Prognostic factor study of survival after enucleation for juxtapapillary melanomas
R. S. Weinhaus, J. M. Seddon, D. M. Albert, E. S. Gragoudas and N. Robinson
We reviewed 242 cases of choroidal and ciliary body melanoma that were
treated by enucleation to determine the importance of juxtapapillary
location as a prognostic factor for tumor-related deaths. Analysis involved
Kaplan-Meier survival curves and Cox proportional hazards analysis.
Patients with juxtapapillary tumors had a worse prognosis than those with
tumors in other locations (64% vs 78% five-year survival), but the
difference was not statistically significant. Juxtapapillary location was
not an independent risk factor on Cox multivariate analysis. Risk factors
included number of epithelioid cells per high-power field, largest tumor
dimension, location of the tumor's anterior margin, and invasion to the
line of transection. In 63 cases (26%), the tumor was in contact with the
optic disc. For these juxtapapillary tumors, we also evaluated the
prognostic importance of six variables relevant to juxtapapillary location.
On univariate analysis, tumor height at the disc margin, subarachnoid space
invasion, and postlaminar optic nerve invasion were significantly related
to survival, while disc compression by tumor, prelaminar optic nerve
invasion, and extent of disc perimeter surrounded by tumor were not. On Cox
multivariate analysis, however, none of these six variables was an
independent risk factor. Risk factors for juxtapapillary tumors included
number of epithelioid cells per high-power field and location of the
tumor's anterior margin.
