The Clinical And Pathological Analysis Of Death Reasons Of Uveal Melanomas After Enucleation

Background: Melanoma of the uvea is the most common primaryintraocular malignancy in adults, It accounts for approximately 80% of primarymalignancies in the ocular region and may occur in iris, ciliary body and choroid,but the most common appearances are in choroid. The pathogen is not clear yet,melanism,naevus,nerval fibroma or endocrine diseases are considerd as itspathogenes. High risk clinical factors predictive of tumor growth includedsymptoms of flashes, floaters, blurred vision, greater tumor thickness, posteriortumor margin touching optic disk, subretinal fluid and orange pigment. It is reported that the 5, 10 and 15-year melamoma-specific survivalprobabilities are 72%, 59% and 53% , respectively. About 50% patients havedied from this disease in 15 years. As many patients today are treated witheye-preserving therapies, the prognosis has to be evaluated by clinical findingsor preoperative biopsy. At present, for patients with uveal melamoma there is noeffective therapy if metastases have developed. Survival time for uncuredpatients is related to the rapidity of the metastatic process. Those who werediagnosed liver metastasis have little time to survive, only 2 to 7 months. Inorder to lower melamoma-related mortality, it is essential to prevent or eradicatemetastatic disease. This calls for early detection and for the development ofreliable prognostic factors. It is, therefore, necessary to increase our knowledgeof the mechanisms underlying metastasis and the indentification of reliableprogression parameters as prognostic markers in primary uveal melamoma.Through big sample, prospective or retrospective cohort studies for many years,researchers have found and grasped some prognostic factors related to choroidalor ciliary body melanoma, such as age, gender, location of the tumors, ansteriortumor margin, LTD, LBD, height, ciliary body involved or not, secondaryglaucoma, extrascleral extention or optic disc/nerve invasion, cell type, numbersof epithelioid cells, microvessel density.In this study, the affect of clinical and histopathological prognosis tomelanomas will be evaluated by 10 years' complete follow-up of patients treatedwith enucleation. The following-up results confirms that prognosis factors formelamoma-specific death included LBD, location of ansterior tumor margin,cell type and extrascleral extention or optic disc/nerve invasion. To thosepatients who are diagnosed as choroidal or ciliary body melanoma, measuringand registing tumors LBD preoperation helps clinical doctors to chooseappropriate treatments and save certain eyesight. After operationhistopathological examination is very nesesarry, it helps to distinguish patientswho have high risks to metastisis, evaluate their prognosis and improve lifequalities.Perfect prognositic factors should operate simply, availably, cheaply, anddeal with the specimens which are treated by traditional methods. When we getthe prospective study's results, we can choose high sensitive, high distinctivefactors and combine them to help doctors find patients who have higher risks tometastasize and take effective treatments to promote survival rates.Objective: To evaluated prognostic factors of patients died of choroidaland ciliary body malenomas after enucleation.Methods: The study included 35 choroidal or ciliary body melanomapatients (35 eyes) treated with enucleation during the period of Janury, 1996 toJune, 2005. Among these patients, 16 are men and 19 are women. The medianage was 51.5 years (range 22-83 years). The clinical and histopathologicalfindings such as the largest tumor basal diameters, anterior tumor location , celltype and cause of death etc were registered. Prognostic factors for death wereevaluated by chi-square test and rate ratio analysis. P<0.05 is significative instatistics and RR>1 is regarded as having positive correlativities betweenmelanoma-related death and the factors upabove.Result: An increased risk factor of melanoma-related death was largestbasal diameter (n=35,P<0.025,RR>1), anterior tumour margin at the iris/ciliarybody versus choroids (P<0.05,RR=2.89), extrascleral extention or opticdisc/nerve invasion versus no extrascleral extention or optic nerve invasion(P<0.05,RR=2.67), and non-spindle cell type versus spindle cell (P<0.025,RR=3.15). In these, LBD and cell type are more important influencing factor.Conclusion: The risk of melanoma-related death after enucleation for achoroidal or ciliary body melanoma was high for tumors with large basaldiameter, of non-spindle cell type, extrascleral extention or optic disc/nerveinvasion and anterior location. In these, LBD and cell type are more importantinfluencing factor.