Выживаемость пациентов с увеальной меланомой малых и средних размеров в зависимости от клинико-патоморфологической картины и клеточного микроокружения

Abstract

Purpose. To assess the survival rate of patients with small and mediumsized uveal melanoma, depending on the clinical and pathomorphological picture and the cellular microenvironment. Material and methods. For a prospective study, 33 patients with T1-2N0M0 stage of the tumor were selected for the period from June 2005 to July 2018 at an average age of 54±2.7 years. In all cases, the enucleation of the affected eye was carried out with a morphological study of it and a study of the composition of the cellular microenvironment of the tumor node, which became the main criterion for compliance and inclusion in the study. Results. During the study period of observation after enucleation due to eye uveal tract melanoma, 9 (27.3%) of 33 patients died from metastatic disease. Of these, 2 with small and 7 with middle size of tumor. The timing of the appearance of metastases ranged from 15 to 96 (average 41.3±34.5) months. The median follow-up was 64.5 (95% confidence interval 29.3– 99.7) month. The 5-year survival rate of patients with small and medium sized uveal melanoma was 78.7%, and the 10-year survival rate was 72.7%. A significant dependence of the mortality of patients was revealed with the epithelioid cell type of melanoma, increase of tumor basal diameter, involvement of optic disc area and ciliary body, a significant degree of pigmentation, the presence of necrosis in tumor stroma, ingrowth into sclera emissarium and large number of tumor vessels. Survival decreases in patients with a large accumulation of lymphocytes around the tumor, the absence of macrophages, mast cells, fibroblasts on the one hand, and the presence of plasmocytes, myeloid-derived suppressor cells (promyelocytes, neutrophils, eosinophils) in tumor microenvironment. Conclusion. Studies have revealed a certain relationship between the life expectancy of patients and their mortality from metastatic disease with clinical and pathological signs and a specific composition of the cell microenvironment. Key words: uveal melanoma, survival, cell microenvironment