부산대학교 도서관

Simple Summary: Choroidal melanomas are treated in the hope of preventing metastatic death; however, such treatment often causes severe visual loss. There is debate as to whether the treatment of small tumors can be deferred until tumor growth is observed. Using the Liverpool Uveal Melanoma Prognosticator Online v.3 (LUMPO3), this study provides an indication of change in the 15-year absolute risk of metastatic death, according to whether the tumor is treated immediately or after 4 or 12 months, when growth is observed. It considers tumor growth rate, dimensions, laboratory indicators of metastasis risk, prevalence of monosomy 3, patient's age, and sex. Our study suggests that deferring treatment until growth is observed is associated with minimal, if any, increase in the risk of metastatic death with usual tumor growth rates of up to 40% per year. It would seem reasonable to delay treatment until tumor growth is documented, especially if this is likely to cause visual loss. Background: We estimated metastatic-death risk when the treatment of small choroidal melanomas is deferred until growth is observed. Methods: In 24 patients with choroidal melanoma (median diameter 5.85 mm), the exponential growth rate estimated by a mixed-effects model was 4.3% per year. Using the Liverpool Uveal Melanoma Prognosticator Online v.3 (LUMPO3), we measured changes in 15-year metastatic and non-metastatic death risks according to whether the tumor is treated immediately or after observing growth 4 or 12 months later, considering age, sex, and metastasis predictors. Results: In 40-year-old females with 10 mm, disomy 3 and monosomy 3 choroidal melanomas (prevalence 16%), the 15-year absolute risks of metastatic death are 4.2% and 76.6%, respectively, increasing after a 4-month delay by 0.0% and 0.2% and by 3.0% and 2.3% with tumor growth rates of 5.0% and 20.0%, respectively. With 12-month delays, these risks increase by 0.0% and 0.5% and by 1.0% and 7.1%, respectively. Increases in metastatic-death risk are less with smaller tumors and with a higher risk of non-metastatic death. Conclusions: Deferring treatment of choroidal melanomas until documentation of growth may delay iatrogenic visual loss by months or years and is associated with minimal increase in metastatic mortality, at least with small tumors with usual growth rates of up to 40% per year. [ABSTRACT FROM AUTHOR]