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Risk factors and prognosis of orbital exenteration in conjunctival melanoma

Eye volume 37, pages 2272–2280 (2023)Cite this article

Subjects

Abstract

Objectives

To identify the risk factors of orbital exenteration and to evaluate the prognosis of exenterated patients with conjunctival melanoma (CM).

Methods

79 consecutive CM patients treated at our centre from January 2000 to September 2021 were included. The demographic, clinical and pathological characteristics were compared between eye-sparing patients and orbital exenteration patients. Main outcomes including progression-free survival (PFS), distant metastasis-free survival (DFS) and disease specific survival (DSS) were assessed in exenterated patients.

Results

The mean follow-up period was 46 ± 39 months. Risk factors for orbital exenteration were identified as worse cT category (OR, 50.75; 95% CI, 5.40–477.07; P = 0.001) and greater tumour thickness (OR, 1.27; CI, 1.04–1.55; P = 0.02). Of the 32 patients who underwent orbital exenteration, three (9.4%) had local recurrence; six (18.8%) experienced regional metastasis; sixteen (50.0%) suffered distant metastasis and fifteen (46.9%) died of metastatic disease. In patients who received orbital exenteration, palpebral conjunctiva involvement (PFS: P < 0.01; DFS: P < 0.05; DSS: P = 0.04), histological ulceration (PFS: P = 0.03; DFS: P = 0.01; DSS: P = 0.03) and regression (PFS: P = 0.01; DFS: P < 0.01; DSS: P = 0.04) were identified as risk factors for poor prognosis. Caruncle involvement (P = 0.01) was also associated with increased risk of melanoma related mortality in exenterated patients.

Conclusions

Histopathological factors should be taken into account when formulating surgical plans for orbital exenteration and when evaluating patients’ prognosis following exenteration. For CM patients with caruncle or palpebral conjunctiva involvement, orbital exenteration should be considered for unresectable disease.

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Fig. 1: Progression-free survival of exenterated CM patients.
Fig. 2: Distant metastasis-free survival of exenterated CM patients.
Fig. 3: Disease specific survival of exenterated CM patients.

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Funding

This research was supported by National Natural Science Foundation of China (81802702), The Science and Technology Commission of Shanghai (20DZ2270800 and 19JC1410202), Project of Biobank of Shanghai Ninth People’s Hospital (YBKA201907), Innovative Research Team of High-level Local Universities in Shanghai (SHSMU-ZDCX20210902), “New Star of Medical College” Young Medical Talents Training Program in Shanghai in 2020, Young Medical Talents of Shanghai Municipal Health Commission in 2022 (2022YQ001) and The Fund for Excellent Young Scholars of Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine (JYYQ008).

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Author notes

  1. These authors contributed equally: Chunyan Zong, Shichong Jia, Tianyu Zhu.

Authors and Affiliations

  1. Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China

    Chunyan Zong, Shichong Jia, Tianyu Zhu, Hanhan Shi, Hao Tian, Yimin Li, Renbing Jia & Shiqiong Xu

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  1. Chunyan Zong
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Contributions

YML, RBJ and SQX were responsible for conception and design of the work. CYZ, SCJ, TYZ, HHS, and HT were responsible for data collection. CYZ, SCJ, and TYZ were responsible for data analysis and interpretation. CYZ drafted the original article. All authors revised the final version of the paper to be published.

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Correspondence to Yimin Li, Renbing Jia or Shiqiong Xu.

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Zong, C., Jia, S., Zhu, T. et al. Risk factors and prognosis of orbital exenteration in conjunctival melanoma. Eye 37, 2272–2280 (2023). https://doi.org/10.1038/s41433-022-02330-w

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