Affiliation:
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 China
2. Department of Pathology, Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
3. Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology Shanghai Jiao Tong University School of Medicine Shanghai China
4. National Clinical Research Center for Oral Diseases Shanghai China
5. Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology Shanghai China
Abstract
AbstractPurposeTo identify high‐risk histopathologic and molecular features of local recurrence, nodal metastasis, distant metastasis (DM) and disease‐specific death (DSD) in conjunctival melanoma (CoM).MethodsNinety patients with pathologically diagnosed CoM between 2008 and 2023 were enrolled. Immunohistochemistry staining of BRAFV600E, NRASQ61R, CD117, PD‐1 and PD‐L1 was performed in 65 and 45 patients, respectively. Cox regression and Kaplan–Meier survival analysis were conducted to identify risk factors for local recurrence, nodal metastasis, DM and DSD.ResultsPathologically, ulceration (hazard ratio [HR]: 3.170; 95% CI: 1.312–7.659; p = 0.01) and regression (HR: 3.196; 95% CI: 1.094–9.335; p = 0.034) were risk factors for DM. Tumour thickness ≥ 4 mm (HR: 4.889; 95% CI: 1.846–12.946; p = 0.001) and regression (HR: 4.011; 95% CI: 1.464–10.991; p = 0.007) were risk factors for DSD. For patients with tumour thickness < 4 mm, the presence of ulceration indicated a higher risk of nodal metastasis (log‐rank p = 0.0011), DM (log‐rank p = 0.00051) and DSD (log‐rank p = 0.02). Patients with regression (+)/tumour‐infiltrating lymphocytes (TILs) (+) had a higher risk for DM (log‐rank p = 0.011) and DSD (log‐rank p = 0.0032). Molecularly, the positive rate of BRAFV600E, NRASQ61R, CD117, PD‐1 and PD‐L1 was 40.00% (26/65), 43.08% (28/65), 70.77% (46/65), 46.67% (21/45) and 28.89% (13/45), respectively. Positive BRAFV600E was identified as an independent risk factor for DM (HR: 2.533; 95% CI: 1.046–6.136, p = 0.039). The expression level of BRAFV600E was positively correlated with vascular invasion (p = 0.01), as well as the expression levels of PD‐1 (p = 0.038) and PD‐L1 (p = 0.049).ConclusionsTumour thickness ≥ 4 mm, ulceration, the coexistence of regression and TILs, and positive BRAFV600E were risk factors for poor prognosis of CoM patients. Besides, expression level of BRAFV600E was positively correlated with the expression levels of PD‐1 and PD‐L1.