Prognostic factor study of survival after enucleation for juxtapapillary melanomas

We reviewed 242 cases of choroidal and ciliary body melanoma that were treated by enucleation to determine the importance of juxtapapillary location as a prognostic factor for tumor-related deaths. Analysis involved Kaplan-Meier survival curves and Cox proportional hazards analysis. Patients with juxtapapillary tumors had a worse prognosis than those with tumors in other locations (64% vs 78% five-year survival), but the difference was not statistically significant. Juxtapapillary location was not an independent risk factor on Cox multivariate analysis. Risk factors included number of epithelioid cells per high-power field, largest tumor dimension, location of the tumor's anterior margin, and invasion to the line of transection. In 63 cases (26%), the tumor was in contact with the optic disc. For these juxtapapillary tumors, we also evaluated the prognostic importance of six variables relevant to juxtapapillary location. On univariate analysis, tumor height at the disc margin, subarachnoid space invasion, and postlaminar optic nerve invasion were significantly related to survival, while disc compression by tumor, prelaminar optic nerve invasion, and extent of disc perimeter surrounded by tumor were not. On Cox multivariate analysis, however, none of these six variables was an independent risk factor. Risk factors for juxtapapillary tumors included number of epithelioid cells per high-power field and location of the tumor's anterior margin.