癌症基因组图谱(TCGA)是由美国国家癌症研究所(NCI)支持的一项综合项目,旨在探索癌症的分子改变。包括葡萄膜黑色素瘤(UM)。这导致了UM的TCGA分类。在这份报告中,我们回顾了NCI癌症基因组学中心(NCICCG)(基于摘除术标本[n=80眼])和Wills眼科医院(WEH)(基于细针穿刺活检[FNAB]标本[n=658眼])对UM的美国癌症联合委员会(AJCC)分类和TCGA分类.然后,我们将AJCC的准确性和可预测性与(与)TCGA。
对已发表的UMAJCC和TCGA分类报告进行审查。评估了基于AJCC第7版和第8版的结果。对于TCGA,UM根据3号和8号染色体的发现进行分类,包括3号染色体(D3),一元3(M3),disomy8(D8),8q增益(8qG),或8q增益倍数(8qGm),并组合成四类,包括A类(D3/D8),B类(D3/8qG),C级(M3/8qG),和D类(M3/8qGm)。探讨了转移和死亡的结果并进行了比较(AJCC与进行TCGA)。
在NCICCG研究中,有80只眼睛通过摘除术进行UM采样(n=77),切除(n=2),或眼眶切开术(n=1)和分析揭示了四个不同的遗传类别。随后在WEH研究中每类评估转移和死亡结果。WEH研究回顾了658只患有UM的眼睛,由FNAB采样,发现A类(n=342,52%),B(n=91,14%),C(n=118,18%),D(n=107,16%)。通过增加类别进行比较(A与Bvs.Cvs.D)显示患者平均年龄较大(P<0.001),进入视力较差(P<0.001),距视神经盘的距离更大(P<0.001),肿瘤直径较大(P<0.001),和更大的肿瘤厚度(P<0.001)。关于结果,更先进的TCGA类别显示5年转移风险增加(4%与20%vs.33%vs.63%,P<0.001),风险比(HR)相应增加(1.0vs.4.1,10.1,30.0,B与P=0.01A和P<0.001对于C与A和Dvs.A)以及增加的5年估计死亡风险(1%与0%vs.9%vs.23%,P<0.001),HR相应增加(1vs.NAvs.3.1vs.13.7,C与D与D的A和P<0.001A).AJCC与TCGA分类的比较显示,TCGA在预测UM的转移和死亡方面具有优势。
UM的TCGA分类很简单,准确,高度预测黑色素瘤相关的转移和死亡,比AJCC分类更重要。
The cancer genome atlas (TCGA) is a comprehensive project supported by the National Cancer Institute (NCI) in the United States to explore molecular alterations in cancer, including uveal melanoma (UM). This led to TCGA classification for UM. In this report, we
review the American Joint Committee on Cancer (AJCC) classification and TCGA classification for UM from the NCI\'s Center for Cancer Genomics (NCI CCG) (based on enucleation specimens [n = 80 eyes]) and from Wills Eye Hospital (WEH) (based on fine needle aspiration biopsy [FNAB] specimens [n = 658 eyes]). We then compare accuracy and predictability of AJCC versus (vs.) TCGA.
Review of published reports on AJCC and TCGA classification for UM was performed. Outcomes based on AJCC 7th and 8th editions were assessed. For TCGA, UM was classified based on chromosomes 3 and 8 findings including disomy 3 (D3), monosomy 3 (M3), disomy 8 (D8), 8q gain (8qG), or 8q gain multiple (8qGm) and combined into four classes including Class A (D3/D8), Class B (D3/8qG), Class C (M3/8qG), and Class D (M3/8qGm). Outcomes of metastasis and death were explored and a comparison (AJCC vs. TCGA) was performed.
In the NCI CCG study, there were 80 eyes with UM sampled by enucleation (n = 77), resection (n = 2), or orbitotomy (n = 1) and analysis revealed four distinct genetic classes. Metastasis and death outcomes were subsequently evaluated per class in the WEH study. The WEH study reviewed 658 eyes with UM, sampled by FNAB, and found Class A (n = 342, 52%), B (n = 91, 14%), C (n = 118, 18%), and D (n = 107, 16%). Comparison by increasing class (A vs. B vs. C vs. D) revealed older mean patient age (P < 0.001), worse entering visual acuity (P < 0.001), greater distance from the optic disc (P < 0.001), larger tumor diameter (P < 0.001), and greater tumor thickness (P < 0.001). Regarding outcomes, more advanced TCGA class demonstrated increased 5-year risk for metastasis (4% vs. 20% vs. 33% vs. 63%,P < 0.001) with corresponding increasing hazard ratio (HR) (1.0 vs. 4.1, 10.1, 30.0,P= 0.01 for B vs. A andP < 0.001 for C vs. A and D vs. A) as well as increased 5-year estimated risk for death (1% vs. 0% vs. 9% vs. 23%,P < 0.001) with corresponding increasing HR (1 vs. NA vs. 3.1 vs. 13.7,P= 0.11 for C vs. A andP < 0.001 for D vs. A). Comparison of AJCC to TCGA classification revealed TCGA was superior in prediction of metastasis and death from UM.
TCGA classification for UM is simple, accurate, and highly predictive of melanoma-related metastasis and death, more so than the AJCC classification.