4 compared with T1. The cohort size for T3 was too small to provide useful information.

中文翻译：

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基于美国癌症分类联合委员会（第八版）的虹膜黑色素瘤结果（432例）

目的

美国癌症联合委员会（AJCC）分类于2017年1月更新为第八版，为虹膜黑色素瘤提供了分期。这项研究根据AJCC分类（第八版）评估了虹膜黑色素瘤的结局。

设计

回顾案例系列。

参加者

432例虹膜黑色素瘤。

方法

处理包括肿瘤切除，斑块放射治疗或摘除。

主要观察指标

局部肿瘤复发，黑素瘤相关的全身转移和黑素瘤相关的死亡。

结果

在432例虹膜黑色素瘤患者中，AJCC的分类为T1类（n = 324 [75％]），T2（n = 83 [19％]），T3（n = 2 [<1％]）和T4（n = 23 [5％]）。在T类中，年龄，种族，性别，眼睛或虹膜颜色没有差异。总体而言，Kaplan-Meier结局分析（5年和10年）显示视力下降了3行或更多（分别为42％和54％），继发性青光眼（分别为29％和33％），局部复发（8 ％和17％），继发摘除术（分别为12％和19％），淋巴结转移（分别为1％和1％），黑素瘤相关的全身转移（分别为5％和10％）和黑素瘤相关死亡（分别为3％和4％）。与T1类相比，无核眼局部复发的危险比（HR）对于T2为1.31，对于T3为不可评估（NE）（由于队列较小），为6。T4为61；T2的转移HR为3.41，T3的NE为（由于小队列），T4的转移的HR为25.6。T2的死亡HR为7.51，T3的NE为NE（由于队列较小），T4的HR为26.5。T2的去核比值比为1.23，T3的比值比为3.63，T4的比值比为4.72。可预测黑色素瘤相关转移的特征（多变量分析）包括继发性青光眼（P <0.001；HR，4.51），T2类别（vs. T1；P  = 0.01； HR，4.09）和T4类别（vs. T1；P <0.001； HR，30.8）。可以预测黑素瘤相关死亡的特征（多变量分析）包括年龄较大（P  = 0.008； HR，每10年增加2.16），T2类别（与T1；P  = 0.005； HR，8.07）和T4类别（与T1；P <0.001； HR，20.3）。

结论

AJCC第八版分类提供了虹膜黑色素瘤的预后分层。通过多变量分析，与T1相比，T2类中黑素瘤相关转移的比例高4倍，T4类中高31倍。与T1相比，T2类中与黑素瘤相关的死亡比例高8倍，T4中高20倍。T3的同类群组太小，无法提供有用的信息。