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Teemu Mäkitie, Paula Summanen, Ahti Tarkkanen, Tero Kivelä; Microvascular Density in Predicting Survival of Patients with Choroidal and Ciliary Body Melanoma. Invest. Ophthalmol. Vis. Sci. 1999;40(11):2471-2480.
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© ARVO (1962-2015); The Authors (2016-present)
purpose. Although malignant uveal melanoma disseminates predominantly
hematogenously because of the absence of intraocular lymphatics,
consensus about prognostic impact of microvascular density (MVD) has
not been reached. This study was undertaken to investigate whether MVD,
microvascular patterns, or both determine prognosis of uveal melanoma.
methods. A population-based retrospective cohort study of melanoma-specific and
all-cause mortality of 167 consecutive patients who had an eye
enucleated because of choroidal or ciliary body melanoma from 1972
through 1981 was conducted. MVD was determined by counting tumor
vessels in a masked fashion from areas of highest vessel density after
immunostaining for CD34 epitope, factor VIII-related antigen
(FVIII-RAg), and α-smooth muscle actin (SMA). Kaplan–Meier and Cox
regression analyses of survival were performed. The association between
MVD and tumor size and location, cell type, and microvascular patterns
results. MVD could be determined from 134 of 167 melanomas (80%). Based on
globally highest count obtained with antibodies to CD34, MVD ranged
from 5 to 121 vessels/0.313 mm2 (median, 40) and its
association with presence of microvascular loops and networks
(P = 0.0006), epithelioid cells
(P = 0.028), and largest basal tumor diameter
(P = 0.0029) was statistically significant. The
10-year melanoma-specific mortality increased with MVD (0.09, 0.29,
0.59, and 0.64, according to quartiles; P <
0.0001), as did all-cause mortality (P = 0.0022).
Equivalent results were obtained with immunostaining for FVIII-RAg,
whereas MVD obtained with antibodies to SMA was not associated with
prognosis. Cox regression showed a hazard ratio of 2.45 (95% CI,
1.43–4.18) for presence of epithelioid cells, 1.11 (95% CI,
1.03–1.20) for largest basal diameter, 1.23 (95% CI, 1.06–1.43) for
square root–transformed MVD, and 1.51 (95% CI, 1.09–2.10) for
presence of loops and networks, all of which independently contributed
conclusions. The findings support the theory that both MVD and microvascular
patterns contribute independently to prognosis in uveal melanoma in
addition to cell type and size of the tumor.
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