Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center
| Autor: | Sarangdev Vaidya, Antonio Yaghy, Lauren A Dalvin, Sara E. Lally, Alejandro L Perez, Jerry A. Shields, Richard R Pacheco, Carol L. Shields |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Enucleation Visual Acuity Conjunctival Neoplasms Ophthalmologic Surgical Procedures 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Child Melanoma Lymph node Aged Proportional Hazards Models Retrospective Studies Aged 80 and over business.industry Hazard ratio Middle Aged medicine.disease Confidence interval Radiation therapy Ophthalmology Outcome and Process Assessment Health Care medicine.anatomical_structure Child Preschool 030221 ophthalmology & optometry Female Presentation (obstetrics) business Conjunctival Melanoma 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Cornea. 40:554-563 |
| ISSN: | 0277-3740 |
| DOI: | 10.1097/ico.0000000000002449 |
| Popis: | PURPOSE To investigate the clinical features and outcomes for conjunctival melanoma based on patient age. METHODS A retrospective review of patients with conjunctival melanoma managed at a single tertiary referral center from April 18, 1974, to September 9, 2019. Clinical features and outcomes were compared by patient age category at presentation (young ≤45 years, middle-aged 46-69 years, and older ≥70 years), with Kaplan-Meier and Cox proportional hazard analysis [hazard ratio (95% confidence interval)]. RESULTS There were 629 patients categorized as young in 130 (21%), middle-aged in 278 (44%), and older in 221 (35%). A comparison by age category (young vs. middle-aged vs. older) revealed that older patients had melanoma with greater number of affected quadrants (1.7 vs. 1.8 vs. 2.0, P = 0.001) and clock hours (3.9 vs. 4.2 vs. 5.2, P = 0.001). All patients were treated with surgical excision, with no difference in requirement for additional medical or radiation therapy. By 10-year Kaplan-Meier outcomes, older patients had more frequent visual acuity loss ≥3 lines (11% vs. 28% vs. 64%, P < 0.001) and local tumor recurrence (38% vs. 46% vs. 70%, P < 0.001). Hazard ratio for the oldest age group (age ≥70) revealed a 7.76-fold (3.33-18.09) increased risk for visual acuity loss (P < 0.001), and a 2.08-fold (1.32-3.28) increased risk of local tumor recurrence (P = 0.002). There was no difference by age in risk for enucleation, exenteration, locoregional lymph node involvement, distant systemic metastasis, or death. CONCLUSIONS Older patients with conjunctival melanoma present with more extensive disease and have increased risk for visual acuity loss and local tumor recurrence. |
| Databáze: | OpenAIRE |
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