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Abstract：
OBJECTIVE: The aim of this study was to compare the clinical outcomes of adolescents and young adults (AYAs) with those of elder adult patients treated with proton therapy (PT) for uveal melanoma (UM).
METHODS: A retrospective, comparative study was conducted in UM patients who underwent PT at the Ocular Oncology Unit of the Jules-Gonin Eye Hospital (University of Lausanne, Lausanne, Switzerland) and the Paul Scherrer Institute (PSI); (Villigen, Switzerland) between January 1997 and December 2007. Propensity score matching (PSM) was used to select for each AYA (between 15-39 years old) an elder adult patient (≥40 years) with similar characteristics. We assessed ocular follow-up, local tumor control, metastasis incidence, and overall and relative survival (OS and RS). Non-terminal outcomes were then compared between the two groups using competing risk survival analysis.
RESULTS: Out of a total of 2261 consecutive UM patients, after excluding 4 children (<15 years) and 6 patients who were metastatic at presentation, we identified 272 AYA patients and matched 270 of them with 270 elder adult patients. Before PSM, the AYA patients had a higher incidence of primary iris melanoma (4.0% vs. 1.4%; p = 0.005), while the elder patients were more likely to have other neoplastic diseases at presentation (9% vs. 3.7%; p = 0.004). Ocular outcomes and local tumor control were similar in both groups. Cumulative metastasis incidence for the AYA and elder adult groups was 13% and 7.9% at 5 years and 19.7% and 12.7% at 10 years, respectively, which was not significantly different between the groups (p = 0.214). The OS was similar in the two groups (p = 0.602), with estimates in the AYA and elder adult groups of 95.5% and 96.6% at 5 years and 94.6% and 91.4% at 10 years, respectively. However, the relative survival (RS) estimation was worse in the AYA group than the elder group (p = 0.036).
CONCLUSIONS: While AYAs treated with PT for UM have similar ocular outcomes and present the same metastasis incidence and OS as elder adults, their RS is worse than that in elder adults, when compared with the population in general.
METHODS: A retrospective, comparative study was conducted in UM patients who underwent PT at the Ocular Oncology Unit of the Jules-Gonin Eye Hospital (University of Lausanne, Lausanne, Switzerland) and the Paul Scherrer Institute (PSI); (Villigen, Switzerland) between January 1997 and December 2007. Propensity score matching (PSM) was used to select for each AYA (between 15-39 years old) an elder adult patient (≥40 years) with similar characteristics. We assessed ocular follow-up, local tumor control, metastasis incidence, and overall and relative survival (OS and RS). Non-terminal outcomes were then compared between the two groups using competing risk survival analysis.
RESULTS: Out of a total of 2261 consecutive UM patients, after excluding 4 children (<15 years) and 6 patients who were metastatic at presentation, we identified 272 AYA patients and matched 270 of them with 270 elder adult patients. Before PSM, the AYA patients had a higher incidence of primary iris melanoma (4.0% vs. 1.4%; p = 0.005), while the elder patients were more likely to have other neoplastic diseases at presentation (9% vs. 3.7%; p = 0.004). Ocular outcomes and local tumor control were similar in both groups. Cumulative metastasis incidence for the AYA and elder adult groups was 13% and 7.9% at 5 years and 19.7% and 12.7% at 10 years, respectively, which was not significantly different between the groups (p = 0.214). The OS was similar in the two groups (p = 0.602), with estimates in the AYA and elder adult groups of 95.5% and 96.6% at 5 years and 94.6% and 91.4% at 10 years, respectively. However, the relative survival (RS) estimation was worse in the AYA group than the elder group (p = 0.036).
CONCLUSIONS: While AYAs treated with PT for UM have similar ocular outcomes and present the same metastasis incidence and OS as elder adults, their RS is worse than that in elder adults, when compared with the population in general.
摘要：
目的：本研究的目的是比较接受质子治疗（PT）治疗葡萄膜黑色素瘤（UM）的青少年和年轻成年人（AYAs）的临床结果。
方法：回顾性研究，在Jules-Gonin眼科医院眼部肿瘤科接受PT的UM患者中进行了比较研究（洛桑大学，洛桑,瑞士)和保罗·谢雷尔研究所(PSI)；(维利根，瑞士）在1997年1月至2007年12月之间。使用倾向评分匹配（PSM）为每位AYA（15-39岁）选择具有相似特征的老年成年患者（≥40岁）。我们评估了眼部随访，局部肿瘤控制,转移发生率，总生存率和相对生存率（OS和RS）。然后使用竞争风险生存分析比较两组之间的非终点结果。
结果：在2261例连续的UM患者中，在排除4名儿童（<15岁）和6名转移患者后，我们确定了272例AYA患者,其中270例患者与270例老年成年患者进行了匹配.在PSM之前,AYA患者原发性虹膜黑色素瘤的发病率较高(4.0%vs.1.4%；p=0.005)，而老年患者在就诊时更有可能患有其他肿瘤性疾病(9%vs.3.7%；p=0.004）。两组的眼部结局和局部肿瘤控制相似。AYA和老年人组的累积转移发生率在5年分别为13％和7.9％，在10年分别为19.7％和12.7％。分别,两组之间没有显着差异（p=0.214）。两组的OS相似（p=0.602），在AYA和老年成年人组中，5岁时的估计为95.5％和96.6％，10岁时的估计为94.6％和91.4％，分别。然而,AYA组的相对生存（RS）估计比老年组差（p=0.036）。
结论：尽管用PT治疗UM的AYAs具有相似的眼部结局，并且与老年人具有相同的转移发生率和OS，他们的RS比老年人差，与一般人口相比。
方法：回顾性研究，在Jules-Gonin眼科医院眼部肿瘤科接受PT的UM患者中进行了比较研究（洛桑大学，洛桑,瑞士)和保罗·谢雷尔研究所(PSI)；(维利根，瑞士）在1997年1月至2007年12月之间。使用倾向评分匹配（PSM）为每位AYA（15-39岁）选择具有相似特征的老年成年患者（≥40岁）。我们评估了眼部随访，局部肿瘤控制,转移发生率，总生存率和相对生存率（OS和RS）。然后使用竞争风险生存分析比较两组之间的非终点结果。
结果：在2261例连续的UM患者中，在排除4名儿童（<15岁）和6名转移患者后，我们确定了272例AYA患者,其中270例患者与270例老年成年患者进行了匹配.在PSM之前,AYA患者原发性虹膜黑色素瘤的发病率较高(4.0%vs.1.4%；p=0.005)，而老年患者在就诊时更有可能患有其他肿瘤性疾病(9%vs.3.7%；p=0.004）。两组的眼部结局和局部肿瘤控制相似。AYA和老年人组的累积转移发生率在5年分别为13％和7.9％，在10年分别为19.7％和12.7％。分别,两组之间没有显着差异（p=0.214）。两组的OS相似（p=0.602），在AYA和老年成年人组中，5岁时的估计为95.5％和96.6％，10岁时的估计为94.6％和91.4％，分别。然而,AYA组的相对生存（RS）估计比老年组差（p=0.036）。
结论：尽管用PT治疗UM的AYAs具有相似的眼部结局，并且与老年人具有相同的转移发生率和OS，他们的RS比老年人差，与一般人口相比。
