vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2020-17-3-320-328vestim-691Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEЭнуклеация или органосохраняющая методика лечения меланомы сосудистой оболочки глаза?Is it enucleation or organ-sparing techniques for choroid melanoma treatment?https://orcid.org/0000-0002-1875-9176НауменкоЛ. В.NaumenkoL. V.

Науменко Лариса Владимировна ‒ кандидат медицинских наук, ведущий научный сотрудник

223040, агр. Лесной, Минский р-н

Larisa V. Naumenko ‒ Ph. D. (Med.), Leading Researcher

223040, Lesnoy, Minsk Region

larisanau@mail.ruКрасныйС. А.KrasnyS. A.

Красный Сергей Анатольевич ‒ член-корреспондент, доктор медицинских наук, профессор, заместитель директора

223040, агр. Лесной, Минский р-н

Sergey A. Krasny ‒ Corresponding Member, D. Sc. (Med.), Professor, Deputy Director

223040, Lesnoy, Minsk Region

sergeykrasny@tut.byhttps://orcid.org/0000-0003-2964-6895ЖиляеваЕ. П.ZhyliaevaK. P.

Жиляева Екатерина Павловна ‒ врач-офтальмолог

223040, агр. Лесной, Минский р-н

Katsiaryna P. Zhyliaeva ‒  Ophthalmologist

223040, Lesnoy, Minsk Region

https://orcid.org/0000-0001-6335-1404ЕвмененкоА. А.EvmenenkoA. A.

Евмененко Алеся Александровна ‒ специалист по противораковому контролю

223040, агр. Лесной, Минский р-н

Alesya A. Evmenenko ‒ Anticancer Control Specialist

223040, Lesnoy, Minsk Region

https://orcid.org/0000-0003-2427-1967СущеняГ. А.SuschenyaG. A.

Сущеня Галина Анатольевна ‒ врач-офтальмолог

223040, агр. Лесной, Минский р-н

Galina A. Suschenya ‒ Ophthalmologist

223040, Lesnoy, Minsk Region

Республиканский научно-практический центр онкологии и медицинской радиологии им. Н. Н. АлександроваN. N. Alexandrov National Cancer Centre of BelarusМинская областная детская клиническая больницаMinsk Regional Children’s Clinical Hospital202029082020173320328Copyright © Науменко Л.В., Красный С.А., Жиляева Е.П., Евмененко А.А., Сущеня Г.А., 20202020Науменко Л.В., Красный С.А., Жиляева Е.П., Евмененко А.А., Сущеня Г.А.Naumenko L.V., Krasny S.A., Zhyliaeva K.P., Evmenenko A.A., Suschenya G.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/691

Меланома сосудистой оболочки глаза, или меланома хориоидеи, относится к злокачественным опухолям. Выбор метода лечения зависит от размеров опухоли и ее локализации, состояния оболочек глаза, материально-технической базы клиники, желания самого пациента. Цель исследования – оценить эффективность лечения пациентов с меланомой сосудистой оболочки глаза. Изучены данные Белорусского канцер-регистра, истории болезни пациентов с диагнозом меланомы сосудистой оболочки глаза (C69.3 по МКБ-10) за период с 1999 по 2018 г. Оценка заболеваемости проводилась на основе анализа абсолютного числа заболевших, грубых интенсивных показателей, рассчитанных на 1 000 000 населения. Для оценки выживаемости использовали показатель скорректированной кумулятивной 5-летней выживаемости. Уровень значимости определяли с помощью критерия χ2. По результатам исследования, показатели заболеваемости за 20-летний период колебались и в среднем составили 0,9  0/00. Энуклеация проведена 724 пациентам: с синхронным и метахронным раком ‒ 101 (13,9 %), с единственной опухолью меланомы хориоидеи ‒ 623. Количество энуклеаций уменьшилось в 1,8 раза. Для оценки выживаемости были сформированы группы пациентов с опухолями больших размеров после проведенной энуклеации и комбинированного лечения. После энуклеации прогрессирование заболевания зарегистрировано у 159 (25,5  %) из 623 пациентов: на первом году ‒ у 25 (15,7 %), на втором – у 50 (31,5 %), на четвертом году и более – у 84 (52,8 %). В группе с комбинированным лечением у 10 (17,2 %) из 58 пациентов зарегистрировано прогрессирование заболевания: на первом году – у 1 (10,0 %), на втором – у 6 (60,0 %), на четвертом году и более – у 3 (30,0 %). Показатель выживаемости после проведенного органосохраняющего лечения был незначительно выше и увеличился к 5-му году наблюдения, хотя данные статистически не значимы (р > 0,5). В настоящее время энуклеация играет не основную роль в выборе метода лечения пациентов с клинически установленным диагнозом меланомы сосудистой оболочки глаза. Показатель кумулятивной скорректированной 5-летней выживаемости пациентов после проведенного органосохраняющего лечения составил 85,7 ± 5,1 %, после проведенной энуклеации – 67,2 ± 2,2 %, данные статистически не значимы (р > 0,5). Перспективным направлением в лечении пациентов с меланомой хориоидеи является усовершенствование органосохраняющих методик лечения.

Choroid melanoma belongs to malignant tumors. The choice of treatment modality depends on a tumor size and site, ocular tunics conditions, clinic logistics, and the patient’s will. The aim of the study was to evaluate the effectiveness of treatment of patients with choroid melanoma. The data of the Belarusian Cancer Registry and the case histories of patients with choroid melanoma (C69.3, ICD-10) over the period of 1999–2018 were studied. The incidence rates were evaluated on the basis of the analysis of the absolute number of persons taken ill with the disease, crude intensive rates calculated per 1,000,000 of population. To calculate the survival, the disease-specific cumulative 5-year survival rate was used. Significance evaluation was made applying the chisquare test. The incidence rates varied over the 20-year period and were 0.9  ‰ on the average. Enucleation was performed in 724 patients, 13.9 % (101 patients) being registered with synchronous and metachronous cancer. Patients with a sole tumor of choroid melanoma were analyzed. The amount of enucleations performed decreased by a factor of 1.8. To evaluate the survival, the groups of patients with large tumors were formed after enucleation and combination treatment was carried out. Of 623 patients subjected to enucleation, disease progression was established in 159 (25.5 %). Of 159 patients, the onset of disease progression occurred in 25 (15.7 %) in the 1st year, in 50 (31.5 %) in the 2nd year, and in 84 (52.8 %) in the 4th year and later. In the combination treatment group, consisting of 58 patients, decease progression was ascertained in 10 (17.2 %): in the 1st year – in 1 (10.0 %), in the 2nd year – in 6 (60.0 %), and in the 4th and later – in 3 (30.0 %). The survival rate after the organ-sparing treatment is insignificantly higher and increases to the 5th year of the follow-up, although the data are statistically insignificant (p > 0.5). At present, enucleation does not play the leading role in the choice of treatment modality for patients with clinical diagnosis of choroid melanoma. The disease-specific cumulative 5-year survival rate in patients receiving organ-sparing treatment was 85.7 ± 5.1 %, and in those subjected to enucleation – 67.2 ± 2.2 %, the data being statistically insignificant (p  >  0.5). The promising trend in treating choroid melanoma patients is the development of organ-sparing treatment techniques.

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The authors declare that there are no conflicts of interest present.